Patient-centredness and the outcome of consultations with depressed patients in areas of high and low socioeconomic deprivation

Jani, B. , Bikker, A., Higgins, M., Fitzpatrick, B., Little, P., Watt, G.C.M. and Mercer, S.W. (2012) Patient-centredness and the outcome of consultations with depressed patients in areas of high and low socioeconomic deprivation. British Journal of General Practice, 62(601), e576-e581. (doi:10.3399/bjgp12X653633)

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Abstract

<b>Background</b> Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.<p></p><b>Aim</b> To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.<p></p> <b>Design and setting</b> Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.<p></p> <b>Method</b> Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.<p></p> <b>Results</b> PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.<p></p> <b>Conclusion</b> In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and Mercer, Professor Stewart and Fitzpatrick, Dr Bridie and Higgins, Ms Maria and Bikker, Ms Annemieke and Watt, Professor Graham
Authors: Jani, B., Bikker, A., Higgins, M., Fitzpatrick, B., Little, P., Watt, G.C.M., and Mercer, S.W.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:British Journal of General Practice
Journal Abbr.:BJGP
ISSN:0960-1643
ISSN (Online):1478-5242

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