Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation

Jani, Bhautesh; Bikker, Annemieke; Higgins, Maria; Fitzpatrick, Bridie; Little, Paul; Watt, Graham; Mercer, Stewart W

doi:10.3399/bjgp12x653633

Cited by 36 publications

(53 citation statements)

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“…22 The higher empathy and patient centeredness regarding disease and illness experience in the affluent multimorbid group is also an important finding, since GP empathy and patient-centered approaches have previously been shown to improve patient enablement and health outcomes. [13][14][15] GP empathy and patient centeredness are generally lower in deprived areas compared with affluent, 15,23 and a systematic review has recently indicated that this is true generally of doctors dealing with patients of low educational status.…”

Section: Comparison With Published Literaturementioning

confidence: 99%

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

et al. 2018

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PURPOSEThe influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODSWe conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP's empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. RESULTSIn affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). CONCLUSIONSIn deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.

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Section: Comparison With Published Literaturementioning

confidence: 99%

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

et al. 2018

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“…On the other hand, a finding with general primary care patients suggested that GPs' responses were often non-specific acknowledgements without any actual exploration of the patient's emotions [22]. In addition, one study adopting the Consultation and Relational Empathy (CARE, [31]) measure, where understanding patients' concerns is incorporated, found that GP empathy was perceived significantly lower in consultations in deprived areas [15]. Putting our finding in the context of this literature, it seems that GPs working in deprived areas were reluctant in taking an active empathic approach to deal with clinical encounters with increasing complexity, characterised with more depressive symptoms, less time and higher practitioner stress [4,32].…”

Section: Deprivation and Gp Acknowledgement Responsementioning

confidence: 99%

“…At this stage we are not certain why this happened. However, it is evident that patients from more deprived areas were associated with more depressive symptoms [15]. A recent study investigated GPs' and psychiatrists' responses to emotional disclosure in patients with depression.…”

Section: Deprivation and Gp Acknowledgement Responsementioning

confidence: 99%

“…Eight GPs and 107 patients, a subsample of a larger study [15], from the Greater Glasgow Emotional Sequences (VR-CoDES CC and VR-CoDES-P) [17,18], during September 2009 and January 2010, for both patients' expressions of cues/concerns and GPs' responses. The coding manual defines an emotional cue as a hint suggesting an underlying negative emotion, whereas a concern is an explicitly verbalised expression of negative emotion.…”

Section: Participants and Proceduresmentioning

confidence: 99%

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Do multimorbidity and deprivation influence patients’ emotional expressions and doctors’ responses in primary care consultations? – An exploratory study using multilevel analysis

Zhou

Lundy

Humphris

et al. 2015

Patient Education and Counseling

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Objective: To explore whether and how patient multimorbidity and socioeconomic deprivation conditions might influence patients' emotional expression and doctors' responses in the general practice (GP) consultations. Results: GPs were less likely to provide space as the consultation proceeded, controlling for multimorbidity and deprivation variables. Patients with multimorbidity were less likely to express emotional distress in an explicit form. GPs were more likely to provide acknowledgement to emotions expressed by patients from more deprived areas. Methods Conclusion:Multimorbidity and deprivation may influence the dynamics of the GP consultations in specific ways. Rigorous methodologies using larger samples are required to explore further how these two variables relate to each other and influence cue expression, provider response and subsequent patient outcomes.Practice implications: Understanding how multimorbidity and deprivation impact on GP consultations may help inform future service improvement programmes.

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“…3 Better outcome is also associated with the GP being rated, by patients or observers, as being skilful in providing empathy and support. 4,5 agreeD benefits Let us accept that expressing warmth and attention, exploring the patient's concerns and expectations, and expressing interest in the effect of the problem on the patient's life are all highly likely to be intrinsically therapeutic.…”

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confidence: 99%