Patients’ Attitudes to General Practice Registrars: A Review of the Literature

Abstract

Introduction With the population ageing, it is imperative for training practices to provide GP registrars with sound experience in managing the health problems of older persons, especially chronic conditions. However, it is reported that a significant proportion of these patients will be resistant to consulting registrars, with concerns regarding disruption of continuity of care being a significant factor. The challenge for training practices is to identify approaches to engage registrars in the management of older patients whilst maintaining patient satisfaction. This paper presents a review of the literature on patient attitudes to general practice registrars to better understand the nature and magnitude of the challenge, and to identify important research gaps. Methods Major electronic medical literature databases were searched for relevant articles using search terms including general practice, registrar, doctor-patient relationship, patient attitudes and elderly, for the period from 1980 to March 2009. The studies were analysed by methodology, content and theme. Results A total of 15 studies were identified that directly addressed patients' attitudes to GP registrars. Whilst there appeared an overall high acceptance of registrars by patients, increasing patient age was associated with more negative attitudes towards registrars, reduced trust and decreased satisfaction with communication. Presentations for chronic or emotional problems were associated with reduced willingness to consult registrars. Patients generally appreciated an ongoing involvement with their usual GP. Discussion These findings have implications for training practices and research directions. Demonstrating continuity of care through shared chronic disease management between supervisors and registrars is a possible model that meets registrars training and continuity needs. There is a need for quality research on the type and magnitude of problems affecting GP registrar encounters with older patients and, based on results from these studies to, create and assess models of registrar training involving older patients, that meet patients' needs for continuity of care.

Exploring differences in patient mix in a cohort of GP trainees and their trainers

“…Patients do not always want to consult a trainee for various reasons, for instance chronic or emotional problems were found to be associated with reduced willingness to consult registrars 46. Also, in another study, medical receptionists reported that patients with complex conditions were relatively more often assigned to the trainer 31…”

Older patients' consultations in an apprenticeship model‐based general practice training program: A cross‐sectional study

“…The limited data from similar training systems in Australia and the UK also suggested their GPRs’ exposure to older patients was less than that for established GPs . A number of reasons for this have been proposed, including older patients’ desire for continuity of care with their usual GPs , older patients not understanding the role of GPRs and older patients not being aware of GPRs’ previous training or experience , supervision arrangements or time they will spend in a practice . Reduced exposure to older patients may also result from structural factors within training practices which result in GPRs being allocated lower complexity presentations .…”

“…Of further concern is evidence that even when GPRs do consult older patients, the consultation content may be superficial. Patient‐based interview and survey data suggest that older patients may treat GPR consultations as a stop‐gap measure, for example for a prescription repeat, until they can consult their regular GP to address management concerns . In addition, it appears that patients’ desire to keep chronic disease management with their regular GP increases with the complexity of older patients’ health problems , supported by data demonstrating reduced rates of consultation between GPRs and patients with chronic disease in comparison with established GPs .…”

Where do older Australians receive their health information? Health information sources and their perceived reliability

“…In order for nurses to be effective in the collaborative management of chronic disease in Australia it is necessary that they are seen as providing reliable health information. A recent study found that older adults' reluctance to have GP registrars manage their chronic conditions could be countered by maintaining a relational link with their regular GP [30] . Models such as this should be investigated to see whether they can be extended to Practice Nurses, allowing nurses to contribute optimally to the primary health care team whilst also helping to alleviate pressure on GPs.…”