Impact of a priority-setting consultation on doctor-patient agreement after a geriatric assessment: Cluster randomised controlled trial in German general practices

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Ulrike Junius-Walker - , Hannover Medical School (MHH) (Author)
  • Jennifer Wrede - , Hannover Medical School (MHH) (Author)
  • Isabel Voigt - , Hannover Medical School (MHH) (Author)
  • Werner Hofmann - , Hannover Medical School (MHH) (Author)
  • Birgitt Wiese - , Hannover Medical School (MHH) (Author)
  • Eva Hummers-Pradier - , University of Göttingen (Author)
  • Marie Luise Dierks - , Hannover Medical School (MHH) (Author)

Abstract

Background: General Practitioners (GPs) often have to simultaneously tackle multiple health problems of older patients. A patient-centred process that engages the patient in setting health priorities for treatment is needed. We investigated whether a structured priority-setting consultation reconciles the often-differing doctor-patient views on the importance of problems. Design: Cluster randomised controlled trial with 40 GPs and their 317 consecutively recruited older patients. Procedure: Following a geriatric assessment, patients and doctors independently rated the importance of each uncovered problem. GPs then selected priorities with their patients in a consultation. Trained intervention GPs held a structured consultation and utilised the list of uncovered patient problems with their importance ratings to agree priorities. Untrained control GPs only used the patient's problem list without importance ratings. Main outcome: Doctor-patient agreement on independent importance ratings two weeks after the priority-setting consultation. Analysis: Weighted kappa (κw) and multilevel logistic regression model. Results: Intervention GPs and their patients determined mutual priorities for 20% of individual problems. In this process, GPs often succeeded in convincing their patients of the importance of vaccinations, lifestyle and cognitive issues. Likewise, patients convinced their GPs to prioritise their social and functional problems. Further treatment

Details

Original languageEnglish
Pages (from-to)321-334
Number of pages14
JournalQuality in Primary Care
Volume20
Issue number5
Publication statusPublished - 2012
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 23114000
ORCID /0000-0003-0097-8589/work/164619287

Keywords

Sustainable Development Goals

Keywords

  • Family practice, Health priorities, Multimorbidity, Older people, Patient-centred care