Multimorbidity and socioeconomic deprivation in primary care consultations

Stewart W. Mercer, Yuefang Zhou, Gerry M. Humphris, Alex McConnachie, Andisheh Bakhshi, Annemieke Bikker, Maria Higgins, Paul Little, Bridie Fitzpatrick, Graham C.M. Watt

Research output: Contribution to journalArticle

Abstract

PURPOSE The 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. 
METHODS We 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. 
RESULTS In 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).
CONCLUSIONS In 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.
Original languageEnglish
Article number16
Pages (from-to)127-131
Number of pages5
JournalThe Annals of Family Medicine
Volume16
Issue number2
DOIs
Publication statusPublished - 31 Mar 2018
Externally publishedYes

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Comorbidity
Primary Health Care
Referral and Consultation
General Practitioners
Scotland
General Practice
Communication
Regression Analysis
Health

Keywords

  • multimorbidity
  • primary care
  • general practice
  • Consultation
  • deprivation

Cite this

Mercer, S. W., Zhou, Y., Humphris, G. M., McConnachie, A., Bakhshi, A., Bikker, A., ... Watt, G. C. M. (2018). Multimorbidity and socioeconomic deprivation in primary care consultations. The Annals of Family Medicine, 16(2), 127-131. [16]. https://doi.org/10.1370/afm.2202
Mercer, Stewart W. ; Zhou, Yuefang ; Humphris, Gerry M. ; McConnachie, Alex ; Bakhshi, Andisheh ; Bikker, Annemieke ; Higgins, Maria ; Little, Paul ; Fitzpatrick, Bridie ; Watt, Graham C.M. . / Multimorbidity and socioeconomic deprivation in primary care consultations. In: The Annals of Family Medicine. 2018 ; Vol. 16, No. 2. pp. 127-131.
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Mercer, SW, Zhou, Y, Humphris, GM, McConnachie, A, Bakhshi, A, Bikker, A, Higgins, M, Little, P, Fitzpatrick, B & Watt, GCM 2018, 'Multimorbidity and socioeconomic deprivation in primary care consultations' The Annals of Family Medicine, vol. 16, no. 2, 16, pp. 127-131. https://doi.org/10.1370/afm.2202

Multimorbidity and socioeconomic deprivation in primary care consultations. / Mercer, Stewart W. ; Zhou, Yuefang ; Humphris, Gerry M. ; McConnachie, Alex ; Bakhshi, Andisheh; Bikker, Annemieke ; Higgins, Maria ; Little, Paul ; Fitzpatrick, Bridie ; Watt, Graham C.M. .

In: The Annals of Family Medicine, Vol. 16, No. 2, 16, 31.03.2018, p. 127-131.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multimorbidity and socioeconomic deprivation in primary care consultations

AU - Mercer, Stewart W.

AU - Zhou, Yuefang

AU - Humphris, Gerry M.

AU - McConnachie, Alex

AU - Bakhshi, Andisheh

AU - Bikker, Annemieke

AU - Higgins, Maria

AU - Little, Paul

AU - Fitzpatrick, Bridie

AU - Watt, Graham C.M.

PY - 2018/3/31

Y1 - 2018/3/31

N2 - PURPOSE The 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. METHODS We 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. RESULTS In 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).CONCLUSIONS In 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.

AB - PURPOSE The 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. METHODS We 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. RESULTS In 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).CONCLUSIONS In 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.

KW - multimorbidity

KW - primary care

KW - general practice

KW - Consultation

KW - deprivation

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U2 - 10.1370/afm.2202

DO - 10.1370/afm.2202

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SP - 127

EP - 131

JO - Annals of Family Medicine

JF - Annals of Family Medicine

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Mercer SW, Zhou Y, Humphris GM, McConnachie A, Bakhshi A, Bikker A et al. Multimorbidity and socioeconomic deprivation in primary care consultations. The Annals of Family Medicine. 2018 Mar 31;16(2):127-131. 16. https://doi.org/10.1370/afm.2202