Document Detail


Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients.
MedLine Citation:
PMID:  20127197     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Many patients with diabetes have multiple other chronic conditions, but little is known about whether these patients and their primary care providers agree on the relative importance that they assign these comorbidities.
OBJECTIVE: To understand patterns of patient-provider concordance in the prioritization of health conditions in patients with multimorbidity.
DESIGN: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with elevated clinic triage blood pressure (> or = 140/90) at nine Midwest VA facilities.
MEASUREMENTS: We constructed a patient-provider concordance score based on responses to surveys in which patients were asked to rank their most important health concerns and their providers were asked to rank the most important conditions likely to affect that patient's health outcomes. We then calculated the change in predicted probability of concordance when the patient reported having poor health status, pain or depression, or competing demands (issues that were more pressing than his health), controlling for both patient and provider characteristics.
RESULTS: For 714 pairs (72%), providers ranked the patient's most important concern in their list of three conditions. Both patients and providers ranked diabetes and hypertension most frequently; however, providers were more likely to rank hypertension as most important (38% vs. 18%). Patients were more likely than providers to prioritize symptomatic conditions such as pain, depression, and breathing problems. The predicted probability of patient-provider concordance decreased when a patient reported having poor health status (55% vs. 64%, p < 0.01) or non-health competing demands (46% vs. 62%, p < 0.01).
CONCLUSIONS: Patients and their primary care providers often agreed on the most important health conditions affecting patients with multimorbidity, but this concordance was lower for patients with poor health status or non-health competing demands. Interventions that increase provider awareness about symptomatic concerns and competing demands may improve chronic disease management in these vulnerable patients.
Authors:
Donna M Zulman; Eve A Kerr; Timothy P Hofer; Michele Heisler; Brian J Zikmund-Fisher
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-02-02
Journal Detail:
Title:  Journal of general internal medicine     Volume:  25     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-15     Completed Date:  2010-11-30     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  408-14     Citation Subset:  IM    
Affiliation:
Department of Veterans Affairs, Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA. dzulman@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cohort Studies
Diabetes Complications / psychology,  therapy*
Female
Health Priorities*
Humans
Hypertension / complications,  psychology,  therapy*
Male
Middle Aged
Patient Participation* / psychology
Patient Satisfaction
Physician-Patient Relations*
Physicians, Primary Care*
Prospective Studies
Comments/Corrections
Comment In:
Home Healthc Nurse. 2011 May;29(5):320-5   [PMID:  21543922 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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