Professional paper
Priority Setting in General Practice: Health Priorities of Older Patients Differ from Treatment Priorities of Their Physicians
Isabel Voigt
; Institute for General Practice, Hannover Medical School,Hannover, Germany
Jennifer Wrede
; Institute for General Practice, Hannover Medical School,Hannover, Germany
Heike Diederichs-Egidi
; Institute for General Practice, Hannover Medical School,Hannover, Germany
Marie-Luise Dierks
; Institute for Epidemiology, Public Medicine and Healthcare Systems Research, Hannover Medical School, Hannover, Germany
Ulrike Junius-Walker
; Institute for General Practice, Hannover Medical School,Hannover, Germany
Abstract
Aim To ascertain health priorities of older patients and
treatment priorities of their general practitioners (GP) on
the basis of a geriatric assessment and to determine the
agreement between these priorities.
Methods The study included a sample of 9 general practitioners
in Hannover, Germany, and a stratified sample of
35 patients (2-5 patients per practice, 18 female, average
age 77.7 years). Patients were given a geriatric assessment
using the Standardized Assessment for Elderly Patients in
Primary Care (STEP) to gain an overview of their health and
everyday problems. On the basis of these results, patients
and their physicians independently rated the importance
of each problem disclosed by the assessment. Whereas
patients assessed the importance for their everyday lives,
physicians assessed the importance for patients’ medical
care and patients’ everyday lives.
Results Each patient had a mean ± standard deviation of
18 ± 9.2 health problems. Thirty five patients disclosed a total
of 634 problems; 537 (85%) were rated by patients and
physicians. Of these 537 problems, 332 (62%) were rated
by patients and 334 (62%) by physicians as important for
patients’ everyday lives. In addition, 294 (55%) were rated
by physicians as important for patients’ medical care. Although
these proportions of important problems were
similar between patients and physicians, there was little
overlap in the specific problems that each group considered
important. The chance-corrected agreement (Cohen
κ) between patients and physicians on the importance of
problems for patients’ lives was low (κ = 0.23). Likewise, patients
and physicians disagreed on the problems that physicians
considered important for patients’ medical care
(κ = 0.18, P < 0.001 for each).
Conclusion The low agreement on health and treatment
priorities between patients and physicians necessitates
better communication between the two parties to
strengthen mutual understanding
Keywords
health priorities; decision making; physician patient relations; health services for aged; aged; geriatric assessment; health status
Hrčak ID:
63524
URI
Publication date:
15.12.2010.
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