プライマリケアの質 オープンアクセス

抽象的な

Health and treatment priorities of older patients and their general practitioners: a cross-sectional study

Ulrike Junius-Walker, Dagmar Stolberg, Patricia Steinke, Gudrun Theile, Eva Hummers-Pradier, Marie Luise Dierks

Background General practitioners (GPs) deal with the multiple health needs of older patients. During patient encounters GPs are often only able to manage a limited number of problems and tend to focus on single diseases resulting in fragmented and overloaded care. A systematic approach that considers multiple health problems simultaneously and sets priorities for treatment is necessary. Aim To disclose patients’ and doctors’ perspectives on individual health and treatment priorities. MethodsCross-sectional study in which 123 older patients and their 11 GPs evaluated the importance and severity of patients’ individual health problems. Patients were systematically enrolled to receive a geriatric assessment. This generated a problem list on the basis of which patients and their GPs independently rated the importance and components of severity (in relation to emotional experience, hindrance in everyday life and prognosis) of each problem. The proportion of important problems and the chance corrected agreement (Cohen’s Kappa) of importance between doctors and patients were assessed. Multilevel logistic regression models were used to relate the importance of a problem with its severity components – from the perspective of both the patient and the doctor. Results Patients and GPs considered about two thirds of all disclosed health problems important (69% and 64% respectively). However, they perceived different problems as important (Kappa 0.11). Doctors and patients also related different components of severity to the importance of a problem: the strongest predictor of a problem’s importance for patients was the emotional experience, whereas for doctors it was an unfavourable prognosis. Conclusion Patients and doctors have different perspectives on the importance of health problems.Setting priorities for treatment necessitates an open exchange of views on what to treat.