Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations
Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations
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DOI：
10.1370/afm.2202
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发表时间：
2018-03-01
影响因子：
4.4
通讯作者：
Watt, Graham C. M.
中科院分区：
文献类型：
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作者：
Mercer, Stewart W.;Zhou, Yuefang;Watt, Graham C. M.
目的 人们对多发病对临床情况的影响知之甚少，特别是在社会经济高度贫困的地区，那里集中了繁重的多发病。本研究的目的是探讨在高贫困和低贫困地区，多重发病对全科医疗咨询的影响。 方法 我们对 659 次视频记录的常规咨询进行了二次分析，涉及苏格兰贫困地区的 25 名全科医生 (GP) 和富裕地区的 22 名全科医生 (GP)。患者在咨询后立即使用咨询和关系同理心（CARE）措施对全科医生的同理心进行评分。使用以患者为中心的沟通衡量标准对视频进行分析。多水平、多回归分析确定了各组之间的差异。 结果 在富裕地区，患有多种疾病的患者比不患有多种疾病的患者接受的会诊时间更长（平均分别为 12.8 分钟 vs 9.3 分钟；P = .015），但在贫困地区情况并非如此（平均分别为 9.9 分钟 vs 10.0 分钟；P = .774）。在富裕地区，患有多种疾病的患者认为他们的全科医生比没有多种疾病的患者更有同理心 (P = .009)；在贫困地区没有发现这种差异（P = .344）。视频分析显示，与不患有多重疾病的患者相比，富裕地区的全科医生更关注多重疾病患者的疾病和患病经历（P < .031）。贫困地区的情况并非如此 (P = .727)。 结论 在贫困地区，对患有多种疾病的患者的更大需求并未反映在富裕地区更长的会诊时间、更高的全科医生患者中心度以及更高的全科医生同理心。如果初级保健要缩小而不是扩大健康不平等，就需要采取行动纠正多病患者的需求和服务提供之间的不匹配。
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.