Stewart W Mercer1, Maria Higgins2, Annemieke M Bikker2, Bridie Fitzpatrick2, Alex McConnachie3, Suzanne M Lloyd3, Paul Little4, Graham C M Watt2. 1. Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland Stewart.Mercer@glasgow.ac.uk. 2. Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland. 3. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland. 4. Primary Medical Care, Aldermoor Health Centre, University of Southampton, Southampton, England.
Abstract
PURPOSE: We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings. METHODS: Six hundred fifty-nine patients attending 47 general practitioners in high- and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and non-verbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods. RESULTS: Patients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups. CONCLUSIONS: Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."
PURPOSE: We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings. METHODS: Six hundred fifty-nine patients attending 47 general practitioners in high- and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and non-verbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods. RESULTS:Patients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups. CONCLUSIONS:Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."
Authors: Karen Barnett; Stewart W Mercer; Michael Norbury; Graham Watt; Sally Wyke; Bruce Guthrie Journal: Lancet Date: 2012-05-10 Impact factor: 79.321
Authors: Stewart W Mercer; Bridie Fitzpatrick; Glen Gourlay; Gaby Vojt; Alex McConnachie; Graham C M Watt Journal: Br J Gen Pract Date: 2007-12 Impact factor: 5.386
Authors: Stewart W Mercer; Bhautesh D Jani; Margaret Maxwell; Samuel Y S Wong; Graham C M Watt Journal: BMC Fam Pract Date: 2012-02-08 Impact factor: 2.497
Authors: Stewart W Mercer; Yuefang Zhou; Gerry M Humphris; Alex McConnachie; Andisheh Bakhshi; Annemieke Bikker; Maria Higgins; Paul Little; Bridie Fitzpatrick; Graham C M Watt Journal: Ann Fam Med Date: 2018-03 Impact factor: 5.166
Authors: Richard Baker; George K Freeman; Jeannie L Haggerty; M John Bankart; Keith H Nockels Journal: Br J Gen Pract Date: 2020-08-27 Impact factor: 5.386
Authors: Hinke Hoffstädt; Jacqueline Stouthard; Maartje C Meijers; Janine Westendorp; Inge Henselmans; Peter Spreeuwenberg; Paul de Jong; Sandra van Dulmen; Liesbeth M van Vliet Journal: Palliat Med Rep Date: 2020-06-11