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Abstrait

Impact of a priority-setting consultation on doctor–patient agreement after a geriatric assessment: cluster randomised controlled trial in German general practices

Ulrike Junius-Walker, Eva Hummers-Pradier, Isabel Voigt, Werner Hofmann, Birgitt Wiese, Marie Luise Dierks

BackgroundGeneral Practitioners (GPs) often have to simultaneously tackle multiple health problems of older patients. A patient-centred process that engages the patient in setting health priorities for treatment is needed. We investigated whether a structured priority-setting consultation reconciles the often-differing doctor–patient views on the importance of problems. DesignCluster randomised controlled trialwith 40 GPs and their 317 consecutively recruited older patients. Procedure Following a geriatric assessment, patients and doctors independently rated the importance of each uncovered problem. GPs then selected priorities with their patients in a consultation. Trained intervention GPs held a structured consultation and utilised the list of uncovered patient problems with their importance ratings to agree priorities. Untrained control GPs only used the patient’s problem list without importance ratings. Main outcome Doctor–patient agreement on independent importance ratings two weeks after the priority-setting consultation. Analysis Weighted kappa (_w) and multilevel logistic regression model. Results Intervention GPs and their patients determined mutual priorities for 20% of individual problems. In this process, GPs often succeeded in convincing their patients of the importance of vaccinations, lifestyle and cognitive issues. Likewise, patients convinced their GPs to prioritise their social and functional problems. Further treatment plans ensued in 84% of these priority areas. The regression model adjusting for clusters and baseline characteristics did not demonstrate significant differences in doctor–patient agreement on problems between groups a two weeks later. ConclusionDiffering views on the importance of health problems between GPs and older patients were not sustainably reconciled. The special consultation facilitated identification of priority problems for treatment despite differences in perceived importance of problems between patients and GPs. German clinical trials register drks 00000792.