Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation
Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported. To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation. Seco...
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| Veröffentlicht in: | British journal of general practice 2012-08, Vol.62 (601), p.e576-e581 |
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| container_title | British journal of general practice |
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| creator | Jani, Bhautesh Bikker, Annemieke P Higgins, Maria Fitzpatrick, Bridie Little, Paul Watt, Graham C M Mercer, Stewart W |
| description | Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.
To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.
Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.
Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.
PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P |
| doi_str_mv | 10.3399/bjgp12X653633 |
| format | Article |
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To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.
Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.
Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.
PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.
In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity.</description><identifier>ISSN: 0960-1643</identifier><identifier>EISSN: 1478-5242</identifier><identifier>DOI: 10.3399/bjgp12X653633</identifier><identifier>PMID: 22867682</identifier><language>eng</language><publisher>England: Royal College of General Practitioners</publisher><subject>Adult ; Aged ; Communication ; Depressive Disorder - epidemiology ; Depressive Disorder - therapy ; Family Practice - organization & administration ; Family Practice - statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care - statistics & numerical data ; Patient-Centered Care - statistics & numerical data ; Physician-Patient Relations ; Prevalence ; Prospective Studies ; Scotland - epidemiology ; Socioeconomic Factors ; Treatment Outcome</subject><ispartof>British journal of general practice, 2012-08, Vol.62 (601), p.e576-e581</ispartof><rights>British Journal of General Practice 2012 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c387t-63defe92c5bc54d4387a1a32de3c852a9df28f8af2cdaecc67d565756f1da4463</citedby><cites>FETCH-LOGICAL-c387t-63defe92c5bc54d4387a1a32de3c852a9df28f8af2cdaecc67d565756f1da4463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404336/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404336/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27922,27923,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22867682$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jani, Bhautesh</creatorcontrib><creatorcontrib>Bikker, Annemieke P</creatorcontrib><creatorcontrib>Higgins, Maria</creatorcontrib><creatorcontrib>Fitzpatrick, Bridie</creatorcontrib><creatorcontrib>Little, Paul</creatorcontrib><creatorcontrib>Watt, Graham C M</creatorcontrib><creatorcontrib>Mercer, Stewart W</creatorcontrib><title>Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation</title><title>British journal of general practice</title><addtitle>Br J Gen Pract</addtitle><description>Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.
To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.
Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.
Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.
PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.
In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity.</description><subject>Adult</subject><subject>Aged</subject><subject>Communication</subject><subject>Depressive Disorder - epidemiology</subject><subject>Depressive Disorder - therapy</subject><subject>Family Practice - organization & administration</subject><subject>Family Practice - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patient-Centered Care - statistics & numerical data</subject><subject>Physician-Patient Relations</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Scotland - epidemiology</subject><subject>Socioeconomic Factors</subject><subject>Treatment Outcome</subject><issn>0960-1643</issn><issn>1478-5242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUtv3CAUhVHUqplOusy2YtmNE-ACtjeVqqhtIkVqF62UHWLgekxkG9fYifo3-ovDPBI1Gy5wz_l4HELOObsAqOvLzf125OJOK9AAJ2TFZVkVSkjxhqxYrVnBtYRT8j6le8aE0Jy9I6dCVLrUlViRfz_tHHCYqcvDhH7AlKgdPJ1bpHGZXexzbeg4hd5Of6mzE1IXh7R0c3bmCX0Mc0vHA-a48jhOGZTbNAw0W2zaQdqwbffwLj7SFF2ImFGxD27vCA974hl529gu4YdjXZPf377-uroubn98v7n6cls4qMq50OCxwVo4tXFKepk3LbcgPIKrlLC1b0TVVLYRzlt0TpdeaVUq3XBvpdSwJp8P3HHZ9Oj3H2A7c3ypiTaY150htGYbHwxIJgF2gE9HwBT_LJhm04fksOvsgHFJhjMQJSiV1WtSHKRuiilN2Lwcw5nZ5Whe5Zj1H_-_24v6OTh4Ajizn7o</recordid><startdate>20120801</startdate><enddate>20120801</enddate><creator>Jani, Bhautesh</creator><creator>Bikker, Annemieke P</creator><creator>Higgins, Maria</creator><creator>Fitzpatrick, Bridie</creator><creator>Little, Paul</creator><creator>Watt, Graham C M</creator><creator>Mercer, Stewart W</creator><general>Royal College of General Practitioners</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120801</creationdate><title>Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation</title><author>Jani, Bhautesh ; Bikker, Annemieke P ; Higgins, Maria ; Fitzpatrick, Bridie ; Little, Paul ; Watt, Graham C M ; Mercer, Stewart W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-63defe92c5bc54d4387a1a32de3c852a9df28f8af2cdaecc67d565756f1da4463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Communication</topic><topic>Depressive Disorder - epidemiology</topic><topic>Depressive Disorder - therapy</topic><topic>Family Practice - organization & administration</topic><topic>Family Practice - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patient-Centered Care - statistics & numerical data</topic><topic>Physician-Patient Relations</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Scotland - epidemiology</topic><topic>Socioeconomic Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jani, Bhautesh</creatorcontrib><creatorcontrib>Bikker, Annemieke P</creatorcontrib><creatorcontrib>Higgins, Maria</creatorcontrib><creatorcontrib>Fitzpatrick, Bridie</creatorcontrib><creatorcontrib>Little, Paul</creatorcontrib><creatorcontrib>Watt, Graham C M</creatorcontrib><creatorcontrib>Mercer, Stewart W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of general practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jani, Bhautesh</au><au>Bikker, Annemieke P</au><au>Higgins, Maria</au><au>Fitzpatrick, Bridie</au><au>Little, Paul</au><au>Watt, Graham C M</au><au>Mercer, Stewart W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation</atitle><jtitle>British journal of general practice</jtitle><addtitle>Br J Gen Pract</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>62</volume><issue>601</issue><spage>e576</spage><epage>e581</epage><pages>e576-e581</pages><issn>0960-1643</issn><eissn>1478-5242</eissn><abstract>Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.
To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.
Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.
Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.
PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.
In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity.</abstract><cop>England</cop><pub>Royal College of General Practitioners</pub><pmid>22867682</pmid><doi>10.3399/bjgp12X653633</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult Aged Communication Depressive Disorder - epidemiology Depressive Disorder - therapy Family Practice - organization & administration Family Practice - statistics & numerical data Female Humans Male Middle Aged Patient Acceptance of Health Care - statistics & numerical data Patient-Centered Care - statistics & numerical data Physician-Patient Relations Prevalence Prospective Studies Scotland - epidemiology Socioeconomic Factors Treatment Outcome |
| title | Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation |
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