Neuner-Jehle Stefan, Zechmann Stefan, Grundmann Maissen Daniela, Rosemann Thomas, Senn Oliver
Institute of Primary Care, University of Zurich, Zurich, Switzerland.
Patient Prefer Adherence. 2017 Aug 22;11:1451-1458. doi: 10.2147/PPA.S137388. eCollection 2017.
Multiple chronic health conditions are leading to multiple treatment procedures and polypharmacy. Prioritizing treatment according to patients' needs and preferences may be helpful for deprescribing. Thus, for improving health care, it is crucial for general practitioners (GPs) to perceive the chief complaints (CCs) of patients. The primary aim of this study was to investigate the patient-provider concordance of CCs and the secondary aim was to investigate the concordance between CCs and diagnosis, in a sample of Swiss multimorbid patients.
A cross-sectional analysis based on a cluster randomized controlled trial (RCT) among 46 GPs, recruited between March 2015 to July 2016, and 334 multimorbid patients (≥60 years taking ≥5 drugs for at least 6 months) in Northern Switzerland was performed. CCs listed by GPs and by patients (n=128) were classified according to the International Classification of Primary Care, version 2 (ICPC-2) coding system on chapter and component level and defined as concordant if ICPC-2 codes of patients and GPs were identical. Concordance was classified into full, moderate or low, depending on the ranking of patients' CCs on GPs' list. As secondary outcome, we compared patients' CCs to GPs' diagnosis. Statistics included descriptive measures and a multivariate regression analysis of factors that are modifying concordance.
The mean age of patients was 76.9 (SD 8.1) years, where 38% were male, taking 7.9 (SD 2.6) drugs on the long term. The most frequent complaint was pain. Concordance of the CC was given in 101/128 (78.9%) on the ICPC-2 chapter level, whereby 86/128 (67.2%) showed full, 8/128 (6.3%) moderate and 7/128 (5.5%) low concordance; 27/128 (21.1%) were discordant. Concordance between CCs and diagnosis was 53.6%. Concordance increased with the intensity of the CC rated by patients (OR 1.48, CI 1.13-1.94, <0.001). The younger age and higher intake of drugs were significantly associated with an increased concordance between CCs and diagnosis.
A majority of GPs perceive the CCs of the multimorbid patients correctly, but there is room for improvement.
多种慢性健康状况导致多种治疗程序和联合用药。根据患者的需求和偏好确定治疗优先级可能有助于减少不必要的药物治疗。因此，为了改善医疗保健，全科医生（GP）了解患者的主要诉求至关重要。本研究的主要目的是调查瑞士多病患者样本中患者与医生之间主要诉求的一致性，次要目的是调查主要诉求与诊断之间的一致性。
基于2015年3月至2016年7月招募的46名全科医生以及瑞士北部334名多病患者（≥60岁，服用≥5种药物至少6个月）的整群随机对照试验（RCT）进行横断面分析。全科医生和患者列出的主要诉求（n = 128）根据国际初级保健分类第2版（ICPC - 2）编码系统在章节和组成部分层面进行分类，如果患者和全科医生的ICPC - 2编码相同，则定义为一致。根据患者主要诉求在全科医生列表中的排名，一致性分为完全一致、中度一致或低度一致。作为次要结果，我们将患者的主要诉求与全科医生的诊断进行了比较。统计分析包括描述性指标以及对影响一致性的因素进行多变量回归分析。
患者的平均年龄为76.9（标准差8.1）岁，其中38%为男性，长期服用7.9（标准差2.6）种药物。最常见的诉求是疼痛。在ICPC - 2章节层面，101/128（78.9%）的主要诉求一致，其中86/128（67.2%）为完全一致，8/128（6.3%）为中度一致，7/128（5.5%）为低度一致；27/128（21.1%）不一致。主要诉求与诊断之间的一致性为53.6%。一致性随着患者对主要诉求的重视程度增加而提高（比值比1.48，置信区间1.13 - 1.94，<0.001）。年龄较小和药物摄入量较高与主要诉求和诊断之间的一致性增加显著相关。
大多数全科医生能够正确了解多病患者的主要诉求，但仍有改进空间。
