Transcript Folie 1
Priority setting with older patients in general practice U. Junius-Walker, G. Theile, E. Hummers-Pradier, ML. Dierks It ‘s cough this time Ok, I prescribe something Patients repeatedly consult with different health problems – doctors react Testing a new approach: Patient receives a health assessment – doctor and patient prioritize problems for treatment 1. Which health problems are important to old patients and what is important to GPs? 2. Do patients and doctors agree on the importance of health problems? 3. What are predicting factors for an “important problem“ ? (perspectives of patient and doctor) Institute of General Practice, Hannover The study: Recruitment Patients 70+yrs 123 GPs 11 STEP-assessment Health status assessment Ratings for each problem problem list problem list How important? How relevant? How much emotionally affected? disease severity How much hindered in daily activities? What prognosis (without treatment)? Institute of General Practice, Hannover 2./3. Health priorities and agreement 69% of problems important Kappa= 0.11 64% problems relevant for care social participation mood function somatic conditions house cognition medication Institute of General Practice, Hannover life-style 3. Predicting importance (OR and 95%CI) doctors Institute of General Practice, Hannover patients Patients with multimorbidity require a comprehensive & holistic, patient-centred approach. Patients‘ health priorities are not doctors‘ treatment priorities. • How can we change the random and hidden priority setting processes between patients and doctors? • In what way does prioritization need to factor in “agreement“? • How would the primary care team engage in priority setting? Institute of General Practice, Hannover A practice example: Problems with… • activities of daily living (e.g. dressing, bathing, gripping, stairs, public transport) • chewing • hearing • pain while walking • bad pain in joints and back • breathlessness Mrs H. (84) • chestpain • hypertension •lives alone • diabetes •receives home • hypercholesterinemia • thyroid dysfunction help • drug side effects: nausea, dizziness, stomach pain • mourning • foot problems • insufficient immunisation Institute of General Practice, Hannover StEP-assessment: health domains daily activities mood Somatic symptoms feet exam.,vaccination Social participation finance medication housing Cognitive function (clock test) lifestyle Institute of General Practice, Hannover 1. What problems are important? 100% 80 60 N=19 * N=1380 N=91 * patients doctors N=185 * N=862 N=37 N=49 N=66 40 N=71 * 20 0 * * P<0.05 Signtest social mood somatic house cognition pills lifestyle 1 2 function 3 4 5 6 7 8 Institute of General Practice, Hannover