Reasons for disagreement regarding illnesses between older patients with multimorbidity and their GPs – a qualitative study

Abstract

BackgroundChronic conditions are the most common themes in doctor-patient communication, especially for older patients with multimorbidity and their GPs. Former quantitative studies identified a variety of socio-demographic and health-related factors which were associated with the (dis-)agreement between medical records and patient self-reported diseases. The aim of this qualitative study was to identify reasons for disagreement regarding illnesses between patients and their GPs.MethodsWe conducted three focus groups with GPs (n = 15) and three focus groups with multimorbid patients aged 65 to 85 (n = 21). The participants were recruited from the MultiCare Cohort Study. Focus groups were audiotaped and transcribed verbatim. The transcripts of the focus groups were analysed using the qualitative content analysis according to Mayring. Categories were determined deductively and inductively.ResultsThe analysis revealed seven themes concerning reasons for disagreement regarding illnesses between patients and their GPs: problems with communication and cooperation between health care professionals, disease management by the GP and the patient, the documentation behaviour of the GP, communication challenges between GP and patient, differences in the understanding of a disease between GP and patient, the prioritization and rating of diseases by GP and patient and obliviousness, repression and avoidance by the patient.ConclusionsFor older patients with multimorbidity, our study demonstrated that there is a need to enhance the cooperation between GPs, specialists and outpatient care, a demand to improve doctor-patient communication and a need for interventions to increase patients’ knowledge of diseases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0286-x) contains supplementary material, which is available to authorized users.

Integrative review of the social determinants of health in older adults with multimorbidity

“…MM is predominantly framed as a medical problem requiring healthcare system redesign, a physician response, or an interdisciplinary healthcare team response (Bayliss et al., , ; Boyd et al., ; Ekdahl et al., ; Gilbert et al., ; Gill et al., ; Hansen et al., ; Hsu, ; Jackson et al., ; Löffler et al., ; Marengoni et al., ; Melis et al., ; St John et al., ; Vassilaki et al., ; Wilson et al., ; Woo & Leung, ). Some literature described multimorbidity as including other non‐medical dimensions, such as social networks and living conditions (Landi et al., ; Martin et al., ; von dem Knesebeck et al., ).…”

“…This search produced 22 relevant articles for review: 16 quantitative studies (three RCTs (Boyd et al., ; Hochhalter et al., ; Ekdahl et al., ) and 13 cohort studies (Bayliss et al., ; Hsu, ; Jackson et al., ; Landi et al., ; Marengoni, von Strauss, Rizzuto, Winblad, & Fratiglioni, ; Martin et al., ; Melis et al., ; Menotti et al., ; St John et al., ; Vassilaki et al., ; von dem Knesebeck et al., ; Warner et al., ; Woo & Leung, ); four qualitative studies (three with no stated methodology (Bayliss et al., ; Löffler et al., ; Hansen et al., ) and one descriptive design (Gill et al., ); and two grey literature reports (Gilbert et al., ; Wilson et al., ).…”

“…Living with MM compared with having a single condition is associated with numerous negative outcomes for older adults: reduced life expectancy, avoidable hospitalizations; lower quality of life; poorer mood; frailty; increased risk of development of cognitive impairment; disability; functional decline; problems with medication use; and treatment conflicts (Bayliss et al., ; Ekdahl et al., ; Gilbert et al., ; Le Reste et al., ; Marengoni et al., ; Martin et al., ; Melis, Marengoni, Angleman, & Fratiglioni, ; Menotti et al., ; St John, Tyas, Menec, & Tate, ; Vassilaki et al., ; Woo & Leung, ). These multiple and interacting negative outcomes for older adults with MM challenge the healthcare system to provide care while containing costs (Bayliss, Edwards, Steiner, & Main, ; Boyd et al., ; Ekdahl et al., ; Gilbert et al., ; Gill et al., ; Hansen, Pohontsch, van den Bussche, Scherer, & Shäfer, ; Wilson, Gauvin, & Lavis, ).…”

“…• Social and public policy development should include consideration of older adults living with multimorbidity. system to provide care while containing costs (Bayliss, Edwards, Steiner, & Main, 2008;Boyd et al, 2009;Ekdahl et al, 2015;Gilbert et al, 2013;Gill et al, 2014;Hansen, Pohontsch, van den Bussche, Scherer, & Sh€ afer, 2015;Wilson, Gauvin, & Lavis, 2013).…”

Studies of Physician‐Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review

“…One study described the distribution of hearing loss in the sample, but did not present further findings . Two studies presented findings about the association between hearing loss and communication with physicians: one was a quantitative study that found that people with severe loss were more likely to communicate with physicians with the help of a medical visit companion; the other was a qualitative study identifying hearing loss as an overall barrier to physician‐patient communication . Finally, there was one interventional study reporting that providing hard‐of‐hearing older patients with a hearing assistance device significantly improved their self‐reports about the quality of communication with physicians and other clinicians …”