Agreement between self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care - results of the MultiCare Cohort Study

BMC Family Practice

Research Article

Siegfried Weyerer¹  Angela Fuchs²  Hans-Helmut König³  Gerhard Schön⁴  Karl Wegscheider⁴  Martin Scherer⁵  Hendrik van den Bussche⁵  Heike Hansen⁵  Ingmar Schäfer⁵  Susanne Höfels⁶  Birgitt Wiese⁷  Juliana J Petersen⁸  Jochen Gensichen⁹  Steffi Riedel-Heller^1,10  Horst Bickel^1,11 

[1] Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany;Department of General Practice, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany;Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany;Department of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany;Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany;Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany;Institute for Biometry, Hannover Medical School, 30623, Hannover, Germany;Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany;Institute for General Practice, University of Jena, Bachstraße 18, 07743, Jena, Germany;Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany;Institute of General Practice, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany;

关键词: Agreement;    Self-report;    Physician report;    Chronic diseases;    Primary care;    Multimorbidity;   

DOI  :  10.1186/1471-2296-15-39

 received in 2013-09-17, accepted in 2014-02-21,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMultimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care, and to discover which patient characteristics are associated with positive agreement.MethodsThe MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models were calculated to analyze which patient characteristics can be associated with positive agreement.ResultsWe identified four chronic conditions with good agreement (e.g. diabetes mellitus κ = 0.80;PA = 0,87), seven with moderate agreement (e.g. cerebral ischemia/chronic stroke κ = 0.55;PA = 0.60), seventeen with fair agreement (e.g. cardiac insufficiency κ = 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problems κ = 0.05;PA = 0.10).Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income, disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41).ConclusionsFor multimorbidity research, the knowledge of diseases with high disagreement levels between the patients’ perceived illnesses and their physicians’ reports is important. The analysis shows that different patient characteristics have an impact on the agreement. Findings from this study should be included in the development of clinical guidelines for multimorbidity aiming to optimize health care. Further research is needed to identify more reasons for disagreement and their consequences in health care.Trial registrationISRCTN89818205

【 授权许可】

CC BY   
© Hansen et al.; licensee BioMed Central Ltd. 2014