Zulman DM (Ann Arbor VA HSR&D COE; University of Michigan), Kerr EA
(Ann Arbor VA HSR&D COE; University of Michigan), Hofer TP
(Ann Arbor VA HSR&D COE; University of Michigan), Zikmund-Fisher BJ
(Ann Arbor VA HSR&D COE; University of Michigan)
Effective patient-provider communication has been associated with improved health outcomes. One measure of effective communication is patient-provider concordance in health care goals. Concordance regarding goals of care has been associated with improved outcomes in acute conditions, but has not been examined in patients with complex chronic conditions. We examined how often diabetic patients and their primary care providers are in concordance in prioritizing health conditions, and whether concordance is affected by competing demands.
In a prospective cohort study at nine Midwest VA facilities, 92 providers and 1,169 diabetic patients with elevated triage blood pressure ( > = 140/90) were surveyed at clinic visits. Patients and providers were asked to independently rank the three most important health conditions affecting the patient. We constructed a measure of patient-provider concordance by counting the number of priority matches, weighting the score with an extra point if the provider’s top three priorities included the patient’s top priority. Using an ordinal logistic regression model, we calculated the change in predicted probability of concordance when competing demands were present, controlling for patient sociodemographic characteristics, provider gender and type, and elements of the patient-provider relationship.
337 patient-provider pairs (38%) ranked the same health condition as top priority. For 714 patients (73%), the provider ranked the patient’s top priority in their top three priorities. 60% of pairs had high concordance on the constructed measure ( > = 3 out of 4 possible points). 58% of patients reported chronic pain, 55% reported depression symptoms, 39% reported fair to poor health status, and 12% agreed they had more pressing issues than health. Predicted probability of patient-provider concordance was significantly lower for patients who reported fair to poor health status (52% vs. 67%, p < 0.01) or more pressing issues than their health (46% vs. 64%, p < 0.01). Concordance was also lower for patients who reported chronic pain, but this was of borderline significance (59% vs. 65%, p = 0.05).
Patients and providers had moderate concordance regarding prioritization of health conditions. Competing demands such as poor health status and issues more pressing than the patient’s health were associated with lower concordance.
Providers are less likely to recognize the healthcare priorities of patients at high risk for poor outcomes: those with competing demands and poor health status. Understanding these competing demands is likely to improve communication and possibly overall disease management.