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Patient-Provider Concordance in the Prioritization of Health Conditions Among Hypertensive Diabetes Patients

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Abstract

BACKGROUND

Many patients with diabetes have multiple other chronic conditions, but little is known about whether these patients and their primary care providers agree on the relative importance that they assign these comorbidities.

OBJECTIVE

To understand patterns of patient-provider concordance in the prioritization of health conditions in patients with multimorbidity.

DESIGN

Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with elevated clinic triage blood pressure (≥140/90) at nine Midwest VA facilities.

MEASUREMENTS

We constructed a patient-provider concordance score based on responses to surveys in which patients were asked to rank their most important health concerns and their providers were asked to rank the most important conditions likely to affect that patient’s health outcomes. We then calculated the change in predicted probability of concordance when the patient reported having poor health status, pain or depression, or competing demands (issues that were more pressing than his health), controlling for both patient and provider characteristics.

RESULTS

For 714 pairs (72%), providers ranked the patient's most important concern in their list of three conditions. Both patients and providers ranked diabetes and hypertension most frequently; however, providers were more likely to rank hypertension as most important (38% vs. 18%). Patients were more likely than providers to prioritize symptomatic conditions such as pain, depression, and breathing problems. The predicted probability of patient-provider concordance decreased when a patient reported having poor health status (55% vs. 64%, p < 0.01) or non-health competing demands (46% vs. 62%, p < 0.01).

CONCLUSIONS

Patients and their primary care providers often agreed on the most important health conditions affecting patients with multimorbidity, but this concordance was lower for patients with poor health status or non-health competing demands. Interventions that increase provider awareness about symptomatic concerns and competing demands may improve chronic disease management in these vulnerable patients.

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Acknowledgements

The authors thank Rob Holleman for assisting with data management, Mandi Klamerus for project management, and Shirley Chen for helping with manuscript preparation.

Financial Disclosures

None reported.

Funding/Support

This work was supported by the Robert Wood Johnson Clinical Scholars Program and an associated VA Advanced Fellowship, as well as research grants from the US Department of Veterans Affairs Health Services Research and Development Service (IIR02-225) and the Michigan Diabetes Research and Training Center Grant (P60DK-20572). Dr. Zikmund-Fisher is supported by a career development award from the American Cancer Society (MRSG-06-130-01-CPPB).

Role of the Sponsor

The funding sources had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Donna M. Zulman MD.

Additional information

Affiliation Changes Following Manuscript Submission: Dr. Zikmund-Fisher is now at the Department of Health Behavior and Health Education, University of Michigan.

APPENDIX

APPENDIX

“Other” health concerns included as write-in responses by patients and providers

Patient

No. of responses

Cancer

5

Eye-related

4

GI

2

GU

2

Sleep-related (includes OSA)

2

Vascular

2

Alcohol

1

All of the above

1

Dental

1

More than one chronic health problem

1

Cognitive

1

Lowering my potassium

1

Parkinson

1

Physical limitations and diet for one problem conflict with other health problems

1

Polio

1

Total

26

Provider

No. of responses

Renal

41

Compliance

38

GI-related

28

GU

16

Cancer

15

PVD, vascular

15

Alcohol

14

Medication related

12

Foot care, foot issues, leg ulcers, BKA, neuropathy

10

Preventive care, maintenance, screening

9

Skin-related

8

Hematology

6

Angina

5

ED

5

Dementia

4

Dizziness, light-headedness, fatigue

4

Stroke, TIA, cerebrovascular, CVA

4

OSA

3

Acute respiratory conditions (i.e., URI, cough)

3

Eye-related

2

Hearing

2

Other

82

Total

326

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Zulman, D.M., Kerr, E.A., Hofer, T.P. et al. Patient-Provider Concordance in the Prioritization of Health Conditions Among Hypertensive Diabetes Patients. J GEN INTERN MED 25, 408–414 (2010). https://doi.org/10.1007/s11606-009-1232-1

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  • DOI: https://doi.org/10.1007/s11606-009-1232-1

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