Multimorbidity and socioeconomic deprivation in primary care consultations

Abstract

PURPOSE The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODS We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multi-level, multi-regression analysis identified differences between the groups. RESULTS In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P =.015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P =.774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P =.009) than patients without multimorbidity; this difference was not found in deprived areas (P =.344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P