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Titled Multi-morbidity and Socioeconomic Deprivation in Primary Care Consultations, the study undertaken in the UK states that, “in deprived areas, the greater need of patients with multi-morbidity is not reflected in the longer consultation length, higher GP patient centeredness and higher perceived GP empathy found in affluent areas”.
Published recently in the Annals of Family Medicine, the authors argue that action is required to address what they describe as the “mismatch of need and service provision for patients with multi-morbidity” in order to narrow health inequalities in primary care.
“Reflecting the inverse care law, patients living in areas of high deprivation have poorer access to primary care, shorter consultation length, less enablement, and doctors who are more stressed compared with those working in more affluent areas,” the study notes.
The inverse care law states that “the availability of good medical care tends to vary inversely with the need for it in the population served”.
Secondary analyses of 659 video-recorded routine consultations involving 25 GPs in deprived areas and 22 in affluent areas of Scotland were analysed.
Patients rated the empathy of GPs using the consultation and relational empathy (CARE) measure immediately after the consultation. Videos were analysed using the measure of patient-centered communication and multi-level, multi-regression analysis identified differences between the groups.
“In affluent areas, patients with multi-morbidity received longer consultations than patients without multi-morbidity (mean 12.8 minutes vs 9.3, respectively), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively),” the results show.
“In affluent areas, patients with multi-morbidity perceived their GP as more empathic than patients without multi-morbidity; this difference was not found in deprived areas. Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multi-morbidity compared with patients without multi-morbidity. This was not the case in deprived areas.”
The authors note that: “Despite the fact that multi-morbidity was more common and more burdensome in deprived areas, consultations did not differ significantly from those of patients without multi-morbidity.”
Similar to Ireland, in Scotland new policy changes are under discussion regarding integrated primary care and a new GP contract.