Original Article

Journal of General Internal Medicine

, Volume 25, Issue 5, pp 408-414

First online:

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

  • Donna M. ZulmanAffiliated withDepartment of Veterans Affairs, Health Services Research and Development Center of ExcellenceDepartment of Internal Medicine, University of Michigan Medical SchoolThe Robert Wood Johnson Clinical Scholars Program, University of Michigan Email author 
  • , Eve A. KerrAffiliated withDepartment of Veterans Affairs, Health Services Research and Development Center of ExcellenceDepartment of Internal Medicine, University of Michigan Medical School
  • , Timothy P. HoferAffiliated withDepartment of Veterans Affairs, Health Services Research and Development Center of ExcellenceDepartment of Internal Medicine, University of Michigan Medical School
  • , Michele HeislerAffiliated withDepartment of Veterans Affairs, Health Services Research and Development Center of ExcellenceDepartment of Internal Medicine, University of Michigan Medical SchoolThe Robert Wood Johnson Clinical Scholars Program, University of Michigan
  • , Brian J. Zikmund-FisherAffiliated withDepartment of Veterans Affairs, Health Services Research and Development Center of ExcellenceDepartment of Internal Medicine, University of Michigan Medical School

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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.

KEY WORDS

concordance chronic disease multimorbidity diabetes competing demands