Journal of General Internal Medicine

, Volume 25, Issue 5, pp 408–414 | Cite as

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

  • Donna M. ZulmanEmail author
  • Eve A. Kerr
  • Timothy P. Hofer
  • Michele Heisler
  • Brian J. Zikmund-Fisher
Original Article



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.


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


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.


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.


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).


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.


concordance chronic disease multimorbidity diabetes competing demands 



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.


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.


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Donna M. Zulman
    • 1
    • 2
    • 3
    Email author
  • Eve A. Kerr
    • 1
    • 2
  • Timothy P. Hofer
    • 1
    • 2
  • Michele Heisler
    • 1
    • 2
    • 3
  • Brian J. Zikmund-Fisher
    • 1
    • 2
  1. 1.Department of Veterans AffairsHealth Services Research and Development Center of ExcellenceAnn ArborUSA
  2. 2.Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.The Robert Wood Johnson Clinical Scholars ProgramUniversity of MichiganAnn ArborUSA

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