The older patient, the general practitioner and the trainee: patients' attitudes and implications for training

The training of future general practitioners (GPs) in the management of older and chronically ill patients is assuming increasing significance with population ageing. Such training, however, may be hampered by the reluctance of older patients to consult GP trainees for chronic problem care. This paper reports on a cross-sectional study investigating the attitudes of older patients to GP trainees, to inform strategies to improve older patient-trainee interaction. The primary hypothesis tested was that older patients' acceptance of trainees for their chronic disease management would be improved by strengthening the relational link with their regular GP around trainee consultations.

The survey instrument was distributed to 1900 patients aged 60 and over from 38 training practices in five Australian states using a stratified, randomised cluster sampling process. Generalised estimating equation models were used to undertake logistic regression for analysis.

The response rate was 47.9% (n=911). Eighty-three percent were happy to see a trainee for a minor problem. Of respondents with a chronic/complex condition, 25.4% were comfortable with independent trainee chronic/complex care, increasing to 77.9% if their usual GP was called in to double-check management. Modelling confirmed increased likelihood of comfort with trainee chronic/complex care with involvement of the regular GP (P<0.001). Strong agreement that their regular doctor was happy for them to see a trainee was associated with frequency of trainee visits (P=0.002); satisfaction with trainee consultations (P<0.001); and comfort in independent trainee chronic/complex care (P<0.001).

There is the potential to develop models of trainee chronic/complex care that maintain older patient satisfaction and retain the favourable patient outcomes associated with interpersonal continuity. Strengthening interpersonal continuity of care with the patient's usual GP around trainee consultations, and open communication regarding having trainees involved in their care, appear key to such models. Further research involving prospective trials is required.