Are Difficult Inpatients Also Difficult Primary Care Patients?

Area of Science:

• Medical Sociology
• Healthcare Provider-Patient Dynamics
• Clinical Psychology

Background:

• Healthcare providers frequently encounter patients perceived as difficult in both inpatient and outpatient settings.
• Patient characteristics associated with difficulty in inpatient settings include personality disorders, extended hospital stays, and chronic pain.
• Ambulatory patients exhibiting medically unexplained symptoms, mental health conditions (depression, anxiety), personality disorders, or chronic pain are often perceived as difficult.

Purpose of the Study:

• To determine if patients identified as difficult by inpatient providers are also perceived as difficult by their primary care providers (PCPs).
• To investigate whether patient characteristics associated with difficulty are consistent across inpatient and primary care settings.

Main Methods:

• A prospective cohort study involving Veterans Affairs (VA) patients was conducted.
• Inpatient and primary care providers rated patient difficulty using dichotomous and continuous scales via surveys.
• Patient data, including characteristics, were abstracted from electronic health records.

Main Results:

• Of 192 inpatients, 161 had PCPs, and 132 (82%) were included in the PCP survey.
• Sixty-seven percent of inpatients rated as difficult by their inpatient providers were also considered difficult by their PCPs.
• Inpatient difficulty, personality disorders, and depression were independent predictors of perceived difficulty in the clinic setting.

Conclusions:

• A significant overlap exists in how inpatient and primary care providers perceive patient difficulty.
• Personality disorders and depression are key factors contributing to patients being perceived as difficult by PCPs.
• Findings underscore the need for consistent approaches to managing difficult patient encounters across different healthcare settings.