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Patient-physician concordance in problem identification in the primary care setting
Annals of Internal Medicine
|September 1, 1980
Summary
Patient and physician agreement on primary health concerns, known as concordance, was only 47% in primary care visits. Lower agreement occurred with psychosocial issues, preventive medicine, musculoskeletal problems, or accidents.
Area of Science:
- Primary Care Medicine
- Health Services Research
- Patient-Physician Communication
Background:
- Effective communication between patients and physicians is crucial for accurate diagnosis and treatment in primary care.
- Understanding the level of agreement on principal health problems (concordance) is essential for improving healthcare quality.
- Previous research has highlighted potential disparities in problem identification between patients and providers.
Purpose of the Study:
- To quantify the concordance between patient-identified and physician-identified principal problems in primary care visits.
- To identify factors influencing the level of agreement or disagreement on principal health concerns.
- To compare concordance rates between different physician training tracks.
Main Methods:
- Analysis of 439 return primary care visits.
- Scoring concordance as complete, partial, or absent based on shared identification of the principal problem.
- Categorizing problems by organ system, psychosocial issues, preventive medicine, musculoskeletal system, and accidents.
Main Results:
- Complete concordance was observed in 47% of visits, partial in 26%, and absent in 27%.
- Concordance was significantly lower when physicians identified psychosocial problems or when patients reported issues related to psychosocial factors, preventive care, musculoskeletal conditions, or accidents.
- Physicians in a specific internal medicine training program showed lower concordance, being more likely to identify psychosocial problems.
Conclusions:
- Patient-physician agreement on the principal health problem is often incomplete in primary care settings.
- Psychosocial issues and certain other problem categories present challenges to achieving high concordance.
- Training programs may influence problem identification and subsequent patient-physician agreement.
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