Improving patient-doctor concordance: an intervention study in general practice

This study aimed to examine if providing feedback to the doctor can improve patient-doctor concordance (PDC) on health problems and treatments.

The study was carried out in a hospital-based primary care service in a lower socioeconomic status (SES) region of metropolitan Melbourne, Australia. A summary of the existing patient-doctor concordance on health problems and treatments was presented to doctors along with a questionnaire seeking their perceptions of and suggestions on how to act on the findings. In a pre- and post-intervention study, data were collected from consecutive new patients who completed a pre- and post-consultation questionnaire seeking information on the presenting complaint, patient-reported health problem, doctor-recorded health problem, treatments received, and patient expectations of and satisfaction with care. Diagnostic data were classified into body systems. Descriptive statistics were obtained and PDC measured. Following the intervention, data collection was repeated to detect any changes in PDC and patient satisfaction.

The pre-intervention sample (n = 197) was young (mean age 33 years), evenly divided into English-speaking (48%) and non-English-speaking (52%), and low SES (66%). The post-intervention samples (n = 95) was similar except for a lower proportion of persons from a low SES (27%). Main body systems reported were musculoskeletal, skin, respiratory, digestive, urological and gynaecological. Post-intervention, PDC on health problems improved significantly from 31% to 63% at the problem level (P = 0.001) and from 65% to 79% at the body system level (P = 0.02). PDC on treatments received also improved significantly from 5.5 to 6 out of 7 treatment options (P = 0.003). There were no significant differences due to gender, SES and non-English-speaking background status.

PDC is a practical, useful and relevant indicator of effective patient-doctor communication. A well-presented summary of existing levels of PDC is an effective intervention to improve PDC and, by inference, patient-doctor communication on health problems and treatments. PDC should also be examined and reported in prevalence and incidence studies based on patient's reports and doctor's records.