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Setting health priorities with older patients: What happens in multimorbidity-consultations ?

Setting health priorities with older patients: What happens in multimorbidity-consultations ?. Junius-Walker U. Hofmann W, Wiese B,Bleidorn J, Voigt I, Wrede J, Dierks ML. Care for all relevant roblems: overview of health longitudinal, pro-active care treatment according to

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Setting health priorities with older patients: What happens in multimorbidity-consultations ?

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  1. Setting health priorities with older patients: What happens in multimorbidity-consultations ? Junius-Walker U. Hofmann W, Wiese B,Bleidorn J, Voigt I, Wrede J, Dierks ML

  2. Care for all relevant roblems: overview of health longitudinal, pro-active care treatment according to mutual prioritization doctor as facilitator • Urgent encounters: • disease centered • reactive – towards immediate relief • treatment focussed on single diseases • doctor as medical expert

  3. 40 practices 21 GPs 174 patients 19 GPs 143 patients Cluster RCT: intervention arm Patient: How important … for you? 1) Step-assessment Evidence on…. 1. patient involvement 2. special treatment attention for priority problems 3. improved patient-doctor agreement on importance importance ratings 2) priority cons. consultation importance ratings

  4. comprehensive assessment:disentangles „ complex health “ into defined problems Ursus Wehrli: „Tidying up art“ Miro

  5. European STEP: 46 items in 10 health domains function in everyday life (4) clock-drawing(1) social and housing (6) somatic symptoms (16) medication (2) Medical findings: RR, DM, feet (6) vaccination (4) lifestyle (4) mood (3) Williams E et al. Evidence-based approach to assessing older people. Occ Paper 82, R Coll Gen Pract 2002

  6. 2) priority-setting consultation: • 30 min training to use PrefCheck-guide: • Individual problem list with importance ratings • Guidance on how to set mutual priorities • Documenting priorities and treatment mutual priorities

  7. Results: 174 patients gender: 58% female age group: 31% >80 years low income: 36% <1000 €

  8. discussed (51%) not discussed (49%) treatment planning (47%) prioritised (20%) Results: 1827health problems 925 857 902 369

  9. Patient involvement in priority setting: 369 prioritised problems 20% Important to patient alone Important to GP alone Important to both Important to none 19%

  10. Determined priorities (N=369) important to.. patient alone doctor alone mutual

  11. discussed treatment planning prioritised 2. Priority setting & treatment attention • treatments planned for: • 86% of priority problems • vs. • 37% of all non-priority • problems • or 68% of discussed non-priority problems

  12. Special treatment attention to priority problems N=311 N=546

  13. 3. Sustained doctor-patient agreement on importance? Multilevel log. regression analysis for all patients (N= 317): Affiliation to patient group did not sig. predict agreement.

  14. Conclusions: Priority setting consultation… has not helped 1….bridging the different views on the importance of health problems has helped • .. giving patients a voice (functional,social matters, symptoms) • .. identifying problems with unmet needs for active treatment

  15. Mr. H. 12 problems, 10 important

  16. 1. Patient involvement: problems receiving…discussion priority setting treatment 925 343 692 Important to both Important to none Important to GP Important to patient

  17. Problems receiving treatment planning (N=857)

  18. Treatment patterns

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