Elderly patients' and GPs' views on different methods for patient involvement: an international qualitative interview study.

BACKGROUND: Elderly patients' interaction with the GP may be improved through patient involvement techniques, and there is a variety of such techniques which improve patients' involvement in their own care, although little is known about their acceptability. OBJECTIVES: The aim of this study was to identify barriers and facilitators for using patient information leaflets and patient satisfaction questionnaires as methods for increasing elderly patients' involvement in general practice care by comparing their views with the GPs' views on these two types of methods. METHODS: In seven countries (Austria, Denmark, Germany, The Netherlands, Portugal, Slovenia and Switzerland) 146 GPs and 284 patients aged 70 and over were interviewed about the use and the acceptability of these two methods. Interviewers followed a semi-structured interview guide, and all interviews were tape-recorded and transcribed verbatim. RESULTS: The arguments for using patient satisfaction questionnaires were that they would provide the GP with more information, function as a basis for change, increase patients' self-confidence and make them more conscious of what to expect. Barriers for their use were cognitive impairment among patients, fear that they would not answer honestly and opposition to written material. The arguments for patient information leaflets were that they could support patients' memories, educate patients and promote their self-responsibility. The barriers were cognitive impairment among patients and fear that they would give them false impressions of what to expect. CONCLUSION: Both instruments were generally well accepted by both GPs and patients. Their use seemed to be dependent upon the individual GP's attitude and the patients' cognitive capacities.

Discordance between self-evaluated health and doctor-evaluated health in relation to general health promotion.

OBJECTIVE: To describe the occurrence of "health realists", "health pessimists" and "health optimists" in a non-patient population by identifying cases of concordance and discordance between doctor-evaluated health and self-evaluated health and to describe the distribution of selected life-style-related physiological risk factors among these health-groups. DESIGN: Comparative study. SETTING: Primary health care. SUBJECTS: 456 middle-aged persons registered with a general practitioner (GP) were after a general health screening invited to a health discussion. Prior to the health screening the participants had assigned their health status to one of five categories ranging from "very poor" to "excellent". After the health discussion the GP rated the participants' general health status on a visual analogue scale. On basis of this information patients were classified as "health realists", "health optimists" and "health pessimists". RESULTS: 54% of the participants could be classified as "good-health realists", 14% as "poor-health realists", 22% as "health optimists", and 10% as "health pessimists". "Poor-health realists" had the greatest accumulation of risk factors, followed by "health optimists", "health pessimists" and "good-health realists". Among the "health pessimists" there was a significantly higher risk score of future cardiovascular disease and poor physical endurance compared with the "good-health realists". CONCLUSION: Discordance between doctor-evaluated health and self-evaluated health was found in 32% of the cases studied. "Health pessimists" had more risk factors than "good-health realists" even though the GPs had rated their general health status as good in both cases.

GPs' views on involvement of older patients: an European qualitative study.

Involvement of older patients in general practice care is regarded as important, but is not widespread. To determine specific barriers to the involvement of older patients in general practice care and to identify variations between countries, we performed an international comparative study based on qualitative interviews with 233 general practitioners (GPs) in 11 countries. Most GPs thought that involving older patients had positive outcomes. GPs saw patient involvement as a process taking place solely during consultations. The main barrier for GPs was lack of time. Barriers related to older patients were their feelings of respect for doctors, their lack of experience in being involved and possible mental and physical impairments. To conclude, increasing involvement of older patients is not easy and will only be effective when GPs have adopted a more developed concept of patient involvement and are supported with the different methods for achieving this. The range of appropriate interventions may be similar in all countries.