Abstract
BackgroundPatient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.MethodsA questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.ResultsAlthough numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.ConclusionsAlthough other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings.
Highlights
Patient ‘enablement’ is a term closely aligned with ‘empowerment’ and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patientrated measure of consultation outcome
In areas of high deprivation such as the West of Scotland we have recently reported lower patient enablement in patients with psychological distress in high deprivation areas compared with less deprived areas [16]
The analysis involved data collected from 3,044 patients (1,966 patients in the high deprivation group, and 1,078 patients in the low deprivation group)
Summary
Patient ‘enablement’ is a term closely aligned with ‘empowerment’ and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patientrated measure of consultation outcome. Many factors may impinge on patient enablement and the outcome of consultations These potentially include patient factors, consultation factors, and system factors. Consultation factors associated with enablement in primary care suggest the importance of consultation length, and interpersonal continuity of care [2,3], and the doctors’ interpersonal aspects include showing an interest in the patients’ life, health promotion, and having a positive approach [8]. System factors (which may arguably include consultation length and continuity of care) indicate that practice size may be important, with larger practices having lower enablement scores [3]
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