Context: Older patients constitute an increasing proportion of the caseloads in general practice (GP) training practices, but are relatively reluctant to consult trainees. Understanding their attitudes is a first step in improving older patient-trainee interaction. Objectives: Characterise the attitudes of older patients to GP trainees. Design: Cross-sectional survey; exploratory factor analysis; logistic regression. Setting: Randomised, stratified sample of 38 training practices across five Australian states. Participants: Patients aged 60 years and over (N=911; response rate 47.9%). Instrument: Questionnaire for self-completion: previously piloted and subjected to factor analysis. Main and secondary outcome measures: Identification of attitude factors; patient characteristics predicting high factor scale scores; patient responses predicted by factor scale scores. Results: Cronbach’s ? =.791. Three factors identified: interpersonal trust (IPT); system trust (ST); and interpersonal continuity of care (IPC). Female gender and age >/= 75 predicted high IPT scores [OR 1.95, 95% CI 1.39-2.72, p<001; OR 1.41, 95% CI 1.01-1.96, p=.044]. Female gender and chronic illness predicted high IPC scores [OR 2.88, 95% CI 1.66-5.00, p<.001; OR 2.17, 95% CI 1.93-3.94, p=.011]. Self-rated health score >/= 4/5 predicted high ST scores [OR 1.91, 95% CI 1.38-2.64, p<.001]. High IPT reduced odds of satisfaction with trainees [OR .51, 95% CI .32-.81, p=.004], and both high IPT and IPC reduced odds of comfort with trainee chronic/complex care [OR .61, 95% CI .40-.92, p=.02; OR .31, 95% CI .18-.56, p<.001]. High IPC predicted reduced odds of seeing a trainee more than once or twice [OR .42, 95% CI .24-.74, p= .002]. High ST predicted increased satisfaction with trainees [OR 6.96, 95% CI 4.47-10.83, p<.001]. Conclusions: Three underlying constructs (IPT, ST and IPC) appear important in influencing older patients’ interactions with trainees. Patients with high IPT and/or IPC scores demonstrate significantly reduced acceptance of trainees. Strategies aimed to improve trust and continuity, e.g. shared continuity of care with their regular GP, may improve acceptance for these patients.
Andrew D Bonney, Sandra C Jones, Donald Iverson and Christopher Magee. "What do older patients want? Understanding older patients' attitudes towards general practice trainees"
Available at: http://works.bepress.com/sjones/88/