Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation.

Abstract

BACKGROUND: Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported. AIM: To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation. DESIGN AND SETTING: Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month. METHOD: Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy. RESULTS: PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas. CONCLUSION: In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity.