title: Priority setting in general practice: health priorities of older patients differ from treatment priorities of their physicians.
abstract: OBJECTIVE
  To ascertain health priorities of older patients and treatment priorities of their general practitioners (GP) on the basis of a geriatric assessment and to determine the agreement between these priorities.
  
  
  METHODS
  The study included a sample of 9 general practitioners in Hannover, Germany, and a stratified sample of 35 patients (2-5 patients per practice, 18 female, average age 77.7 years). Patients were given a geriatric assessment using the Standardized Assessment for Elderly Patients in Primary Care (STEP) to gain an overview of their health and everyday problems. On the basis of these results, patients and their physicians independently rated the importance of each problem disclosed by the assessment. Whereas patients assessed the importance for their everyday lives, physicians assessed the importance for patients' medical care and patients' everyday lives.
  
  
  RESULTS
  Each patient had a mean ± standard deviation of 18 ± 9.2 health problems. Thirty five patients disclosed a total of 634 problems; 537 (85%) were rated by patients and physicians. Of these 537 problems, 332 (62%) were rated by patients and 334 (62%) by physicians as important for patients' everyday lives. In addition, 294 (55%) were rated by physicians as important for patients' medical care. Although these proportions of important problems were similar between patients and physicians, there was little overlap in the specific problems that each group considered important. The chance-corrected agreement (Cohen κ) between patients and physicians on the importance of problems for patients' lives was low (κ=0.23). Likewise, patients and physicians disagreed on the problems that physicians considered important for patients' medical care (κ=0.18, P<0.001 for each).
  
  
  CONCLUSIONS
  The low agreement on health and treatment priorities between patients and physicians necessitates better communication between the two parties to strengthen mutual understanding.
authors.affiliation: Hannover Medical School, Institute for General Practice, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. voigt.isabel@mh-hannover.de
authors.forename: Isabel
authors.initials: I
authors.lastname: Voigt
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wrede
authors.forename: Heike
authors.initials: H
authors.lastname: Diederichs-Egidi
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Dierks
authors.forename: Ulrike
authors.initials: U
authors.lastname: Junius-Walker
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000704:Analysis of Variance; D003142:Communication; D005194:Family Practice / Q000592:standards*; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D012307:Risk Factors; D012737:Sex Factors; D012931:Social Environment; D013223:Statistics as Topic; D018709:Statistics, Nonparametric