title: Agreement between self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care - results of the MultiCare Cohort Study.
abstract: BACKGROUND
  Multimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care, and to discover which patient characteristics are associated with positive agreement.
  
  
  METHODS
  The MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models were calculated to analyze which patient characteristics can be associated with positive agreement.
  
  
  RESULTS
  We identified four chronic conditions with good agreement (e.g. diabetes mellitus κ = 0.80;PA = 0,87), seven with moderate agreement (e.g. cerebral ischemia/chronic stroke κ = 0.55;PA = 0.60), seventeen with fair agreement (e.g. cardiac insufficiency κ = 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problems κ = 0.05;PA = 0.10).Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income, disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41).
  
  
  CONCLUSIONS
  For multimorbidity research, the knowledge of diseases with high disagreement levels between the patients' perceived illnesses and their physicians' reports is important. The analysis shows that different patient characteristics have an impact on the agreement. Findings from this study should be included in the development of clinical guidelines for multimorbidity aiming to optimize health care. Further research is needed to identify more reasons for disagreement and their consequences in health care.
  
  
  BACKGROUND
  ISRCTN89818205.
authors.affiliation: Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. h.hansen@uke.de.
authors.forename: Heike
authors.initials: H
authors.lastname: Hansen
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.forename: Steffi
authors.initials: S
authors.lastname: Riedel-Heller
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.forename: Juliana J
authors.initials: JJ
authors.lastname: Petersen
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.forename: Susanne
authors.initials: S
authors.lastname: Höfels
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D057566:Self Report