title: Do multimorbidity and deprivation influence patients' emotional expressions and doctors' responses in primary care consultations?--An exploratory study using multilevel analysis.
abstract: OBJECTIVE
  To explore whether and how patient multimorbidity and socioeconomic deprivation might influence patients' emotional expression and doctors' responses in the general practice (GP) consultations.
  
  
  METHODS
  Video recordings of 107 consultations (eight GPs) were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Multilevel logistic regressions modelled the probability of GP providing space response, considering patient multimorbidity, deprivation conditions and other contextual factors. Further multinomial regressions explored the possible impact of multimorbidity and deprivation on expression of and specific responses to patients' emotional distress.
  
  
  RESULTS
  It was less likely for GPs to provide space as the consultation proceeded, controlling for multimorbidity and deprivation variables. Patients with multimorbidity were less likely to express emotional distress in an explicit form. GPs were more likely to provide acknowledgement to emotions expressed by patients from more deprived areas.
  
  
  CONCLUSIONS
  Multimorbidity and deprivation may influence the dynamics of the GP consultations in specific ways. Rigorous methodologies using larger samples are required to explore further how these two variables relate to each other and influence cue expression, provider response and subsequent patient outcomes.
  
  
  CONCLUSIONS
  Understanding how multimorbidity and deprivation impact on GP consultations may help inform future service improvement programmes.
authors.affiliation: School of Medicine, University of St Andrews, St Andrews, UK. Electronic address: yz10@st-andrews.ac.uk.
authors.forename: Yuefang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Jenna-Marie
authors.initials: JM
authors.lastname: Lundy
authors.affiliation: School of Medicine, University of St Andrews, St Andrews, UK.
authors.forename: Gerry
authors.initials: G
authors.lastname: Humphris
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Stewart William
authors.initials: SW
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D004644:Emotions; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D000076322:Multimorbidity; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D014743:Videotape Recording; D055815:Young Adult
keywords: Deprivation; Emotional distress; General practice; Multimorbidity; The VR-CoDES