Publication Details

Bonney, A., Jones, S. & Iverson, D. (2011). The older patient, the doctor and the trainee: patients' attitudes and implications for models of care. 2011 PHC Research Conference Brisbane: Primary Health Care Research & Information Service.


Aims & rationale/Objectives Population ageing poses major challenges for health systems. Additionally, training future general practitioners in the management of older and chronically ill patients is potentially hampered by the reluctance of these patients to consult trainees for chronic care. This paper reports a cross-sectional study investigating the attitudes of older patients to trainees, to inform strategies to improve older patient-trainee interaction. Methods The survey instrument was distributed to 1900 patients aged 60 and over from 38 training practices from five Australian states using a stratified, randomised cluster sampling process. Generalised estimating equation models were used for analysis. Principal findings The response rate was 47.9% (n=911). Over three-quarters (83.0%) were happy to see a trainee for a minor problem. Of respondents with a chronic/complex condition, a quarter (25.4%) was comfortable with independent trainee chronic/complex care; increasing to three-quarters (77.9%) if their usual GP checked management during the consultation. Modelling confirmed increased likelihood of comfort with trainee chronic/complex care with increasing involvement of the regular GP (p<.001). Perceived regular GP approval of seeing a trainee predicted frequency of trainee visits (p=.002); satisfaction with trainee consultations (p<.001); and comfort in independent trainee chronic/complex care (p<.001). Implications These data provide the foundation for a patient-centred GP training approach, which promises more effective chronic care training with timely access and satisfaction for patients. Ensuring inter-personal continuity with the patient’s regular GP should also aid patient safety. In addition, some older patients may be comfortable with their GP taking a consultant-like role in chronic disease management, with significant implications for models of care.