Do doctors and patients agree on cardiovascular-risk management recommendations post-consultation? The INTERMEDE study

Background Understanding interactions between patients and GPs may be important for optimising communication during consultations and improving health promotion, notably in the management of cardiovascular risk factors. Aim To explore the agreement between physicians and patients on the management of cardiovascular risk factors, and whether potential disagreement is linked to the patient's educational level. Design of study INTERMEDE is a cross-sectional study with data collection occurring at GPs offices over a 2-week period in October 2007 in France. Method Data were collected from both patients and doctors respectively via pre- and post-consultation questionnaires that Were 'mirrored', meaning that GPs and patients were presented with the same questions. Results The sample consisted of 585 eligible patients (61% females) and 27 GPs. Agreement between patients and GPs was better for tangible aspects of the consultation, such as measuring blood pressure (kappa = 0.84, standard deviation [SD] = 0.04), compared to abstract elements, like advising the patient on nutrition (kappa =0.36, SD = 0.04), and on exercise (kappa = 0.56, SD = 0.04). Patients' age was closely related to level of education: half of those without any qualification were older than 65 years;The statistical association between education and agreement between physicians and patients disappeared after adjustment for age, but a trend remained. Conclusion This study reveals misunderstandings between patients and GPs on the content of the consultation, especially for health-promotion outcomes. Taking patients' social characteristics into account, notably age and educational level, could improve mutual understanding between patients and GPs, and therefore, the quality of care.