Context: Older patients constitute an increasing proportion of the caseloads in general practice (GP) training practices, but are relatively reluctant to consult trainees. Understanding their attitudes is a first step in improving older patient-trainee interaction. Objectives: Characterise the attitudes of older patients to GP trainees. Design: Cross-sectional survey; exploratory factor analysis; logistic regression. Setting: Randomised, stratified sample of 38 training practices across five Australian states. Participants: Patients aged 60 years and over (N=911; response rate 47.9%).
Instrument: Questionnaire for self-completion: previously piloted and subjected to factor analysis. Main and secondary outcome measures: Identification of attitude factors; patient characteristics
predicting high factor scale scores; patient responses predicted by factor scale scores.
Results: Cronbach’s ? =.791. Three factors identified: interpersonal trust (IPT); system trust (ST); and interpersonal continuity of care (IPC). Female gender and age >/= 75 predicted high IPT scores [OR 1.95, 95% CI 1.39-2.72, p<001; OR 1.41, 95% CI 1.01-1.96, p=.044]. Female gender and chronic
illness predicted high IPC scores [OR 2.88, 95% CI 1.66-5.00, p<.001; OR 2.17, 95% CI 1.93-3.94, p=.011]. Self-rated health score >/= 4/5 predicted high ST scores [OR 1.91, 95% CI 1.38-2.64, p<.001]. High IPT reduced odds of satisfaction with trainees [OR .51, 95% CI .32-.81, p=.004], and both high IPT and IPC reduced odds of comfort with trainee chronic/complex care [OR .61, 95% CI
.40-.92, p=.02; OR .31, 95% CI .18-.56, p<.001]. High IPC predicted reduced odds of seeing a trainee more than once or twice [OR .42, 95% CI .24-.74, p= .002]. High ST predicted increased satisfaction with trainees [OR 6.96, 95% CI 4.47-10.83, p<.001].
Conclusions: Three underlying constructs (IPT, ST and IPC) appear important in influencing older patients’ interactions with trainees.
Patients with high IPT and/or IPC scores demonstrate significantly reduced acceptance of trainees. Strategies aimed to improve trust and continuity, e.g. shared continuity of care with their regular GP, may improve acceptance for these patients.