INFLUENCE OF SOCIAL-PROBLEMS ON MANAGEMENT IN GENERAL-PRACTICE - MULTIPRACTICE QUESTIONNAIRE SURVEY

Objectives: To find how often social problems influence clinical manag ement in general practice, hew management is changed, and how the char acteristics of patients, doctors, and the doctor-patient relationship influence this management influence this management. Design: Multiprac tice sun ey of patients consulting general practitioners. Doctors comp leted a questionnaire for each patient Setting General practices in Bu skerud county Norway. Subjects: 1401 consecutive adult patients attend ing 89 general practitioners. Main outcome measures: How often managem ent of patients was influenced by different types of social problem an d main reasons for consultation; frequency and intercorrelation of dif ferent types of management applied; odds ratios for social problems' i nfluence on management, controlled for by characteristics of doctors, patients, and their relationship. Results: In 17% of all consultations the doctors' knowledge of patients' social problems influenced their management, stressful working conditions being the most frequent influ encing type of problem. Knowledge of social problems influenced manage ment more often when the doctor knew a patient well, but less often th e longer a doctor had worked in a practice. When social problems influ enced management, the commonest types of management offered were extra time for consultation (51%), advice (42%), authorisation of sick leav e (28%), and prescription of a psychotropic drug (20%), while referral to community services was used in 2.6% of these consultations. Prescr iption of a psychotropic drug was positively correlated with use of ex tra time, and was made more often by female doctors. Conclusions: Pati ents' social problems influenced choice of management in at least a si xth of consultations. Prior knowledge of the patient, the doctor's tim e in present practice, age and sex of the patient, and sex of the doct or significantly influenced management of patients.