De invloed van sociale concordantie in de spreekkamer van de huisarts - Extern Promotieonderzoek

Decision making in primary care is a complex process where medical, psychosocial and social factors are weighed by both patient and caregiver. During this process, which can be seen as an attempt to tailer care to the needs, desires and possibilities of the patient and doctor, there is inherent variation in consultation outcomes (e.g. prescriptions, referrals, lab tests etc.). More or less variation in consultation outcomes is not necissarily good or bad. However, in the context of healthcare policy making, it is higly relevant to understand what drives decision making to be able to give guidence to daily practice in case of desired changes.

In this manuscript, it is explored whether the combined demographic characteristics of both patient and doctor are associated with consultation outcomes. More specifically, we will research the influence of social concordance on decision making in primary care. Social concordance is a construct describing shared identity based on shared demographic characteristics. In this manuscript, we will focus on gender concordance and age concordance between patient and general practitioner as aspects of social concordance.

In the first two research chapters, we will investigate whether gender and age concordance are associated with prescription and referral rates in primary care. As sub-questions we also

try to understand what can moderate possible ‘concordance effects’. In the third research

chapter, we will investigate whether gender and age concordance are associated with patient experiences related to the primary care consultation (PREMs). In addition, we investigate whether these associations are affected by the degree of gender equality of the countries concerned. After the first three research chapters, which are focussed on associations of social concordance with consultation outcomes, we will conduct two qualitative studies aiming to explore how possible social concordance effects might take place. In research chapter four, we study video-recordings of health care consultations. In this chapter, we aim to find out if social concordance causes explicit and objectifiable different behaviour in the decision-making process. In research chapter five, we will perform reflective practice interviews with general physicians, asking them about their own actions during their consultations and asking them about their own ideas regarding social concordance and decision making.