P61 Could disagreement between doctors and patients on evaluating patient's health contribute to worsening health inequalities? The INTERMEDE study

Objective To determine whether disagreement between doctors and patients may be linked to the production of health inequalities. Methods INTERMEDE is a multidisciplinary study of doctor/patient interaction. These results are from the quantitative cross-sectional phase. 27 GPs located in Paris, Nantes and Toulouse volunteered to participate in the study. 585 eligible patients were included after being approached in the GP9s waiting room. Pre-consultation questionnaires were used to collect information on patients and doctors. Post-consultation mirrored-questionnaires were used to collect information from the GPs and patients, respectively, about what happened during the consultation. The outcome of interest is the difference between patient9s perception of their own health status and patient9s health status as evaluated by their doctor. Health status is categorised into three groups: very good/good; average; bad/very bad. The difference between the two health status variables provides an outcome variable indicating whether or not the patient and doctor agree on the patient9s health status. Social position was measured using education level categorised into three groups: low; medium and high. Results Patients with the highest level of education were most likely to agree with their doctors about their health status (75.4%) compared to those with a medium (74.8%) or a low (50.4%) education level. Among patients with a low education level who disagree with their doctors, 75.4% evaluate their health as being worse than their doctor9s evaluation compared to 59.2% and 55.5% of those with a medium and high education level, respectively (p Conclusion Disagreement between patients and doctors on patient9s health status was related to the patient9s social position. Doctors underestimated their patient9s health relative to the patient9s own evaluation when patients had a low education level. This could potentially lead to differences in diagnosis and follow-up and consequently to exacerbating health inequalities.