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Continuity, trust and cooperation: a game theory perspective on the GP-patient interaction

By Carolyn Clare Tarrant

Abstract

There is evidence that personal continuity is associated with positive processes and\ud outcomes, although much of the previous work has lacked a theoretical framework. This\ud thesis aims to explore, and develop a model of, the relationship between continuity,\ud trust and cooperation in primary care, based on existing principles from game theory.\ud Hypotheses generated from a game theory perspective were tested through a\ud questionnaire survey of 279 patients. A secondary qualitative analysis of two data sets – interviews with patients and GPs – was also carried out to explore experiences of trust and cooperation in primary care.\ud The survey findings indicated that a history of positive interactions between a patient\ud and a GP, and expectation of future interactions, were associated with higher trust, as was interpersonal care. Trust was found to be weakly associated with self-reported adherence to treatment.\ud The analysis of patient interviews found that patients described relatively high levels of initial trust. Repeated interactions allowed initial trust in the GP to be validated, and allowed the patient to build their own reputation as cooperative. Over time, experience of consulting the same GP could lead to a reduction of uncertainty, and a move to a more stable, affective basis for trust. This was associated with increased willingness to disclose information, and to accept treatment or advice. Analysis of GP interviews explored GP views of patient trust, and identified mechanisms inherent in repeated interactions that could promote quality of care.\ud The findings from the qualitative and quantitative work are drawn together in order to develop a model of trust and cooperation in primary care, informed by game theory principles.\ud This thesis highlights the reciprocal and interdependent nature of the health\ud professional-patient relationship, and the value of repeated interactions in promoting\ud mutual trust and cooperation. The implications of this for policy are discussed

Publisher: University of Leicester
Year: 2006
OAI identifier: oai:lra.le.ac.uk:2381/847

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Citations

  1. 1 placed trust sufficient for minor/routine probs
  2. 2.12 devel IP trust - patient getting to know GP
  3. 2.22 devel IP trust - needs patient cooperation
  4. 4.10 outcomes IP trust - patient willing to consult / does not delay
  5. 6.13 undermine trust - GP not having time for patient
  6. 6.14 undermine IP trust - overstepping prof boundaries
  7. 6.18 undermine IP trust - unfamiliar GP does not know full history
  8. 6.19 undermine IP trust - GP does not recall patient
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  26. devel IP trust - anticipation future
  27. devel IP trust - builds from first consultation
  28. devel IP trust - experience of effective
  29. devel IP trust - giving impression that trust other
  30. devel IP trust - GP recall of (personal knowledge from) past interactions
  31. devel IP trust - initial evaluation
  32. devel IP trust - initially need Gp to demonstrate trustworthiness
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  55. outcomes IP trust - can lead to higher patient expectation/demand
  56. outcomes IP trust - deal with difficult issues/talk not prescribe
  57. outcomes IP trust - easier for GP to reassure patient
  58. outcomes IP trust - fewer consultations / more effective care
  59. outcomes IP trust - GP
  60. outcomes IP trust - GP incentive to be trustworthy
  61. outcomes IP trust - makes patient feel more comfortable
  62. outcomes IP trust - makes patient feel more comfortable/ reduce anxiety
  63. outcomes IP trust - more confidence
  64. outcomes IP trust - patient wants to maintain continuity
  65. outcomes IP trust - patients want to maintain continuity
  66. outcomes IP trust - reduction of uncertainty
  67. outcomes IP trust disclosure /open communication
  68. outcomes IP trust less constrained by formal rules
  69. outcomes no IP trust - avoid consulting GP
  70. outcomes no IP trust - continuity not important
  71. outcomes no IP trust - lack confidence
  72. outcomes no IP trust - leads to poor outcomes/patient dissat
  73. outcomes no IP trust - no compliance
  74. outcomes no IP trust - patient not willing to consult/ may delay
  75. outcomes no IP trust - patient won't accept dealing with difficult issues
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  92. undermine IP trust - belief that GP is not taking the time to act in your best interests
  93. undermine trust - GP doing something that worries patient
  94. undermine trust - GP giving decision to patient / belief that GP does not know what's best
  95. undermine trust - lack anticip future
  96. undermine trust - lack of GP accountability/responsibility
  97. undermine trust concerns confidentiality
  98. undermine trust GP agency /conflict of interest
  99. undermine trust GP chars (gender, ethnicity)
  100. undermine trust GP doesn't care
  101. undermine trust GP doesn't take seriously
  102. undermine trust lack conf expertise
  103. undermine trust reputation doi
  104. unfamiliar GP - less likely to treat appropriately (expertise in partic problem)
  105. unfamiliar GP - patients less comfortable/ less likely to accept treatment
  106. validation of Gp - choice of seeing other GPs to validate
  107. validation of GP - good med opinion and referral
  108. validation of GP - patients testing of GP competence doi
  109. validation of patient - doi
  110. validation of patient - frequent consulters as valid patients
  111. validation of patient - inappropriate use of service
  112. validation of patient - knowing how they react
  113. validation of patient GP PK judge validity /trustworthiness
  114. validation of patient self justification as valid/deserving (eg appropriate use of service)

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