Center for Medical Ethics and Health Policy Staff Publications
Publication Date
1-4-2025
Journal
Annals of Behavioral Medicine
DOI
10.1093/abm/kaaf028
PMID
40257120
PMCID
PMC12010244
PubMedCentral® Posted Date
4-21-2025
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Humans, Veterans, Male, Female, Patient Satisfaction, Middle Aged, United States, Adult, Persian Gulf Syndrome, Patient Compliance, Prospective Studies, Gulf War illness, persistent physical symptoms, illness perceptions, concordance, adherence, veteran
Abstract
Background: Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.
Purpose: This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.
Methods: Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War Related Illness and Injury Study Centers (WRIISCs). Veterans' GWI perceptions and perceived concordance with their providers regarding GWI were assessed at a medical visit. Veterans' self-reported satisfaction with care, adherence to care plans, and disability levels were measured at 1 week, 1 month, and 6 months post-baseline.
Results: Bivariate correlations indicated that veterans' GWI-related illness perceptions were related to veterans' satisfaction with care and reports of functional disability. Beyond these effects, veterans' perceived concordance with the provider regarding GWI was positively associated with satisfaction over time (e.g., fixed-effect estimate = 0.36, P < .001 for 1-week follow-up) and adherence to care plans (fixed-effect estimate averaged across all timepoints = 0.03, P = .03) but was unrelated to reported disability.
Conclusions: Veterans' perceived concordance with their providers about GWI seems to be important for patient satisfaction and adherence to care plans. More research with longer-term follow-up is needed to understand how perceived concordance might influence disability levels and the outcome of care plans.
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