Dataset Information

More time for complex consultations in a high-deprivation practice is associated with increased patient enablement.

ABSTRACT:

Background

Evidence of the beneficial effects of longer consultations in general practice is limited.

Aim

To evaluate the effect of increasing consultation length on patient enablement in general practice in an area of extreme socioeconomic deprivation.

Design of study

Longitudinal study using a 'before and after' design.

Setting

Keppoch Medical Centre in Glasgow, which serves the most deprived practice area in Scotland.

Method

Participants were 300 adult patients at baseline, before the introduction of longer consultations, and 324 at follow-up, more than 1 year after the introduction of longer consultations. The intervention studied was more time in complex consultations. Patient satisfaction, perceptions of the GPs' empathy, GP stress, and patient enablement were collected by face-to-face interview. Additional qualitative data were obtained by individual interviews with the GPs, relating to their perceptions of the impact of the longer consultations.

Results

Response rates of 70% were obtained. Overall, 53% of consultations were complex. GP stress was higher in complex consultations. Patient satisfaction and perception of the GPs' empathy were consistently high. Average consultation length in complex consultations was increased by 2.5 minutes by the intervention. GP stress in consultations was decreased after the introduction of longer consultations, and patient enablement was increased. GPs' views endorsed these findings, with more anticipatory and coordinated care being possible in the longer consultations.

Conclusion

More resource to provide more time in complex consultations in an area of extreme deprivation is associated with an increase in patient enablement.

SUBMITTER: Mercer SW

PROVIDER: S-EPMC2084135 | biostudies-literature | 2007 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

More time for complex consultations in a high-deprivation practice is associated with increased patient enablement.

Mercer Stewart W SW Fitzpatrick Bridie B Gourlay Glen G Vojt Gaby G McConnachie Alex A Watt Graham C M GC

The British journal of general practice : the journal of the Royal College of General Practitioners 20071201 545

<h4>Background</h4>Evidence of the beneficial effects of longer consultations in general practice is limited.<h4>Aim</h4>To evaluate the effect of increasing consultation length on patient enablement in general practice in an area of extreme socioeconomic deprivation.<h4>Design of study</h4>Longitudinal study using a 'before and after' design.<h4>Setting</h4>Keppoch Medical Centre in Glasgow, which serves the most deprived practice area in Scotland.<h4>Method</h4>Participants were 300 adult pati ...[more]

PMID: 18252071

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Project description:BackgroundChronic lifestyle-related-diseases can be prevented by healthy lifestyle. Patients at high risk of disease may benefit from targeted health checks in general practice. However, general-practice-based-studies have shown that patient outcome, enablement, and well-being may be influenced by general practitioner (GP) empathy. The aim of this study is to investigate 1) how high risk patients evaluate their GPs' empathy during a health check consultation, 2) whether the perceived GP empathy is associated with the patient's enablement in immediate continuation of the health check consultation and 3) the patient's subsequent lifestyle changes.MethodsThis study is part of a population based non-randomized feasibility study testing a complex intervention that systematically identifies citizens at high risk of lifestyle-related disease and with health-risk behavior and offers targeted preventive services in the Danish primary care sector. The ultimate aim of the intervention is to improve lifestyle and thereby reduce the risk of lifestyle-related disease. In the feasibility study a random sample of patients aged 30 to 59 years were invited to participate, and to fill in a questionnaire on lifestyle-risk factors. Participants deemed to be at high risk of disease were offered a focused clinical examination and a subsequent health check consultation at the GP. Following each health check consultation GP empathy and patient enablement were assessed using The Care Measure (CARE) and Patient Enablement Instrument (PEI). Patient's perceived healthy-lifestyle change (y/n) was assessed after three months. The study has been approved by the Danish Data Protection Agency (J.nr 2015-57-0008) and registered at ClinicalTrial. Gov on June 13, 2016.ResultsTwenty-six GP's participated in the study. Among 93 patients receiving a health check consultation 60 rated the GPs empathy. The median CARE-score was 40. The PEI median was 5.5 and 44.9% achieved a healthier lifestyle. No association was observed between GP empathy and patient enablement or a perceived healthier lifestyle.ConclusionNo statistical significant association between the CARE-score and patient enablement or a perceived healthier lifestyle was observed. Our results contrast previous findings and may to some extent be explained by a small sample size and the selected high-risk group.Trial registration numberNCT02797392 .

Project description:BackgroundDuring the first COVID-19 pandemic 'lockdown' in Aotearoa/New Zealand (March-May 2020, in which strict 'stay at home' measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future.MethodsUsing a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient's perspective.ResultsIn general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person.ConclusionsEven in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.

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Dataset Information

More time for complex consultations in a high-deprivation practice is associated with increased patient enablement.

Background

Aim

Design of study

Setting

Method

Results

Conclusion

Publications

More time for complex consultations in a high-deprivation practice is associated with increased patient enablement.

Similar Datasets

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