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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Sunita Procter, Kate Stewart, David Reeves, Leah Bowen, Sarah Purdy, Matthew Ridd, Chris Salisbury
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-105) contains supplementary material, which is available to authorized users.

Competing interests

SPr, KS, DR, LB, SPu, MR, CS had financial support from the NIHR School for Primary Care Research for the submitted work. None of the authors have any competing interests.

Authors’ contributions

SPr collected the data, contributed to the development of the tool, analysed all the data and drafted the manuscript. KS led the design of the study, participated in the tool development and analysed data to ascertain the inter-rater reliability. DR performed the statistical analysis. SPu and MR participated in the tool development. LB participated in the initial tool development. CS conceived of the study, participated in the tool development and helped to draft the manuscript. All authors read and approved the final manuscript.

Abstract

Background

There is an increasing recognition that many consultations in general practice involve several problems covering multiple disease domains. However there is a paucity of reliable tools and techniques to understand and quantify this phenomenon. The objective was to develop a tool that can be used to measure the number and type of problems discussed in primary care consultations.

Methods

Thirteen consultations between general practitioners and patients were initially videoed and reviewed to identify the problems and issues discussed. An iterative process involving a panel of clinicians and researchers and repeated cycles of testing and development was used to develop a measurement proforma and coding manual for assessment of video recorded consultations. The inter-rater reliability of this tool was assessed in 60 consultations.

Results

The problems requiring action were usually readily identified. However the different dimensions of the problem and how they were addressed required the identification and definition of ‘issues’. A coding proforma was developed that allowed quantification of the numbers and types of health problems and issues discussed. Ten categories of issues were identified and defined. At the consultation level, inter-rater agreements for the number of problems discussed (within ±1), types of problems and issues were 98.3%, 96.5% and 90% respectively. The tool has subsequently been used to analyse 229 consultations.

Conclusion

The iterative approach to development of the tool reflected the complexity of doctor-patient interactions. A reliable tool has been developed that can be used to analyse the number and range of problems managed in primary care consultations.
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