The online version of this article (doi:10.1186/1471-2296-15-105) contains supplementary material, which is available to authorized users.
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.
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.
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.
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.
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.
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.
Additional file 1: Table S1: Summary of agreement between raters on presence (positive agreement) and absence (negative agreement) of discussion of disease areas in consultations. (PDF 96 KB)
Additional file 2: Table S2: Summary of agreement between raters on presence (positive agreement) and absence (negative agreement) of discussion of issues in consultations. (DOCX 16 KB)
Pendleton D, Schofield T, Tate P, Havelock P: The consultation: an approach to learning and teaching. 1984, Oxford: Oxford University Press
Bower P, Macdonald W, Harkness E, Gask L, Kendrick T, Valderas JM, Dickens C, Blakeman T, Sibbald B: Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. Fam Pract. 2011, doi:10.1093/fampra/cmr018
McCormick A, Fleming D, Charlton J: Morbidity Statistics from General Practice. Fourth national study 1991–1992. Series MB5 no3. 1995, London: HMSO
Britt HC, Harrison CM, Miller GC, Knox SA: Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008, 189: 72-77. PubMed
Laux G, Kuehlein T, Rosemann T, Szecsenyi J: Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project. 2008, 8: doi:10.1186/1472-6963-1188-1114
Classification Committee of the World Organization of Family Doctors: ICPC-2: International Classification of Primary Care. 1998, Oxford: Oxford University Press, 2
O’Neil M, Payne C, Read J: Read Codes Version 3: A User Led Terminology. Methods Inf Med. 1995, 34: 187-192. PubMed
World Health Organization: International classification of diseases: 9th revision. 1977, Geneva
Flocke SA, Frank SH, Wenger DA: Addressing Multiple Problems in the Family Practice Office Visit. J Fam Pract. 2001, 50: 211-216. PubMed
Del-Piccolo L, Mazzi MA, Scardoni S, Gobbi M, Zimmermann C: A theory-based proposal to evaluate patient-centred communication in medical consultations. The Verona Patient-centred Communication Evaluation scale (VR-COPE). Health Educ. 2008, 108: 355-372. 10.1108/09654280810899984. CrossRef
Stewart M, Brown JB, Weston WW, McWhinney IR, Mc William CL, Freeman TR: Patient-centered medicine: transforming the clinical method. 2003, Oxford: Radcliffe Medical Press Ltd, 2
Salisbury C, Procter S, Bowen L, Stewart K, Purdy S, Ridd M, Valderas J, Blakeman T, Reeves D: The content of general practice consultations: cross-sectional study based on video-recordings. Br J Gen Pract. 2013, 63: e751-e759. 10.3399/bjgp13X674431. doi:710.3399/bjgp3313X674431 CrossRefPubMedPubMedCentral
- Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II