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

Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-2021]

Medical History Taking* ; Physician-Patient Relations* ; Primary Health Care* ; Surveys and Questionnaires*; Female ; Humans ; Male ; Reproducibility of Results ; Video Recording

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.

Patient Educ Couns. 2002 Apr;46(4):243-51. (PMID: 11932123)
BMC Health Serv Res. 2008 Jan 18;8:14. (PMID: 18205916)
J Clin Epidemiol. 2006 Oct;59(10):1033-9. (PMID: 16980142)
J Fam Pract. 2001 Mar;50(3):211-6. (PMID: 11252208)
Psychol Bull. 1979 Mar;86(2):420-8. (PMID: 18839484)
J Asthma. 2002 Dec;39(8):719-28. (PMID: 12507192)
Am J Public Health Nations Health. 1968 Feb;58(2):274-88. (PMID: 5688773)
Ann Fam Med. 2009 Jul-Aug;7(4):357-63. (PMID: 19597174)
J Eval Clin Pract. 2013 Dec;19(6):1067-72. (PMID: 23510440)
Med Care. 1998 Aug;36(8):1138-61. (PMID: 9708588)
Health Serv Res. 2007 Oct;42(5):1871-94. (PMID: 17850524)
Br J Gen Pract. 2011 Jan;61(582):e12-21. (PMID: 21401985)
Br J Gen Pract. 1994 Apr;44(381):153-6. (PMID: 8185988)
Br J Gen Pract. 2013 Nov;63(616):e751-9. (PMID: 24267858)
Med J Aust. 2008 Jul 21;189(2):72-7. (PMID: 18637770)
Fam Pract. 2011 Oct;28(5):579-87. (PMID: 21613378)
Methods Inf Med. 1995 Mar;34(1-2):187-92. (PMID: 9082130)

MR/K023233/1 United Kingdom MRC_ Medical Research Council; United Kingdom DH_ Department of Health

Date Created: 20140603 Date Completed: 20150116 Latest Revision: 20220129

20240628

PMC4046503

10.1186/1471-2296-15-105

24885298