The content of general practice consultations: cross-sectional study based on video recordings

Demographic and policy changes appear to be increasing the complexity of consultations in general practice. To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorde...

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Published in:British journal of general practice Vol. 63; no. 616; p. e751
Main Authors: Salisbury, Chris, Procter, Sunita, Stewart, Kate, Bowen, Leah, Purdy, Sarah, Ridd, Matthew, Valderas, Jose, Blakeman, Tom, Reeves, David
Format: Journal Article
Language:English
Published: England 01.11.2013
Subjects:
Adolescent
Adult
Aged
Cross-Sectional Studies
England
Female
General Practice - statistics & numerical data
Humans
Male
Medical Records
Middle Aged
Physician-Patient Relations
Retrospective Studies
Time Factors
Young Adult
England
ISSN:1478-5242, 1478-5242
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Abstract Demographic and policy changes appear to be increasing the complexity of consultations in general practice. To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records. Cross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset. Consultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded. Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded. Consultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.
AbstractList Demographic and policy changes appear to be increasing the complexity of consultations in general practice.BACKGROUNDDemographic and policy changes appear to be increasing the complexity of consultations in general practice.To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records.AIMTo describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records.Cross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset.DESIGN AND SETTINGCross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset.Consultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded.METHODConsultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded.Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded.RESULTSOf 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded.Consultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.CONCLUSIONConsultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.
Demographic and policy changes appear to be increasing the complexity of consultations in general practice. To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records. Cross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset. Consultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded. Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded. Consultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.
Author Stewart, Kate
Purdy, Sarah
Procter, Sunita
Blakeman, Tom
Valderas, Jose
Bowen, Leah
Ridd, Matthew
Salisbury, Chris
Reeves, David
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Snippet Demographic and policy changes appear to be increasing the complexity of consultations in general practice. To describe the number and types of problems...
Demographic and policy changes appear to be increasing the complexity of consultations in general practice.BACKGROUNDDemographic and policy changes appear to...
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SubjectTerms Adolescent
Adult
Aged
Cross-Sectional Studies
England
Female
General Practice - statistics & numerical data
Humans
Male
Medical Records
Middle Aged
Physician-Patient Relations
Retrospective Studies
Time Factors
Young Adult
Title The content of general practice consultations: cross-sectional study based on video recordings
URI https://www.ncbi.nlm.nih.gov/pubmed/24267858
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