The ‘One in a Million’ study: Creating a database of primary care consultations and linked data
Around one million GP consultations happen in the NHS every working day, addressing multiple and often complex problems. Despite this, studies of what goes on during these encounters are uncommon. Challenges to undertaking this work include technical difficulties in recording consultations, obtaining ethical permissions, recruiting participants, and data collection costs. The One in a Million study has been funded to create a database of video-recorded consultations plus linked data that can be shared for future research and teaching purposes. The first stage of research aimed to establish whether it is possible to recruit a representative sample of patients attending consultations in general practice, gaining consent for a wide range of future unspecified purposes.
We sought to recruit at least 240 patients and 24 GPs from 12 practices serving areas of high and low deprivation across the Bristol area. Two GPs were recruited from each practice via the West of England CRN to video-record up to 20 consecutive consultations with adult patients recruited in the waiting room by a researcher. Informed consent was obtained before, and immediately after, the consultation. GP and patient (pre- and post-consultation) data was collected by self-administered questionnaires covering a range of intermediate and final outcomes. Follow-up patient data at 10 days was collected by postal / electronic questionnaires and patient record data relating to the index consultation at three months.
Since September 2014, we have recorded 235 consultations from 16 GPs, with an overall consent rate of 80%. 8 of the 16 GPs were working in areas of low deprivation as measured by IMD scores (113 participants, CR=76%), and 8 in areas of high deprivation (122 participants, CR=84%). Patients were given the option to consent for their data to be used by the research team only, or additionally for their data to be archived for future use by other researchers. The majority (93%, n=218) consented to use by: ‘other researchers, subject to specific ethical approval’. 92% (n=216) consented to use: ‘for development of medical and research training materials’. Recruitment will close in March 2015, when we expect to have recorded circa 320 consultations.Consequence: Our experience suggests that most patients are willing to allow consultations to be video-recorded, and with very few exceptions, are also willing to allow recordings and linked data to be stored in a data archive for future use by bona fide researchers with NHS ethical approval. Presenting information to patients in the waiting room, and allowing them opportunity to ask questions of the researcher, appears to have been helpful in ensuring high level of consent rates, whilst minimising disruption. In July we will describe the resource in fuller detail and illustrate how the database can be used.
- Rebecca Barnes
- Marcus Jepson
- Matthew Ridd
- Chris Metcalfe
- Chris Salisbury