Understanding the presentation, content and management of patient concerns in GP consultations: a secondary analysis of video-data.

Talk Code: 
EP2E.05
Presenter: 
Elisabeth Gennery
Co-authors: 
Ms. Elisabeth Gennery, Ms. Catherine J. Woods, Dr. Christopher Elsey, Dr. Beth Stewart, Dr. Rachael Summers, Prof. Paul Little, Prof. Michael Moore, Prof. Paul Drew, Dr. Rebecca Barnes, Dr. Fiona Stevenson, Prof. Carolyn Chew-Graham, Dr. Geraldine M. Leydon.
Author institutions: 
Primary Care and Population Sciences (PCPS) University of Southampton, Faculty of Health Sciences University of Southampton, Department of Social Sciences Loughborough University, School for Social and Community Medicine Bristol University, UCL Priment Clinical Trials Unit UCL, Primary Care and Health Sciences Keele University.

Problem

Patients often attend GP consultations with multiple health concerns. Salisbury et al’s (2013) study found that on average, 2.5 concerns were discussed per consultation. Evidence suggests patients may find it difficult to voice all of their concerns during their appointments. GP's can struggle to ask about patients additional concerns, especially with time-limited 10 minute consultations. These unmet patient concerns i.e. concerns not voiced in consultations, have been associated with worsening of symptoms which require more severe treatment, increased patient anxiety and the need for additional primary care visits which are costly both in terms of patient time and limited medical resources (Heritage et al. 2007; McKinley and Middleton 1999). Little is known about how and when patients raise or GP's solicit additional concerns in UK GP consultations and how GP's respond to multiple health concerns.

The study aims to describe how additional concerns are raised (e.g. solicited by GP's or volunteered by patients), the nature of these concerns, and if so, how they are addressed in more detail.

Approach

This study is a secondary analysis of 195 video recordings building on findings from an intervention study (Elicitation of Patient Concerns, EPaC) that found it was feasible to train GP's in the early solicitation of patient concerns. The intervention and control arm of video-recorded GP consultations were quantitatively coded. Our coding framework was initially informed by our objectives and Salisbury et al’s (2013) study about how to code the number and type of problems discussed in GP consultations. It was further developed inductively by watching 20 GP-patient consultations from the data-set. 3 members of the research team coded and verified 20% of the consultations to ensure the framework was robust and the coding was accurate. To date 141/195 videos have been coded. Data will be analysed descriptively (frequencies, percentages etc.) using SPSS.

Findings

Data analysis is currently ongoing. The project report will be completed by May 2016. The following results will be presented:

a) Number of patient concerns voiced within GP-patient consultations.

b) Where and how GP's solicit for additional patient concerns within the consultation and the result of their solicitations.

c) How GP's respond to patient’s additional concerns (e.g. attended to, postponed until a later consultation, not attended to).

d) Types of concerns raised within consultations (e.g. back pain, depression).

e) Patterns of findings from the above according to GP and/or patient factors (such as demographics, practice size, deprivation, intervention vs control arm etc.)

Consequences

Findings from this research will be used to inform a qualitative analysis of the consultations (using conversation analysis) and both aspects of the study will inform the development of further work aimed at improving effective management of multiple concerns in time-limited GP consultations.

Submitted by: 
Elisabeth Gennery
Funding acknowledgement: 
The team would like to thank the School for Primary Care Research (SPCR) for funding this research and the GP's and patients who participated and permitted their video recorded consultation to be used.