The Consultation Open and Close Study: developing a generic pre-consultation form for use in primary care.

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

N.12

Presenter:

Mairead Murphy

Twitter:

@mairead_murf

Co-authors:

Chris Salisbury, Geoff Wong, Richard Morris, Jude Hancock

Author institutions:

University of Bristol, University of Oxford, Bristol North Somerset and South Gloucestershire CCG

Problem

Many patients leave GP consultations without having voiced all their concerns, especially when they want to discuss multiple problems, resulting with reduced satisfaction with the consultation. Also, patients often have difficulty remembering the advice given during consultations, which can increase their concern and reduce adherence to advice. The Consultation Open and Close (COAC) intervention is designed to address both these problems. It is a two-year NIHR Research for Patient Benefit funded study aimed at designing and testing an intervention to allow patients to better share their concerns, incorporating the use of an online form at consultation opening and a printed report at consultation closure. These are being developed separately in accordance with MRC guidance. This abstract discusses development of the COAC pre-consultation form.

Approach

Three GP practices in the Bristol and surrounding area are iteratively developing the form by testing it with 15 patients each. Patients fill in the online form before their appointment; this includes problems which might otherwise be missed, such as how worried they are about their health, whether they are low in mood or finding it difficult to adhere to their medication or other health advice. After trying the form and the report in one practice, we will interview the GPs, nurses, administrators and patients who used them and implement improvements before testing in the next practice.

Findings

As of 14/02/2020 two of three practices have recruited 15 patients each. Eight patients and two GPs have been interviewed. All interviewed patients would use the form again. GPs demonstrating that they had read the form was important to patients. Patients noted that completing the form: - Helped them plan before the consultation; - Made them feel more at ease in the consultation, knowing that the GP had read their information in advance. - Helped communicate their problems to the GP more easily; - Uncovered problems which may otherwise have been missed.GPs said the form was not excessively time-consuming and may help uncover information more quickly. The forms were less useful for GPs when patients provided either too much free-text information, or none at all.Adopting an iterative approach resulted in improvements between the rounds including adding information, removing items, changing the colour-codes and format.

Consequences

The COAC pre-consultation form is a useful adjunct to the consultation and may have wider applicability. It is particularly relevant in the current context (where practices must offer e-consultations as standard) as including the COAC form in an e-consultation could provide GPs with more information than current available templates. A feasibility study, in which the COAC pre-consultation form and a consultation closure report will be combined, will be carried out from October 2020 – 2021.

Submitted by:

Mairead Murphy

Funding acknowledgement:

This study was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.