Can a digital 'open and close' intervention improve general practice consultations?

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2C.1

Presenter:

Chris Salisbury

Twitter:

@prof_tweet

Co-authors:

Chris Salisbury, Anne Scott, Geoff Wong, Scott Walter, Jude Hancock, Tom Palmer

Author institutions:

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

Problem

For some patients GP consultations are too short. At the start of a consultation, patients may not mention some things that are bothering them. The end of the consultation can feel rushed and patients may not remember everything the GP said. The Consultation Open and Close (COAC) Study aimed to develop a complex intervention to address patients’ concerns more comprehensively and help them remember advice in general practice, and to test the feasibility of a cluster RCT of this intervention.

Approach

The intervention comprised a patient-completed pre-consultation form and a doctor-provided summary report at consultation closure. A person-based approach was used to develop and iteratively test both elements. An online system allowed patients to self-complete the pre-consultation form which was summarised in a colour-coded report and shared with GPs. An electronic template was designed to automatically generate the consultation summary report. The intervention was tested in six practices: four randomised to intervention, two to control. Patient-reported outcomes were collected via baseline and follow-up patient questionnaires and data on follow-up consultations and consultation content extracted from the patient record. Qualitative analysis included interviews with GPs, patients and administrators analysed in a realist framework. Quantitative analysis focused on recruitment and follow-up rates to assess feasibility of a future trial.

Findings

Seventy-one patients and practice staff were interviewed across the development and feasibility phases. Both the pre-consultation form and the summary report were acceptable to patients and GPs, but useful for different types of patients. The pre-consultation questionnaire identified issues that patients found difficult to voice. Having the information in writing helped GPs to quickly focus on what mattered. Patients felt listened to and were more satisfied with their consultation. The technology for sending pre-consultations forms was administratively complex. The summary report improved patients’ understanding of follow-up arrangements, and provided a memory aid they could share with their family. GPs reflected more on how to plan and communicate follow-up. The summary was most useful for consultations when safety-netting advice was important or for patients with complex follow-up or difficulty remembering.In the feasibility RCT, 195 patients were recruited. Recruitment rates were high but so was attrition, so criteria to proceed to full trial were not met.

Consequences

Both the pre-consultation form and the summary report showed important potential benefits. They should be considered as separate interventions and evaluated independently. The technology to send pre-consultation forms needs further development to allow seamless integration with GP computer systems. The additional time needed to generate summary reports meant GPs preferred to use it selectively in patients most likely to benefit. Collection of outcome data using online questionnaires was efficient but associated with high attrition, so alternative approaches to recruitment and retention are needed before a full RCT is feasible.

Submitted by:

Mairead Murphy

Funding acknowledgement:

This study was funded by the National Institute for Health Research (NIHR) as an Research for Patient Benefit (RfPB) grant. Professor Chris Salisbury is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.