Is GP-patient communication related to their perceptions of illness severity, coping and social support?

Association between continuity of primary care and both prescribing and adherence of common cardiovascular medications: a cohort study among patients in England

OBJECTIVES

To investigate whether better continuity of care is associated with increased prescribing of clinically relevant medication and improved medication adherence.

SETTING

Random sample of 300 000 patients aged 30+ in 2017 within 83 English general practitioner (GP) practices from the Clinical Practice Research Datalink.

DESIGN

Patients were assigned to a randomly selected index date in 2017 on which medication use and continuity of care were determined. Adjusted associations between continuity of care and the prescribing and adherence of five cardiovascular medication groups were examined using logistic regression.

PARTICIPANTS

Continuity of Care Index was calculated for 173 993 patients with 4+ GP consultations 2 years prior to their index date and divided into five categories: absence of continuity, below-average continuity, average, above-average continuity and perfect continuity.

MAIN OUTCOME MEASURES

(A) Prescription for statins (primary or secondary prevention separately), anticoagulants, antiplatelet agents and antihypertensives covering the patient's index date. (B) Adherence (>80%) estimated using medication possession ratio.

RESULTS

There was strong evidence (p<0.01) that prescription of all five cardiovascular medication groups increased with greater continuity of care. Patients with absence of continuity were less likely to be prescribed cardiovascular medications than patients with above-average continuity (statins primary prevention OR 0.73, 95% CI 0.59 to 0.85; statins secondary prevention 0.77, 95% CI 0.57 to 1.03; antiplatelets 0.55, 95% CI 0.33 to 0.92; antihypertensives 0.51, 95% CI 0.39 to 0.65). Furthermore, patients with perfect continuity were more likely to be prescribed cardiovascular medications than those with above-average continuity (statins primary prevention OR 1.23, 95% CI 1.01 to 1.49; statins secondary prevention 1.37, 95% CI 1.10 to 1.71; antiplatelets 1.37, 95% CI 1.08 to 1.74; antihypertensives 1.10, 95% CI 0.99 to 1.23). Continuity was generally not associated with medication adherence, except for adherence to statins for secondary prevention (OR 0.75, 95% CI 0.60 to 0.94 for average compared with above-average continuity).

CONCLUSION

Better continuity of care is associated with improved prescribing of medication to patients at higher risk of cardiovascular disease but does not appear to be related to patient's medication adherence.

Informal interpreting in general practice: Are interpreters' roles related to perceived control, trust, and satisfaction?

OBJECTIVE

The aim of this observational study was twofold. First, we examined how often and which roles informal interpreters performed during consultations between Turkish-Dutch migrant patients and general practitioners (GPs). Second, relations between these roles and patients' and GPs' perceived control, trust in informal interpreters and satisfaction with the consultation were assessed.

METHODS

A coding instrument was developed to quantitatively code informal interpreters' roles from transcripts of 84 audio-recorded interpreter-mediated consultations in general practice. Patients' and GPs' perceived control, trust and satisfaction were assessed in a post consultation questionnaire.

RESULTS

Informal interpreters most often performed the conduit role (almost 25% of all coded utterances), and also frequently acted as replacers and excluders of patients and GPs by asking and answering questions on their own behalf, and by ignoring and omitting patients' and GPs' utterances. The role of information source was negatively related to patients' trust and the role of GP excluder was negatively related to patients' perceived control.

CONCLUSION

Patients and GPs are possibly insufficiently aware of the performed roles of informal interpreters, as these were barely related to patients' and GPs' perceived trust, control and satisfaction.

PRACTICE IMPLICATIONS

Patients and GPs should be educated about the possible negative consequences of informal interpreting.

Factors Influencing People’s Personal Information Disclosure Behaviors in Online Health Communities: A Pilot Study

To effectively facilitate health information sharing and personal information protection in online health communities (OHCs), it is important to examine the factors influencing people’s personal information disclosure behavior in OHCs. Five factors were supposed as the predictors of people’s personal information disclosure behavior in OHCs. A total of 376 participants in a Chinese online cancer community were analyzed. The empirical results indicate that more participants give more attention to risk factors than motivating factors when they disclose information in OHCs. In a not so severe condition, participants post their personal information to only obtain needed information. In severe disease situations, participants disclose personal information to obtain both needed information and emotional support, and emotional support is prioritized; in addition, they even risk financial loss to seek more useful information or emotional support. OHC managers should make policies to protect people’s personal information, and thus encourage them to share more health information in OHCs.

GPs asking patients to self-rate their health: a qualitative study

Background

In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.

Aim

To investigate what happens in consultations when the question ‘How would you assess your general health compared with others your own age?’ is posed.

Design and setting

Authentic consultations with GPs at health centres in Sweden.

Method

Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors’ assessment of the value of the question was documented in a short questionnaire.

Results

Two overarching themes are used to describe patients’ responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients’ situation and making it easier to discuss difficulties and resources. The patients’ speaking time increased noticeably during this part of the consultation.

Conclusion

Asking patients to comparatively self-rate their health is an effective tool in general practice.

Patient perception and the barriers to practicing patient-centered communication: A survey and in-depth interview of Chinese patients and physicians

OBJECTIVE

To investigate patient perceptions of patient-centered communication (PCC) in doctor-patient consultations and explore barriers to PCC implementation in China.

METHODS

This study was conducted in public teaching hospital in Guiyang, Guizhou, China. In Phase 1, patient attitudes to PCC were quantitatively assessed in 317 outpatients using modified Patient-Practitioner Orientation Scale (PPOS). In Phase 2, we conducted in-depth interviews with 20 outpatients to explore their views on PCC and expose potential barriers to PCC implementation.

RESULTS

Participants communicated "patient-centered" preferences, particularly with regard to their doctors' empathy, communication skills, time and information sharing. Patients were more concerned about doctors exhibiting caring perspective than power sharing. Younger and highly educated patients were more likely to prefer PCC and highly educated patients paid more attention to power sharing. Several factors including inadequate time for PCC resulting from doctors' high patient-load, doctor-patient communication difficulties and excessive treatment due to inappropriate medical payment system affected PCC implementation in China.

CONCLUSIONS

Patients expressed moderate enthusiasm for PCC in China. They expressed strong preferences concerning physician respect for patient perspective, but less concern for power sharing.

PRACTICE IMPLICATIONS

Government should improve health care system by implementing PCC in daily healthcare practice to improve patient awareness and preferences.

Talking about psychosocial problems: an observational study on changes in doctor-patient communication in general practice between 1977 and 2008

OBJECTIVE

To examine whether GPs' communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s.

METHODS

From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as 'completely psychosocial' were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time.

RESULTS

We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9-3.2 to 1.4-1.6 between periods).

CONCLUSION

Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy.

PRACTICE IMPLICATIONS

GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients' personal contexts and giving room to their emotions.

Effective doctor-patient communication: an updated examination

This article examines, in detail, the quality of doctor-patient interaction. Doctor-patient communication is such a powerful indicator of health care quality that it can determine patients' self-management behavior and health outcomes. The medical visit (i.e., the medical encounter) plays a pivotal role in the health care process. In fact, doctor-patient communication is one of the most essential dynamics in health care, affecting the course of patient care and patient compliance with recommendations for care. Unlike many other analyses (that often look at only one or two specific aspects of doctor-patient relationships), this analysis is more encompassing; it looks at doctor-patient communication from multiple perspectives.

Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union: trends between 1990 and 2008

After the collapse of the Soviet Union the various Eastern European (EE) countries adapted in different ways to the social, political and economic changes. The present study aims to analyse whether the factors related to social integration and regulation are able to explain the changes in the suicide rate in EE. A separate analysis of suicide rates, together with the undetermined intent mortality (UD), was performed. A cross-sectional time-series design and applied a panel data fixed-effects regression technique was used in analyses. The sample included 13 countries from the former Soviet bloc between 1990 and 2008. Dependent variables were gender-specific age-adjusted suicide rates and suicide plus UD rates. Independent variables included unemployment, GDP, divorce rate, birth rate, the Gini index, female labour force participation, alcohol consumption and general practitioners per 100,000 people. Male suicide and suicide or UD rates had similar predictors, which suggest that changes in suicide were related to socioeconomic disruptions experienced during the transition period. However, male suicide rates in EE were not associated with alcohol consumption during the study period. Even so, there might be underestimation of alcohol consumption due to illegal alcohol and differences between methodologies of calculating alcohol consumption. However, predictors of female suicide were related to economic integration and suicide or UD rates with domestic integration.

Comunicação entre os profissionais de saúde e o idoso: uma revisão da investigação

A investigação empírica tem demonstrado consistentemente que a qualidade da comunicação entre os profissionais com responsabilidade de prestação de cuidados de saúde e os idosos assume-se como uma das principais variáveis explicativas do processo de saúde-doença, da recuperação e da optimização da saúde dos idosos. Partindo de uma perspectiva biopsicossocial da saúde, o presente artigo teórico tem como objectivo apresentar de uma forma sistemática os principais conclusões da investigação recente sobre o tema. Globalmente, os estudos têm demonstrado que o tom amistoso, cortesia, o encorajamento, a empatia e a construção de uma parceria no processo terapêutico por parte dos profissionais estão relacionados com a percepção de qualidade dos cuidados por parte dos idosos. No final do artigo serão discutidos estes resultados, sendo apresentadas sugestões para a investigação futura , bem como possíveis implicações para a Gerontologia.

Depression and the health care experiences of Medicare beneficiaries

OBJECTIVES

To compare health care experiences of Medicare beneficiaries with and without symptoms of depression and investigate the role of patient confidence in shaping these experiences.

DATA SOURCES

Data came from the 2009 CAHPS Medicare 4.0 Fee-for-Service (FFS) Survey, which was fielded to a national probability sample of 298,492 FFS Medicare beneficiaries.

STUDY DESIGN

Linear regression was used to model associations of depression with four global ratings and three composite measures of health care and to test whether beneficiaries' confidence in their ability to recognize the need for care mediates these associations.

PRINCIPAL FINDINGS

Beneficiaries with depressive symptoms reported worse experiences with care across the full range of patient experience covered by the CAHPS survey. Depressive symptoms were associated with decreased patient confidence and decreased confidence was in turn associated with poorer reports of care.

CONCLUSIONS

Our study highlights depressive symptoms as a risk factor for poorer experiences of health care and highlights depressed patients' confidence in recognizing their need for care and for designing programs to improve the health care of this population.

Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality

Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching hospital in Indonesia, using a qualitative and a quantitative design. In-depth interviews were conducted with ten internal medicine specialists, ten internal medicine residents, 16 patients in two groups based on education level and ten most senior medical students. The contributions of doctors and patients to the communication during consultations were observed and rated quantitatively by thirty internal medicine residents, 393 patients with different educational backgrounds and ten senior medical students. The 'informed and shared decision making' is the central observation in this quantitative study. The results of the interviews showed that Southeast Asian stakeholders are in favor of a partnership style of communication and revealed barriers to achieving this: doctors and patients are not prepared for a participatory style and high patient load due to an inefficient health care system does not allow sufficient time for this type of communication. The results of the quantitative study showed a sharp contrast between observed and ideal communication styles. A paternalistic style seems to prevail, irrespective of patients' educational background. We found a sharp conflict between ideal and reality concerning doctor-patient communication in a Southeast Asian context. Further studies should examine ways to change the prevailing communication style in the desired direction.

Clinician-patient communication in a glaucoma clinic in India

We compiled data from nonparticipant observations of clinician-patient communication in clinical interactions in a tertiary care eye hospital in India. Applying elements of the French philosopher Michel Foucault's concept of power and knowledge, we deconstructed the structuring and moderating influences on the expert/nonexpert dyad. We found that clinicians enforce their "disciplining power" through varying degrees of communicativeness to bring about compliance in the patient. Clinicians appear to classify the patient as "participant" or "deviant" based on the patient's "internalization" of instructions, and then communicate in predictable ways with the patient. Patients can also wield power, communicating it by understanding and following or not understanding and not clarifying/verifying instructions in the clinic, and thereafter failing to comply with the clinician's advice. We suggest that clinicians need to hone their communication skills both to optimally utilize interactions in the clinic and to encourage patient compliance, thereby making possible better treatment outcomes.

Considering culture in physician-- patient communication during colorectal cancer screening

Racial and ethnic disparities exist in both incidence and stage detection of colorectal cancer (CRC). We hypothesized that cultural practices (i.e., communication norms and expectations) influence patients' and their physicians' understanding and talk about CRC screening. We examined 44 videotaped observations of clinic visits that included a CRC screening recommendation and transcripts from semistructured interviews that doctors and patients separately completed following the visit. We found that interpersonal relationship themes such as power distance, trust, directness/ indirectness, and an ability to listen, as well as personal health beliefs, emerged as affecting patients' definitions of provider-patient effective communication. In addition, we found that in discordant physician-patient interactions (when each is from a different ethnic group), physicians did not solicit or address cultural barriers to CRC screening and patients did not volunteer culture-related concerns regarding CRC screening.

General beliefs about medicines among doctors and nurses in out-patient care: a cross-sectional study

Background

Doctors and nurses are two natural partners in the healthcare team, but they usually differ in their perspectives on how to work for increased health. These professions may also have different beliefs about medicines, a factor important for adherence to medicines. The aim was to explore general beliefs about medicines among doctors and nurses.

Methods

Questionnaires were sent to 306 private practitioners (PPs), 298 general practitioners (GPs) and 303 nurses in the county of Västra Götaland, Sweden. The questionnaire included sociodemographic questions and the general part of the Beliefs about Medicines Questionnaire (BMQ), which measures the beliefs people have about medicines in general. General beliefs about medicines in relation to background variables were explored with independent t-tests and ANOVA analyses. Differences between occupations and influences of interaction variables were analysed with multiple linear regression models for general beliefs about medicines.

Results

The data collection resulted in 616 questionnaires (62.1% PPs; 61.6% GPs; 80.5% nurses). The majority of the PPs and 40% of the GPs were male but most of the nurses were female. The GPs' mean age was 47 years, PPs' 60 years and nurses' 52 years. Few nurses originated from non-Nordic countries while 15% of the PPs and 25% of the GPs did. Nurses saw medicines as more harmful and less beneficial than did PPs and GPs. These differences could not be explained by the included interaction variables. GPs with a Nordic background saw medicines as more beneficial and less harmful than did GPs with a non-Nordic background.

Furthermore, GPs of non-Nordic origin were most likely to believe that medicines were overprescribed by doctors.

Conclusion

Doctors were more positive about medicines than nurses. The differences in beliefs about medicines found between doctors and nurses could not be explained by any of the included interaction variables. These differences in beliefs may be useful in discussions among future and practising doctors and nurses to enhance understanding of each other's profession and teamwork.

How well do GPs fulfill their educator role in consultations for depression and anxiety?

OBJECTIVE

To assess general practitioners' (GPs) provision of patient education with respect to patients with depression or anxiety.

METHODS

The study relied on the prospective self-recording of patient consultations by GPs. The participating GPs (n = 78) completed 385 registration forms. For each performance indicator, an indicator score was calculated by dividing the number of clinical situations in which the GPs actually offered patient education by the total number of situations demanding for the provision of such education.

RESULTS

High indicator scores (> 85%) were found for the provision of patient education about the effect and side effects of antidepressant medication in depression care. Moderate indicator scores (60-85%) were found for the provision of patient education about the prevalence and the course of both depression and anxiety. Giving advice to depressed patients to place restrictions upon the amount of demands the patient places on himself showed a substantial gap between recommended and actual care. Furthermore, a low indicator score was also found for patient education about the side effects of antidepressant medication in anxiety care (indicator scores < 60%). The variance across GPs was considerable. The clinical characteristic that had the most robust relationship with a variety of performance indicators was first or follow-up consultation for depression or anxiety.

CONCLUSION

GPs' provision of patient education in depression and anxiety care ranged from poor to excellent, depending on the type of educational item.

PRACTICE IMPLICATIONS

Insight into both the actual clinical performance of GPs and determinants of variation in their performance contributes to select the most appropriate means for quality improvement in depression and anxiety care.

Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies

OBJECTIVE

To identify ethical processes and recruitment strategies, participation rates of studies using audio or video recording of primary health care consultations for research purposes, and the effect of recording on the behaviour, attitudes and feelings of participants.

METHODS

A structured literature review using Medline, Embase, Cochrane Library, and Psychinfo. This was followed by extensive hand search.

RESULTS

Recording consultations were regarded as ethically acceptable with some additional safeguards recommended. A range of sampling and recruitment strategies were identified although specific detail was often lacking. Non-participation rates in audio-recording studies ranged from 3 to 83% for patients and 7 to 84% for GPs; in video-recording studies they ranged from 0 to 83% for patients and 0 to 93% for GPs. There was little evidence to suggest that recording significantly affects patient or practitioner behaviour.

CONCLUSIONS

Research involving audio or video recording of consultations is both feasible and acceptable. More detailed reporting of the methodical characteristics of recruitment in the published literature is needed.

PRACTICE IMPLICATIONS

Researchers should consider the impact of diverse sampling and recruitment strategies on participation levels. Participants should be informed that there is little evidence that recording consultations negatively affects their content or the decisions made. Researchers should increase reporting of ethical and recruitment processes in order to facilitate future reviews and meta-analyses.

The workload of general practitioners does not affect their awareness of patients' psychological problems

OBJECTIVE

To investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems.

METHODS

Data from 2095 videotaped consultations from a representative selection of 142 Dutch GPs were used. Multilevel regression analyses were performed with the GPs' awareness of the patient's psychological problems and their communication as outcome measures, the GPs' workload as a predictor, and GP and patient characteristics as confounders.

RESULTS

GPs' workload is not related to their awareness of psychological problems and hardly related to their communication, except for the finding that a GP with a subjective experience of a lack of time is less patient-centred. Showing eye contact or empathy and asking questions about psychological or social topics are associated with more awareness of patients' psychological problems.

CONCLUSION

Patients' feelings of distress are more important for GPs' communication and their awareness of patients' psychological problems than a long patient list or busy moment of the day. GPs who encourage the patient to disclose their psychological problems are more aware of psychological problems.

PRACTICE IMPLICATIONS

We recommend that attention is given to all the communication skills required to discuss psychological problems, both in the consulting room and in GPs' training. Additionally, attention for gender differences and stress management is recommended in GPs' training.

Are sore throat patients who hope for antibiotics actually asking for pain relief?

PURPOSE

Antibiotics are still overprescribed for self-limiting upper respiratory tract infections such as acute sore throat, and physicians mention patient's desire for antibiotics as a driving force. We studied patients' concerns when visiting their family physician for acute sore throat, more specifically the importance they attach to antibiotic treatment and pain relief.

METHODS

Family physicians in 6 peer groups in Belgium participated in an observational postvisit questionnaire survey. Patients aged 12 years and older making an office visit for acute sore throat were invited to indicate the importance of different reasons for the visit.

RESULTS

Sixty-eight family physicians provided data from 298 patients. The 3 most frequently endorsed reasons for visiting the physician were examination to establish the cause of the symptoms, pain relief, and information on the course of the disease. Hopes for an antibiotic ranked 11th of 13 items. Patients who considered antibiotics very/rather important valued pain relief significantly more than patients who considered them little/not important (P <.001). Patients who hoped for antibiotics felt more unwell (P <.001), had more faith in antibiotics to speed recovery (P <.001), and were less convinced that sore throat was a self-limiting disease (P <.012). A multivariate model, adjusted for age, sex, and educational status, showed that the desire for pain relief is a strong predictor of the hope to receive a prescription for antibiotics.

CONCLUSION

Our study suggests that patients with acute sore throat and who hope for antibiotics may in fact want treatment for pain. Trials are needed to test whether exploring patients' expectations about pain management and offering adequate analgesia can assist physicians in managing sore throats without prescribing antibiotics.

Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs

OBJECTIVE

The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables.

METHODS

Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST.

RESULTS

Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses.

CONCLUSION

The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted.

PRACTICE IMPLICATIONS

We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Assessment of mutual understanding of physician patient encounters: development and validation of a Mutual Understanding Scale (MUS) in a multicultural general practice setting

Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.

Training general practitioners in behavior change counseling to improve asthma medication adherence

OBJECTIVE

Adherence to asthma medication regimens is problematic in general practice. We developed and evaluated a communication training for general practitioners (GPs) to help them address medication adherence during routine consultations. This paper describes the development of the training and evaluation results of a pilot study.

METHODS

The training was based on behavior change counseling (BCC), a technique derived from motivational interviewing. We developed a five phases BCC consultation model. Participating GPs answered questions at baseline (T0), directly after (T1) and 4-10 months after (T2) the training that assessed their attitudes and confidence regarding adherence communication. They completed evaluation forms at T1 and T2.

RESULTS

The 19 participating GPs were positive about the course and the feasibility of BCC in GP consultations. Also, after the training, their attitudes and confidence had improved (p<0.05) and all reported to use BCC skills at least sometimes 4-10 months after the training.

CONCLUSION

These positive effects provide us with some hope that the training positively influenced the GP's communication behavior.

PRACTICE IMPLICATIONS

If further data on physician behavior and patient outcomes justify implementation of the training, it would then be worthwhile to also involve practice nurses.

Information-giving sequences in general practice consultations

RATIONALE, AIMS AND OBJECTIVE

Most patients want to be involved in the decision-making process regarding their health and doctors need to improve their ability to meet these needs. Before implementing educational interventions, a better understanding of how information is provided in routine clinical practice is necessary. Aim of this study was to analyse the information-giving sequence of general practice consultations.

METHODS

This is an observational study that involved six general practitioners (GPs) in single-handed practices and patients (aged between 16 and 74) who consulted over a 2-month period for a new illness episode. Transcripts of 252 consultations were coded using the Verona Medical Interview Classification System that provides three categories for information giving (information on illness management; instructions on illness management and information and instructions on psychosocial aspects). Lag1 and lag2 sequential analyses were performed.

RESULTS

Information represented about one-third of the average consultation length. Medical and psychosocial information were preceded most often by patients' replies to previous questions (36% and 41%, respectively) and by listening and agreement (21% and 23%, respectively), less frequently by expression of opinions (10% and 6%, respectively). Listening and agreement were the most likely patient response after information (36%). GPs rarely tried to find out patients' view before and after the delivery of information or an instruction (<1%).

CONCLUSION

The low frequency of expressions of opinions and questions immediately before and after GPs' information and instructions, and the lack of facilitating questions indicate a limited degree of patient involvement in the information-giving sequence.

Patient evaluation on family doctors' family orientation

Family orientation is one of basic features of family practice. The purpose of the study was to explore the patients' opinions about family physician involvement in family related issues, and to identify the factors that may influence the patients' opinions. Altogether 514 patients completed a questionnaire. Logistic regression analysis was used to predict the factors which determine patient orientation to talk about family related issues. The results indicate that the patients' health and the family background influence their willingness to talk to family physicians about their family related problems. The findings of the study confirm that special attention should be paid to patients who definitely have family problems because of chronic illness, or an alcohol or drug using family member, or those who are widowed or divorced. Also, the ethnic origin was found to have an impact on patient opinions of family physicians' family involvement.

Is the communicative behavior of GPs during the consultation related to the diagnosis? A cross-sectional study in six European countries

This study explores the relation between the diagnosis made by the general practitioner (GP) and his or her communicative behavior within a consultation, by means of the analysis of 2095 videotaped consultations of 168 GPs from six countries participating in the Eurocommunication study. The doctors' diagnoses were coded into ICPC chapters and merged into seven clinically relevant diagnostic clusters. The communicative behavior was gauged by means of the Roter interaction analysis system (RIAS). We found the most important differences for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations, doctors show more affective behavior, are more concerned about having a good relationship with their patients, ask more questions and give less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. The communicative behavior of doctors reflects a global pattern in every consultation. This pattern is the most stable for affective behavior (social talk, agreement, rapport building and facilitation). Within instrumental behavior (the other categories), the directions and the information the doctor gives are adapted to the problems presented.

Consultation in general practice: a standard operating procedure?

The objectives of this study were to describe the features of consultation within general practice with special attention to the differences between short, moderate and long consultations. An analysis of 2801 videotaped consultations of 183 General Practitioners from six countries participating in the Eurocommunication Study was made. The communicative behaviour was gauged by means of the Roter Interaction Analysis System. The consultation can be seen as a "standard operating procedure" consisting of 8% social behaviour, 15% agreement, 4% rapport building, 10% partnership building, 11% giving directions, 28% giving information, 14% asking questions and 7% counselling. A short consultation can be described as an encounter with a little bit of social behaviour to set the contact, medical questioning, giving directions for the further consultation and advises in order to solve the problem(s) mentioned. In a long consultation doctors take more time for a social talk, they give more attention to the relation or contact with the patient, they listen more extensively, especially to psychosocial problems, and they give more information.