More time for complex consultations in a high-deprivation practice is associated with increased patient enablement

• Published in: British journal of general practice Vol. 57; no. 545; pp. 960 - 966
• Main Authors: Mercer, Stewart W, Fitzpatrick, Bridie, Gourlay, Glen, Vojt, Gaby, McConnachie, Alex, Watt, Graham C M
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-12-2007
• Subjects: Adult; Appointments and Schedules; Attitude of Health Personnel; Empathy; Family Practice - organization & administration; Family Practice - standards; Female; Humans; Longitudinal Studies; Male; Middle Aged; Original Papers; Patient Satisfaction; Physician-Patient Relations; Professional Practice; Psychosocial Deprivation; Quality of Health Care - organization & administration; Quality of Health Care - standards; Reproducibility of Results; Scotland; Socioeconomic Factors; Surveys and Questionnaires; Time Factors; Scotland
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/096016407782604910

Evidence of the beneficial effects of longer consultations in general practice is limited.
To evaluate the effect of increasing consultation length on patient enablement in general practice in an area of extreme socioeconomic deprivation.
Longitudinal study using a 'before and after' design.
Keppoch Medical Centre in Glasgow, which serves the most deprived practice area in Scotland.
Participants were 300 adult patients at baseline, before the introduction of longer consultations, and 324 at follow-up, more than 1 year after the introduction of longer consultations. The intervention studied was more time in complex consultations. Patient satisfaction, perceptions of the GPs' empathy, GP stress, and patient enablement were collected by face-to-face interview. Additional qualitative data were obtained by individual interviews with the GPs, relating to their perceptions of the impact of the longer consultations.
Response rates of 70% were obtained. Overall, 53% of consultations were complex. GP stress was higher in complex consultations. Patient satisfaction and perception of the GPs' empathy were consistently high. Average consultation length in complex consultations was increased by 2.5 minutes by the intervention. GP stress in consultations was decreased after the introduction of longer consultations, and patient enablement was increased. GPs' views endorsed these findings, with more anticipatory and coordinated care being possible in the longer consultations.
More resource to provide more time in complex consultations in an area of extreme deprivation is associated with an increase in patient enablement.