Caring against the clock
-
Upload
greg-irving -
Category
Health & Medicine
-
view
363 -
download
0
Transcript of Caring against the clock
“7 minutes had become the summary statistic of the day”
Sir Denis Pereira Gray PRCGP 1998
Pereira Gray D. BJGP. 1998;48:1816–1817
Year 1997 2006 2008
Mean consultation length (mins) (DDRB)
9.37
Mean no consultation / year
(GHS)
5
Mean no. consultations (any
health professional) / year (NHS IC)
4.01
Mean number of consultations / year
(NHS IC)
2.92
Total time / year (GHS) (mins)
47
Total time /year (NHS IC) (mins)
27.8
DDRB: Doctors and Dentists Review BodyGHS: General Household Survey NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404
Year 1997 2006 2008
Mean consultation length (mins) (DDRB)
9.37 11.7
Mean no consultation / year
(GHS)
5 4
Mean no. consultations (any
health professional) / year (NHS IC)
4.01 5.22
Mean number of consultations / year
(NHS IC)
2.92 3.23
Total time / year (GHS) (mins)
47 47
Total time /year (NHS IC) (mins)
27.8 37.8
DDRB: Doctors and Dentists Review BodyGHS: General Household Survey NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404
Year 1997 2006 2008
Mean consultation length (mins) (DDRB)
9.37 11.7 -
Mean no consultation / year
(GHS)
5 4 -
Mean no. consultations (any
health professional) / year (NHS IC)
4.01 5.22 5.5
Mean number of consultations / year
(NHS IC)
2.92 3.23 3.4
Total time / year (GHS) (mins)
47 47 -
Total time /year (NHS IC) (mins)
27.8 37.8 -
DDRB: Doctors and Dentists Review BodyGHS: General Household Survey NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404
Average consultation length (min)
*Based on best available evidence from each country *Methodological heterogeneity
Sweden
France
Switzerla
nd
Belgium
Canada
Australia
USA
New Zealand UK
Croatia
Netherlands
Estonia
Spain
Germany
Quatar
Japan UAE
Saudi Arabia
0
5
10
15
20
25
21
18.5
15.615 15 14.8
1312 11.7 11.5
10.29
7.8 7.66.6
6 5.9 5.7
• Survey of 3713 GP principles in Scotland 2001• 21% felt not currently providing high-quality
holistic care• Average consultation length 9.3 minutes• 30% provided less than 10 minutes • 5% provided more than 10 minutes
Holism in primary care
Hasegawa H et al. PHCRD 2005; 6: 320–328
• 40% felt rushed at end of consultations (>50% consultations)
• Booked consultation length was shorter in urban & deprived areas
• Mean optimum consultation length was 13.3 mins – 43.3% between 10 - 15 mins– 39.8% specified 15 mins – 9.9% > 15 mins
Holism in primary care
Hasegawa H et al. PHCRD 2005; 6: 320–328
Consultation length Routine Emergency
0.5 - 4.5 mins 2 (0.3%) 5 (0.8%)
5 - 9.5 mins 18 (2.7%) 157 (24.8%)
10 - 14.5 mins 575 (85.4%) 360 (56.9%)
15 - 19.5 mins 52 (7.7%) 37 (5.85%)
20 - 24.5 mins 12 (1.78%) 10 (1.6%)
>25 mins 0 0
No set time 14 (2.1%) 64 (10.0%)
• 2010 UK Cross sectional survey • Consultation length offered by GP trainers
Irving et al. BJGP 2011; 62 (12):238
n=673
Systematic review (Hutton et al 2007)
• Focus on psychological problems
• 29 studies included
• Consultations with a recorded diagnosis of a psychological problem were longer.
• GPs reported that time pressure is a major barrier to treating depression.
• Evidence that increased consultation length is associated with more accurate diagnosis of psychological problems.
Hutton C et al. BMC HSR 2007; 7: 71
Cochrane review (Wilson et al 2009)• 4 trials : Short term, not of high quality, 1978-1992
• Insufficient evidence to say whether increasing consultation length provides patient benefit (or not)
• With longer consultations• More health promotion • Doctors did not run more tests, examine or refer more• Patients were not any more satisfied with care • Patients did not alter follow-up behavior
Wilson A et al. Cochrane Database of Systematic Reviews 2006;1:CD003540