EVALUATING CARE OF PATIENTS REPORTING PAIN IN FUNDHOLDING PRACTICES

Objective-To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain. Design-Questionnaire and record based study. Subjects-Patients identified at consecutive consultations duri ng two weeks in 1990, 1991, and 1992. Setting-Six practice groups in p ilot fundholding scheme in Scotland. Main outcome measures-length of c onsultation; numbers referred or investigated or prescribed drugs; res ponses to questions about enablement and satisfaction. Results-About 1 5% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992; about a fifth wante d to discuss their social problems. Social problems were associated wi th a raised general health questionnaire score. The mean length of con sultation for patients with pain was 7.6 min in 1990 and 7.7 min in 19 92. Patients wishing to discuss social problems received longer consul tations (8.5 min 1990; 10.4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7.2 min). The level of prescribing was stable but the proportion of patients having invest igations or attending hospital fell significantly from 1990 to 1992 (3 1% to 24%; 31% to 13% respectively). Fewer patients responded ''much b etter'' to six questions about enablement in 1992 than in 1990. Enable ment was better after longer than shorter consultations for patients w ith social problems. Conclusions-Quality of care for patients with pai n has been broadly maintained in terms of consultation times. The effe cts of lower rates of investigation and referral need to be investigat ed further.