COMPLEX HEALTH-PROBLEMS IN GENERAL-PRACTICE - DO WE NEED AN INSTRUMENT FOR CONSULTATION IMPROVEMENT AND PATIENT INVOLVEMENT - THEORETICAL FOUNDATION, DEVELOPMENT AND USER EVALUATION OF THE PATIENT PERSPECTIVE SURVEY (PPS)

Background and objectives. Many patients in general practice present w ith complex health problems. It is argued that the GP who is in a prim e position to counsel patients with such problems, will, however, ofte n perceive a lack of tools to manage them. The aim of the present stud y was to develop a novel instrument in terms of a patient-administered questionnaire, the Patient Perspective Survey (PPS), designed to enha nce the quality of clinical communication in the consultation. It is b ased on a biopsychosocial patient perspective, patient centredness, pa tient resources, involvement and coping, and quality of life orientati on. Methods. Development of the PPS has included comprehensive literat ure research, discussions and advice, during several phases, from grou ps of GPs, patients, broad panels of experts and testing in pilot stud ies. After many revisions, a 102-item version, consisting of a main so matic, mental and social domain axis, was evaluated by GPs and patient s in 213 consultations. Results. The basic idea, theoretical elements and purpose of the PPS appeared in general to be well accepted. Sevent y-five to eighty-five per cent of the patients found the questions rel evant and easy to understand and there were high positive scorings reg arding influence on the doctor-patient relationship, communication, re source and coping aspects, occurrence of new information and general s atisfaction with the consultation. Similar scorings were obtained from the GPs' evaluation. Both parties agreed that there is a need for a s horter and more specific PPS version, and that the resource and coping dimension should be even more extended. Conclusions. We consider it w ell documented that there is a need for this new instrument to deal wi th complex health problems in general practice, and that it has promis ing potentials for consultation improvement.