Quality at general practice consultations: cross sectional survey

Objectives To measure quality of care at general practice consultations in diverse geographical areas, and to determine the principal correlates assoc iated with enablement as an outcome measure. Design Cross sectional multipractice questionnaire based study. Setting Random sample of practices in four participating regions: Lothian, Coventry, Oxfordshire, and west London. Participants 25994 adults attending 53 practices over two weeks in March an d April 1998. Main outcome measures Patient enablement, duration of consultation, how wel l patients know their doctor, and the size of the practice list. Results A hierarchy of needs or reasons for consultation was created. Simil ar overall enablement scores were achieved for most casemix presentations ( mean 3.1, 95% confidence interval 3.1 to 3.1). Mean duration of consultatio n for all patients was 8.0 minutes (8.0 to 8.1); however, duration of consu ltation increased for patients with psychological problems or where psychol ogical and social problems coexisted (mean 9.1, 9.0 to 9.2). The 2195 patie nts who spoke languages other than English at home were analysed separately as they had generally higher enablement scores (mean 4.5, 4.3 to 4.7) than those patients who spoke English only despite having shorter consultations (mean 7.1 (6.9 to 7.3) minutes. At individual consultations, enablement sc ore was most closely correlated with duration of consultation and knowing t he doctor well. Individual doctors had a wide range of mean enablement scor es (1.1-5.3) and mean durations of consultation (3.8-14.4 minutes). Doctors ' ability to enable was linked to die duration of their consultation and th e percentage of their patients who knew them well and was inversely related to the size of their practice. At practice level, mean enablement scores r anged from 2.3 to 4.4, and duration of consultation ranged from 4.9 to 12.2 minutes. Correlations between ranks at practice level were not significant . Conclusions It may be time to reward doctors who have longer consultations, provide greater continuity of care, and both enable more patients and enab le patients more.