Observational study of effect of patient centredness and positive approachon outcomes of general practice consultations

Objective To measure patients' perceptions of patient centredness and the r elation of these perceptions to outcomes. Design Observational study using questionnaires. Setting Three general practices. Participants 865 consecutive patients attending the practices. Main outcome measures Patients' enablement, satisfaction, and burden of sym ptoms. Results Factor analysis identified five components. These were communicatio n and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronb ach's alpha = 0.96); personal relationship (a doctor who knows die patient and their emotional needs, alpha = 0.89); health promotion (alpha = 0.87); positive approach (being definite about the problem and when it would settl e, alpha = 0.84); and interest in effect on patient's life (alpha = 0.89). Satisfaction was related to communication and partnership (adjusted beta = 19.1; 95% confidence interval 17.7 to 20.7) and a positive approach (4.28; 2.96 to 5.60). Enablement was greater with interest in die effect on life ( 0.55; 0.25 to 0.86), health promotion (0.57; 0.30 to 0.85), and a positive approach (0.82; 0.52 to 1.11). A positive approach was also associated with reduced symptom burden at one month (beta = -0.25; -0.41 to -0.10). Referr als were fewer if patients felt they had a personal relationship with their doctor (odds ratio 0.70; 0.54 to 0.90). Conclusions Components of patients' perceptions can be measured reliably an d predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may hav e greater symptom burden and higher rates of referral.