SEARCH · Search PubMed

Results for “CONSULTATIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 487 records · Page 27Linked to original sources

PubMed1995

How does the content of consultations affect the recognition by general practitioners of major depression in women?

BACKGROUND: Major depression is a common and disabling condition. However, for many reasons, the condition is not recognized in about half of the patients with major depression. AIM: The aim of the study was to establish whether the content of general practice consultations affected general practitioners' recognition of major depressive illness in women patients. METHOD: The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity. Patients newly recognized as depressed by their general practitioner and those not recognized as depressed who scored 11 or more on the questionnaire were interviewed, usually within three days of consulting their general practitioner, using the combined psychiatric interview. Videorecordings of the consultations for these two groups of women were analysed; analyses were based on mentions of physical, psychiatric and social symptoms and on whether the first mention of a psychiatric symptom was within the first four mentions of any symptoms (early in the consultation) or after four mentions of any symptoms (late) or if psychiatric symptoms were not mentioned. RESULTS: A paired sample of 72 women with major depression was obtained from patients consulting 36 general practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultation compared with those who either left it later to mention such symptoms or never mentioned them. Major depression was more likely to be recognized if no physical illness was present. After adjusting for physical illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultation. CONCLUSION: General practitioners need to remember that patients who present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation, regardless of the presence or absence of physical illness.

Adolescent↗

PubMed1996

Adhering to inpatient geriatric consultation recommendations.

BACKGROUND: The purpose of this study was to evaluate the rate of and factors associated with attending physicians' adherence to geriatric consultation recommendations in an urban community hospital. METHODS: A retrospective review was performed of the charts of 47 patients referred for inpatient geriatric consultation over the previous 1 1/2-year period. Study variables included patient and attending physician demographics, length of stay in hospital before geriatric consultation, status of patient on discharge, level of expertise of consultant, number of diagnoses per patient, and types and number of recommendations per patient made by consultant and acted upon by attending physicians. RESULTS: The recommendations made included medical (23.4%), medication (28.6%), laboratory (15.8%), radiological (2.6%), nutritional (11.7%), psychosocial (7.7%), skin care (1.6%), rehabilitative (6.4%), and other (2.2%). The percentage of total recommendations acted upon was 55.5%. By multivariate analysis, decreasing length of time prior to consultation was statistically associated with referring physician adherence to consultation recommendations (P=.03). Slightly more than 40% of the variability in adherence was explained by this single variable. CONCLUSIONS: Inpatient geriatric consultations are aimed at providing a comprehensive assessment for attending physicians. Recommendations are acted upon more than 50% of the time. Physician adherence to recommendations does not appear to be dependent on patient or physician demographic variables, but to some extent, adherence is associated with less time in the hospital prior to consultation. This is a relatively new concept in hospital medicine.

Adult↗

PubMedDate not supplied

Effective consultation in nursing.

Given the fiscal challenges within health care today, nurse administrators, whether acting in the role of client or consultant, must determine the most effective and efficient way to solve problems and achieve goals. The consultation process can be viewed from both the client's and the consultant's perspective. This article is intended to provide a practical approach to addressing the issues within the consultation process. The steps of the consultation process are reviewed. The evolution from solving problems to achieving goals is described. The importance of the use of a screening tool when interviewing prospective consultants is emphasized and an example of a generic screening tool is provided. During the interview, consultants are advised to clearly determine the problem or goal, the outcomes which the client expects, possible barriers and risks, and the philosophical fit between both parties. Nurses practise consultation skills daily and, therefore, consultation is a viable opportunity for self-employment.

Consultants↗

PubMed1997

Urgent self-referrals to ambulatory consultant--a prospective evaluation of triage by a qualified family physician.

Direct self-referrals to a consultant, especially on an urgent basis, has not been widely explored before. The health insurance system in Israel permits elective direct self-referrals to various specialists, but the range and reasons of urgent self-referrals has not yet been evaluated. Our aim was to evaluate urgent self-referrals to ambulatory consultants and to see to what extent a qualified family physician can triage and treat those patients. The setting was an urban ambulatory multi-disciplinary consultation center in the city of Ashdod in central Israel, serving a population of approximately 150,000. Over a three-month period, all patients who made urgent self-referrals for an ambulatory consultant in Ophthalmology, Ear, Nose and Throat (ENT) and Dermatology were triaged by an on-duty qualified family physician. The physician was instructed to take care of the patient in one of three ways: 1) immediate referral to a specialist; 2) begin treatment and schedule the patient for a specialist consultation; 3) administration of definitive treatment. Eight hundred and ninety-eight patients aged 46 +/- 22 years were treated by the triaging family physician. Forty-six percent had ophthalmological symptoms, 26% had dermatological symptoms and 20% had ENT-related symptoms. A symptom duration of less than 24 hours was reported by 36% of the patients. Eye problems were more commonly of short duration (p < 0.001). Sixty percent of the patients were given a definitive treatment, another 19% were given immediate treatment and scheduled for elective consultation with a specialist and 21% were referred for an immediate specialist consultation. Of the immediate consultations, 73% were ophthalmological and 27% came from a range of other complaints (p < 0.001). Our conclusion was that a family physician can treat most of the urgent self-referrals to ambulatory consultations in the three domains that were evaluated. A triage system is particularly suitable for urgent self-referrals to ENT as well as dermatological problems.

Adolescent↗

PubMed1976

[Consultation hours for special surgery in a surgical department of a district infirmary ("kreiskrankenhaus") (author's transl)].

At the Surgical Department of the Kreiskrankenhaus of Burg five consultation hours for special surgery have been established and have been working for 2 to 3 years: 1. consultation hours for surgical angiology, especially varicosis and proctology, 2. consultation hours for goitre, 3. consultation hours for traumatology, especially follow up control of patients after operative fracture treatment, 4. consultation hours for pediatric surgery, 5. consultation hours for surgical gastroenterology, especially follow up control of patients after partial and total gastrectomy, vagotomy, and complications after biliary surgery. The experiences gained from these consultation hours are discussed. With regard to the personal and organizational problems in district infirmaries many difficulties have to be overcome in establishing consultation hours for special surgery. However, these consultation hours offer the possibility to improve the surgical care in the rural population and to hold international standards in general surgery practice even in smaller surgical departments.

Adult↗

PubMed2001

Interventions for providers to promote a patient-centred approach in clinical consultations.

BACKGROUND: Communication problems in health care may arise as a result of health care providers focusing on diseases and their management, rather than people, their lives and their health problems. Patient-centred approaches to care are increasingly advocated by consumers and clinicians and incorporated into training for health care providers. The effects of interventions that aim to promote patient-centred care need to be evaluated. OBJECTIVES: To assess the effects of interventions for health care providers that aim to promote patient-centred approaches in clinical consultations. SEARCH STRATEGY: We searched Medline (1966 - Dec 1999); Health Star (1975 - Dec 1999); PsycLit (1887- Dec 1999); Cinahl (1982 - Dec 1999); Embase (1985-Dec 1999) and the bibliographies of studies assessed for inclusion. SELECTION CRITERIA: Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions for health care providers that promote patient-centred care in clinical consultations. Patient-centred care was defined as a philosophy of care that encourages: (a) shared control of the consultation, decisions about interventions or management of the health problems with the patient, and/or (b) a focus in the consultation on the patient as a whole person who has individual preferences situated within social contexts (in contrast to a focus in the consultation on a body part or disease). The participants were health care providers, including those in training. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data onto a standard form and assessed study quality for each study. We extracted all outcomes other than health care providers' knowledge, attitudes and intentions. MAIN RESULTS: 17 studies met the inclusion criteria. These studies display considerable heterogeneity in terms of the interventions themselves, the health problems or health concerns on which the interventions focused, the comparisons made and the outcomes assessed. All included studies used training for health care providers as an element of the intervention. Ten studies evaluated training for providers only, while the remaining studies utilised multi-faceted interventions where training for providers was one of several components. The health care providers were mainly primary care physicians (general practitioners or family doctors) practising in community or hospital outpatient settings. In two studies, the providers also included nurses. There is fairly strong evidence to suggest that some interventions to promote patient-centred care in clinical consultations may lead to significant increases in the patient centredness of consultation processes. 12 of the 14 studies that assessed consultation processes showed improvements in some of these outcomes. There is also some evidence that training health care providers in patient-centred approaches may impact positively on patient satisfaction with care. Of the eleven studies that assessed patient satisfaction, six demonstrated significant differences in favour of the intervention group on one or more measures. Few studies examined health care behaviour or health status outcomes. REVIEWER'S CONCLUSIONS: Interventions to promote patient-centred care within clinical consultations may significantly increase the patient centredness of care. However, there is limited and mixed evidence on the effects of such interventions on patient health care behaviours or health status; or on whether these interventions might be applicable to providers other than physicians. Further research is needed in these areas.

Clinical Trials as Topic↗

PubMed2001

Standards of documentation of the surgeon-patient consultation in current surgical practice.

BACKGROUND: This study was designed to assess the reliability of the system whereby junior doctors document the surgeon-patient consultation in general surgical practice in the UK. METHODS: A prospective observational study was carried out, with an independent observer recording details of the surgeon-patient consultation and assessing the reliability of documentation. An exact record of the information given by consultants was transcribed in shorthand at the time of consultation. Data were recorded in the categories recommended for notation by the General Medical Council: clinical findings, decisions made, information given to patient and treatment prescribed. Case notes were examined within 24 h of the ward round to ascertain reliability of the documentation. RESULTS: The study population comprised 432 surgeon-patient consultations. There were important deficiencies in the documentation of consultants' clinical findings and management decisions. In addition, information given by consultants to the patients regarding clinical findings and treatment planned (including the need for operation) was recorded in a median of 6 per cent of consultations. CONCLUSION: This study provides objective evidence of shortfalls in the documentation of the surgeon-patient consultation process. These deficiencies are such that, under present circumstances, the requirements of the General Medical Council with respect to case note documentation are not fulfilled in this setting.

Bias↗

PubMed2001

Teaching consultation skills: a survey of general practice trainers.

BACKGROUND: Consultation skills are vitally important in general practice (GP), and now form part of the summative assessment of GP registrars in the UK. GP trainers need to be skilled in teaching consultation skills, and also need the time and resources to ensure that their registrars are competent in consultation skills. AIMS: To describe the teaching methods used by GP trainers in one deanery, the frequency of teaching of consultation skills, the problems encountered and the training that GP trainers have themselves received both in consultation skills and how to teach them. METHOD: Postal questionnaire survey of all the 164 trainers in the Yorkshire Deanery. RESULTS: Replies were received from 129 trainers (response rate 79%) of which 123 could be analysed. Of these trainers, 45 (37%) trainers taught consultation skills fewer than five times a year, 45 (37%) five to 10 times, and 14 (11%) more than 10 times a year. A total of 24 trainers reported problems with teaching consultation skills, most commonly lack of time, technical difficulties, and unreceptive registrars, and 97 (79%) trainers had had some postgraduate training in consultation skills with 112 (91%) reporting some form of teacher training. CONCLUSION: There is considerable variation in the reported frequency of teaching consultation skills, the models used, and the preparation of trainers for teaching, despite a systematic approach to teacher training in the Yorkshire Deanery.

Clinical Competence↗

PubMed2003

Increased vaginal bleeding: the reasons women give for consulting primary care.

A previous study identified interference with life as the main reason for consultation with increased vaginal bleeding. The purpose of this study was to determine the reasons why the heaviness of periods interferes with life and how this may be related to consultation. The design was a case-control study in which questionnaires were sent to women who consulted primary care with new episodes of increased vaginal bleeding and two groups of controls: consulting controls with another illness and non-consulting community controls. Of the 186 women who reported that heaviness of periods interfered with life the most common reason given was 'mood' (87%). There was no difference in the reporting of 'mood' interfering with life or general health questionnaire score between cases, consulting controls and non-consulting controls. Women who report heavy periods interfering with life complain most commonly of mood as one of the reasons. This does not distinguish consulters and non-consulters and is not reflected in objective measures of psychological distress. Clinicians should focus initially on treating the presenting physical symptoms.

Adolescent↗

PubMed2006

Regulatory end-point assessment of the consultation competence of family practice trainees in Kuwait.

BACKGROUND: No single approach to the regulatory assessment of global consultation competence has been shown to possess the required levels of validity, reliability and feasibility. OBJECTIVE: To evaluate the approach adopted in Kuwait to the regulatory end-point assessment of the global consultation competence of family practice trainees with particular reference to validity, reliability and feasibility. METHODS: Family practice trainees in Kuwait were individually and directly observed for 3 hours in consultation with a minimum of 10 patients by a pair of examiners. Performance was judged against the explicit criteria of consultation competence as contained in the Leicester Assessment Package (LAP). RESULTS: The marks independently allocated by the pairs of examiners to 126 trainees between 1994 and 2001 were within five percentage points on 91% of occasions. A reliability coefficient of 0.82 was achieved when two examiners independently marked candidates consulting with 10 real patients; this rose to 0.95 at the critical 50% pass-fail margin. The main sources of variance contributing to the reliability of marks allocated were candidate performance (42%) and the interaction of candidate performance across cases, i.e., case specificity (30%). The clinical challenges presented by the patients were judged by both examiners to be sufficient to enable performance to be assessed across the seven LAP consultation categories as follows: behaviour and relationship with patients (100% of consultations), interviewing/history taking (100%), record keeping (99%), patient management (99%), problem solving (98%), physical examination (95%), and anticipatory care (86%). Each assessment involved a pair of examiners and lasted approximately 3.5 hours. CONCLUSION: The Kuwait clinical examination achieves high content validity and authenticity as it uses direct observation of performance, validated and explicit criteria against which performance is judged, and real patient challenges. It can discriminate between different levels of consultation performance and satisfies the recognized reliability threshold for regulatory examinations (0.82 vs 0.80). Accordingly, we recommend the use of such an approach in the regulatory end-point assessment of the global consultation competence of trainees in family practice. Such an approach is more valid, and is likely to be more feasible, than simulated surgeries or the short-case OSCE format.

Family Practice↗

PubMed1998

The Kaiser Permanente/USC Patient Consultation Study: patient satisfaction with pharmaceutical services. University of Southern California.

The impacts of two models of pharmacist consultation on patient satisfaction with pharmaceutical services relative to a control model were studied. Patients in the random-assignment and areawide studies of the Kaiser Permanente/USC Patient Consultation Study were asked to rate their satisfaction with six aspects of the service they received at the pharmacy. The patients were receiving pharmaceutical services under the Kaiser Permanente (KP) model of consultation, a state-mandated model, or a control model. They were assigned to risk categories according to their pattern of prescription drug use. Differences in satisfaction among the three consultation models for all patients and for each risk group and correlations between satisfaction items were determined. The KP and state models of consultation were associated with better satisfaction than the control model on five of the six satisfaction items. In the high-risk patient groups, the KP and state models were associated with higher levels of satisfaction than the control model. In the low-risk group, the state model was associated with higher levels of satisfaction than the control model; results for low-risk patients assigned to the KP model were inconsistent between the random-assignment study and the areawide study. Overall satisfaction appeared to be a suboptimal measure of satisfaction with consultation. Overall satisfaction was more closely related to satisfaction with waiting time and with whether the pharmacy staff was helpful and caring than with the three items reflecting satisfaction with the content of the consultation. Patients were more satisfied under the state model of pharmacist consultation or the KP model of consultation, which resulted in more-intensive counseling for fewer patients, than under a control model.

Ambulatory Care↗

PubMed2001

On the relationship between the efficiency and the quality of the consultation. A validity study.

OBJECTIVES: The aim of this study was to determine how the medical performance of physicians during consultations is related to doctor-patient communication and satisfaction of patients, taking into account the actual length of the consultations. In addition, we studied the validity of the 'efficiency-per-time score' as a measure of competence. METHODS: General practice trainees participated in a test situation in which they were confronted with six consultations with standardized (simulated) patients (SPs). All consultations were videotaped and evaluated by multiple observers, using national guidelines on medical content and on communication. The SPs scored satisfaction with the consultation using a satisfaction checklist. Forty GP-trainees were invited, of whom 34 participated. The main outcome measures were the number of obligatory actions undertaken by the GP-trainees, total number of actions undertaken, consultation time, efficiency-per-time score, patient satisfaction and quality of communication score, and the Pearson correlations between these measures. RESULTS: There was a negative correlation between the 'efficiency-per-time score' of the GP-trainees and the satisfaction of the SPs in five of the six consultations [Pearson r from -0.29 (P < 0.05) to -0.58 (P < 0.001)] and between the 'efficiency-per-time score' and the quality of the communication in three of the six consultations [Pearson r from -0.34 (P <.05) to -0.51 (P < 0.001)]. CONCLUSIONS: Short consultations with high technical medical efficiency seem to be related to bad communication and dissatisfied patients, thus questioning the validity of the 'efficiency-per-time score' as a measure of competence.

Belgium↗

PubMed2005

Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice.

BACKGROUND: The Consultation and Relational Empathy (CARE) Measure has been developed as a tool for assessing the patients' perceptions of relational empathy in the consultation. OBJECTIVES: The present paper provides performance data on the CARE measure in a large sample of general practice consultations in areas of high and low deprivation. METHODS: The CARE Measure was included in a self-completed questionnaire study involving 3044 patients attending 26 GPs in 26 different practices (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). RESULTS: GPs and patients, in both high and low deprivation settings, endorsed the relevance of the CARE Measure. Overall, 76% of patients rated the measure as being 'very important' to their current consultation. Higher rating of importance were observed in older patients, patients consulting with psycho-social problems, patients with long-standing illness or disability, and patients with significant emotional distress. Few patients rated individual CARE Measure items as being 'not applicable' to their current consultation; only 3.1% of patients felt that more than 2 of the 10 items in the measure did not apply to their current consultation. Mean values were not influenced by deprivation, gender, reason for consulting, chronic illness, or emotional distress. Correlational analysis indicated that a sample size of 50 patients is sufficient to reliably estimate mean CARE score for an individual GP. CONCLUSIONS: These results indicate that the CARE Measure is considered by GPs and patients alike as being of direct relevance to everyday consultations in general practice, in both high and low deprivation settings. The measures is stable across patient groups and a reliable estimate of perceived GP empathy requires 50 completed questionnaires per doctor.

Adolescent↗

PubMed2006

Age-related changes in consultations and antibiotic prescribing for acute respiratory infections, 1995-2000. Data from the UK General Practice Research Database.

BACKGROUND: International studies using data aggregated for all ages have shown decreasing rates of general practice consultations for acute respiratory infections with fewer antibiotic prescriptions issued per consultation. The occurrence of different respiratory infections varies widely at different ages but we do not know whether prescribing has reduced equally in all age groups. OBJECTIVE: We aimed to determine how reductions in consultation rates and antibiotic prescribing varied with age for different respiratory infections. METHODS: Data were abstracted from the General Practice Research Database for 108 general practices in the UK (mean registered population 642 685). We estimated age-specific changes between 1995 and 2000 in consultation rates, and the proportion of consultations resulting in an antibiotic prescription for 'all respiratory infections' and for 'sore throat', 'ear infection', 'bronchitis' and 'chest infection'. RESULTS: Consultation rates for 'all respiratory infections' declined in all age groups with the greatest decreases in children aged 1-4 years (41%), 5-10 year olds (53%) and 11-16 year olds (54%), whereas at 75-84 years the reduction was 28%. The pattern of greater reductions in children held for each separate condition even though the age of peak incidence varied. The relative reduction in antibiotic prescribing was greatest at 1-4 years (18%), 5-10 years (17%) and 11-16 years (17%), compared with 5% at 75-84 years. Antibiotic prescribing decreased most for sore throat and this was observed at all ages particularly in 5-10 year olds (relative reduction, 32%). CONCLUSIONS: School age children account for the greatest reduction in consultations for acute respiratory infection. School age and preschool children account for the greatest reductions in antibiotic prescribing during the consultation. The rapid changes in consultation rates are unexplained.

Adolescent↗

PubMed1990

Effect of a general practitioner's consulting style on patients' satisfaction: a controlled study.

OBJECTIVE: To compare the effect of directing and sharing styles of consultation by a general practitioner on patients' satisfaction with the consultation. DESIGN: Patients were randomised to receive a directing or sharing style in the part of the consultation concerned with giving treatment, advice, and prognosis. SETTING: An inner London general practice. PATIENTS: 359 Randomly selected patients consulting with one general practitioner. Four patients refused to participate and five were excluded. Thirty failed to complete the initial assessment and 110 failed to complete the assessment a week later, giving response rates of 89% and 58% respectively. MAIN OUTCOME MEASURES: Patients' satisfaction with the general practitioner's perceived understanding of their problem and the explanation they received and whether they felt that they had been helped immediately after the consultation and one week later. RESULTS: Patients who had the directing style of consultation reported significantly higher levels of satisfaction on almost all the outcome measures. This was particularly striking for patients with physical problems (excellent explanation 23/68 (34%) v 10/65 (15%), p less than 0.02; excellent understanding 25/68 (37%) v 9/66 (14%), p = 0.004), and for patients who received a prescription (excellent explanation 20/60 (33%) v 9/59 (15%), p less than 0.04; excellent understanding 27/60 (45%) v 10/59 (17%), p = 0.04). There was no significant difference in the responses to the directing and sharing styles in longer consultations (8/31 (26%) v 8/31 (26%)), in which the main treatment was advice (10/30 (33%) v 7/36 (19%)), and among patients with psychological (6/17 (35%) v 6/27 (22%)) or chronic problems (14/28 (50%) v 8/32 (25%)). CONCLUSIONS: Style of consultation does influence the satisfaction of the patient, but its effect is most noticeable in consultations with patients with physical problems and patients who receive a prescription.

Adolescent↗

PubMed1995

Rectal bleeding: prevalence and consultation behaviour.

OBJECTIVES: To determine prevalence of rectal bleeding in the community and to examine factors that lead some patients to consult their general practitioner about rectal bleeding while others do not. DESIGN: Questionnaire survey followed by semistructured interviews of sample of respondents with rectal bleeding. SETTING: Two general practices on Tyneside. SUBJECTS: 2000 adult patients registered with the general practices were sent a validated questionnaire. Respondents with rectal bleeding were divided into consulters and non-consulters, and 30 patients from each group (matched for age, sex, and characteristics of bleeding) were interviewed. MAIN OUTCOME MEASURES: Prevalence of rectal bleeding, proportion of subjects with rectal bleeding who sought medical advice, and reasons for consulting or not consulting a doctor about rectal bleeding. RESULTS: 287 of the 1200 respondents to the questionnaire had noticed rectal bleeding at some time in their lives, and 231 had noticed it within previous 12 months. Only 118 (41%) of all respondents with rectal bleeding had ever sought medical advice for the problem. Those aged over 60 were most likely to have consulted, as were those who reported blood mixed with their stools. Main difference between those who had sought medical advice and those who had not was that consulters were more likely than non-consulters to perceive their symptoms as serious. CONCLUSIONS: Although rectal bleeding is common, only minority of patients seek medical of symptoms seems to be most important factor in deciding whether to consult a doctor for rectal bleeding.

Adult↗

PubMed1998

Community survey of factors associated with consultation for low back pain.

OBJECTIVE: To investigate the psychosocial factors associated with consultation for low back pain. DESIGN: Two phase cross sectional postal survey. SETTING: Bradford Metropolitan Health District. SUBJECTS: 1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12 months completed the second questionnaire. MAIN OUTCOME MEASURES: Six psychosocial constructs. RESULTS: 406 (52%) of the respondents reporting back pain in the past 12 months had not consulted a health professional. Logistic regression showed that consultation was associated with externalised beliefs regarding pain management (odds ratio 3.6; 95% confidence interval 2.1 to 6.0). Duration of pain affected the factors associated with consultation. Consultation for episodes lasting less than two weeks (n=290) was associated with greater than median pain (3.0; 1.7 to 5.5), consultation for episodes over two weeks (n=243) was associated with increased disability (3.7; 1.5 to 9.0), and consultation for episodes over three months (n=143) with increased depression (3.9; 1.3 to 11.8). CONCLUSIONS: The results support a role for psychosocial factors in consultation for low back pain and suggest that the reasons for consultation vary with duration of pain. Duration of the episode may be a useful guide to management of non-specific low back pain.

Adult↗

PubMed2006

Effect of patient completed agenda forms and doctors' education about the agenda on the outcome of consultations: randomised controlled trial.

OBJECTIVE: To assess the effect of patient completed agenda forms for the consultation and doctors' education on identifying patients' agendas on the outcome of consultations. DESIGN: Randomised controlled trial. SETTING: General practices in Leicestershire and Nottinghamshire, United Kingdom. PARTICIPANTS: 46 general practitioners and 976 patients. INTERVENTIONS: Education for general practitioners, with an embedded clustered randomised controlled trial of a patient agenda form. MAIN OUTCOME MEASURES: Number of problems identified, time required to manage each problem, duration of consultations, number of problems raised after the doctor considered the consultation finished ("by the way" questions), and patient satisfaction. RESULTS: Data were available from 45 doctors (98%) and 857 patients (88%). The number of problems identified in each consultation increased by 0.2 (95% confidence interval 0.1 to 0.4) with the agenda form, by 0.3 (0.1 to 0.6) with education, and by 0.5 (0.3 to 0.7) with both interventions. The time required to manage each problem was not affected. The duration of consultations with the agenda form was increased by 0.9 minutes (0.3 to 1.5 minutes) and with the combined intervention by 1.9 minutes (1.0 to 2.8 minutes). Patient satisfaction with the depth of the doctor-patient relationship was increased with the agenda form. The occurrence of "by the way" presentations did not change. CONCLUSION: A patient completed agenda form before the consultation or general practitioner education about the agenda form, or both, enabled the identification of more problems in consultations even though consultations were longer.

England↗