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

Little, Paul, Everitt, Hazel, Williamson, Ian, Warner, Greg, Moore, Michael, Gould, Clare, Ferrier, Kate and Payne, Sheila (2001) Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ, 323 (7318), 908-911. (doi:10.1136/bmj.323.7318.908).

Abstract

Objective: to measure patients' perceptions of patient centredness and the relation 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 symptoms.
Results: factor analysis identified five components. These were communication and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronbach's alpha =0.96); personal relationship (a doctor who knows the patient and their emotional needs, alpha =0.89); health promotion (alpha =0.87); positive approach (being definite about the problem and when it would settle, 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 the 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). Referrals 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 and predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and higher rates of referral.

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Contributors

Author: Paul Little

Author: Hazel Everitt

Author: Michael Moore

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