Family Practice Vol. 21, No. 2, 140-142
Family Practice Vol. 21, No. 2 © Oxford University Press 2004, all rights reserved.
Article |
Alternative forms of consulting: survey of patients and GPs about their consultations
Department of General Practice, University of Wales College of Medicine, Wrexham Technology Park, Wrexham LL13 7YP, a Meanwood Group Practice, 548 Meanwood Road, Leeds LS6 4JN and b Centre for Research in Primary Care, University of Leeds, 71–75 Clarendon Road, Leeds LS2 9PL, UK
E mail: nealrd{at}cf.ac.uk
Received 7 August 2003; Revised 15 October 2003; Accepted 3 November 2003.
Neal RD, Pascoe SW and Allgar VL. Alternative forms of consulting: survey of patients and GPs about their consultations. Family Practice 2004; 21: 140–142.
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Introduction |
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Telephone consulting is used mainly in primary care for out-of-hours work and for triage. There is potential for greater use of telephone consulting as an alternative to face to face consultations,1 in order to manage demand for same-day appointments, and for consultations in which new problems are presented. Despite the relative lack of evidence on which to base practice and policy,2 telephone use is promoted as part of the National Primary Care Development Team's initiatives on access.3 In one study, patients reported that 11.4% of face to face consultations could have been conducted by telephone, while GPs reported that 13.8% could have been, with agreement for only 5% of consultations.4 Reports of the use of the Internet and of e-mail have so far been limited to specialist exchange of knowledge,5 or by specialist care only.6 We set out to determine, for a consecutive sample of adult patients consulting with their GP, whether their consultation could have been managed over the telephone or by e-mail. Secondary aims are to describe the degree of agreement between patients and GPs, and describe the response by patients' and GPs' perception of the type of consultation.
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Methods |
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The study was conducted in one group practice with eight GPs. The practice is in a mixed urban area of north-east Leeds with a socio-economically diverse list of 12 500 patients. Over a 2-week period in July and August 2002, all consecutively attending adult patients were asked to complete a questionnaire relating to their consultations. This included two questions regarding alternative forms of consulting. GPs were asked to complete similar sheets. The two questions were: "Do you believe your problems (or main reason for coming) could have been dealt with over the phone rather than a face to face consultation?", and a similarly worded question for e-mail. A further question (to both patients and GPs) asked them to categorize the consultation into one of the following: ‘a new problem’, ‘a planned follow-up or review of existing problem’, ‘a medication review suggested by GP’, ‘a further consultation because a previous problem had not settled’ or ‘other’. Responses were returned anonymously to the practice researcher, coded and analysed using descriptive statistics, and Cohen's kappa co-efficient for paired data. The study reported here only relates to general practice consultations; a parallel study of consultations between patients and practice nurses will be reported elsewhere.
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Results |
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Data were collected from 1150 consultations between patients and GPs. There were 1044/1150 (90.8%) responses from GPs, and 840/1150 (73.0%) valid responses from patients. Paired data (i.e. from both patients and GPs) were complete for 711 pairs (telephone question) and 693 pairs (e-mail question). Not all respondents answered the question regarding the initiation of the consultation. Of those who responded, the number and percentage answering ‘yes’ or ‘no’ to each question are shown in Table 1. This shows that GPs thought that a far greater proportion of these consultations could have been dealt with by telephone or e-mail (22.8 and 17.6%, respectively) than did patients (9.6 and 5.8%, respectively). There was only a ‘yes’ agreement for 3.5% of consultations for telephone use and 2.2% for e-mail. Kappa was 0.67 for the telephone question and 0.86 for the e-mail question. Tables 2 and 3 show the breakdown of both patients’ and GPs’ responses to the telephone and e-mail question by their own perceptions of the type of consultation. These show that whilst the response to ‘new problem’ consultations was similar between patients and GPs, there were quite marked differences in response to the telephone question between patients and GPs for ‘planned reviews’ (10% versus 31% saying yes), medication reviews (16% versus 45% saying yes) and ‘further consultation for a problem not settling’ (5% versus 26% saying yes). Similar trends are present for the e-mail question.
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Discussion |
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The findings of this paper shed light on types of consultations that patients and GPs think would be suitable for alternative forms of consulting other than face to face. Our findings with regard to telephone use are similar to those reported by Stevenson et al.,5 suggesting that our sample and our setting did not differ significantly from other settings. The findings reported here must be interpreted with some caution given some limitations of the study. Responses to the question on the type of consultation may have been influenced because we asked patients before their consultations and GPs afterwards. Respondents may have had difficulty conceptualizing the pre-determined categories, although this was not the case during the pilot phase. The way in which the questions were asked presumed that patients (and perhaps GPs) have good access to e-mail and indeed telephones; respondents would have been unlikely to answer yes if this was not the case. The finding that there was greater acceptance of telephone than e-mail consulting comes as no great surprise, but this may change over time. Several factors may have contributed to the moderate levels of agreement between GPs and patients. These include: greater familiarity that GPs have with alternative forms of consulting; patients valuing face to face contact more than GPs; patients being more wary of change; and GPs feeling pressurized and overworked by the current level of face to face consultations. The finding that GPs found ‘follow-up’ consultations (e.g. medication reviews) more amenable to alternative forms of consulting suggests that there may be scope to develop this service; however, patients may need more convincing that this is acceptable.
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Acknowledgments |
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We would like to thank all the patients and staff at Meanwood Group Practice for their co-operation. Meanwood Group Practice is a Primary Care Research Team Assessment (PCRTA) accredited research practice funded through NHSE Northern and Yorkshire R&D Directorate.
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References |
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1 Brown A, Armstrong D. Telephone consultations in general practice; an additional or alternative service? Br J Gen Pract 1995; 45: 673.[Web of Science][Medline]
2 Toon P. Using telephones in primary care. Br Med J 2002; 324: 1230–1231.
3 Oldham J. Telephone use in primary care. Br Med J 2002; 325: 547.
4 Stevenson M, Marsh J, Roderick E. Can patients predict which consultations can be dealt with by telephone? Br J Gen Pract 1998; 48: 1771–1772.[Medline]
5 Kedar I, Ternullo JL, Weinrib CE KM et al. Internet based consultations to transfer knowledge for patients requiring specialist care: retrospective case review. Br Med J 2003; 326: 696–699.
6 Pal B. Internet helps communication between doctors and patients. Br Med J 2000; 32: 59.
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