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To make a difference - how GPs conceive consultation outcomes: A phenomenographic study
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Bergnäsets Vårdcentral, Luleå, Sweden .
Umeå University, Sweden.
Kalmar City Council, Sweden.
2009 (English)In: BMC Family Practice, ISSN 1471-2296, Vol. 10, no 4Article in journal (Refereed) Published
Abstract [en]

Background: Outcomes from GPs consultations have been measured mainly with disease specific measures and with patient questionnaires about health, satisfaction, enablement and quality. The aim of this study was to explore GPs conceptions of consultation outcomes.

Methods: Interviews with 17 GPs in groups and individually about consultation outcomes from recently performed consultations were analysed with a phenomenographic research approach.

Results: The GPs conceived outcomes in four ways: patient outcomes, GPs self-evaluation, relationship building and change of surgery routines.

Conclusion: Patient outcomes, as conceived by the GPs, were generally congruent with those that had been taken up in outcome studies. Relationship building and change of surgery routines were outcomes in preparation for consultations to come. GPs made self-assessments related to internalized norms, grounded on a perceived collegial professional consensus. Considerations of such different aspects of outcomes can inspire professional development.

Place, publisher, year, edition, pages
2009. Vol. 10, no 4
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-16883DOI: 10.1186/1471-2296-10-4OAI: diva2:174430
Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2014-01-10Bibliographically approved
In thesis
1. Outcomes from GPs' Consultations
Open this publication in new window or tab >>Outcomes from GPs' Consultations
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Resultat av konsultationer hos allmänläkare
Abstract [en]

Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes.

Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs.

Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients.

Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice.

The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 91 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1047
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-18483 (URN)978‐91‐7393‐968‐3 (ISBN)
Public defence
2009-06-04, Aulan, Hälsans Hus, ingång 16, Campus US, Linköpings Universitet , Linköping, 13:00 (English)
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-06-10Bibliographically approved

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