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Outcomes from GPs' Consultations
Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Resultat av konsultationer hos allmänläkare (Swedish)
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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1047
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-18483ISBN: 978‐91‐7393‐968‐3 OAI: oai:DiVA.org:liu-18483DiVA: diva2:219802
Public defence
2009-06-04, Aulan, Hälsans Hus, ingång 16, Campus US, Linköpings Universitet , Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-06-10Bibliographically approved
List of papers
1. Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study
Open this publication in new window or tab >>Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study
2005 (English)In: BMC family practice, ISSN 1471-2296, Vol. 6, no 43Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Evaluation of outcome in general practice can be seen from different viewpoints. In this study we focus on the concepts patients use to describe the outcome of a consultation with a GP.

METHOD: Patients were interviewed within a week after a consultation with a GP. The interviews were made with 20 patients in 5 focus groups and 8 individually. They were analysed with a phenomenographic research approach.

RESULTS: From the patient's perspective, the outcome of a consultation is about cure or symptom relief, understanding, confirmation, reassurance, change in self-perception and satisfaction.

CONCLUSION: General practice consultations are often more important for patients than generally supposed. Understanding is the most basic concept.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18478 (URN)10.1186/1471-2296-6-43 (DOI)16242048 (PubMedID)
Note
Original Publication: Annika Andén, Sven-Olof Andersson and Carl-Edvard Rudebeck, Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study, 2005, BMC family practice, (6), 43. http://dx.doi.org/10.1186/1471-2296-6-43 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-10-30Bibliographically approved
2. To make a difference - how GPs conceive consultation outcomes: A phenomenographic study
Open this publication in new window or tab >>To make a difference - how GPs conceive consultation outcomes: A phenomenographic study
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16883 (URN)10.1186/1471-2296-10-4 (DOI)
Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2014-01-10Bibliographically approved
3. What happened? GPs' perceptions of consultation outcomes and a comparison with the experiences of their patients
Open this publication in new window or tab >>What happened? GPs' perceptions of consultation outcomes and a comparison with the experiences of their patients
2010 (English)In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 16, no 2, 80-84 p.Article in journal (Other academic) Published
Abstract [en]

Objective: To investigate GPs’ perceptions of consultation outcomes and to investigate the associations between these and outcomes perceived by the patients. Design: 25 GPs and 10 patients for each GP filled in a questionnaire about the outcome of the same consultation. The questions in the questionnaires were formulated from concepts found in preceding qualitative studies. Their answers were analysed and compared. Setting: GPs and patients from 16 group practices in Norrbotten, Sweden. Results: The GPs had the apprehension that their consultations would lead to cure/symptom relief in half of their consultations. They believed that their patients were satisfied up to 90% and that up to 75% had been reassured, understood more or could cope better. The GPs were satisfied themselves with up to 95% of the consultations, they enhanced their relationship to their patient up to 70%. Their affirmative concordance with their patients was high regarding satisfaction, intermediate regarding patient reassurance and patient understanding and lowest regarding cure/symptom relief.

Conclusion: The GPs’ were lacking in their ability to assess the patients’ increased understanding and the concordance between their own and the patients’ expectation of cure/symptom relief was low.

Keyword
Family Practice, Outcome, Outcome Assessment, Consultation, General Practitioner
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18480 (URN)10.3109/13814780903528587 (DOI)20100110 (PubMedID)
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2010-06-03Bibliographically approved
4. Clinical Strategies in General Practice: GPs' Perceptions
Open this publication in new window or tab >>Clinical Strategies in General Practice: GPs' Perceptions
2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Background: General practice operates at the point of intersection between health care as a medical-technological and a humanistic enterprise, as manifested through the coherent attention given to both the patient as a person and to the disease.

Objective: To analyse the problem-solving strategies of GPs with regard to problems encountered and presumed patient outcomes throughout the range of problems and patients encountered in the everyday work of the GP.

Methods: Sixteen GPs from different areas of Sweden filled out questionnaires concerning 15-30 of their recent consecutive consultations.

Results: In 94% of the consultations a somatic problem was registered, in 28% of these together with a psychosocial problem. Only a small fraction (5.8%) was registered as psychosocial problems only. In most of the consultations characterised as somatic, the main emphasis was on the symptoms only, whereas emphasis was given only to the person in consultations where the problem was registered as psychosocial. Immediate problem solving was used in about half of the consultations, where the patients were more often considered to be reassured, cope better and to be satisfied. With increasing psychosocial content of the consultations, the GPs registered more dissatisfaction, both for themselves and their patients.

Limitations: The GPs were not randomly selected and the results are based solely on the GPs perceptions.

Conclusions: 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. This might be regarded as the quintessence of the expert skill of the experienced GP.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18481 (URN)
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-08-17Bibliographically approved

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