Do better quality consultations result in better health? Relationship between quality of consultations and health status of patients with non-acute abdominal complaints in general practice.

BACKGROUND: In theory, a positive relationship is expected between the quality of a consultation and a patient's subsequent health status. However, such a relationship has not yet been firmly established in daily practice. OBJECTIVE: We aimed to study the relationship between the quality of the first consultation in a new episode of non-acute abdominal complaints and subsequent health status of patients in general practice. METHODS: Quality scores for 743 consultations were calculated on the basis of review criteria developed by expert panels. Functional health status was measured by the SIP (Sickness Impact Profile) at baseline, and at 1 and 6 months after the consultation. Multilevel regression analysis was used to examine the relationship between the quality of consultations and health status, and to identify factors of influence on this relationship. RESULTS: In the majority of these patients (97%) health status improved regardless of consultation quality. In patients with malignant disease, and chronic colitis, however, an association between consultation quality and subsequent health status was found: in those with a high consultation quality score (>66-percentile) the health status deteriorated in the first month but improved over the following 5 months; in those with a low consultation quality score (<33-percentile) it deteriorated continuously. CONCLUSION: For the great majority of patients we found no relation between the quality of consultation and health status. However, for a very small subgroup of patients there is proof of benefit from better quality consultations.

How do we compare with our colleagues? Quality of general practitioner performance in consultations for non-acute abdominal complaints.

OBJECTIVE: To investigate what factors influence the quality of general practitioner performance in consultations for non-acute abdominal complaints and to establish the extent to which performance quality differs between general practitioners (GPs). DESIGN: Explorative study in two parts: (i) detection of variables influencing quality scores of consultations; and (ii) comparison of mean quality scores of the consultations, selected by each GP. SETTING: Sixty-two family practices across The Netherlands. SUBJECTS: Eight-hundred and forty consultations concerning non-acute abdominal complaints, first encounters; 62 GPs. METHOD: Multilevel analysis was carried out to detect factors that influence quality. After correction for the effect of significant factors the mean quality scores of individual GPs were calculated and compared. RESULTS: Eighty-eight per cent of the total variance in quality scores was located at the consultation/patient level, and 12% at the GP level. One consultation characteristic had significant influence on quality: quality scores were higher in consultations of longer than average duration (>15 minutes). Several patient characteristics were of significant influence. Consultation quality scores were higher in consultations for patients with upper abdominal or non-specific abdominal complaints. Quality scores were lower in consultations with female patients and with patients aged >40 years. Together these characteristics explained 20% of the variance at the GP level. None of the GP characteristics investigated in this study appeared to have significant influence on the quality of their performance. After correction of the scores for the effect of significant factors the differences in performance quality between GPs remained significant. CONCLUSIONS: Quality of performance is far more influenced by consultation and patient characteristics than by GP characteristics. After correction for influencing factors, the mean quality scores of GPs still differed considerably and significantly. For many GPs the quality scores varied substantially between different consultations; to a large extent this variation remained unexplained. Consultation quality can be improved by booking more time per patient and by giving more medical/technical attention to female and older patients.

How well are patients treated in family practice? Quality of consultations for non-acute abdominal complaints.

OBJECTIVE: To describe the application of weighted review criteria, developed by the Delphi technique, for the assessment of the quality of consultations concerning non-acute, abdominal complaints. DESIGN: Descriptive study in two parts: (i) comparison of actual family doctor (FD)-performance with predefined review criteria; (ii) calculation of quality scores per consultation, utilizing the weighted criteria. SETTINGS: Sixty-two family practices across The Netherlands. SUBJECT: Eight-hundred and forty consultations concerning non-acute abdominal complaints, first encounters. MAIN OUTCOME MEASURES: The percentage of consultations in which each criterion was met; quality scores per consultation and their distribution. RESULTS: (i) Little effort was made to trace risk groups for gastrointestinal malignancies (< 50% of the consultations concerned); medication was often described without dietary advice (17%); inappropriate activities were not carried out on a large scale (6%). (ii) Quality scores were normally distributed. CONCLUSIONS: The Delphi technique yields a useful instrument for assessment of the quality of consultations. The review criteria for quality assessment of FD performance used in this study made it possible to distinguish quite clearly between high- and low-quality consultations. Some important deficiencies in daily practice emerged.