http://bmj.com/cgi/content/abstract/323/7318/908

 

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Collections under which this article appears: Health Services Research Sociology Patient - caregiver communication (including Patient education) Patient - caregiver relationships Patients' views

BMJ 2001;323:908-911 ( 20 October )

Primary care

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

Paul Little, Medical Research Council clinician scientist, ^a Hazel Everitt, Medical Research Council training fellow, ^a Ian Williamson, senior lecturer, ^a Greg Warner, general practitioner, ^b Michael Moore, general practitioner, ^c Clare Gould, research assistant, ^a Kate Ferrier, medical student, ^a Sheila Payne, professor. ^d

^a Primary Medical Care Group, Community Clinical Sciences Division, Faculty of Medicine, Health and Biological Sciences, Southampton University, Aldermoor Health Centre, Southampton SO16 5ST, ^b Nightingale Surgery, Romsey, Hampshire SO51 7QM, ^c Three Swans Surgery, Salisbury, Wiltshire SP1 1DX, ^d Sheffield Palliative Care Studies Group, University of Sheffield, Sheffield S11 9NE

Correspondence to: P Little psl3@soton.ac.uk

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 =0.96); personal relationship (a doctor who knows the patient and their emotional needs, =0.89); health promotion (=0.87); positive approach (being definite about the problem and when it would settle, =0.84); and interest in effect on patient's life (=0.89). Satisfaction was related to communication and partnership (adjusted =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 (=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.

 

© BMJ 2001

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BMJ 2001 323: 0. [Full text]  

 

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