title: Quality at general practice consultations: cross sectional survey.
abstract: OBJECTIVE
  To measure quality of care at general practice consultations in diverse geographical areas, and to determine the principal correlates associated with enablement as an outcome measure.
  
  
  METHODS
  Cross sectional multipractice questionnaire based study.
  
  
  METHODS
  Random sample of practices in four participating regions: Lothian, Coventry, Oxfordshire, and west London.
  
  
  METHODS
  25 994 adults attending 53 practices over two weeks in March and April 1998.
  
  
  METHODS
  Patient enablement, duration of consultation, how well patients know their doctor, and the size of the practice list.
  
  
  RESULTS
  A hierarchy of needs or reasons for consultation was created. Similar overall enablement scores were achieved for most casemix presentations (mean 3.1, 95% confidence interval 3.1 to 3.1). Mean duration of consultation for all patients was 8.0 minutes (8.0 to 8.1); however, duration of consultation increased for patients with psychological problems or where psychological and social problems coexisted (mean 9.1, 9.0 to 9.2). The 2195 patients who spoke languages other than English at home were analysed separately as they had generally higher enablement scores (mean 4.5, 4.3 to 4.7) than those patients who spoke English only despite having shorter consultations (mean 7.1 (6. 9 to 7.3) minutes. At individual consultations, enablement score was most closely correlated with duration of consultation and knowing the doctor well. Individual doctors had a wide range of mean enablement scores (1.1-5.3) and mean durations of consultation (3. 8-14.4 minutes). Doctors' ability to enable was linked to the duration of their consultation and the percentage of their patients who knew them well and was inversely related to the size of their practice. At practice level, mean enablement scores ranged from 2.3 to 4.4, and duration of consultation ranged from 4.9 to 12.2 minutes. Correlations between ranks at practice level were not significant.
  
  
  CONCLUSIONS
  It may be time to reward doctors who have longer consultations, provide greater continuity of care, and both enable more patients and enable patients more.
authors.affiliation: Department of Community Health Sciences-General Practice, University of Edinburgh, Edinburgh EH8 9DX. John.Howie@ed.ac.uk
authors.forename: J G
authors.initials: JG
authors.lastname: Howie
authors.forename: D J
authors.initials: DJ
authors.lastname: Heaney
authors.forename: M
authors.initials: M
authors.lastname: Maxwell
authors.forename: J J
authors.initials: JJ
authors.lastname: Walker
authors.forename: G K
authors.initials: GK
authors.lastname: Freeman
authors.forename: H
authors.initials: H
authors.lastname: Rai
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000592:standards*; D012044:Regression Analysis; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D006113:United Kingdom