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.


CONCLUSIONS
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.
van Berkestijn
L G
LG
Department of General Practice/Family Medicine, Utrecht University, The Netherlands.
Kastein
M R
MR
Lodder
A
A
de Melker
R A
RA
Bartelink
M L
ML
D015746:Abdominal Pain / Q000175:diagnosis / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002983:Clinical Competence; D003625:Data Collection; D005194:Family Practice / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D012494:Sampling Studies; D012680:Sensitivity and Specificity