Deprivation, psychological distress, and consultation length in general practice.
BACKGROUND
Recent research has shown the benefits of longer consultations in general practice. Approximately 40% of patients presenting to general practitioners (GPs) are psychologically distressed. Studies have shown that psychological morbidity increases with increasing socioeconomic deprivation. The combined effects of psychological morbidity and socioeconomic deprivation on consultation length are unknown. In addition, though it is known that doctors correctly identify half their distressed patients as such, the effect of consultation length on identification is unknown.


OBJECTIVE
To examine factors associated with presentation and recognition of psychological distress in GPs' surgeries and the interaction of these factors with consultation length.


METHODS
A cross-sectional study.


METHODS
Nine general practices in the West of Scotland, involving 1075 consultations of 21 full-time GPs.


METHODS
The main outcome measures were patient psychological distress (measured by General Health Questionnaire-12), doctors' identification of psychological distress, consultation length, and Carstairs deprivation category scores.


RESULTS
The mean consultation length was 8.71 minutes (SD = 4.40) and the prevalence of positive GHQ scores was 44.7%. Increasing GHQ (greater psychological distress) and lower deprivation category scores (greater affluence) were associated with longer consultations. Positive GHQ scoring increased with greater socioeconomic deprivation and also peaked in the 30 to 39 years age group. Recognition of psychological distress was greater in longer consultations (50% increase in consultation length associated with 32% increase in recognition).


CONCLUSIONS
Increasing socioeconomic deprivation is associated with higher prevalence of psychological distress and shorter consultations. This provides further evidence to support Tudor Hart's 'inverse care law' and has implications for the resourcing of primary care in deprived areas.
Stirling
A M
AM
Department of General Practice, University of Glasgow, 4 Lancaster Crescent, Glasgow G12 0RR.
Wilson
P
P
McConnachie
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011204:Poverty Areas; D011364:Professional Practice / Q000458:organization & administration; D012606:Scotland; D013315:Stress, Psychological / Q000175:diagnosis*; D013997:Time Factors