title: Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations.
abstract: OBJECTIVE
  To measure patients' perceptions of patient centredness and the relation of these perceptions to outcomes.
  
  
  METHODS
  Observational study using questionnaires.
  
  
  METHODS
  Three general practices.
  
  
  METHODS
  865 consecutive patients attending the practices.
  
  
  METHODS
  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 alpha=0.96); personal relationship (a doctor who knows the patient and their emotional needs, alpha=0.89); health promotion (alpha=0.87); positive approach (being definite about the problem and when it would settle, alpha=0.84); and interest in effect on patient's life (alpha=0.89). Satisfaction was related to communication and partnership (adjusted beta=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 (beta=-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.
authors.affiliation: Primary Medical Care Group, Community Clinical Sciences Division, Faculty of Medicine, Southhampton University, Southampton SO165ST. psl3@soton.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Little
authors.forename: H
authors.initials: H
authors.lastname: Everitt
authors.forename: I
authors.initials: I
authors.lastname: Williamson
authors.forename: G
authors.initials: G
authors.lastname: Warner
authors.forename: M
authors.initials: M
authors.lastname: Moore
authors.forename: C
authors.initials: C
authors.lastname: Gould
authors.forename: K
authors.initials: K
authors.lastname: Ferrier
authors.forename: S
authors.initials: S
authors.lastname: Payne
mesh_terms: D003142:Communication; D005194:Family Practice / Q000592:standards*; D006293:Health Promotion; D006801:Humans; D019370:Observation; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D016896:Treatment Outcome