title: More time for complex consultations in a high-deprivation practice is associated with increased patient enablement.
abstract: BACKGROUND
  Evidence of the beneficial effects of longer consultations in general practice is limited.
  
  
  OBJECTIVE
  To evaluate the effect of increasing consultation length on patient enablement in general practice in an area of extreme socioeconomic deprivation.
  
  
  METHODS
  Longitudinal study using a 'before and after' design.
  
  
  METHODS
  Keppoch Medical Centre in Glasgow, which serves the most deprived practice area in Scotland.
  
  
  METHODS
  Participants were 300 adult patients at baseline, before the introduction of longer consultations, and 324 at follow-up, more than 1 year after the introduction of longer consultations. The intervention studied was more time in complex consultations. Patient satisfaction, perceptions of the GPs' empathy, GP stress, and patient enablement were collected by face-to-face interview. Additional qualitative data were obtained by individual interviews with the GPs, relating to their perceptions of the impact of the longer consultations.
  
  
  RESULTS
  Response rates of 70% were obtained. Overall, 53% of consultations were complex. GP stress was higher in complex consultations. Patient satisfaction and perception of the GPs' empathy were consistently high. Average consultation length in complex consultations was increased by 2.5 minutes by the intervention. GP stress in consultations was decreased after the introduction of longer consultations, and patient enablement was increased. GPs' views endorsed these findings, with more anticipatory and coordinated care being possible in the longer consultations.
  
  
  CONCLUSIONS
  More resource to provide more time in complex consultations in an area of extreme deprivation is associated with an increase in patient enablement.
authors.affiliation: General Practice and Primary Care, Division of Community-Based Sciences, University of Glasgow, Glasgow.stewmercer@blueyonder.co.uk
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
authors.forename: Bridie
authors.initials: B
authors.lastname: Fitzpatrick
authors.forename: Glen
authors.initials: G
authors.lastname: Gourlay
authors.forename: Gaby
authors.initials: G
authors.lastname: Vojt
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.forename: Graham C M
authors.initials: GC
authors.lastname: Watt
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D004645:Empathy; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011364:Professional Practice; D011610:Psychosocial Deprivation; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*; D015203:Reproducibility of Results; D012606:Scotland; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors