Developing a longitudinal database of routinely recorded primary care consultations linked to service use and outcome data.
The primary care consultation provides access to the majority of health care services and is central to obtaining diagnoses, treatment and ongoing management of long-term conditions. This paper reports the findings of an interdisciplinary feasibility study to explore the benefits and practical, technical and ethical challenges (and solutions) of creating a longitudinal database of recorded GP consultations in Tayside, Scotland which could be linked to existing routine data on intermediate and long-term health outcomes. After consultation we attempted to recruit and audio-record the consultations of all patients attending three general practices over a two week period. Background patient data, and patient and staff experiences of participation were also collected. Eventually, two practices participated with 77% of patients approached agreeing to participate. The findings suggest that the perceived integrity of the consultation was preserved. The overwhelming majority of patients believed that recording was worthwhile and did not feel it impacted on communication or the treatment they received; 93% indicated they would be willing to have subsequent consultations recorded and 81% would recommend participation to a friend. Staff had similar beliefs but raised concerns about potential increases in workload, confidentiality issues and ease of software use. We conclude that practice participation could be increased by providing safeguards on data use, financial reward, integrated recording software, and procedures to lessen the impact on workload. The resulting Scottish Clinical Interactions Project (SCIP) would provide the largest and most detailed longitudinal insight into real world medical consultations in the world, permitting the linking of consultation events and practices to subsequent outcomes and behaviours.
Williams
Brian
B
Centre for Population Sciences & Education, Ninewells Hospital & Medical School, University of Dundee, United Kingdom. Electronic address: b.y.williams@cpse.dundee.ac.uk.
Dowell
Jon
J
Centre for Population Sciences & Education, Ninewells Hospital & Medical School, University of Dundee, United Kingdom.
Humphris
Gerry
G
Bute Medical School, University of St Andrews, United Kingdom.
Themessl-Huber
Markus
M
School of Nursing & Midwifery, University of Dundee, United Kingdom.
Rushmer
Rosemary
R
Department of Management, University of St Andrews, United Kingdom.
Ricketts
Ian
I
School of Computing, University of Dundee, United Kingdom.
Boyle
Paul
P
School of Geography & Geosciences, University of St Andrews, United Kingdom.
Sullivan
Frank
F
Centre for Population Sciences & Education, Ninewells Hospital & Medical School, University of Dundee, United Kingdom.
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D019992:Databases as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods*; D012606:Scotland; D011795:Surveys and Questionnaires; D013637:Tape Recording