title: The Quality and Outcomes Framework and self-management dialogue in primary care consultations: a qualitative study.
abstract: BACKGROUND
  Two key elements to improve the quality of care for people with long-term conditions in primary care are improved clinical information systems to support delivery of evidence-based care, and enhanced self-management support. Although both elements are viewed as necessary, their interaction is not well understood.
  
  
  OBJECTIVE
  To explore the use of computer-based 'disease management' templates and their relevance to self-management dialogue within clinical encounters.
  
  
  METHODS
  Qualitative study of general practices located in three primary care trusts in the north of England.
  
  
  METHODS
  A qualitative mixed methods study was conducted that included comparative analysis of (1) observations of general practice consultations (n = 86); and (2) interviews with health professionals in general practice (n = 17).
  
  
  RESULTS
  The analysis suggested that use of the computer templates reinforced a checklist approach to consultations, which included professionals working through several self-management topics framed as discrete behaviours. As a consequence, conversation tended to become focused on the maintenance of the professional-patient relationship at the expense of expansion in self-management dialogue. The computer templates also shaped how patient-initiated self-management dialogue was managed when it arose, with a shift towards discussion around medical agendas.
  
  
  CONCLUSIONS
  In order to enhance the management of long-term conditions in primary care, the design and implementation of clinical information systems to improve evidence-based care need to take into account their potential impact on supporting self-management.
authors.affiliation: School of Community Based Medicine, Health Sciences, Primary Care Research Group, The University of Manchester, Manchester. tom.blakeman@manchester.ac.uk
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration* / Q000592:standards; D008490:Medical Informatics / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012648:Self Care; D013813:Therapy, Computer-Assisted / Q000458:organization & administration / Q000592:standards