RESUMO
Background: Use of telephone, video and e-consultations is increasing. These can make consultations more transactional, potentially missing patients' concerns. This study aimed to develop a complex intervention to address patients' concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework.The complex intervention used two technologies: a patient-completed pre-consultation form used at consultation opening and a doctor-provided summary report provided at consultation closure. This paper reports on the development and realist evaluation of the pre-consultation questionnaire. Methods: A person-based approach was used to develop the pre-consultation form. An online questionnaire system was designed to allow patient self-completion of a form which could be shared with GPs. This was tested with 45 patients in three rounds, with iterative adjustments made based on feedback after each round.Subsequently, an intervention incorporating the pre-consultation form with the summary report was then tested in a cluster-randomised framework with 30 patients per practice in six practices: four randomised to intervention, and two to control. An embedded realist evaluation was carried out. The main feasibility study results are reported elsewhere. Results: Intervention Development: 15 patients were recruited per practice. Twelve patients, six GPs and three administrators were interviewed and 32 changes were made iteratively in three rounds. Recruitment rates (proportion of patients responding to the text) increased from 15% in round one to 50% in round three.Realist evaluation: The pre-consultation form was most useful for people comfortable with technology and with hidden concerns or anxiety about the consultation. It resulted in more issues being discussed and support provided, more effective use of time and greater patient satisfaction. Conclusions: The person-based approach was successful. The pre-consultation form uncovers more depth and improves satisfaction in certain consultations and patients. Technological improvements are required before this could be rolled out more widely.
THE PROBLEM: For some patients, GP consultations are too short. Sometimes patients' problems are missed. We wanted to improve GP consultations. What we did: We developed a better way to start and end consultations using a new digital method. Before a GP consultation, patients fill in a form online that lets them describe their problems. This is shared with their GP. At the end of the consultation GPs can give patients a one-page summary of what was discussed. This paper reports on how we developed and tested the online pre-consultation form. How we tested it: We first piloted the online form in three GP practices in turn. We interviewed patients, GPs and an administrator in each practice and made changes based on their suggestions. Each new version was tested in a new practice. We then tested the final online form together with the one-page summary in four practices with 30 patients each. We interviewed patients and GPs to find who it was most useful for and when. What we found: GPs and patients agreed the final version of the online form was much better than the first version. The percentage of patients who filled in a form after getting a text message increased from 15% in practice 1 to 50% in practice 3. By testing the final form in four practices, we found it worked best for people who find technology easy to use and have hidden concerns or worries about the consultation. These patients found their GP was better prepared and problems were dealt with better. GPs thought consultations were more efficient. CONCLUSIONS: The approach we took was very successful in developing the online form and patients and GPs found it useful. The technology would need to be improved before it could be rolled out more widely.
