BMJ 1994;309:1483-1485 (3 December)

General practice

Comparison of patient questionnaire, medical record, and audio tape in assessment of health promotion in general practice consultations

Andrew Wilson, senior lecturer in general practice,a Paul McDonald, research associate b

a Department of General Practice, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, b Department of General Practice, University of Nottingham, Nottingham

Correspondence to: Dr Wilson.

Abstract

Objective: To determine what proportion of health promotion activities reported by the patient is recorded in the general practice notes and to compare these methods of assessing health promotion with audio tape analysis.
Design: Secondary analysis of data obtained in a controlled trial of differing appointment lengths. After each consultation the medical record was examined and the patient invited to completed a questionnaire. A subsample of consultations was audio taped.
Setting: Nottinghamshire. Subjects--16 general practitioners from 10 practices. This report includes 3324 consultations with patients aged >/=17, with data on measurement of blood pressure and advice about smoking and alcohol.
Results: Data from questionnaire and medical notes were available for 2281 consultations. Advice on smoking was recorded in the notes in 30.9% of cases in which a patient reported it (for alcohol and measurement of blood pressure, 44.4% and 82.7% of cases respectively). In 516 cases analysis of audio tape and review of records was performed. Advice on smoking was recorded in the patient's notes in 28.6% of cases in which it was detected on audio tape (for alcohol, 31.1% of cases). In 335 consultations data from audio tape and questionnaire were available. Advice on smoking was reported by patients in 73.9% of cases in which it was detected on audio tape (for alcohol, 75.0% of cases).
Conclusions: Review of the medical record is a reasonably accurate method of assessing measureent of blood pressure in the consultation but would lead to significant underestimation of advice about smoking and alcohol.

Practice implications

  • Practice implications

  • Assessment of health promotion in general practice is needed for research, audit, and contractual reasons

  • The accepted "gold standard" for measurement is audio tape or video tape analysis; less labour intensive methods include review of records and patient questionnaires

  • Medical records seriously underestimate the occasions on which advice on lifestyle is given but are reasonably accurate for the measurement of blood pressure

  • Questionnaires completed by patients after consultation overestimate health promotion activity

  • Changes in ascertainment of lifestyle information since the new contract may reflect changing recording practices rather than increased health promotion activity


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