BMJ 2001;323:908-911 ( 20 October )

Primary care

Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations

Paul Little, Medical Research Council clinician scientist, a Hazel Everitt, Medical Research Council training fellow, a Ian Williamson, senior lecturer, a Greg Warner, general practitioner, b Michael Moore, general practitioner, c Clare Gould, research assistant, a Kate Ferrier, medical student, a Sheila Payne, professor. d

a Primary Medical Care Group, Community Clinical Sciences Division, Faculty of Medicine, Health and Biological Sciences, Southampton University, Aldermoor Health Centre, Southampton SO16 5ST, b Nightingale Surgery, Romsey, Hampshire SO51 7QM, c Three Swans Surgery, Salisbury, Wiltshire SP1 1DX, d Sheffield Palliative Care Studies Group, University of Sheffield, Sheffield S11 9NE

Correspondence to: P Little psl3{at}soton.ac.uk

Objective: To measure patients' perceptions of patient centredness and the relation of these perceptions to outcomes.
Design: Observational study using questionnaires.
Setting: Three general practices.
Participants: 865 consecutive patients attending the practices.
Main outcome measures: Patients' enablement, satisfaction, and burden of symptoms.
Results: Factor analysis identified five components. These were communication and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronbach's alpha =0.96); personal relationship (a doctor who knows the patient and their emotional needs, alpha =0.89); health promotion (alpha =0.87); positive approach (being definite about the problem and when it would settle, alpha =0.84); and interest in effect on patient's life (alpha =0.89). Satisfaction was related to communication and partnership (adjusted beta =19.1; 95% confidence interval 17.7 to 20.7) and a positive approach (4.28; 2.96 to 5.60). Enablement was greater with interest in the effect on life (0.55; 0.25 to 0.86), health promotion (0.57; 0.30 to 0.85), and a positive approach (0.82; 0.52 to 1.11). A positive approach was also associated with reduced symptom burden at one month (beta =-0.25; -0.41 to -0.10). Referrals were fewer if patients felt they had a personal relationship with their doctor (odds ratio 0.70; 0.54 to 0.90).
Conclusions: Components of patients' perceptions can be measured reliably and predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and higher rates of referral.


What is already known on this topic
Preliminary evidence suggests that patients' perceptions of patient centredness predict outcomes better than analysing what the doctor says in a consultation

What this study adds
There are five distinct components of patients' perceptions that can be measured reliably: communication and partnership, personal relationship, health promotion, positive approach to diagnosis and prognosis, and interest in the effect on life

Each component predicts different consultation outcomes

If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and use more health service resources



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