BMJ 2002;325:472 ( 31 August )

Primary care

Consultation length in general practice: cross sectional study in six European countries

Myriam Deveugele, psychologist, ^a Anselm Derese, professor, ^a Atie van den Brink-Muinen, senior researcher, ^b Jozien Bensing, professor, ^b Jan De Maeseneer, professor. ^a

^a Department of General Practice and Primary Health Care, Ghent University, B 9000 Ghent, Belgium, ^b Netherlands Institute of Primary Health Care (NIVEL), Postbus 1568 BN Utrecht, Netherlands

Correspondence to: M Deveugele myriam.deveugele{at}rug.ac.be

Objectives: To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors' and patients' perceptions of psychosocial aspects.
Design: Analysis of videotaped consultations of general practitioners from the Eurocommunication study and of questionnaires completed by doctors and by patients.
Setting: General practices in six European countries.
Participants: 190 general practitioners and 3674 patients.
Results: In a multilevel analysis with three levels (country, general practitioner, and patient), country and doctor variables contributed a similar amount to the total variance in consultation length (23% and 22%, respectively) and patient variables accounted for 55% of the variance. The variables used in the multilevel analysis explained 25% of the total variation. The country in which the doctor practised, combined with the doctors' variables, was as important for the variance in consultation length as the variation between patients. Consultations in which psychosocial problems were considered important by the doctor and the patient lasted longer than consultations about biomedical problems only. The doctor's perception had more influence in this situation than the patient's. Consultation length is influenced by the patients' sex (women got longer consultations), whether the practice was urban or rural, the number of new problems discussed in the consultation (the more problems the longer the consultation), and the patient's age (the older the patient the longer the consultation). As a doctor's workload increased, the length of consultations decreased. The general practitioner's sex or age and patient's level of education were not related to the length of consultation.
Conclusion: Consultation length is determined by variables related to the doctor and the doctor's country as well as by those related to patients. Women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.

What is already known on this topic Patients are satisfied with care from general practice but often say that consultations are too short Studies have investigated the determinants of consultation length, but different studies use different methods to determine the exact length of consultation Determinants identified by studies in one country cannot be extrapolated to those in another What this study adds Consultation length varies from country to country Characteristics of patients have as much effect on consultation length as the characteristics of countries and doctors combined Consultations are longest for women patients seeing general practitioners in urban practices about problems that doctor and patient perceive as psychosocial

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