BMJ  2004;328:441 (21 February), doi:10.1136/bmj.37999.716157.44 (published 13 February 2004)

Primary care

Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care

¹ Primary Medical Care, Community Clinical Sciences Division, Southampton University, Aldermoor Health Centre, Southampton SO16 5ST, ² Nightingale Surgery, Romsey SO51 7QN, ³ Three Swans Surgery, Salisbury SP1 1DX

Objective To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation.

Design Randomised controlled trial.

Setting Five general practices in three settings in the United Kingdom.

Participants 636 consecutive patients, aged 16-80 years, randomised to receive a general leaflet, a depression leaflet, both, or neither.

Main outcomes Mean item score on the medical interview satisfaction scale, consultation time, prescribing, referral, and investigation.

Results The general leaflet increased patient satisfaction and was more effective with shorter consultations (leaflet 0.64, 95% confidence interval 0.19 to 1.08; time 0.31, 0.0 to 0.06; interaction between both -0.045, -0.08 to—0.009), with similar results for subscales related to the different aspects of communication. Thus for a 10 minute consultation the leaflet increased satisfaction by 7% (seven centile points) and for a five minute consultation by 14%. The leaflet overall caused a small non-significant increase in consultation time (0.36 minutes, -0.54 to 1.26). Although there was no change in prescribing or referral, a general leaflet increased the numbers of investigations (odds ratio 1.43, 1.00 to 2.05), which persisted when controlling for the major potential confounders of perceived medical need and patient preference (1.87, 1.10 to 3.19). Most of excess investigations were not thought strongly needed by the doctor or the patient. The depression leaflet had no significant effect on any outcome.

Conclusions Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication, particularly in short consultations. Doctors do, however, need to elicit expectations to prevent needless investigations.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Patient agendas in primary care

William Hamilton and Nicky Britten
BMJ 2006 332: 1225-1226. [Extract] [Full Text] [PDF]

Activation leaflets may improve patients' satisfaction...
BMJ 2004 328: 0. [Full Text]

Patients' expectations of consultations

Nicky Britten
BMJ 2004 328: 416-417. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Davis, R E, Koutantji, M, Vincent, C A (2008). How willing are patients to question healthcare staff on issues related to the quality and safety of their healthcare? An exploratory study. Qual Saf Health Care 17: 90-96 [Abstract] [Full text]  
• Hamilton, W., Russell, D., Stabb, C., Seamark, D., Campion-Smith, C., Britten, N. (2007). The effect of patient self-completion agenda forms on prescribing and adherence in general practice: a randomized controlled trial. Fam Pract 24: 77-83 [Abstract] [Full text]  
• Hamilton, W., Britten, N. (2006). Patient agendas in primary care.. BMJ 332: 1225-1226 [Full text]  
• Geest, T. A., Wetzels, R., Raposo, V., Lopes Ferreira, P., Baker, R., Wensing, M., Olesen, F., on behalf of the Improve Research Group, (2005). Elderly patients' and GPs' views on different methods for patient involvement: an international qualitative interview study. Fam Pract 22: 184-191 [Abstract] [Full text]  
• Williams, N., Ogden, J. (2004). The impact of matching the patient's vocabulary: a randomized control trial. Fam Pract 21: 630-635 [Abstract] [Full text]  
• (2004). Empowering Patients. Journal Watch Cardiology 2004: 5-5 [Full text]  
• (2004). Empowering Patients. JWatch General 2004: 6-6 [Full text]  
• Britten, N. (2004). Patients' expectations of consultations. BMJ 328: 416-417 [Full text]  

Rapid Responses:

Read all Rapid Responses

Clinical effects of depression

Justine M H Carr-Brion
bmj.com, 24 Feb 2004 [Full text]

Were doctors "activated" or could patients have been better "activated"?

Robbie C Foy, et al.
bmj.com, 27 Feb 2004 [Full text]

Show doctors what patients have written down

Thomas P E Wells, et al.
bmj.com, 28 Feb 2004 [Full text]