BMJ, 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

Paul Little 1, Martina Dorward 1, Greg Warner 2, Michael Moore 3, Katharine Stephens 1, Jane Senior 1, Tony Kendrick 1

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.

(Accepted 10 December 2003)
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