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Primary Care

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

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.37999.716157.44 (Published 19 February 2004) Cite this as: BMJ 2004;328:441
  1. Paul Little, professor of primary care research (psl3{at}soton.ac.uk)1,
  2. Martina Dorward, research nurse1,
  3. Greg Warner, general practitioner2,
  4. Michael Moore, general practitioner3,
  5. Katharine Stephens, medical student1,
  6. Jane Senior, medical student1,
  7. Tony Kendrick, professor1
  1. 1Primary Medical Care, Community Clinical Sciences Division, Southampton University, Aldermoor Health Centre, Southampton SO16 5ST
  2. 2Nightingale Surgery, Romsey SO51 7QN
  3. 3Three Swans Surgery, Salisbury SP1 1DX
  1. Correspondence to: P Little
  • Accepted 10 December 2003

Abstract

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, Rerral, 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 Rerral, 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 pRerence (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.

Footnotes

  • Contributors PL had the original idea for the study which was developed by all authors. MD, JS, and KS ran the study on a day to day basis, and with PL analysed the results. All authors contributed to writing the paper. PL will act as guarantor for the paper. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Southampton University

  • Competing interests None declared. JS can no longer be contacted but PL states she has no competing interests.

  • Ethical approval Salisbury and Southampton and South West Hants ethics committees.

  • Accepted 10 December 2003
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