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The authors have provided a commendable amount of detail about their
methods and I am persuaded that the conclusions are valid.
How then should this guide our practice? We need an estimate of the
costs and benefits.
The costs of the communication training are significant.
- A simulated consultation at the GP's place of work, which is
audiotaped and transcribed
- A seminar in a very small group (5-8) lasting around 1/3 of a day
- A subsequent simulated consultation in the workplace, with a more
complex process of transcription, review and feedback
My estimate is that a commercial organisation would need to charge
around £400 per head for this package - and that is with some heroic
assumptions about scheduling and organisation.
The ongoing costs arent mentioned. An obvious one would be
consultation length, which might "leak" into non-cough consultations. I
would speculate that the training might lengthen subsequent consultations
- but it may not (and might even shorten them). This is an important cost
and is worth knowing.
The CRP intervention is much cheaper up front (a half-hour seminar
for larger numbers). £20 per head should cover it. CRP testing has ongoing
The reconsultation rate in both cases is similar over 28 days. Of
course, if one or both of these approaches leads to a lessening of the
propensity to consult with acute cough (and if it proves safe) then this
would be a potentially large saving.
The bottom line is that I cannot imagine many commissioners being
prepared to invest in this communication intervention, despite its being
an excellent process and with the benefits demonstrated in this study.
I conculde that we may need a cheaper, more feasible intervention
showing comparable evidence of effectiveness, or else better data to
convince commissioners that the outcomes justify the cost of investment.
Director of Effective Professional Interactions Ltd
No competing interests
11 May 2009
Malcolm I Thomas
Hilltop, Pottery Bank, Morpeth, Northumberland, NE61 1SH