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Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7167.1202 (Published 31 October 1998) Cite this as: BMJ 1998;317:1202

Rapid Response:

Trial did not measure patient-centredness

Kinmonth et al should not claim that their study "shows the power of
a consultation to affect patients' health and well being"(1). They robustly
-evaluated some of the outcomes of training health professionals in
patient-centred clinical method, but failed to measure the patient-
centredness of general practitioners' or nurses' consulting behaviour.
Consequently, we have no idea whether training actually resulted in
clinicians providing more patient-centred care. The study provides, at
best, circumstantial evidence about the influence of patient-centred
clinical method on clinical outcomes.

Before we can accurately investigate the effects of patient-centred
care, we need reliable instruments for measuring the relevant aspects of
doctor: patient communication(2). Although a number of communication coding
systems exist(3), few have been validated adequately for their intended
uses(3). One of these research tools was designed to measure clinicians'
patient-centredness(4) and there is some evidence for its reliability(4) and
validity(5). Further development of this research instrument will inform us
of its strengths and weaknesses for measuring clinicians' patient-
centredness in routine primary care consultations. This would enable
those investigating the effects of patient-centred care to use it to
monitor doctor: patient communication appropriately. Although this is
methodologically challenging and likely to be costly, it could ultimately
lead to trials providing more relevant information. If Kinmonth et al had
used this approach, they would, perhaps, have produced hard evidence to
relate their unexpected findings to clinicians' consulting behaviours.

Yours faithfully,

Tim Coleman,
Clinical Lecturer

References

1 Kinmonth AL, Woodcock A, Griffin S, Spiegal N, Campbell MJ.
Randomised controlled trial of patient centred care of diabetes in general
practice: impact on current wellbeing and future disease risk. BMJ
1998;317:1202-1208.

2 Inui TS, Carter WB. Problems and prospects for health services
research on provider-patient communication. Medical Care 1985;23:521-538.

3 Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient
communication: a review of the literature. Social Science & Medicine
1995;40:903-918.

4 Henbest RJ, Stewart MA. Patient-centredness in the consultation.
1: A method for measurement. Family Practice 1989;6:249-253.

5 Henbest RJ, Stewart M. Patient-centredness in the consultation. 2:
Does it really make a difference? Family Practice 1990;7:28-33.

Competing interests: No competing interests

09 November 1998
Tim Coleman
clinical lecturer in general practice
dept of general practice and primary health care , Unuiversity of leicester