Preferences of patients for patient centred approach to consultation in primary care: observational study

Objective: To identify patient's preferences for patient centred consultation in general practice. Design: Questionnaire study. Setting: Consecutive patients in the waiting room of three doctors' surgeries. Main outcome measures: Key domains of patient centredness from the patient perspective. Predictors of preferences for patient centredness, a prescription, and examination. Results: 865 patients participated: 824 (95%) returned the pre-consultation questionnaire and were similar in demographic characteristic to national samples. Factor analysis identified three domains of patient preferences: communication (agreed with by 88-99%), partnership (77-87%), and health promotion (85-89%). Fewer wanted an examination (63%), and only a quarter wanted a prescription. As desire for a prescription was modestly associated with desire for good communication (odds ratio 1.20; 95% confidence interval 0.85 to 1.69), partnership (1.46; 1.01 to 2.09), and health promotion (1.61; 1.12 to 2.31) this study may have underestimated preferences for patient centredness compared with populations with stronger preferences for a prescription. Patients who strongly wanted good communication were more likely to feel unwell (very, moderately, and slightly unwell; odds ratios 1, 0.56, 0.39 respectively, z trend P<0.001), be high attenders (1.70; 1.18 to 2.44), and have no paid work (1.84; 1.21 to 2.79). Strongly wanting partnership was also related to feeling unwell, worrying about the problem, high attendance, and no paid work; and health promotion to high attendance and worry. Conclusion: Patients in primary care strongly want a patient centred approach, with communication, partnership, and health promotion. Doctors should be sensitive to patients who have a strong preference for patient centredness-those vulnerable either psychosocially or because they are feeling unwell

Influence of the duration of penicillin prescriptions on outcomes for acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice.

Background Guidelines recommend prolonged treatment courses for acute sore throat but shorter courses may be used in practice. Aim To determine whether antibiotic duration and class predicts adverse outcome of acute sore throat in adults in routine care. Design and setting A secondary analysis of a prospective cohort study of 14610 adults presenting with acute sore throat in primary care. Methods A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review and in a sample a symptom diary. Primary outcome: Re-consultation with new/non-resolving symptoms within 1 month. Secondary outcome ‘global’ poorer symptom control (longer than the median duration or higher than median severity). Results Antibiotics were prescribed for 60% (8572/14610) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were 5 (20%), 7 (57%), or 10 (22%) days.. Compared with 5 day courses those receiving longer courses were less likely to re-consult with new or worsening symptoms 5 days 15.3%, 7 days 13.9%, 10 days 12.2%, (7 day course adjusted risk ratio 0·92 (0·76, 1·11) and 10 days 0·86 (0·59, 1·23)) but this difference did not reach statistical significance. Conclusions In adults prescribed antibiotics for sore throat, we cannot rule out a small advantage in terms of reduced re-consultation for a 10 day course of penicillin but that effect is likely to be small.</p