Caring against the clock:Overview of the evidence

Greg Irving

“7 minutes had become the summary statistic of the day”

Sir Denis Pereira Gray PRCGP 1998

Pereira Gray D. BJGP. 1998;48:1816–1817

Year 1997 2006 2008

Mean consultation length (mins) (DDRB)

9.37

Mean no consultation / year

(GHS)

5

Mean no. consultations (any

health professional) / year (NHS IC)

4.01

Mean number of consultations / year

(NHS IC)

2.92

Total time / year (GHS) (mins)

47

Total time /year (NHS IC) (mins)

27.8

DDRB: Doctors and Dentists Review BodyGHS: General Household Survey NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404

Year 1997 2006 2008

Mean consultation length (mins) (DDRB)

9.37 11.7

Mean no consultation / year

(GHS)

5 4

Mean no. consultations (any

health professional) / year (NHS IC)

4.01 5.22

Mean number of consultations / year

(NHS IC)

2.92 3.23

Total time / year (GHS) (mins)

47 47

Total time /year (NHS IC) (mins)

27.8 37.8

DDRB: Doctors and Dentists Review BodyGHS: General Household Survey NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404

Year 1997 2006 2008

Mean consultation length (mins) (DDRB)

9.37 11.7 -

Mean no consultation / year

(GHS)

5 4 -

Mean no. consultations (any

health professional) / year (NHS IC)

4.01 5.22 5.5

Mean number of consultations / year

(NHS IC)

2.92 3.23 3.4

Total time / year (GHS) (mins)

47 47 -

Total time /year (NHS IC) (mins)

27.8 37.8 -

DDRB: Doctors and Dentists Review BodyGHS: General Household Survey NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404

Average consultation length (min)

*Based on best available evidence from each country *Methodological heterogeneity

Sweden

France

Switzerla

nd

Belgium

Canada

Australia

USA

New Zealand UK

Croatia

Netherlands

Estonia

Spain

Germany

Quatar

Japan UAE

Saudi Arabia

0

5

10

15

20

25

21

18.5

15.615 15 14.8

1312 11.7 11.5

10.29

7.8 7.66.6

6 5.9 5.7

• Survey of 3713 GP principles in Scotland 2001• 21% felt not currently providing high-quality

holistic care• Average consultation length 9.3 minutes• 30% provided less than 10 minutes • 5% provided more than 10 minutes

Holism in primary care

Hasegawa H et al. PHCRD 2005; 6: 320–328

Hasegawa H et al. PHCRD 2005; 6: 320–328

• 40% felt rushed at end of consultations (>50% consultations)

• Booked consultation length was shorter in urban & deprived areas

• Mean optimum consultation length was 13.3 mins – 43.3% between 10 - 15 mins– 39.8% specified 15 mins – 9.9% > 15 mins

Holism in primary care

Hasegawa H et al. PHCRD 2005; 6: 320–328

Consultation length Routine Emergency

0.5 - 4.5 mins 2 (0.3%) 5 (0.8%)

5 - 9.5 mins 18 (2.7%) 157 (24.8%)

10 - 14.5 mins 575 (85.4%) 360 (56.9%)

15 - 19.5 mins 52 (7.7%) 37 (5.85%)

20 - 24.5 mins 12 (1.78%) 10 (1.6%)

>25 mins 0 0

No set time 14 (2.1%) 64 (10.0%)

• 2010 UK Cross sectional survey • Consultation length offered by GP trainers

Irving et al. BJGP 2011; 62 (12):238

n=673

Systematic review (Hutton et al 2007)

• Focus on psychological problems

• 29 studies included

• Consultations with a recorded diagnosis of a psychological problem were longer.

• GPs reported that time pressure is a major barrier to treating depression.

• Evidence that increased consultation length is associated with more accurate diagnosis of psychological problems.

Hutton C et al. BMC HSR 2007; 7: 71

Cochrane review (Wilson et al 2009)• 4 trials : Short term, not of high quality, 1978-1992

• Insufficient evidence to say whether increasing consultation length provides patient benefit (or not)

• With longer consultations• More health promotion • Doctors did not run more tests, examine or refer more• Patients were not any more satisfied with care • Patients did not alter follow-up behavior

Wilson A et al. Cochrane Database of Systematic Reviews 2006;1:CD003540