BMJ Open 2:e000744 doi:10.1136/bmjopen-2011-000744
  • Health services research
    • Research

Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation

  1. Mark F Harris3
  1. 1International Screening Committee for Austria, Austrian Public Health Association, Vienna, Austria
  2. 2Department for Clinical Epidemiology and Evidence-based Medicine, Danube University Krems, Austria
  3. 3Centre for Primary Health Care and Equity, UNSW Sydney, Australia
  1. Correspondence to Dr Franz Piribauer; franz.p{at}
  • Received 19 January 2012
  • Accepted 2 July 2012
  • Published 7 August 2012


Objective To assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking.

Design Secondary data analysis of a clustered cross-sectional direct observation survey.

Setting General practitioners (GPs) in Vienna, Austria, visited unannounced by mystery shoppers (incognito standardised patients (ISPs)).

Participants 21 randomly selected GPs were visited by two different ISPs each. 40 observation protocols were realised.

Main outcome measures Robustness of sampling and data collection by the consumer organisation. GPs consultation and waiting times, guideline adherence in history taking.

Results The double stratified random sampling method was robust and representative for the private and contracted GPs mix of Vienna. The clinical scenarios presented by the ISPs were valid and believable, and no GP realised the ISPs were not genuine patients. The average consultation time was 46 min (95% CI 37 to 54 min). Waiting times differed more than consultation times between private and contracted GPs. No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found. According to the analysis, 20% of the GPs took a perfect history (95% CI 9% to 39%).

Conclusions The analysis of secondary data collected by a consumer organisation was a valid method for drawing conclusions about GPs preventive practice. Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data.


  • To cite: Piribauer F, Thaler K, Harris MF. Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation. BMJ Open 2012;2:e000744. doi:10.1136/bmjopen-2011-000744

  • Contributors FP conceived the study, performed the statistical analysis and drafted the manuscript. KT extracted data, helped in the interpretation and finalisation of the manuscript. MFH helped in the interpretation, internal review and finalisation. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Statutory Public Health Ethics Committee of the City of Vienna.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data of this study are owned by the Austrian Consumer Organisation (Verein für Konsumenteninformation, VKI). On our written request in October 2008, VKI provided us with the electronic data set (raw data: Excel file, 23 lines), and hardcopies of the completed medical result sheets (34 sheets) for the sole purpose of conducting health service research studies by us, the International Screening Committee for Austria. We extracted data from the hardcopies and added it to our own secondary data set. We encourage any researcher to ask permission and perhaps request the data set also from VKI in Vienna, Austria (http:\\

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