Article Text

Download PDFPDF

Patient-level and practice-level factors associated with consultation duration: a cross-sectional analysis of over one million consultations in English primary care
  1. Sarah Stevens1,
  2. Clare Bankhead1,
  3. Toqir Mukhtar1,
  4. Rafael Perera-Salazar,
  5. Tim A Holt1,
  6. Chris Salisbury2,
  7. F D Richard Hobbs1
  8. on behalf of the NIHR School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Sarah Stevens; sarah.stevens{at}phc.ox.ac.uk

Abstract

Objectives Consultation duration has previously been shown to be associated with patient, practitioner and practice characteristics. However, previous studies were conducted outside the UK, considered only small numbers of general practitioner (GP) consultations or focused primarily on practitioner-level characteristics. We aimed to determine the patient-level and practice-level factors associated with duration of GP and nurse consultations in UK primary care.

Design and setting Cross-sectional data were obtained from English general practices contributing to the Clinical Practice Research Datalink (CPRD) linked to data on patient deprivation and practice staffing, rurality and Quality and Outcomes Framework (QOF) achievement.

Participants 218 304 patients, from 316 English general practices, consulting from 1 April 2013 to 31 March 2014.

Analysis Multilevel mixed-effects models described the association between consultation duration and patient-level and practice-level factors (patient age, gender, smoking status, ethnic group, deprivation and practice rurality, number of full-time equivalent GPs/nurses, list size, consultation rate, quintile of overall QOF achievement and training status).

Results Mean duration of face-to-face GP consultations was 9.24 min and 5.32 min for telephone consultations. Nurse face-to-face and telephone consultations lasted 9.70 and 5.73 min on average, respectively. Longer GP consultation duration was associated with female patient gender, practice training status and older patient age. Shorter duration was associated with higher deprivation and consultation rate. Longer nurse consultation duration was associated with male patient gender, older patient age and ever smoking; and shorter duration with higher consultation rate. Observed differences in duration were small (eg, GP consultations with female patients compared with male patients were 8 s longer on average).

Conclusions Small observed differences in consultation duration indicate that patients are treated similarly regardless of background. Increased consultation duration may be beneficial for older or comorbid patients, but the benefits and costs of increased consultation duration require further study.

  • primary care
  • quality in health care
  • organisation of health services
  • health policy

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors FDRH and CS conceived the research, obtained funding and are joint principal investigators. FDRH, CB and CS drafted the protocol, which SS, TM, RP-S and TAH then contributed to. SS and TM were responsible for data management. SS did the statistical analyses and drafted the report, which FDRH, CS, CB, RP-S, TM and TAH then contributed to. SS is the guarantor and corresponding author.

  • Funding This project is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). FDRH is partly supported as an NIHR Senior Investigator, Director of the NIHR SPCR, Director of the NIHR CLARHC Oxford, Theme Leader of the NIHR Oxford BRC, NIHR Oxford DEC and Professorial Fellow of Harris Manchester College.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of Health.

  • Competing interests SS, CS and RP-S report grants from the National Institute for Health Research School for Primary Care Research during the conduct of the study.

  • Ethics approval CPRD ISAC.

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

  • Data sharing statement Data are available from CPRD directly: https://www.cprd.com/intro.asp.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.