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Consultation length in general practice: cross sectional study in six European countries
Myriam Deveugele1, Anselm Derese, Atie van den Brink-Muinen
1Department of General Practice and Primary Health Care, Ghent University, B 9000 Ghent, Belgium. myriam.deveugele@rug.ac.be
Objectives:
To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors' and patients' perceptions of psychosocial aspects.
Design:
Analysis of videotaped consultations of general practitioners from the Eurocommunication study and of questionnaires completed by doctors and by patients.
Setting:
General practices in six European countries.
Participants:
190 general practitioners and 3674 patients.
Results:
In a multilevel analysis with three levels (country, general practitioner, and patient), country and doctor variables contributed a similar amount to the total variance in consultation length (23% and 22%, respectively) and patient variables accounted for 55% of the variance. The variables used in the multilevel analysis explained 25% of the total variation. The country in which the doctor practised, combined with the doctors' variables, was as important for the variance in consultation length as the variation between patients. Consultations in which psychosocial problems were considered important by the doctor and the patient lasted longer than consultations about biomedical problems only. The doctor's perception had more influence in this situation than the patient's. Consultation length is influenced by the patients' sex (women got longer consultations), whether the practice was urban or rural, the number of new problems discussed in the consultation (the more problems the longer the consultation), and the patient's age (the older the patient the longer the consultation). As a doctor's workload increased, the length of consultations decreased. The general practitioner's sex or age and patient's level of education were not related to the length of consultation.
Conclusion:
Consultation length is determined by variables related to the doctor and the doctor's country as well as by those related to patients. Women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.