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Evaluating care of patients reporting pain in fundholding practices
J G Howie1, D J Heaney, M Maxwell
1Department of General Practice, University of Edinburgh.
Objective:
To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain.
Design:
Questionnaire and record based study.
Subjects:
Patients identified at consecutive consultations during two weeks in 1990, 1991, and 1992.
Setting:
Six practice groups in pilot fundholding scheme in Scotland.
Main Outcome Measures:
Length of consultation; numbers referred or investigated or prescribed drugs; responses to questions about enablement and satisfaction.
Results:
About 15% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992; about a fifth wanted to discuss their social problems. Social problems were associated with a raised general health questionnaire score. The mean length of consultation for patients with pain was 7.6 min in 1990 and 7.7 min in 1992. Patients wishing to discuss social problems received longer consultations (8.5 min 1990; 10.4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7.2 min). The level of prescribing was stable but the proportion of patients having investigations or attending hospital fell significantly from 1990 to 1992 (31% to 24%; 31% to 13% respectively). Fewer patients responded "much better" to six questions about enablement in 1992 than in 1990. Enablement was better after longer than shorter consultations for patients with social problems.
Conclusions:
Quality of care for patients with pain has been broadly maintained in terms of consultation times. The effects of lower rates of investigation and referral need to be investigated further.