Effects of interventions aimed at changing the length of primary care physicians' consultation

Wilson AD, Childs S

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Summary

Effects of interventions aimed at changing the length of time of consultations between family doctors and patients

There has been concern that doctors do not have enough time with patients during consultations. It has been suggested that if doctors and patients have more time to talk then patients might be more satisfied with care and their problems might be better dealt with, or doctors might prescribe less and talk more about how to make lifestyle changes. But does research show that increasing the length of consultations benefits patients, doctors and the health care system overall?

This systematic review found five studies testing whether methods to change consultation length provides any benefits. These studies changed appointment lengths which led to smaller changes in actual consultation lengths. The studies found that given more consultation time, doctors and patients did not discuss more problems, or psychological problems.

With more time, doctors did not prescribe more drugs, did not run more tests, did not make more referrals and did not do more examinations (except perhaps checking blood pressure more often). People were not more satisfied with their care with longer consultations, and longer consultations did not change whether they came back for another appointment about the same medical problem. But with more time, doctors did discuss how patients could take better control of their health, for example, by quitting smoking. It is not clear whether longer or shorter consultations changed doctors' level of stress. It is also not clear whether longer consultations improved the overall health of patients, and there were no studies evaluating whether longer consultations improved the behaviours of patients or saved or wasted money for the health care system.

In conclusion, there were only five studies which were short term and not of high quality. Therefore, at this time, there is not enough evidence to say whether increasing the amount of time that doctors consult with patients provides benefits or not.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Wilson AD, Childs S. Effects of interventions aimed at changing the length of primary care physicians' consultation. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD003540. DOI: 10.1002/14651858.CD003540.pub2.

This version first published online: January 25. 2006
Last assessed as up-to-date: May 14. 2008

Abstract

Background

Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average consultation lengths differ. These differences may be due to self selection.

Objectives

To assess the effectiveness and efficiency of interventions to alter the length of primary care physicians' consultations.

Search strategy

The following electronic databases were searched: Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (October 2002); CENTRAL (The Cochrane Library June 2003); MEDLINE (1966 to October 2002);EMBASE (1981 to October 2002); NHS National Research Register (June 2003).
The search strategies combined subject terms for 'general practice', 'consultation' and 'length' with methodological filters. The register search and the Medline search were updated in August 2007.

Selection criteria

Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of interventions to alter the length of primary care physicians' consultations.

Data collection and analysis

Data were extracted independently by two authors using agreed criteria. Disagreements were resolved by discussion. Where data were missing attempts were made to contact authors. Given the heterogeneity of studies meta-analysis was not attempted, and results are presented as a narrative summary.

Main results

Seven articles describing five UK trials met the inclusion criteria. All tested short term changes in the consultation time allocated to each patient and most had methodological weaknesses, particularly due to non-random allocation of patients. Altering appointment length resulted in modest changes in average length of consultation. There were no consistent differences in problem recognition, examination, prescribing, referral or investigation rates. There was some evidence that blood pressure was checked and smoking discussed more often when more time was available. None of the interventions were associated with differences in patient satisfaction. No trials examined efficiency.

Authors' conclusions

The findings of this review do not provide sufficient evidence to support or resist a policy of altering the lengths of primary care physicians' consultations. Further trials are needed that focus on health outcomes and cost effectiveness.

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