The effect of interventions to alter the consultation length of family physicians: a systematic review

Andrew Wilson; Susan Childs

Article Figures & Data

Tables

Supplementary Materials

View popup

Table 1

Characteristics of included studies.

Study ID	Methods	Participants	Interventions	Outcomes	Analysis
Morrell 1986	CCT. Non-randomised to surgery sessions with 5, 7. 5 or 10 minute appointments	1 Practice 5 Doctors 60 Surgery sessions 780 Consultations	5, 7.5 and 10 minute appointments (usual appointment, length 6.7 minutes)	Consultation length, examination, prescribing and referral, investigation rates, number of problems and psychological problems identified, language content Re-consultation in 4 weeks	Logistic regression allowing for age and sex of patient. As case mix varied between groups, doctor and patient initiated consultations were analysed separately for several outcomes

Ridsdale 1989	CCT. Non-randomised to surgery sessions with 5, 10 or 15 minute appointments	1 Practice 2 Doctors 914 Consultations	5, 10 or 15 minute appointments (usual appointment length 10 minutes)	Consultation length, examination, number of problems and psychological problems identified, language content. Re-consultation in 4 weeks	Regression, account for age and sex of patient and consulting doctor

Thomas 1978	RCT. Random allocation by participating doctor – method not stated	1 Practice 1 Doctor 52 Surgery sessions 200 Patients in whom no diagnosis could be made	Patients randomly assigned to 1 of 4 groups: long consultation with or without treatment; short consultation with or without treatment. The participating doctor terminated short consultations as soon as possible and aimed to make the long consultations last for more than 10 minutes	Re-consultation	χ²

Wilson 1992	CCT. Non-randomised to surgery sessions with examination, prescribing, usual or 10 minute appointments (run in control sessions not included)	10 Practices 16 Doctors 208 Surger sessions 2957 Consultations	10 minute appointments	Consultation length, referral and investigation rates, health promotion procedures and examinations. Re-consultation	By patient, no account for clustering by doctor

View popup

Table 2

Consultation length.

Author	Appointment length (mins)	Consultations (n) doctor/patient initiated	Median length (mins) doctor/patient initiated	Mean (95% CI)
Morrell 1986	5	65/155	4.3^a/5.5
	7.5	96/117	6.4/6.7
	10	88/102	7.0/7.9

Ridsdale 1989	5	−/339	−/5.9	6.6 (6.2 to 7.0)
	10	−/259	−/7.5	8.0 (7.5 to 8.5)
	15	−/316	−/7.9	9.2 (8.6 to 9.8)

Wilson 1992	6–7.5	−/1496	−/6^b	7.16
	10	−/1461	−/7	8.25

↵a Not tested statistically.
↵b (P<0.001 Mann Whitney test).

View popup

Table 3

Recording of problems, referral investigation, prescribing and re-consultation rate.

	Appointment length in minutes (number of patients included)	Consultation with >1 problem (%)	Consultation with psychological problem (%)	Referred to specialist (%)	Investigation (%)	Prescribing (%)	Re-consultation (%)
Morrell 1986		P<0.01^a	P NS	P NS^a	P NS^a	P NS^a	P NS^a
	5 (275)	11	9	8	9	59	16^b
	7.5 (262)	16	14	9	10	63	12
	10 (243)	22	12	10	10	62	18

Ridsdale 1989		P NS^a	P NS^a			P NS^a	P NS^a
	5 (348)	14	8	-	-	61	30^d
	10 (277)	19	8	-	-	63	29
	15 (336)	14	5	-	-	58	31

Wilson 1992 (unpublished results in parentheses)
		P NS^c		P NS^c	P NS^c	P NS^c	P NS^c
	6–7.5 (1496)	(32)	-	(5.0)	(8.8)	55.7	(42)^d
	10 (1461)	(35)	-	(5.7)	(10.6)	56.9	(46)

Thomas 1978							P NS^c
	Short consultation (100)						27^e
	Long consultation (100)						20

↵a χ² for trend.
↵b Asked to book return consultation.
↵b χ².
↵d Re-consultation within 12 weeks.
↵e Re-consultation within 4 weeks.
NS = Not stated.

View popup

Table 4

Examinations.

Author	Doctor/patient initiated	Appointment length (mins)	Consultations n (%)	Any examination (%)	P	BP recorded	P	Vaginal examination (% female consultations)	P
Morrell 1986	Doctor	5	80	41		18		2
	Doctor	7.5	117	55	<0.01^a	27	NS	10	NS
	Doctor	10	114	63		29		10
	Patient	5	195	77		7		5
	Patient	7.5	145	76	NS	8	NS	11	NS
	Patient	10	129	69		12		7

Ridsdale 1989		5	348	82		22		3
		10	277	83	NS^a	17	NS^a	2	<0.05^a
		15	336	83		16		7

Wilson 1992		6	1496	65^b	NS^c	19	<0.001
		10	1461	64^b		24

↵a χ² for trend.
↵b Unpublished results.
↵c χ².
NS = Not stated.

View popup

Table 5

Health education/prevention.

Author	Appointment length (mins)	Eligible consultations n	Item present n (%)	P
Roland 1986 (detected on audiotape)	5	220	14.5^a
	7.5	213	16.9^a	<0.001^b
	10	190	22.1^a

Wilson 1992 (detected on audiotape)	6	180	44 (24.4)	NS
	10	275	78 (28.4)

Extracted from medical record	6	1432	126 (8.8)	<0.001^c
	10	1411	218 (15.5)

Current smoker reporting advice^d	6	212	42 (19.8)	<0.01^c
	10	258	82 (31.8)
Discussion of diet^d	6	839	95 (11.3)	NS
	10	950	108 (11.4)
Discussion of alcohol^d	6	839	42 (5.0)	NS
	10	956	67 (7.0)

↵a Percentage consultations in which number of health education statements greater than oversall median percentage consultations with health education.
↵b χ² for trend.
↵c χ².
↵d From patient questionnaire.