Endorsement of patient complexity factors in two rounds of Delphi study
| Patient variables: final wording | Round 1 result | Median scorea | Round 2result | Median scorea | Final status |
|---|---|---|---|---|---|
| Factors accepted or rejected in round 1 | |||||
| Homelessness (noted in the previous year) | ✓ | 3.0 | – | – | Included |
| Child protection/adult safeguarding (until resolved code) | ✓ | 4.0 | – | – | Included |
| Domestic violence (recorded in previous year) | ✓ | 3.0 | – | – | Included |
| Interpreter needed/no English (noted in last 3 years) | ✓ | 3.0 | – | – | Included |
| Learning disability/autism (noted ever) | ✓ | 3.0 | – | – | Included |
| Dementia (noted ever) | ✓ | 3.0 | – | – | Included |
| Receiving palliative care (noted ever) | ✓ | 3.0 | – | – | Included |
| Drug misuse/alcoholism (noted in the previous year) | ✓ | 3.5 | – | – | Included |
| Severe mental illness (in previous 3 years) | ✓ | 4.0 | – | – | Included |
| Wheelchair use (in previous 2 years) | × | 2.0 | – | – | Rejected |
| Recent outpatient referral | × | 2.0 | – | – | Rejected |
| Patient currently on warfarin | × | 2.0 | – | – | Rejected |
| Cancer (noted ever) | × | 2.0 | – | – | Rejected |
| Diabetes (noted ever) | × | 2.0 | – | – | Rejected |
| Factors carried forward to round 2 | |||||
| Patient has ≥3 major long-term chronic conditions | ? | 2.0 | ✓ | 3.0 | Included |
| Deafness (noted ever) | ? | 2.0 | ? | 2.0 | Rejected |
| Paraplegic (noted ever) | ? | 2.5 | ✓ | 3.0 | Included |
| Blind or partially sighted (noted ever) | ? | 2.0 | ? | 2.0 | Rejected |
| Patient on immunosuppressant medication (currently) | ? | 2.0 | ? | 3.0 | Rejected |
| Factors suggested by participants and included in round 2 | |||||
| Patient is housebound or a nursing home patient | – | – | ✓ | 4.0 | Included |
| Personality disorder or disruptive behaviour (noted ever) | – | – | ✓ | 4.0 | Included |
| Diagnostic code for ‘Medically unexplained symptoms’ entered in last year | – | – | ✓ | 3.0 | Included |
| Patient is morbidly obese (BMI >40) | – | – | ? | 3.0 | Rejected |
| Frequent attender (high number of GP consultations in the last year) | – | – | ✓ | 3.0 | Included |
| Chronic pain recorded as a code in the last year | – | – | ✓ | 3.0 | Included |
| Polypharmacy (high number of drugs prescribed in the last 2 months) | – | – | ✓ | 3.5 | Included |
BMI = body mass index. ✓ endorsement ? uncertain × rejection.
c Scores: 1 = no more complex than the average consultation; 5 = very much more complex than the average consultation.