چکیده (انگلیسی):

Background:There is an increasing recognition that many consultations in general practice involve several
problems covering multiple disease domains. However there is a paucity of reliable tools and techniques to
understand and quantify this phenomenon. The objective was to develop a tool that can be used to measure the
number and type of problems discussed in primary care consultations.
Methods:Thirteen consultations between general practitioners and patients were initially videoed and reviewed to
identify the problems and issues discussed. An iterative process involving a panel of clinicians and researchers and
repeated cycles of testing and development was used to develop a measurement proforma and coding manual for
assessment of video recorded consultations. The inter-rater reliability of this tool was assessed in 60 consultations.
Results:The problems requiring action were usually readily identified. However the different dimensions of the
problem and how they were addressed required the identification and definition of‘issues’. A coding proforma was
developed that allowed quantification of the numbers and types of health problems and issues discussed. Ten
categories of issues were identified and defined. At the consultation level, inter-rater agreements for the number of
problems discussed (within ±1), types of problems and issues were 98.3%, 96.5% and 90% respectively. The tool has
subsequently been used to analyse 229 consultations.
Conclusion:The iterative approach to development of the tool reflected the complexity of doctor-patient
interactions. A reliable tool has been developed that can be used to analyse the number and range of problems
managed in primary care consultations.