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The domains contained in patient evaluation questionnaires of office visits with primary care physicians: a systematic r

The domains contained in patient evaluation questionnaires of office visits with primary care physicians: a systematic review. Robert K McKinley, 1 Ged M Murtagh, 2 Elizabeth M Ockleford, 2 Mary L Edmunds Otter, 2 Sheila Bonas 2 1 Keele University and 2 University of Leicester. Aim.

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The domains contained in patient evaluation questionnaires of office visits with primary care physicians: a systematic r

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  1. The domains contained in patient evaluation questionnaires of office visits with primary care physicians: a systematic review Robert K McKinley,1 Ged M Murtagh,2 Elizabeth M Ockleford,2 Mary L Edmunds Otter,2 Sheila Bonas2 1Keele University and 2University of Leicester Keele University School of Medicine 3.11.09

  2. Keele University School of Medicine 3.11.09

  3. Aim • With respect to patient report questionnaires of office visits with primary care physicians to: • categorise constructs • generate a taxonomy of themes and sub-themes Keele University School of Medicine 3.11.09

  4. Ultimately • Beyond satisfaction…… Keele University School of Medicine 3.11.09

  5. Office visit = consultation Keele University School of Medicine 3.11.09

  6. Methodology • Theoretical stance • Systematic review • Qualitative analysis Keele University School of Medicine 3.11.09

  7. Methodology • Theoretical stance • Stewart (Ann Fam Med 2004; 2:388) • Gaze • Professional • Patient Keele University School of Medicine 3.11.09

  8. Patient’s perspective Opinion Information Office visit: process Knowledge / behaviour Change in health Physician’s perspective Keele University School of Medicine 3.11.09

  9. Methodology • Theoretical stance • Stewart (Ann Fam Med 2004; 2:388) • Gaze • Professional • Patient • Analysis • Questionnaires as text/data • Thematic analysis • Constant comparative method • Inclusiveness vs. validity/psychometrics • Saturation Keele University School of Medicine 3.11.09

  10. Methodology • Systematic review • Medline, Embase HAPI, IBSS, Qolid, Cinahl, Dh Data, Kings Fund, Science Citation Index, Social Science Citation Index, Assia and psycinfo • Search terms • consultation$’, ‘family practi$’, ‘family physician$’, ‘measurement tool$’, ‘instrument$’, ‘measurement scale$’, ‘questionnaires’, ‘health surveys/ or health status indicators/ or health care surveys’, [office visit] • Inception until 24.8.06 Keele University School of Medicine 3.11.09

  11. Methodology • Systematic review • English language • Any mention of • patient report questionnaires • office visits • primary care physicians • Double review • Either/or inclusion Keele University School of Medicine 3.11.09

  12. Methodology • Analysis • Batches of 20 papers • Coding frame • Iterative • Testing against more data • Revising and retesting • Explanation of all data Keele University School of Medicine 3.11.09

  13. Results Total papers identified from electronic search = 363 Total papers potentially relevant papers identified from screening = 138 33 papers excluded because: 11 not patient measures 18 not consultation outcome measures 4 not general practice consultation Papers recovered for analysis =62 39 papers excluded because: 19 source papers identified 20 questionnaires already included Alternative source papers identified = 19: Papers describing unique instruments = 42 (including 43 individual questionnaires) Keele University School of Medicine 3.11.09

  14. Results • 42 papers: • USA 16 • UK 16 • Netherlands 3 • Norway 3 • Australia 3 • Canada 1 • 30 ‘named’ questionnaires • 13 ‘single study’ questionnaires Keele University School of Medicine 3.11.09

  15. Results • 5 Domains • Antecedents (3 themes) • Office visit process (8 themes) • Outcome of office visit (7 themes) • Future care planning (5 themes) • Patient borne cost (1 themes) Keele University School of Medicine 3.11.09

  16. Results • Domains and Themes • Antecedents (Access, Delay to be seen, Staff) • Office visit process(Person centred – Technical/Behaviours/Care, Comprehensive, Satisfaction – General/Information, Treatment, Knowledge/Skills/Attitudes) • Outcomes of office visit (Enablement/empowerment, Improvement - General wellness/Symptoms/Relationship with physician, Advice, Understanding, Health maintenance) • Future care planning (Choice, Care planning, Information, Confidentiality, Co-ordination) • Patient borne costs Keele University School of Medicine 3.11.09

  17. Patient’s perspective Opinion Information Office visit: process Knowledge / behaviour Change in health Physician’s perspective Keele University School of Medicine 3.11.09

  18. Patient’s perspective Patient-borne health care costs Opinion Information Office visit: process Outcome of office visit Knowledge / behaviour Antecedents Change in health Care planning Professional’s perspective Prior elements New elements Keele University School of Medicine 3.11.09

  19. Conclusions • ‘Current’ domains and themes • Framework • Repository • Test framework with patients • ?Comprehensive • ?Reduce • New PROM Keele University School of Medicine 3.11.09

  20. Acknowledgements • Kerry Glover and Jo Hardman • Martin Williams • Funding: • University of Leicester • Trent Research and Development Unit Keele University School of Medicine 3.11.09

  21. http://www.keele.ac.uk/depts/ms/staff_info/profiles/robert_mckinley.htmhttp://www.keele.ac.uk/depts/ms/staff_info/profiles/robert_mckinley.htm Keele University School of Medicine 3.11.09

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