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. 2002 Oct;52(Suppl):S22–S26.

What do patients want from high-quality general practice and how do we involve them in improvement?

Angela Coulter 1, Glyn Elwyn 1
PMCID: PMC1316137  PMID: 12389766

Abstract

Patient involvement is being encouraged by the government and by others as a way of improving the quality of the service provided in general practice. Patients can be involved in their own individual care; for example, in treatment decision making and in disease management; or collectively, by providing feedback on aspects of practice organisation and quality. Active participation in treatment decisions and in self management of chronic conditions can benefit patients in the short-term and may lead to better health outcomes in the longer term, although the evidence for this is currently equivocal. However, the ethical and societal arguments in its favour seem overwhelming. Helping patients to help themselves makes sense for general practitioners as well. Strengthening patients' coping skills could help to reduce inappropriate demands on their time. Involving the public in quality improvement activities has become a key policy direction, and trusts will be required to survey their patients on an annual basis. The proposed new general practitioner contract has recognised the importance of the patient's perspective in its quality framwork. Practices that want to anticipate these trends should look for patient survey instruments to obtain feedback on their organisation and the interpersonal skills of the clinicians.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams S., Pill R., Jones A. Medication, chronic illness and identity: the perspective of people with asthma. Soc Sci Med. 1997 Jul;45(2):189–201. doi: 10.1016/s0277-9536(96)00333-4. [DOI] [PubMed] [Google Scholar]
  2. Baker R. Development of a questionnaire to assess patients' satisfaction with consultations in general practice. Br J Gen Pract. 1990 Dec;40(341):487–490. [PMC free article] [PubMed] [Google Scholar]
  3. Baker R., Streatfield J. What type of general practice do patients prefer? Exploration of practice characteristics influencing patient satisfaction. Br J Gen Pract. 1995 Dec;45(401):654–659. [PMC free article] [PubMed] [Google Scholar]
  4. Bekker H., Thornton J. G., Airey C. M., Connelly J. B., Hewison J., Robinson M. B., Lilleyman J., MacIntosh M., Maule A. J., Michie S. Informed decision making: an annotated bibliography and systematic review. Health Technol Assess. 1999;3(1):1–156. [PubMed] [Google Scholar]
  5. Birchall M., Richardson A., Lee L. Eliciting views of patients with head and neck cancer and carers on professionally derived standards for care. BMJ. 2002 Mar 2;324(7336):516–516. doi: 10.1136/bmj.324.7336.516. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Coulter Angela. After Bristol: putting patients at the centre. BMJ. 2002 Mar 16;324(7338):648–651. doi: 10.1136/bmj.324.7338.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Deber R. B. Physicians in health care management: 8. The patient-physician partnership: decision making, problem solving and the desire to participate. CMAJ. 1994 Aug 15;151(4):423–427. [PMC free article] [PubMed] [Google Scholar]
  8. Elwyn G., Edwards A., Gwyn R., Grol R. Towards a feasible model for shared decision making: focus group study with general practice registrars. BMJ. 1999 Sep 18;319(7212):753–756. doi: 10.1136/bmj.319.7212.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Elwyn G., Edwards A., Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999 Jun;49(443):477–482. [PMC free article] [PubMed] [Google Scholar]
  10. Fidler H., Lockyer J. M., Toews J., Violato C. Changing physicians' practices: the effect of individual feedback. Acad Med. 1999 Jun;74(6):702–714. doi: 10.1097/00001888-199906000-00019. [DOI] [PubMed] [Google Scholar]
  11. Freeman George K., Horder John P., Howie John G. R., Hungin A. Pali, Hill Alison P., Shah Nayan C., Wilson Andrew. Evolving general practice consultation in Britain: issues of length and context. BMJ. 2002 Apr 13;324(7342):880–882. doi: 10.1136/bmj.324.7342.880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Greco M., Brownlea A., McGovern J., Cavanagh M. Consumers as educators: implementation of patient feedback in general practice training. Health Commun. 2000;12(2):173–193. doi: 10.1207/S15327027HC1202_4. [DOI] [PubMed] [Google Scholar]
  13. Howie J. G., Heaney D. J., Maxwell M., Walker J. J. A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract. 1998 Apr;15(2):165–171. doi: 10.1093/fampra/15.2.165. [DOI] [PubMed] [Google Scholar]
  14. Jones A., Pill R., Adams S. Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ. 2000 Dec 16;321(7275):1507–1510. doi: 10.1136/bmj.321.7275.1507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kennelly C., Bowling A. Suffering in deference: a focus group study of older cardiac patients' preferences for treatment and perceptions of risk. Qual Health Care. 2001 Sep;10 (Suppl 1):i23–i28. doi: 10.1136/qhc.0100023... [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Krupat E., Rosenkranz S. L., Yeager C. M., Barnard K., Putnam S. M., Inui T. S. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000 Jan;39(1):49–59. doi: 10.1016/s0738-3991(99)00090-7. [DOI] [PubMed] [Google Scholar]
  17. McIver S. Preparation and training: the key to better patient involvement. Qual Health Care. 2001 Mar;10(1):3–3. doi: 10.1136/qhc.10.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moynihan Ray, Smith Richard. Too much medicine? BMJ. 2002 Apr 13;324(7342):859–860. doi: 10.1136/bmj.324.7342.859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Murray E., Davis H., Tai S. S., Coulter A., Gray A., Haines A. Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care. BMJ. 2001 Sep 1;323(7311):493–496. doi: 10.1136/bmj.323.7311.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Murray E., Davis H., Tai S. S., Coulter A., Gray A., Haines A. Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care. BMJ. 2001 Sep 1;323(7311):490–493. doi: 10.1136/bmj.323.7311.490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pickard S., Smith K. A 'Third Way' for lay involvement: what evidence so far? Health Expect. 2001 Sep;4(3):170–179. doi: 10.1046/j.1369-6513.2001.00131.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Popay J., Williams G. Public health research and lay knowledge. Soc Sci Med. 1996 Mar;42(5):759–768. doi: 10.1016/0277-9536(95)00341-x. [DOI] [PubMed] [Google Scholar]
  23. Ramsay J., Campbell J. L., Schroter S., Green J., Roland M. The General Practice Assessment Survey (GPAS): tests of data quality and measurement properties. Fam Pract. 2000 Oct;17(5):372–379. doi: 10.1093/fampra/17.5.372. [DOI] [PubMed] [Google Scholar]
  24. Stiggelbout A. M., Kiebert G. M. A role for the sick role. Patient preferences regarding information and participation in clinical decision-making. CMAJ. 1997 Aug 15;157(4):383–389. [PMC free article] [PubMed] [Google Scholar]
  25. Vickery D. M., Kalmer H., Lowry D., Constantine M., Wright E., Loren W. Effect of a self-care education program on medical visits. JAMA. 1983 Dec 2;250(21):2952–2956. [PubMed] [Google Scholar]
  26. Wensing M., Elwyn G. Research on patients' views in the evaluation and improvement of quality of care. Qual Saf Health Care. 2002 Jun;11(2):153–157. doi: 10.1136/qhc.11.2.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wensing M., Jung H. P., Mainz J., Olesen F., Grol R. A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain. Soc Sci Med. 1998 Nov;47(10):1573–1588. doi: 10.1016/s0277-9536(98)00222-6. [DOI] [PubMed] [Google Scholar]

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