Professor Chris Salisbury is Professor of Primary Health Care and an NIHR Senior Investigator, University of Bristol. He has published 5 books and over 230 research papers on the broad topic of how to improve provision of primary care. He has conducted several high-profile evaluations of new models of care, such as changes in out-of-hours arrangements, NHS walk-in centres, GPs with Special Interests, telehealth for chronic disease management, and the potential of new forms of consultation such as e-consultations.
Dr Jose Ordonez-Mena is a Research Associate at the Nuffield Department of Primary Care Health Sciences, Oxford University with research interest in aging, cancer, nutritional and clinical epidemiology, and infectious diseases. He is experienced in the analysis of large cohort studies, systematic reviews, traditional and IPD meta-analyses.
GP workload is increasing. GPs say that what matters is not only the number of consultations, but also the nature of those consultations, which are getting increasing complex. This is related to changes in the population (e.g. multimorbidity) and changes in expectations of GPs. To test these ideas requires a measure of complexity, but no such measure exists.
We set out to develop and validate a suitable measure. We started by conducting a Delphi study to identify factors that GPs believed made consultations more complex. Using the factors around which consensus was reached, we explored the independent relationship between each factor and consultation duration, as one form of validation. After retaining factors with a significant relationship with duration, we defined a complex consultation as one which included one or more complexity factor, and showed the prevalence of complexity in different age-sex groups.
This new measure can be used to explore how complexity in GP consultations changes over time, and is different in different settings and patient populations. This could be useful in both national and local policy-making, e.g. identifying practices which need more support.
Developing the measure raised a number of conceptual and methodological issues, which will be discussed.
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