Title: Using health information systems to address patient concerns in GP consultations: a feasibility study
Funder: Department of Health and Social Care

Abstract: Background Problems are missed in up to 50% of primary care consultations. This is costly for the NHS, both in terms of re-consultation rates and in missed opportunities to increase patient empowerment. Research suggests that interventions at each end of the consultation can help to address patient concerns. At consultation initiation, sharing the results from electronic patient-reported outcome measures (ePROMs) with clinicians can help to elicit concerns. At consultation closure, providing the patient with written information to supplement spoken can improve recall and adherence. Aims and Objectives Aim: To develop and test a complex intervention designed to more comprehensively address patients concerns in general practice, thereby reducing re-consultation rates, improving patients well-being and health knowledge, reducing health concerns and increasing patients confidence in their health provision and health plan. The aims will be achieved through two studies. Firstly a complex intervention will be designed, which uses an ePROM at consultation opening and a printed report at consultation closure. Secondly, this intervention will be tested to establish the feasibility both of the intervention and of a randomised control trial (RCT) of the intervention. Methods 1. Intervention Design Study: This will involve: Design of an online questionnaire system using practice SMS/email systems and online survey software to allow patient self-completion of a pre-consultation questionnaire and a report showing low-scoring questionnaire items, which is shared with GPs. Testing the pre-consultation system with 45 patients in three rounds, with iterative adjustments made based on patient and GP feedback. Design of an electronic template, integrated with the patient record, to provide a printable post-consultation report to patients on issues raised in the consultation, advice given, treatment, follow-up and safety-netting. Testing the post-consultation report iteratively with 45 patients in three rounds. 2. Feasibility Study: The intervention will be tested in a cluster-randomised framework as follows: Refinement of the intervention and update to programme theory. Randomisation of six practices: four randomised to intervention, and two to control. Recruitment of 18 patients per practice: 72 intervention and 36 control. Data Collection of quantitative data via GP-report, patient-report and health records. Interview of five GPs and 30 patients. Realist evaluation of the data to identify and understand the mechanisms by which outcomes have occurred within the programme theory. Data analysis of recruitment rates, follow-up rates, data completeness, re-consultation rates within one/three months and other outcomes measures to assess feasibility of a future RCT. Evaluation of pre-agreed success criteria to decide whether to continue to RCT, stop, or modify the intervention. Timelines for delivery Study 1 will be completed from September 2019 &ndash; August 2020 and study 2 from September 2020 &ndash; August 2021. Anticipated impact and dissemination Results will be disseminated through targeted communications in social media, the University of Bristol website, policy briefings, academic papers, patient participation groups, community associations and seminars and conferences. The study output resources will be made available for immediate use. If progression criteria are met, we will aim to complete a randomised control trial within five years.

Lay abstract: Aim The aim of this study is to develop and test a method to more comprehensively address patients concerns in general practice. This will involve patients completing an electronic questionnaire about their concerns before a GP consultation, which is shared with the GP, and receiving a printable summary of advice at the end. If successful, the research will improve care for patients receiving the new consultation method and reduce rates of reconsultation for the same problem. Background Problems are missed in up to 50% of primary care consultations. This might be because of insufficient time for patients to discuss all their problems, or they could be interrupted by the GP when they start to explain. Sometimes, patients are unclear after the consultation about advice given, or what to do if their problem worsens. This can be distressing for patients, can lead to health problems, or increased NHS costs, as patients might re-consult to get their concerns addressed. Reducing consultation rates by just 1% could save the NHS over &pound;100 million. Widespread use of smartphones and GP SMS-technology provides an opportunity to address this problem through more efficient information-sharing. Methods We will carry out two studies. In study 1 we will develop two technologies and processes. First, we will design a questionnaire for patients to complete on smartphone/computer before their consultation. This questionnaire, which will identify their reasons for consulting and other health issues, will be shared with the GP before the consultation. This may include problems troubling the patient that would otherwise not have been raised. The second technology will be a report to be printed for the patient at the end of the consultation, including problems raised, advice given and follow-up required. This will provide a joint understanding between the patient and GP and help the patient remember advice given. In study 2, we will test these technologies in consultations with 72 patients. GPs will be asked to read the questionnaire information before the consultation and provide the printed report at the end of the consultation. To assess the new method, we will collect information about how well the consultation worked for these 72 patients. We will collect the same information from 36 patients who had a consultation without the new method, so that we can compare the two groups. If this works successfully, we will seek funding to test it in a larger sample. Patient and Public Involvement Design of this has already started, informed by GPs and a PPI group, who have advised on the preliminary design of both technologies. They will continue to advise throughout the research. Dissemination Findings will be disseminated through social media, the university website, policy briefings, academic papers, conferences and community groups.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE