1. Keele University School of Medicine 3.11.09 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

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

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

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

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

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

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

9. Keele University School of Medicine 3.11.09 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

10. Keele University School of Medicine 3.11.09 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

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

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

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

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

15. Keele University School of Medicine 3.11.09 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)

16. Keele University School of Medicine 3.11.09 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

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

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

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

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

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