Objective To measure patients' perceptions of patient centredness and the relation of these perceptions to outcomes. Design Observational study using questionnaires. Setting Three general practices. Participants 865 consecutive patients attending the practices. Main outcome measures Patients' enablement, satisfaction, and burden of symptoms. Results Factor analysis identified five components. These were communication and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronbach's = 0.96); personal relationship (a doctor who knows the patient and their emotional needs, = 0.89); health promotion ( = 0.87); positive approach (being definite about the problem and when it would settle, = 0.84); and interest in effect on patient's life ( = 0.89). Satisfaction was related to communication and partnership (adjusted = 19.1; 95% confidence interval 17.7 to 20.7) and a positive approach (4.28; 2.96 to 5.60). Enablement was greater with interest in the effect on life (0.55; 0.25 to 0.86), health promotion (0.57; 0.30 to 0.85), and a positive approach (0.82; 0.52 to 1.11). A positive approach was also associated with reduced symptom burden at one month ( = − 0.25; − 0.41 to − 0.10). Referrals were fewer if patients felt they had a personal relationship with their doctor (odds ratio 0.70; 0.54 to 0.90). Conclusions Components of patients' perceptions can be measured reliably and predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and higher rates of referral.
CUTE LOWER RESPIRATORYtract illness is the most common condition treated in primary care. 1,2 Assuming 75% of patients are prescribed antibiotics 1 and using conservative national morbidity survey estimates, 2 acute cough costs the UK National Health Service at least US $270 million in consultation costs and US $35 million to 70 million antibiotic prescription costs annually. In the United States, excess antibiotic prescribing is mainly for pharyngitis and acute bronchitis, amounting to 55% of prescriptions and costing $726 million per year. 3 A consensus has been made for limiting antibiotic use in acute lower respiratory tract infection. [4][5][6] However, recent systematic reviews 7,8 have come to diverse conclusions about the likely effectiveness of antibiotics, and the most recent Cochrane review 7 confirms a moderate effect of antibiotics on illness course; the debate continues unabated about the role of antibiotics be-For editorial comment see p 3062.
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