How QOF is shaping primary care review consultations: a longitudinal qualitative study

BMC Family Practice

Research Article

Alexandra Stenhoff¹  Peter Salmon²  Carolyn A Chew-Graham³  Cheryl Hunter⁴  Jessica Drinkwater⁵  Susanne Langer⁶  Elspeth A Guthrie⁷ 

[1] Department of Mental and Behavioural Health Sciences, Institute of Psychology Health & Society, University of Liverpool, Whelan Building, L69 3GB, Liverpool, England;Division of Clinical Psychology, Institute of Psychology, Health and Society, University of Liverpool, L69 3GB, Liverpool, England;General Practice Research, Research Institute, Primary Care and Health Sciences, Keele University, ST5 5BG, Keele, Staffordshire, England;Institute of Population Health, Primary Care Centre, and National School for Primary Care Research, University of Manchester, 5th floor, Williamson Building Oxford Road, M13 9PL, Manchester, England;Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Rosemary Rue Building, Old Road Campus, OX3 7LF, Oxford, England;Institute of Population Health, Primary Care Centre, and National School for Primary Care Research, University of Manchester, 5th floor, Williamson Building Oxford Road, M13 9PL, Manchester, England;Mental Health and Well-Being, Department of Mental and Behavioural Health Sciences, University of Liverpool, L69 3GB, Liverpool, England;Psychological Medicine & Medical Psychotherapy, Manchester Royal Infirmary, Rawnsley Building, M13 9WL, Manchester, England;

关键词: Primary care;    Long-term conditions;    Quality and Outcomes Framework (QOF);    Consultations;    Longitudinal qualitative research;   

DOI  :  10.1186/1471-2296-14-103

 received in 2013-05-24, accepted in 2013-07-08,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundLong-term conditions (LTCs) are increasingly important determinants of quality of life and healthcare costs in populations worldwide. The Chronic Care Model and the NHS and Social Care Long Term Conditions Model highlight the use of consultations where patients are invited to attend a consultation with a primary care clinician (practice nurse or GP) to complete a review of the management of the LTC. We report a qualitative study in which we focus on the ways in which QOF (Quality and Outcomes Framework) shapes routine review consultations, and highlight the tensions exposed between patient-centred consulting and QOF-informed LTC management.MethodsA longitudinal qualitative study. We audio-recorded consultations of primary care practitioners with patients with LTCs. We then interviewed both patients and practitioners using tape-assisted recall. Patient participants were followed for three months during which the research team made weekly contact and invited them to complete weekly logs about their health service use. A second interview at three months was conducted with patients. Analysis of the data sets used an integrative framework approach.ResultsPractitioners view consultations as a means of ‘surveillance’ of patients. Patients present themselves, often passively, to the practitioner for scrutiny, but leave the consultation with unmet biomedical, informational and emotional needs. Patients perceived review consultations as insignificant and irrelevant to the daily management of their LTC and future healthcare needs. Two deviant cases, where the requirements of the ‘review’ were subsumed to meet the patient’s needs, focused on cancer and bereavement.ConclusionsRoutine review consultations in primary care focus on the biomedical agenda set by QOF where the practitioner is the expert, and the patient agenda unheard. Review consultations shape patients’ expectations of future care and socialize patients into becoming passive subjects of ‘surveillance’. Patient needs outside the narrow protocol of the review are made invisible by the process of review except in extreme cases such as anticipating death and bereavement. We suggest how these constraints might be overcome.

【 授权许可】

CC BY   
© Chew-Graham et al.; licensee BioMed Central Ltd. 2013