Hajira Dambha-Miller

International variations in primary care physician consultation time: a systematic review of 67 countries

Objective To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. Design and outcome measures This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. Results One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. Conclusion There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.

Patient-centred care, health behaviours and cardiovascular risk factor levels in people with recently diagnosed type 2 diabetes: 5-year follow-up of the ADDITION-Plus trial cohort

Objective To examine the association between the experience of patient-centred care (PCC), health behaviours and cardiovascular disease (CVD) risk factor levels among people with type 2 diabetes. Design Population-based prospective cohort study. Setting 34 general practices in East Anglia, UK, delivering organised diabetes care. Participants 478 patients recently diagnosed with type 2 diabetes aged between 40 and 69 years enrolled in the ADDITION-Plus trial. Main outcome measures Self-reported and objectively measured health behaviours (diet, physical activity, smoking status), CVD risk factor levels (blood pressure, lipid levels, glycated haemoglobin, body mass index, waist circumference) and modelled 10-year CVD risk. Results Better experiences of PCC early in the course of living with diabetes were not associated with meaningful differences in self-reported physical activity levels including total activity energy expenditure (β-coefficient: 0.080 MET h/day (95% CI 0.017 to 0.143; p=0.01)), moderate-to-vigorous physical activity (β-coefficient: 5.328 min/day (95% CI 0.796 to 9.859; p=0.01)) and reduced sedentary time (β-coefficient: −1.633 min/day (95% CI −2.897 to −0.368; p=0.01)). PCC was not associated with clinically meaningful differences in levels of high-density lipoprotein cholesterol (β-coefficient: 0.002 mmol/L (95% CI 0.001 to 0.004; p=0.03)), systolic blood pressure (β-coefficient: −0.561 mm Hg (95% CI −0.653 to −0.468; p=0.01)) or diastolic blood pressure (β-coefficient: −0.565 mm Hg (95% CI −0.654 to −0.476; p=0.01)). Over an extended follow-up of 5 years, we observed no clear evidence that PCC was associated with self-reported, clinical or biochemical outcomes, except for waist circumference (β-coefficient: 0.085 cm (95% CI 0.015 to 0.155; p=0.02)). Conclusions We found little evidence that experience of PCC early in the course of diabetes was associated with clinically important changes in health-related behaviours or CVD risk factors. Trial registration number ISRCTN99175498; Post-results.

Therapeutic empathy: what it is and what it isn't

Jeremy Howick , Valeria Bizzari and Hajira Dambha-Miller; on behalf of the Oxford Empathy Programme Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Infirmary Quarter, Oxford OX2 6GG, UK Klinik für Allgemeine Psychiatrie mit Poliklinik, Universität Heidelberg, Vosstrasse, 4 Heidelrberg, Heidelberg 69115, Germany Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK Corresponding author: Jeremy Howick. Email: jeremy.howick@phc.ox.ac.uk

Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta-analysis of trials in primary care

To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.

Technology: a help or hindrance to empathic healthcare?

John Preece was the first British general practitioner to use a computer in the consulting room in 1970. Since then, technology in healthcare consultations has advanced tremendously. There has been continuous progression with computerisation of notes, results, imaging and much more. This has allowed information to be in a central place allowing for better preparation and understanding before, during and after the consultation. More recent technological advances include video consultation, smart phone applications and the use of artificially intelligent robot doctors. Due to recent progress in technology, it is unsurprising that many bold claims about its ability to improve healthcare consultations have been made. For example, Alemi et al. have suggested that humanoid robots can alleviate children’s stress and depression, while Crain reported that nurse robots can express empathy to patients. Can we believe these claims? In this instalment of the empathy series, we will focus on the relationship between technology and empathy, and examine whether technology may help or hinder empathic healthcare.

Empathy as a state beyond feeling: a patient and clinician perspective:

Amy Price and Hajira Dambha-Miller ; on behalf of the Oxford Empathy Programme Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK Corresponding author: Amy Price. Email: dr.amyprice@gmail.com

Patients’ views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years

Background It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient–practitioner interactions might be changing. Aim To explore the views of patients with type 2 diabetes on factors that are of significance to them in patient–practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease. Design and setting A longitudinal qualitative analysis over 10 years in UK primary care. Method The study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics. Results At the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time. Conclusion This study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.

Patients’ views on interactions with their practitioners for type 2 diabetes: A longitudinal qualitative study over ten years in UK primary care

The ADDITION trial is supported by the Medical Research Council (grant reference no: G0001164 and Epidemiology Unit programme grant: MC_UU_12015/4), the Wellcome Trust (grant reference no: G061895 ), Diabetes UK and National Health Service R&D support funding. The Primary Care Unit is a member of the National Institute for Health Research (NIHR) School for Primary Care Research and supported by NIHR Research funds. SJG is an NIHR Senior Investigator. HDM is an NIHR Doctoral Research Fellow. GI is an NIHR Academic Clinical Lecturer. BS was supported by the Medical Research Council [MC_UU_12015/4]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

An appealing prospect? A survey into the numbers, outcomes, and editorial policies for appeals of rejected biomedical manuscripts

The opportunity for authors to appeal against rejected manuscripts provides an important step in ensuring that high‐quality and credible science is not incorrectly rejected from publication in the highest impact factor journals. However, little is known about editorial processes related to appeals and their outcomes. Our research investigated the number of appeals against rejected manuscripts, their success rates, and the current editorial processes for managing appeals amongst biomedical journals. We sent out an e‐mail survey to a sample of 20 editorial teams worldwide, between January and August 2016. A descriptive summary of e‐mail responses from editorial teams was collated. We found considerable variations in appeal processes amongst journals, with little evidence of any detailed, reproducible, or established appeal policies in operation. Journals disclosed limited information on the number of appeals received and their success rates. The credibility of an appeal process relies on robust, reproducible, and evidence‐based policies, which do not seem to be currently established amongst biomedical journals. Further empirical evidence is needed to ascertain how variations in the appeal process may relate to successful publication.

Books: The 10-Minute Clincial Assessment: A Systematic and Easy to Follow Guide — From Hirsutism to Heart Failure to Self-Harm

Knut Schroeder Wiley-Blackwell, 2016, PB, 832pp, £49.99, 978-1119106340 Ten-minute consultations are often rushed affairs with most of us running late. So how do we keep to time while being clinically effective, safe, and patient centred? The 10-Minute Clinical Assessment by Knut Schroeder has the answers. The book provides a helpful guide for GPs, nurses, GP trainees, and medical students wanting to deliver a more efficient consultation that also includes the essential clinical content. It covers a comprehensive range of …