Evaluating care of patients reporting pain in fundholding practices (original) (raw)

Objective-To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain. Design-Questionnaire and record based study. Subjects-Patients identified at consecutive consultations during two weeks in 1990, 1991, and 1992. Setting-Six practice groups in pilot fundholding scheme in Scotland. Main outcome measures-Length of consultation; numbers referred or investigated or prescribed drugs; responses to questions about enablement and satisfaction. Results-About 15% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992; about a fifth wanted to discuss their social problems. Social problems were associated with a raised general health questionnaire score. The mean length of consultation for patients with pain was 7*6 min in 1990 and 7-7 min in 1992. Patients wishing to discuss social problems received longer consultations (8.5 min 1990; 10-4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7-2 min). The level of prescribing was stable but the proportion of patients having investigations or attending hospital fell significantly from 1990 to 1992 (31% to 24%/; 31% to 13% respectively). Fewer patients responded "much better" to six questions about enablement in 1992 than in 1990. Enablement was better after longer than shorter consultations for patients with social problems. Conclusions-Quality of care for patients with pain has been broadly maintained in terms of consultation times. The effects of lower rates of investigation and referral need to be investigated firther.