Review of the medical record is a reasonably accurate method of assessing measurement of blood pressure in the consultation but would lead to significant underestimation of advice about smoking and alcohol.
Objective-To see whether extending appointment length from seven and a half minutes or less to 10 minutes per patient would increase health promotion in general practice consultations.Design-Controlled trial of 10 minute appointments. Consultations were compared with control surgeries in which the same doctors booked patients at their normal rate (median six minutes per patient).Setting-10 general practices in Nottinghamshire. Subjects-16 general practitioners were recruited. Entry criteria were a booking rate of eight or more patients an hour, a wish for longer consultations, and plans to increase appointment length.Main outcome measures-Duration of consultations; recording of blood pressure, weight, and cervical cytology in the medical record; recording of advice about smoking, alcohol, diet, exercise, and immunisation in the medical record; reporting of the above activities by patients.Results-Mean consultation times were 8-25 minutes in the experimental sessions and 7-04 and 7-16 minutes in the control sessions. Recording of blood pressure, smoking, alcohol consumption, and advice about immunisation was significantly more frequent in the experimental sessions, and the proportion of consultations in which one or more items of health education were recorded in the medical notes increased by an average of over 6% in these sessions. Patients more often reported discussion of smoking and alcohol consumption and coverage of previous health problems in the experimental sessions. There was little change in discussion ofexercise, diet, and weight or cervical cytology activity.
Registered Sick Children's Nurses take less time than Registered Nurses to triage calls about children presenting with 'rash' or 'fever'. Further investigation is required into the content and consultation process of the nurses, and also the safety and appropriateness of referral.
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