The Quality and Outcomes Framework and self-management dialogue in primary care consultations: A qualitative study

Thomas Blakeman, Tom Blakeman, Carolyn Chew-Graham, David Reeves, Anne Rogers, Peter Bower

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Two key elements to improve the quality of care for people with long-term conditions in primary care are improved clinical information systems to support delivery of evidence-based care, and enhanced self-management support. Although both elements are viewed as necessary, their interaction is not well understood. Aim: To explore the use of computer-based 'disease management' templates and their relevance to self-management dialogue within clinical encounters. Design and setting: Qualitative study of general practices located in three primary care trusts in the north of England. Method: A qualitative mixed methods study was conducted that included comparative analysis of (1) observations of general practice consultations (n = 86); and (2) interviews with health professionals in general practice (n = 17). Results: The analysis suggested that use of the computer templates reinforced a checklist approach to consultations, which included professionals working through several self-management topics framed as discrete behaviours. As a consequence, conversation tended to become focused on the maintenance of the professional-patient relationship at the expense of expansion in self-management dialogue. The computer templates also shaped how patient-initiated self-management dialogue was managed when it arose, with a shift towards discussion around medical agendas. Conclusion: In order to enhance the management of longterm conditions in primary care, the design and implementation of clinical information systems to improve evidence-based care need to take into account their potential impact on supporting self-management. ©British Journal of General Practice.
    Original languageEnglish
    Pages (from-to)e666-e673
    JournalBritish Journal of General Practice
    Volume61
    Issue number591
    DOIs
    Publication statusPublished - 2011

    Keywords

    • Chronic disease
    • Consultation
    • Doctor-patient relations
    • Primary care
    • Self-management

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