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Patients more likely than GPs to raise ideas, concerns and expectations during consultations

6 September 2023

Eliciting patients’ Ideas, Concerns, Expectations and whether their medical problem or associated treatment has an Effect on their daily activities (ICEE) is widely recommended in patient-centred consulting in primary care. A new study, led by researchers at the Centre for Academic Primary, University of Bristol and published in BJGP Open, has found that, while most GP consultations included at least one ICEE component (90.2%), most of these were raised by patients rather than GPs.

The data were collected through the analysis of video-recorded face-to-face consultations from the One in a Million primary care consultations archive, and linked to patient electronic health records and survey data.

The most common ICEE component per consultation was patient ideas (79.3%), followed by concerns (55.4%), expectations (51.1%) and effects on life (42.4%). For all ICEE components, patients more commonly initiated the ICEE dialogue and in only 3.3% of consultations did GPs ask patients about their expectations.

Despite being the least frequent verbalised component of ICEE, effects on life were documented in the patient medical records more than any other component.

There were more ICEE components mentioned for problems that were acute and assessed by older GPs, and less for problems assessed later in the consultation, by patients of 75 years or over and living in the most deprived neighbourhoods, compared to the least deprived.

The voicing of patient ideas was associated with increased patient satisfaction scores, whereas the opposite was true for the voicing of patient concerns, but more research is required to explore potential confounding in these associations.

Dr Peter Edwards, NIHR Clinical Research Fellow, at the Centre for Academic Primary Care, said: “Asking about ICEE is considered best practice in GP training in the UK, though not much is known about how it is used in practice. This study shows that ICEE discussions do take place but more often than not are initiated by patients rather than GPs.

“We hope that our findings can be used to inform clinical practice and future research, including identifying population groups less likely to communicate ICEE and how closely medical records reflect what has happened in the consultation.

“With increasing use of remote consultations, this study also provides a benchmark of ICEE frequencies in face-to-face consultations which could be usefully compared with data on remote consultations in future research.”

Paper: Ideas, Concerns, Expectations and Effects on life (ICEE) in GP consultations: an observational study using video-recorded UK consultations. Published in BJGP Open. September 2023.

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Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.

It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

Follow on Twitter: @capcbristol

About the National Institute for Health and Care Research (NIHR)

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

· Funding high quality, timely research that benefits the NHS, public health and social care;

· Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;

· Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;

· Attracting, training and supporting the best researchers to tackle complex health and social care challenges;

· Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;

· Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

The NIHR is the research partner of the NHS, public health and social care.

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