The Consultation Open and Close (COAC) Study


There is good evidence that many patients leave GP consultations without having voiced some of their main concerns, especially when a patient wants to discuss multiple problems, and this is associated with reduced satisfaction with the consultation. Up to 50% of primary care consultations do not deal with all the concerns the patient has. These missed problems are costly for the NHS in terms of re-consultation rates, delayed treatments and in missed opportunities to increase patient empowerment. Also, patients often have difficulty remembering the advice they are given during consultations, which can increase their concern and reduce adherence to advice.

The COAC intervention is designed to address both these problems.

The COAC Study

The aim of the study is to design and test an intervention (The Consultation Open and Close Intervention) to allow patients to better share their concerns, incorporating the use of an online form at consultation opening and a printed report at consultation closure.  Patients will be asked to fill in an online form before their appointment, and this will then be shared with the doctor or nurse. The online form will ask why they have made an appointment and for details of their health problems. This will include problems which might otherwise be missed, such as how worried they are about their health, whether they are low in mood or finding it difficult to adhere to their medication or other health advice. The printed report the patient gets at the end will show what the doctor and patient agreed. Having the doctor’s advice in writing make it easier to remember.

Anticipated Outcomes

The COAC intervention should help address more of patients’ problems in the consultation. This is likely to improve patient satisfaction, health and well-being and potentially reduce rates of re-consultation for the same problem. We plan to measure the following outcomes in the study:

  • Proportion of patients with at least one follow-up appointment for the same problem within 1) one month 2) three months
  • Health-related quality of life measured through the EQ-5D
  • Profile of health and well-being, health knowledge and self-care and confidence in health plan measured through the Primary Care Outcomes Questionnaire.
  • Perceived clinician empathy and doctor-patient communication measured through The Consultation and Relational Empathy Measure
  • Patient satisfaction
  • Extent to which the patient’s main problem was resolved
  • Extent to which consultation addresses patients’ priorities (from the LTC6)
  • Extent to which consultation provided patients with information to manage their health (from the LTC6)

 Further information

The tabs on the left give more information. Or see Information for Study Participants  for a brief summary.




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