Patient involvement in assessing consultation quality

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Patient enablement can be defined as the extent to which a patient is capable of understanding and coping with his or her health issues. This concept is linked to a number of health outcomes such as self-management of chronic diseases and quality of life.

Dr Aelita Skarbaliene from Klaipeda University (Lithuania) together with colleagues from Lund University (Sweden) and RCSI (Ireland) carried out the research with the aim to identify the level of patient enablement in Lithuanian general practice and compare Lithuanian patients’ enablement with previous studies in Europe to see if factors associated with patient enablement in Lithuania were reflective of those in the previous studies.

A total of 2500 consulting patients participated in the study. This was the first report on patient enablement in Lithuanian general practice.

The average patient enablement reported was 6.43 (out of 12) and was very similar to the study in Croatia and higher than a similar study in Sweden, Poland, the UK, Scotland, and France. Since the sample sizes in the studies mentioned above were very similar, the differences in the level of patient enablement may be explained by cultural and linguistic differences, since social and cultural issues shape different patient expectations and influence enablement.

Regardless of the differences of enablement level, a difference when comparing age groups and gender was revealed in most of the countries. In Lithuania, scores declined with increasing patient age and female patients were more enabled than male patients. Older age in male patients predicted low enablement in Croatia and patient enablement was positively associated with female patients and younger age in Poland. However, another study revealed that middle-aged patients (31–60 years) were significantly less enabled than the group aged 16–30 years. However, the negative association with increasing age did not hold among older patients (≥61 years). It was argued that enablement results with regard to the patient’s age are contradictory. This allows us to question the influence of age on enablement.

The patient needs exhibited that patients consult family doctors mostly for biomedical or complex problems and that was similar to some findings in Western European countries. The enablement of patients who consulted for biomedical problems was higher in Lithuania, and enablement decreased when the consultation was for complex or administrative problems. Similar tendencies were revealed in the UK study and the Polish study reported that enablement scores were the highest for biomedical problems and lower for complex problems (biomedical, psychological and social in combination). Enablement was the lowest for patients with administrative needs. Enablement was also independently negatively associated with the complexity of consultation (patients wishing to discuss psychological or social problems plus or minus physical problems) in Scotland.

Studies found a high rate of prescribing in Lithuania and revealed that patient enablement increased when patients’ expectations of receiving a prescription were fulfilled, as in the Poland and UK studies.

This study underlined the importance of knowing the doctor for patient enablement in Lithuania: this tendency supporting continuity of practitioners is very similar to the experience of other countries. At individual consultations in the UK, knowing the doctor well was most
closely associated with the enablement score. The lack of continuity of care predicted low enablement in Croatia. The patient’s perception of continuity and the doctor’s communication skills were related to the higher PEI scores in Sweden, and knowing the doctor was independently related to patient enablement in the Polish context. However, it was found before that consultation length and continuity of care (knowing the doctor well) were not related to enablement in the last study in Scotland, but previous work did find a weak positive association between enablement and continuity of care.

Consultation duration was another factor associated with higher enablement in Lithuania: patient enablement rose with consultation duration. Sufficient consultation time is a global concern. Longer mean consultation time associates with increased enablement around Europe. Enablement score was closely associated with duration of consultation in the UK, Croatia, Poland, and Scotland. It is worth noting that the value of continuity and longer duration of the consultation was not only established for patients attending a GP in primary care, but also for those consulting with general practice nurses. Thus, once again, studies underline the importance of consultation duration for patient enablement.

Thus the results of the study of patient enablement and its relationship with respondents’ characteristics replicate those found in Western and Central Europe: a longer consultation time and greater continuity of care increases patient enablement. Based on the results it is possible to make suggestions for improvement of GP practice, i.e., seeking continuity of care and longer consultations in primary care.