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‘Person-focused’ GP consultations may reduce frequent attendance

Training GPs to ask person-focused questions in appointments could empower frequent attenders, reducing the need for regular consultations and saving money, a study has found.

The cluster randomised feasibility trial, published in BJGP Open, was based on six practices in Bristol, in the west of England.

The researchers, from Bristol Medical School, the University of the West of England, Frome Valley Medical Centre and the NIHR CLAHRC West, identified the top 3% of frequent attenders at each practice in the study, and selected an eligible sample for the trial.

Participating GPs were trained to use BATHE, a consultation method which uses a series of linked questions to understand the context of health problems, empower self-management, and improve patient-GP relationships (see box).

Reception staff attempted to match patients with a single GP during the trial, and encouraged phone consultations. The GPs were asked to use BATHE techniques in they appointments with frequent attenders.

The study found an improvement in patient self-management and a 5.6% reduction in consultation rates compared to the controls.

The paper concluded that ‘GPs reported BATHE to be a helpful tool to structure discussion about the wider context to patients’ problems and gave examples of it yielding new insights, even from patients they felt they knew well.’

But though ‘patients were positive about the intervention’, they ‘noticed little change in their care’, it added.

There were also difficulties matching patients with the same GP throughout the study, and in ensuring that GPs used BATHE correctly.

The study concluded that ‘if a strategy were put in place to address key barriers to uptake, this intervention could be associated with increased support for patient self-management, lower consultation rates, and cost savings’.

What is the BATHE consultation technique?

BATHE is an acronym pertaining to a series of four linked questions and a closing statement as given below:

B = Background

 Question 1. What is going on in your life?

A = Affect

 Question 2. How do you feel about that?

T = Trouble

 Question 3. What about the situation troubles you the most?

H = Handling

 Question 4. How are you handling that?

E = Empathy

 Closing Statement. That must be difficult for you (or something of an appropriately similar nature).

Source: A consultation-level intervention to improve care of frequently attending patients: a cluster randomised controlled feasibility trial; BJGP Open; 8 January 2019