Factors influencing consultation length in general practice: conversation analysis and econometric models

Background A standard General Practice (GP) consultation falls under Level B of the Medicare Benefit Scheme (six to 20 minutes) with consultations averaging 10-15minutes. This imposes time constraints on the consultation, that could be a limiting for patients with multiple or complex concerns. This limitation may lead GPs to compromise on the quality of care either by inadequately addressing patient’s concerns by prioritising time or by extending consultations and running late due to systemic pressures in the consultation length model.Objectives This study of communication in healthcare adopts a novel approach to assess how external factors, such as patient age and education, and internal factors, such as how multiple medical concerns were raised, impact the length of general practice consultations.Design This study used a mixed-method design using conversation analysis and econometric models to explore the influence of external factors and internal factors affecting consultation length.Setting This study use data available for secondary analysis from three General Practice (GP) Clinics in metropolitan Sydney, Australia, collected between 2018 and 2019.Participants Forty-one consultations across three GPs were video recorded, with linked patient surveys. All participants were 18 years and older and spoke English fluently.Results Both external and internal factors affect consultation length. Older patients (35–64 years-old & 65-85 + years-old) had shorter consultations than younger patients (18–34 years-old). Patients with tertiary education had shorter consultation length than patients with only High School Certificate/School Certificate qualifications. Consultations with agenda setting to establish a medical concerns list and consultations which had a clear “driver” were shorter.Conclusions Factors beyond number of medical concerns presented can influence GP consultation length. Thus, the standard length of consultation could be limiting not only for patients with several presenting concerns or single complicated concerns, but also for those who may otherwise benefit from a longer consultation time, such as younger people. Future policy development and workload planning should consider aspects of patient age and education when determining consultation length. As internal conversational factors can reduce consultation length, training for GPs in specific consultation approaches may also improve efficiency.