63. A Pain in the Neck: The Association Between Chronic Health Conditions and Frequent Consultation in Primary Care

Abstract

tells us little about the process or content of consultations. In this project, video-recorded GP consultations were analysed in order to describe the content of musculoskeletal consultations and secondly, to explore the potential of video-recorded routine consultations to enhance areas of the undergraduate medical curriculum, relating to MSK conditions. Methods: Videos of routine patient and doctor consultations (adults aged over 45), that had been previously collected for study of musculoskeletal problems were used. Ethical approval was granted and informed consent gained from all participants. A framework for analysis was identified, incorporating elements of GeCos (a structured tool for assessment of consultation skills, based on the Calgary Cambridge model), MSK specific items and a global assessment of educational value. The framework underwent iterative modification as other items of importance emerged during the analysis. All videos were watched and analysed using the framework. Excel 2010 was used to document findings. Results: Patients presented with MSK symptoms in 68/195 (34.9%) video recorded consultations. MSK issues were discussed alongside other symptoms or problems in 43/68 (63.2%) consultations, and talk on MSK issues accounted for an average of 64% of the total time spent in the consultation. GPs often did not discuss how they were prioritizing the consultation when multiple problems presented. In terms of generic consultation skills, GPs were observed to be undertaking the consultation in line with the GeCos model. Other important themes identified were patients expressing self-management approaches and patients expressing concerns about their condition or treatment. More details of these will be presented. Educational value was felt to relate to the usefulness of watching GPs explaining MSK problems in lay terms. Conclusion: This work demonstrates MSK problems may present much more commonly than existing research suggests in this age group. It also highlights the complexity of the primary care consultation and the way in which MSK complaints may be dealt with alongside other problems. Observing routine video recorded MSK consultations may be helpful during undergraduate teaching; however, students may need guidance to understand the context and pressures of real-life GP consultations. Strengths of this research include the underpinning qualitative methodology used for the analysis and the richness of the sample of real-life routine GP consultations. Limitations include the possible influence of recording on consultation interactions and limits of this sample. Further work is needed to assess if these qualitative findings are replicated elsewhere, whether GPs would contribute to an educational video bank and the possible usefulness of this within the curriculum. Disclosure statement: S.S.P. has received grants/research support from Arthritis Research UK. All other authors have declared no conflicts of interest.