Open Access Highly Accessed Research article

Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations

Sunita Procter1*, Kate Stewart2, David Reeves3, Leah Bowen1, Sarah Purdy1, Matthew Ridd1 and Chris Salisbury1

Author Affiliations

1 Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK

2 University of Nottingham, Medical School at Derby, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, UK

3 Centre for Primary Care and Centre for Biostatistics, Williamson Building, University of Manchester, Manchester M13 9PL, UK

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BMC Family Practice 2014, 15:105  doi:10.1186/1471-2296-15-105

Published: 27 May 2014



There is an increasing recognition that many consultations in general practice involve several problems covering multiple disease domains. However there is a paucity of reliable tools and techniques to understand and quantify this phenomenon. The objective was to develop a tool that can be used to measure the number and type of problems discussed in primary care consultations.


Thirteen consultations between general practitioners and patients were initially videoed and reviewed to identify the problems and issues discussed. An iterative process involving a panel of clinicians and researchers and repeated cycles of testing and development was used to develop a measurement proforma and coding manual for assessment of video recorded consultations. The inter-rater reliability of this tool was assessed in 60 consultations.


The problems requiring action were usually readily identified. However the different dimensions of the problem and how they were addressed required the identification and definition of ‘issues’. A coding proforma was developed that allowed quantification of the numbers and types of health problems and issues discussed. Ten categories of issues were identified and defined. At the consultation level, inter-rater agreements for the number of problems discussed (within ±1), types of problems and issues were 98.3%, 96.5% and 90% respectively. The tool has subsequently been used to analyse 229 consultations.


The iterative approach to development of the tool reflected the complexity of doctor-patient interactions. A reliable tool has been developed that can be used to analyse the number and range of problems managed in primary care consultations.

Primary health care; Consultation; Clinical coding