Wilson A D, Childs S
University of Leicester, Department of General Practice and Primary Health Care, Leicester, Leicestershire, UK, LE5 4PW.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD003540. doi: 10.1002/14651858.CD003540.pub2.
Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average consultation lengths differ. These differences may be due to self selection.
To assess the effectiveness and efficiency of interventions to alter the length of primary care physicians' consultations.
The following electronic databases were searched: Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (October 2002); CENTRAL (The Cochrane Library June 2003); MEDLINE (1966 to October 2002);EMBASE (1981 to October 2002); NHS National Research Register (June 2003). The search strategies combined subject terms for 'general practice', 'consultation' and 'length' with methodological filters.
Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of interventions to alter the length of primary care physicians' consultations.
Data were extracted independently by two authors using agreed criteria. Disagreements were resolved by discussion. Where data were missing attempts were made to contact authors. Given the heterogeneity of studies meta-analysis was not attempted, and results are presented as a narrative summary.
Six articles describing four UK trials met the inclusion criteria. All tested short term changes in the consultation time allocated to each patient and all had methodological weaknesses, particularly due to non-random allocation of patients. Altering appointment length resulted in modest changes in average length of consultation. There were no consistent differences in problem recognition, examination, prescribing, referral or investigation rates. There was some evidence that blood pressure was checked and smoking discussed more often when more time was available. None of the interventions were associated with differences in patient satisfaction. No trials examined efficiency.
AUTHORS' CONCLUSIONS: The findings of this review do not provide sufficient evidence to support or resist a policy of altering the lengths of primary care physicians' consultations. Further trials are needed that focus on health outcomes and cost effectiveness.
观察性研究表明，平均会诊时长不同的基层医疗医生在会诊过程和结果方面存在差异。这些差异可能是由于自我选择造成的。
评估改变基层医疗医生会诊时长的干预措施的有效性和效率。
检索了以下电子数据库：Cochrane有效实践与医疗组织小组（EPOC）专业注册库（2002年10月）；Cochrane系统评价数据库（Cochrane图书馆，2003年6月）；医学索引数据库（1966年至2002年10月）；荷兰医学文摘数据库（1981年至2002年10月）；英国国家医疗服务体系国家研究注册库（2003年6月）。检索策略将“全科医疗”“会诊”和“时长”的主题词与方法学筛选条件相结合。
关于改变基层医疗医生会诊时长的干预措施的随机对照试验（RCT）和对照临床试验（CCT）。
两位作者按照商定的标准独立提取数据。分歧通过讨论解决。数据缺失时，尝试联系作者。鉴于研究的异质性，未尝试进行荟萃分析，结果以叙述性总结的形式呈现。
描述四项英国试验的六篇文章符合纳入标准。所有试验均测试了分配给每位患者的会诊时间的短期变化，且均存在方法学上的弱点，尤其是患者的非随机分配。改变预约时长导致会诊平均时长有适度变化。在问题识别、检查、开处方、转诊或检查率方面没有一致的差异。有一些证据表明，时间更充裕时，血压检查和吸烟问题讨论得更频繁。没有一项干预措施与患者满意度的差异相关。没有试验考察效率。
本综述的结果没有提供足够的证据来支持或反对改变基层医疗医生会诊时长的政策。需要进一步开展关注健康结局和成本效益的试验。
