प्राथमिक देखभाल में गुणवत्ता खुला एक्सेस


Pilot study to develop and test a generic peer feedback instrument to review videotaped consultations in primary care

Rhona McMillan, Niall Cameron, Ailsa Power

Background The ability to consult effectively is key to the delivery of quality patient care. External peer review of consultations has been available to general medical practitioners (GPs) in the west of Scotland for several years. Pharmacists are expected to provide increasingly complex advice for patients. This study describes the development and first steps in the evaluation of a generic tool to be used to inform feedback about both GP and pharmacist consultations with patients. MethodThe toolwas developed by a small group of GPs and tested for validity using a content validity inventory. An item correlation pilot (ICP) was carried out. Three experienced reviewers reviewed and scored three consultations in each of six GP tapes, a further three reviewers reviewed and scored three consultations in each of four pharmacists’ tapes. The results underwent statistical analysis. ResultsPharmacists do not examine patients and so two similar instruments were developed, whereby two questions pertinent to patient examination were omitted from the pharmacist instrument. The content validity inventory demonstrated aspects of face validity and content validity of instruments. Statistical analysis of GP tapes suggested that the instrument could discriminate between GP consultations. Skills demonstrated by pharmacists were given lower scores, were less consistent than the GPs and the instrument did not discriminate between those performing at different levels. ConclusionThe results suggest that the instrument is useful only when applied to practitioners who have been taught how to consult in a patientcentred manner, and have led to the introduction of training in consultation skills for pharmacists throughout Scotland. Potential reliability in providing peer feedback for GP consultations is important in the context of the provision of consistent, meaningful evidence for GP appraisal and revalidation in the UK.

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