The consultation open and close study: A feasibility study of a complex intervention

Background: Use of telephone, video and online consultations in general practice is increasing. This can lead to transactional consultations which make it harder for patients to describe how symptoms affect their lives, and confusion about plans for future care. The aim of this study was to test the feasibility of a randomised control trial (RCT) for a complex intervention designed to address patients’ concerns more comprehensively and help them remember advice from general practitioners (GPs). Methods: The complex intervention used two technologies: a patient-completed pre-consultation form at consultation opening and a doctor-provided summary report printed or texted at consultation closure. The feasibility of the intervention was tested in a cluster-randomised framework in six practices: four randomised to intervention, and two to control. Thirty patients were recruited per practice. Quantitative data was collected via patient-reported questionnaires and health records. GPs, patients and administrators were interviewed. Analysis included a process evaluation, recruitment and follow-up rates, and data completeness to assess feasibility of a future RCT. Results: The intervention was acceptable and useful to patients and GPs, but the process for the pre-consultation form required too much support from the researchers for a trial to be feasible. Both technologies were useful for different types of patients. Recruitment rates were high (n=194) but so was attrition, therefore criteria to progress to an RCT were not met. Conclusions: Both the pre-consultation form and the summary report showed important potential benefits. They should be considered as separate interventions and evaluated independently. The technology to send pre-consultation forms needs further development to allow integration with GP computer systems. The additional time needed to generate summary reports meant GPs preferred to use it selectively. Collecting outcome data using online questionnaires was efficient but associated with high attrition, so alternative approaches are needed before a full RCT is feasible.