Even though there was no increase in recourse to trainer or other sources of in-consultation assistance, chronic disease consultations were significantly more likely to prompt the trainee to generate learning goals.
References. 1. Dodick D, Loder E, Manack Adams A, Buse D, Fanning K, Reed M, Lipton R. Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.
Chronic disease consultations often (though not always) took a linear and standardised format.
Four studies linked evaluation of the access to medicines prescribed in the last visit to the doctor [ 1, 12, 14, 18]; one study excluded chronic conditions consultations [ 1].
This careful attention to codes (or diagnoses) which aligned with institutional goals (e.g. high QOF achievement) is something we also observed in 'front stage' regions of the clinic, such as nurse-led chronic disease consultations [ 24].
This is line with a number of other studies that have found that PHC providers are more likely to address lifestyle issues during 'wellness' or chronic care consultations [ 18, 20, 44].
One practice routinely recorded all consultations regarding a chronic illness as 'Consultation, check up'.
These measures include, management of chronic marternal illness, consultation with healthcare providers before taking any medication, consulting health care providers regularly and avoidance of alcohol, smoking and the use of illicit drugs.
A potentially worrying (albeit speculative) example of such 'false negatives' might be the following: a well-conducted chronic care management consultation as part of an on-going and well-constructed care plan, with a (by now) well-informed and confident patient, during which nothing surprising is discussed.
