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The main outcome parameters of this study are weight status, type of complaints, number of GP consultations, quality of life and physical activity.
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Even though guideline specifications were continuously integrated into the working procedures in regular quality circles of the IPC, consultation quality still remains dependent on the knowledge and conversation techniques of the consultant.
Evaluation of any new initiatives should, in our view, include measures of consultation quality from the patients' perspective [ 40, 41].
Previous studies have found clinically coherent correlations between indicators of consultation quality and outcomes measured by ORIDL [ 10- 120]20].
It has been suggested that a combination of the CARE Measure with other measures of consultation quality may be useful in the evaluation and reward of GPs [ 41].
Full details of the two groups in terms of patient characteristics (see table 1) and consultation quality markers (including enablement scores) have been published previously [ 16, 20].
14 The user-generated quality standards differ from existing quality standards for young people in the areas of treatment options (quality standards 5 and 7) and communication during consultation (quality standards 11, 12, 14 and 15).
Relational continuity of care (being able to see the same GP and having a good relationship), and having sufficient time in the consultation were closely linked with perceptions of consultation quality.
Studies have shown that sufficient time in the consultation as well as making a patient feel valued and understood as an individual by the doctor are aspects closely linked with patients' perceptions of good consultation quality [ 17].
CAT: COPD Assessment Test COPDD: Chronic Obstructive Pulmonary Disease; CQI-2: Consultation Quality Index-2; ICC: Intraclass correlation coefficient; MRCF: Medication-Related Consultation Framework; PROM: Patient reported outcome measure; RIAS: Roter's Interaction Analysis System; SGRQ: St George's Respiratory Questionnaire; UK: United Kingdom.
In contrast to continuity and consultation length, there was little overlap between access and consultation quality themes in the narratives and discussion sequences in the transcripts of the focus groups.
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