"There is a problem with adding in more preventive type consultations in practices that are stretched to the limit.
In reality, the complex and evolving nature of the patient surgeon relationship results in a hybrid-type consultation, for example, as knowledge is gained by the patient the process may start as SDM and evolve to become an informed type. 2 Decision-making is distributed over time and involves many sources of information (human and non-human), 30 a finding echoed by our patient cohort.
An additional strength is that PROSAIC can interpret multiple data types (consultation records, diagnostic codes, medications) and can be used on large sets of unstructured notes gathered from multiple practitioners in multiple primary care practices with multiple EHR systems rather than being confined to a single data type, a single institution or a single EHR system.
Direct costs within the out of hours care included resource use (e.g. prescriptions, test & investigations, referral to other ED or hospital), length of consultations, type of consultations (i.e. telephonic consultation, face to face consultation or home visit), consultation rate and salary costs.
Physicians were asked to document the same consultations with reference to type of consultation, general health, severity and duration of symptoms of their patients.
For the following consultation types, consultations with women aged 15-49 years were also (separately) examined.
Providers also recorded the type of consultation (first or review consultation) and whether they thought it was appropriate to address lifestyle risk factors in the consultation (yes/no) and if no the reasons why (open response).
Family physicians/general practitioners make also phone consultations, although in Poland and Russia this type of consultation is not formally recognized.
Per type of consultation, i.e. telephone advice, consultation at the GP cooperative, or home visit, number of patient contacts were registered.
One limitation is that the patterns observed in length and type of consultation could not be statistically verified, as we were not able to record every consultation for each patient.
