Consultation length by multimorbidity and deprivation: observational study using electronic patient records
AbstractBackgroundLonger GP consultations are recommended for people with multimorbidity. In Scotland, multimorbid patients in deprived areas did not have longer consultations though their counterparts in the least deprived areas did. We are not aware of research testing this particular example of the inverse care law in England.AimTo assess length of GP consultation for patients with and without multimorbidity and whether this varies by socioeconomic deprivation.Design and SettingRandom sample of over 1.2 million consultations between 1st April 2014 and 31st March 2016 for 185,755 adults in England drawn from the Clinical Practice Research Datalink.MethodConsultation duration was derived from time of opening and closing the patient’s electronic record. Duration was modelled as a function of multimorbidity status, index of multiple deprivation, and their interaction, with adjustment for age, sex, GP trainee status and patient level random effect.ResultsMean adjusted consultation length in the most deprived fifth of areas was 10.8 (95% CI 10.7,10.9) minutes for people with 2+ physical conditions and 11.0 (95% CI 10.9,11.1) minutes for people with 2+ conditions including a mental health condition. This compares with 11.0 (95% CI 10.9,11.0) minutes for non-multimorbid people in the least deprived fifth of areas.ConclusionConsultation length for people with multimorbidity in the most deprived areas is no higher than that for non-multimorbid people in the least deprived areas. Further research is needed to assess the impact of consultation length on patient and system outcomes for people with multimorbidity.