Patient-Centredness in a Black Township

Abstract

Purpose: The purposes of this study were to assess the degree to which a patient-centred approach is used by the private general practitioners in the black township where we practise and to test both its short and long term effectiveness. We postulated that patient-centredness would be positively associated with: (i) patients feeling understood; (ii) patient satisfaction; (iii) symptom resolution; (iv) concern resolution; and (v) the long term control of hypertension, diabetes mellitus and asthma.
Method: The study was conducted in Ga-Rankuwa, South Africa, a large black township, northwest of Pretoria. A random sample of 10 private general practitioners was chosen. Eligible patients were all those over 16 years who presented with a symptom or one of the three target conditions. Patient-centredness was scored in terms of the doctor's facilitation of the patient's reasons for coming, including symptoms, thoughts, feelings and expectations, from an audio-tape of the entire consultation. Post-consultation interviews were conducted to assess the immediate patient outcomes. Follow-up during the next l2 months was planned in order to assess the long-term outcomes, but this was circumvented by failure to obtain sufficient patients with the targeted chronic conditions.
Results: Seven general practitioners conducted 167 consultations for a patient response rate of 94%, of which 154 of the audio-tapes were of sufficient sound quality to be scored. The mode, median and mean of the patient-centred scores were 1.00, 1.25 and 1.40 respectively out of a total possible of 3.00. Only four of the consultations scored high enough to be considered patient-centred. None of the immediate patient outcomes was found to be associated with the level of patient-centredness present in the consultations studied. Only six patients had hypertension, diabetes mellitus or asthma.
Conclusion: The degree to which a patient-centred approach is practised by the private general practitioners in Ga-Rankuwa township is low. Half measures with respect to patient-centredness would seem not to be of value; rather, it would seem that patient-centredness is only effective once a reasonably high level of skill has been reached. Further research into the long term effectiveness of a patient-centred approach is required.