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Table 3 Relevant data and conclusions of cross-sectional studies on consultation length and management of psychological problems.

From: Do longer consultations improve the management of psychological problems in general practice? A systematic literature review

Author Analysis/key data Conclusions/findings
Westcott 1977 [25] Psychoneurotic conditions were significantly assoc with longer consultations longer than the median (p < 0.001) mean = 14.14 mins(5–32) Shorter consultations for age group 15–29 years and for lower socioeconomic class. Psychoneurotic consultations are associated with longer consultations
Raynes 1980 [38] GPs with positive orientation to mental health spent longer with patients (p < 0.05). Focus on psychosocial matters (p < 0.01), diagnosis of psychological problem & prescription of psychotropic drug resulted in longer consultation Diagnosis and management of psychological disorder took longer.
Hughes 1983 [3] Comparison of results between faster & slower practice. Practice A (mean = 8 mins) 7.5% psych diagnosis. Practice B(mean = 5 mins), 7.1%. No significant difference in psychological problems managed
Whitehouse 1987 [29] In consultations <6 minutes, 60%of doctors recorded less than 6.3%rate of psychosocial diagnosis. For consultations >8 mins, 34% of doctors recorded over 10% rate., p,0.05, df = 12, x2 = 25 Increasing consultation time assoc with increased diagnosis of psychosocial illness.
Andersson 1989 [37] Consultations with psychological problems were longer than those with physical, (mean 28 vs 14 minutes). Consultation for psychological problem took longer compared to physical
Howie 1991 [36]/1989 [24] Increased cons length assoc with greater recognition & management of chronic illness & psychosocial problems P < 0.05.
"Faster" doctors were less likely to deal with a psychosocial problem in depth, when detected p < 0.09
Increased consultation length associated with increase chance of GP dealing with detected psychosocial problem.
Longer consultations assoc with reduced prescribing.
Andersson 1993 [52] The "doctors speed" contributed to 22.5%, the character of the problem 11.6%, the age of the patient 2.9% and the patients sex 0.4%, with coefficient of determination R2 = 0.374. Majority (41% according to dr, 69% according to patient) of short consultations are entirely physical. The consultation length mainly associated with the doctors "speed" and patient factors including psychological problem and age.
Rost 1994 USA [28] 30% of primary care physicians state that lack of time, & 23% that patient not recognising problem, is the biggest barrier to treating depression 30% of primary care physicians state that lack of time is the biggest barrier to treating depression.
Winefield 1996 [40] Consultations in top quartile of Patient centerness, compared to bottom quartile, lasted longer (p < 0.001), dealt with more psychosocial or complex problems, had more pt satisfaction (p < 0.05) and same dr satisfaction (p < 0.05), x2 (2d.f.) = 28.84 Patient centred consultations are likely to be longer and include psychological or complex problems.
Martin 1997 [45] Longer consultations more likely than standard consultations to deal with psychological problems (OR, 2.06; 95%CI 1.83–2.32) Longer consultations more likely to deal with psychological problems
Carr-Hill 1998 [39] Multilevel modelling used to analyse assoc of consultation length and multiple factors including diagnosis, doctor, age & gender, & patient age & gender. Average consultation for ICD VIII (Ears) = 5.0 mins, ICD V (Mental & behavioural) = 8.9 mins. ICD XX (social) = 11.8. Only pregnancy longer Length of consultation explained by variability amongst patients, the diagnosis, GPs & practices.
Consultation length not a marker of quality
Howie 1999 [26] Using multiple regression with enablement as outcome variable, the enablement score was most closely linked to duration of consultations and patient knowing doctor well.
Duration of consultation increased for patients with psychological (8.9 mins) or complex problems(9.2 mins) compared to biomedical (7.6 mins).95%CI
Consultation length significant predictor of enablement. Longer consultations for psychological problems(mean = 9.0)
Blumenthal 1999 [30] Multivariate analysis determined that Psychosocial diagnosis is associated with 9 (6–12)% increase in visit duration, P = <0.001, Age>70, assoc with>11% increase, p < 0.001. Patient characteristics of increasing age & psychosocial problem are associated with increased duration.
Stirling 2001 [9] 50%increase in consultation length assoc with 32% increase in recognition of psychological distress (95%CI = 10.7–57.3%) Accurate rating of psychological distress increased with consultation length.
Harman 2001 [42] Multivariate analysis showing that visits where depression is diagnosed are 2.9 minutes longer on average, 19.3 minutes compared to 16.4 minutes. Visits with a diagnosis of depression were longer than those without.
Deveugele 2002 [43] Multilevel analysis with length of consultation a dependent variable. The regression coefficient for diagnosis of psychological problem by the doctor = 0.05(0.08–1.81), for consultation where pt recorded psychosocial aspect important+0.52 (.10–.95) Increased consultation length associated with positive orientation of doctors to psychosocial problems (not gender); new problems; psychosocial problems perceived by doctor; women patients.
Telford 2002 [34]   GPs believe that time and lack of services are the main obstacles to managing depression, not knowledge or skills.
Tahepold, 2003 [41] Longest consultation for psychological problem, mean = 11+/- 5.0 mins, p < 0.015. Older patients and those with psychological problems tend to have longer consultations
Britt 2004 [17] Psychological problems: 6.7%(6.4–6.4) of consultations<20 mins, 11.6%(11.0–12.2) of longer consultations> 20 mins (95%CI) Psychological, social & female genital problems more frequently managed in longer consultations. Female doctors have longer consultations.
Britt 2005 [27] Regression coefficient for Psychological problem = +1.75 mins(1.32–2.18), p < 0.001 Variables with positive effect on consultation length include: Female GP, social, psychological or female genital problem & Chronic disease.
Zantigne 2005 [33] Consultations with psychological problems are longer than those for somatic problems.12.65 mins compared to 9.06, p < 0.01 Consultations where a GP notices psychological problems make heavier demands on the GPs' workload
Wright 2005 [35] Ranking of 1–5. Time constraints main barrier to providing care for depressed patients; ranking = 3.04(0.92) The most common barrier to providing care for depressed patients was "time constraints"