Met or matched expectations: what accounts for a successful back pain consultation in primary care.

Abstract

Background: Back pain is a common disorder, affecting up to 2 in 3 of the adult population, with the general practitioners (GPs) being the first point of contact for help. Bio-psychosocial management of back pain has been shown to be problematic. Meeting patients‟ expectations is alleged to play a vital role in concordance, adherence and satisfaction with the given treatment; a more potent aspect, however, could be a state of matched patient-GP expectations, which could have an influential effect on the process and outcome of the medical consultation. This aspect, however, has not been fully investigated in the literature and further research is needed to discern the potential importance of this matching on different aspects of the consultation. Methods: The main aim of the study was to investigate the matching of patient-GP expectations related to the back pain consultation in primary care by means of (1) developing a structured questionnaire that can measure this matching; (2) using the tool to measure the matching of patient-GP expectations; and (3) exploring the perceived importance of such matched expectations on different aspects of the consultation. Using a mixed methods sequential nested design, 11 GPs and 57 back pain patients (from 11 general practices in the South of England) completed the Expectations Questionnaire (EQ) that measured the matching of their expectations. Telephone interviews were then used for exploring the perceived importance of this matching. The study tested the hypothesis that the matching of patients‟ and GPs‟ expectations was perceived as an important attribute for a successful back pain consultation in primary care, from the patients‟ and GPs‟ perspectives. Results: The study showed that the EQ can be used as a valid and reliable tool for measuring the matching of patient-GP expectations. The results showed that patients and GPs had mismatched expectations regarding one third of the EQ items. These were mainly related to the psychosocial aspect of the management. The data suggested a trend within the back pain consultations, where patients were less likely to express their expectations and the GPs were less likely to enquire about any unmet expectations at the end of the visit, which could render many expectations unaddressed and unmet. Thematic data analysis revealed several emerging themes with regard to the importance of matched expectations, namely, enhanced communication, trust, empathy, satisfaction and adherence, and have identified different or lack of agendas, time, caseload, cultural and language variations and continuity of care as possible barriers to this matching. Conclusion: The study revealed several convergences, but also identified a significant mismatch between patients‟ and GPs‟ expectations. Matched expectations were perceived as a significant indicator of the quality of the back pain consultation. Considering the many challenges and difficulties in managing back pain in general practice, a state of matched patient-GP expectations has the potential for improving the overall consultation experience, in terms of both the process and the outcome.