Developing a longitudinal database of routinely recorded primary care consultations linked to service use and outcome data

The primary care consultation provides access to the majority of health care services and is central toobtaining diagnoses, treatment and ongoing management of long-term conditions. This paper reportsthe findings of an interdisciplinary feasibility study to explore the benefits and practical, technical andethical challenges (and solutions) of creating a longitudinal database of recorded GP consultations inTayside, Scotland which could be linked to existing routine data on intermediate and long-term healthoutcomes. After consultation we attempted to recruit and audio-record the consultations of all patientsattending three general practices over a two week period. Background patient data, and patient and staffexperiences of participation were also collected. Eventually, two practices participated with 77% ofpatients approached agreeing to participate. The findings suggest that the perceived integrity of theconsultation was preserved. The overwhelming majority of patients believed that recording wasworthwhile and did not feel it impacted on communication or the treatment they received; 93% indicatedthey would be willing to have subsequent consultations recorded and 81% would recommendparticipation to a friend. Staff had similar beliefs but raised concerns about potential increases inworkload, confidentiality issues and ease of software use. We conclude that practice participation couldbe increased by providing safeguards on data use, financial reward, integrated recording software, andprocedures to lessen the impact on workload. The resulting Scottish Clinical Interactions Project (SCIP)would provide the largest and most detailed longitudinal insight into real world medical consultations inthe world, permitting the linking of consultation events and practices to subsequent outcomes andbehaviours.