Development of a tool for coding safety-netting behaviours in primary care: a mixed-methods study using existing UK consultation recordings.
clinical coding
health communication
patient safety
primary health care
reproducibility of results
safety netting
video recording
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
18
03
2019
accepted:
02
07
2019
pubmed:
20
11
2019
medline:
17
6
2020
entrez:
20
11
2019
Statut:
epublish
Résumé
Safety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours. To develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations. A mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations. Key components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated. The tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% ( The authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.
Sections du résumé
BACKGROUND
BACKGROUND
Safety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours.
AIM
OBJECTIVE
To develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations.
DESIGN AND SETTING
METHODS
A mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations.
METHOD
METHODS
Key components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated.
RESULTS
RESULTS
The tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (
CONCLUSION
CONCLUSIONS
The authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.
Identifiants
pubmed: 31740456
pii: bjgp19X706589
doi: 10.3399/bjgp19X706589
pmc: PMC6863675
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e869-e877Informations de copyright
© British Journal of General Practice 2019.
Références
Patient Educ Couns. 2014 May;95(2):248-53
pubmed: 24569180
Am J Epidemiol. 1987 Aug;126(2):161-9
pubmed: 3300279
BMC Fam Pract. 2014 May 27;15:105
pubmed: 24885298
Br J Gen Pract. 2013 Nov;63(616):e751-9
pubmed: 24267858
Br J Gen Pract. 2011 Jan;61(582):43-6
pubmed: 21401991
Tutor Quant Methods Psychol. 2012;8(1):23-34
pubmed: 22833776
BMJ. 2016 Nov 9;355:i5515
pubmed: 28291732
Br J Gen Pract. 2019 Jan;69(678):e70-e79
pubmed: 30510099
BMJ. 2016 Dec 5;355:i6411
pubmed: 27919933
BMC Fam Pract. 2019 Jul 19;20(1):102
pubmed: 31324157
BMJ Open. 2014 Jan 14;4(1):e003874
pubmed: 24430877
J Clin Epidemiol. 2011 Jan;64(1):96-106
pubmed: 21130355
Epidemiology. 1996 Mar;7(2):199-202
pubmed: 8834562
J Clin Epidemiol. 1990;43(6):543-9
pubmed: 2348207
Qual Saf Health Care. 2003 Apr;12(2):93-9
pubmed: 12679504
Inform Prim Care. 2014;21(4):161-70
pubmed: 25479346
Perm J. 2008 Summer;12(3):67-9
pubmed: 21331214
Pain Med. 2016 Oct;17(10):1892-1905
pubmed: 26936453
Br J Gen Pract. 2018 Jul;68(672):e505-e511
pubmed: 29739779
Br J Gen Pract. 2019 Nov 28;69(689):e878-e886
pubmed: 31740458
Br J Gen Pract. 2018 May;68(670):e333-e341
pubmed: 29581127
BMC Fam Pract. 2013 Sep 25;14:140
pubmed: 24066842
Patient Educ Couns. 2000 Apr;40(1):59-65
pubmed: 10705065
Br J Gen Pract. 2009 Nov;59(568):872-4; discussion 874
pubmed: 19861036
Br J Gen Pract. 2017 May;67(658):e345-e351
pubmed: 28396369
Psychol Bull. 1968 Oct;70(4):213-20
pubmed: 19673146
Arch Dis Child Educ Pract Ed. 2013 Dec;98(6):232-5
pubmed: 24046395
Br J Gen Pract. 2018 May;68(670):e323-e332
pubmed: 29686134
Biometrics. 1977 Mar;33(1):159-74
pubmed: 843571
Br J Gen Pract. 2013 Jan;63(606):e37-46
pubmed: 23336459
Arch Dis Child Educ Pract Ed. 2014 Apr;99(2):48-53
pubmed: 24164728
Arch Dis Child. 2016 Feb;101(2):131-9
pubmed: 26163122