The content and conduct of GP consultations for dermatology problems: a cross-sectional study

Background Skin complaints are common in primary care, and poor outcomes in long-term conditions are often due to low adherence to treatment. Shared decision making and self-management support may help, yet there is little understanding of patient involvement or the support provided by GPs. Aim To describe the content of primary rare consultations for skin problems, including shared decision making practice. delivery of self-management advice, and follow-up. Design and setting Cross-sectional study of video-recorded UK adult GP consultations and linked data. Method A coding tool was developed and applied to all consultations with skin problems. Shared decision making was assessed using the observer OPTION5 scale. Results A total of 45/318 consultations (14.2%) related to one or more skin problems, which were discussed alongside other problems in 71.1% (32/45) of consultations. Of the 100 different problems discussed in these consultations, 51 were dermatological. I he mean amount of time spent on skin problems in the consultations was 4 minutes 16 seconds. Medication was recommended for 66.7% (34/51) of skin problems, with low shared decision making (mean OPTION5 score = 10.7). Sell-management advice (verbal only) was given for 47.1% (24/51) of skin problem. Most skin problems (84.3%; 43/51) were not referred to secondary care; 32.6% (14/43) of the skin problems not referred were seen again in primary care within 12 weeks, of which 35.7% (5/14) follow-up appointments were not planned. Conclusion In this study, skin problems were usually presented alongside other - complaints and resulted in a medication recommendation. Shared decision making was uncommon and self-management advice not consistently given. with re attendance for the same problem common. GPs training should reflect how frequently skin pmblems are seen and seek to improve patient involvement in decision making and support self-management.