Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Background Although studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. Aim To evaluate the presence of ICE and its relation to medication prescription. Design of study Cross-sectional study. Setting Thirty-six GP teaching practices affiliated with the University of Ghent, in Flanders, Belgium. Method Participants were all patients consulting on 30 May 2005, and their doctors. Reasons for an encounter (consultation or home visit) with new and follow-up contacts, the identification of ICE, and the prescription of medication were recorded by 36 trainee GPs undergoing observational training. The study included 613 consultations. Results One, two, or three of the ICE components were expressed in 38.5%, 24.4%, and 20.1% (n = 236,150, 123) of contacts respectively. On the other hand, in 17.0% (104/613) of all contacts, and in 22% (77/350) of the new contact reasons, no ICE was voiced, and the GPs operated without knowing this information about the patients. Mean number of ICE components per doctor and per contact was 1.54 (standard deviation = 0.54). A logistic regression analysis of the 35D new contacts showed that the presence of concerns (P 0.037, odds ratio [OR] 1.73, 95% confidence interval [CI] = 1.03 to 2.9), and expectations (P = 0.039, OR = 2.0, 95% CI = 1.2 to 3.4) was associated with not prescribing new medication (dichotomised into the categories present/absent); however, other patient, doctor, and student variables were not significantly associated with medication prescription. Conclusion An association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.