Measuring outcomes in primary care

by Dr Mairead MurphyDr Mairead Murphy
Senior Research Associate
Centre for Academic Primary Care

With ninety percent of patient interaction with health services going through primary care, it’s not surprising that primary care clinicians and researchers try to figure out ways to improve primary care services. Interventions are many and varied, and result in important questions about their effectiveness. Do electronic consultations offer a good service to patients? If GPs introduce advice on healthy lifestyles into the consultation, does it make patients healthier? What about increasing the duration of GP appointments to ten minutes – does this improve outcomes for patients? Or ensuring that patients always see the same named doctor? Or painting the waiting room green?

Questions like these are normally answered by administration of a generic patient-reported questionnaire. By comparing the responses of groups of patients (say those with eight minute consultations and those with ten minute consultations), researchers can see which group has the highest scores, and therefore whether one method of delivering care is better than the other.

Although this might sound a simple process, in reality it is not so easy. What does it mean to say one method is better than another? Some might say a method is better if a patient prefers it. If this is true, the question of whether an intervention ‘improves’ a service can be easily answered by administering patient satisfaction questionnaires. But this doesn’t really get to the nature and purpose of healthcare, which is to make people healthier. For example, many patients might prefer the waiting room painted green but it might not make any difference to how they feel once they leave the waiting room. This is why we shouldn’t measure the success of primary care interventions or service changes through patient experiences of care, but rather through outcomes for patients.

The problem with this is that primary care delivers a range of outcomes, some of which are more directly health-related than others. Some outcomes, such as reduction in pain or depression, are captured on most generic patient-reported questionnaires. But others, such as reduction in concern, a sense of confidence in health plan, or an understanding of illnesses/problems and an ability to manage symptoms, are less well-captured.

This is why we have designed a new questionnaire, called the Primary Care Outcomes Questionnaire, or the PCOQ. The PCOQ was designed specifically to measure outcomes which many primary care patients seek, and which GPs seek to deliver. It contains 24 questions in four areas: health and well-being; health knowledge and understanding; confidence in health plan; and confidence in health provision. We tested the PCOQ in a sample of primary care patients and found that it was easy for patients to complete and able to show change in each of the four areas. We have made the PCOQ available free of charge for non-commercial use and hope that researchers will find it useful for assessing the effectiveness of interventions in primary care. In the future, we plan to test the PCOQ for use in routine clinical practice.

For researchers and clinicians: The PCOQ is available from

For patients: An opportunity for public involvement in a project to test the PCOQ in clinical practice was advertised on 7 July by People in Health West of England. See

For further information, please email

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