Communication skills of general practitioners in Nairobi, Kenya: a descriptive observational study

Abstract

Background: High-quality primary care needs to be person-centred, and GPs must communicate effectively to ensure continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by GPs. Aim: To evaluate the quality of communication in consultations by GPs. Design & setting: Descriptive, observational study of 23 GP consultations in 13 private sector primary care facilities in Nairobi, Kenya. Method: One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool (SUOT). A total percentage score was calculated per consultation, and compared with the GPs’ demographics and the consultation complexity and duration using the Statistical Package for Social Sciences (SPSS, version 25). Results: The GPs’ median age was 30.0 years (interquartile range [IQR] 29.0–32.0) and median consultation time was 7.0 minutes (IQR 3.0–9.0). Median overall score was 64.3% (IQR 48.4–75.7). GPs demonstrated skills in gathering information, making and explaining the diagnosis, and suggesting appropriate management. GPs did not make an appropriate introduction, explore the context or patients‘ perspectives, allow shared decision making, or provide adequate safety netting. There was a positive correlation between the scores and duration of the consultations (r = 0.680; P = 0.001). The score was higher in consultations of moderate complexity (78.1, IQR 57.1–86.7) versus low complexity (52.2, IQR 45.1–66.6) (P = 0.012). Conclusion: Consultations were brief and biomedical by young GPs. GPs need further training in communication skills, particularly with regard to delivering person-centred consultations. Deploying family physicians to the primary care setting would also improve the overall quality of service delivery