Brief conversations in primary care are a golden opportunity to boost health

Recent research from the NIHR encourages primary care staff to make the most of consultations. The big topics in public health – obesity, alcohol, smoking, and mental health – can be raised in even the shortest conversations.

The research suggests that patients appreciate a discussion on broader health issues, and no topic need be out of bounds. It offers tips on the specific words and phrases to use, to maximise the impact of these conversations. Primary care consultations provide an ideal chance to improve the health and wellbeing of the public.

Our most recent project at NIHR Evidence is a Collection of research on how to have effective – and brief – conversations in primary care. This means talking about public health issues such as obesity, alcohol, smoking and mental health. They aren’t the easiest subjects for anyone to broach. Busy professionals may be concerned that they will cause offence, or fear that they are embarking on a lengthy conversation.

But the studies show that patients are open to receiving lifestyle advice, and often expect it. The research gives examples of specific phrases and types of question that can help professionals make the most of these encounters. Using these phrases increases the numbers of patients who accept help to change lifestyle behaviours. And they help keep conversations short.

Primary care staff can be reassured that:

• no topic need be avoided
• patients value their advice.

Our public contributor, Fabiana Mariscotti, said “I was surprised that there is any doubt about whether or not healthcare professionals should have these conversations. They definitely should. Primary care is the perfect place for this.’’

She described the lasting impact of advice from her GP: “I was feeling quite low during the winter. I had a chat with my GP and she suggested I try to go for a daily run or a walk. That advice still lives with me, if I’m feeling low I’ll go for a walk or a run and feel better afterward.”

The research shows that the best conversations:

• are personalised – for example, alcohol advice should build on strategies individuals already use to manage drinking
• include key details at the start – such as that a weight management programme is local and free of charge – this keeps conversations brief and increases the chances that a patient will accept a referral
• use open-ended questions to ask about mental health, and encourage patients to expand when they give hesitant or ambiguous responses.

“It’s an important opportunity,” primary care nurse and Queen’s Nurse, Mary Codling told us. “These conversations can make a difference. It’s a chance to ask, and to provide patients with useful tools that they can use to help themselves.’’ The pandemic has influenced these conversations: “In some ways virtual consultations can be better. Patients are in their own homes, in a comfortable environment. They are not anxious about being in a new place or a busy waiting room. Their behaviour can be different, they may feel more relaxed and willing to be open.” 

GP Carolyn Chew-Graham also supported the findings, and said, “Missed conversations are missed opportunities. These moments can have a big impact. Long term, we’d have a healthier population.” 

“Whilst we should deal with the presenting problem, it is important to also consider the patient’s other problems and take the opportunity to offer advice about how to stay well,’’ she said. “It’s also gratifying for healthcare professionals when our consultations go well: seeing that your patient who used to smoke 20 cigarettes a day has stopped, or your patient who used to drink six bottles of wine a week has cut down to just weekends.”

Opportunistic conversations are encouraged in guidelines, but still do not often happen. Tackling sensitive subjects can feel challenging when appointments are already short. Staff may be concerned about causing offence, or feel they need more training. But this research suggests that primary care appointments are the right place to address these issues. Millions of people visit every month, and even the briefest conversations have the potential to improve health and wellbeing. We hope this research encourages primary care staff that no subject need be a no-go zone.

The full Collection is at ‘Brief conversations in primary care: an opportunity to boost health’.

At NIHR Evidence, we publish short, plain language summaries of NIHR-funded research. We want health and social care research to be accessible for everyone: the public, healthcare professionals, policy makers. We aim to package our research in a friendly, accessible format, and put it into the hands of those who can act on it.

You can keep up to date with our research summaries and collections of evidence on the NIHR Evidence website, on Twitter @NIHREvidence, and via our monthly NIHR Evidence newsletter.

Deniz Gursul, Research Dissemination Officer for NIHR Evidence at the NIHR Centre for Engagement and Dissemination (CED)

@NIHREvidence