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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATIONIntroductionThe core values of general practiceinclude holism and patientcentredness.Holism, the integrationof physical, psychological and socialcomponents of health problems inmaking diagnoses and planningmanagement, is well established asa central issue of good consultingpractice,(1) and there is goodevidence that this is promoted bylonger consultations(2-4) and bygreater continuity of care.(5-6)‘Patient-centredness’ is harder todefine. It indicates a commitmentby doctors to value the contributionof patients to deciding what iswrong with them and how theircare should be managed. Amongother things, patients place greatemphasis on being helped tounderstand the nature of theirproblems and made able to managetheir own illnesses.(7) ‘Enablement’,measured by the Patient EnablementInstrument (PEI), is an outcomemeasure which captures theseissues. (8)Finding a way of assessing whetherthe goals of holism and patientcentrednessare achieved atconsultations by doctors has proveddifficult, but it is a necessary part ofassessing quality of general practicecare across its full breadth. (9) Withingeneral practice, work on quality andthe development of performanceindicators(10-11) is in hand on issuesof practice organization, (12) careof continuing health problems, (13)and achievement of public healthtargets. (14) However, the coreactivity of general practice remainsthe consultation. Two areas of workin this discipline are particularlyrelevant to this paper: the use of timein consultations and its relation to“enablement,” an outcome measurethat seems related to, but differentfrom, satisfaction (8-9); and continuityof care. (5-6)Aim of the WorkThe aim of the present work was tostudy the quality of consultation thatreflects the core values of generalpractice. The Specific objectivesincluded the following:1. Measurement of the consultationlength of type2 diabetics2. Assessment of enablement of thediabetic patients3. Determination of the principalcorrelates associated withenablement as an outcomemeasure.Subjects and MethodsStudy Area and Study PopulationA cross sectional design was used.The study was conducted in IsmailiaCity, Egypt, from February 2009to October 2010. Ismailia City isapproximately 120 km from Cairo. Itis the capital of Ismailia Governoratethat is located along the coast ofSuez Canal, midway between PortSaid and Suez. The target populationwas type 2 diabetic patients inIsmailia City. The study populationwas type-2 diabetics attending thefamily medicine clinic in IsmailiaUniversity hospital. The followingequation, according to Holland etal., 1985, was used for sample sizecalculation: (15)N> [(1.96)2 x Sd2]/ (0.05 x M) 2N, number of cases;S.d, standard deviationM, the true value to be estimated andknown from previous worksA pilot study was conducted todetermine the mean and standarddeviation of the PEI of type-2diabetics. The pilot included 50patients. The mean of the PEI was3.58 1.6 (from the pilot study). So thesample size needs to be:N> [(1.96)2 x 1.62]/ (0.05 x 3.58) 2N> 303The study sample (n=310) wasselected randomly by systematicrandom sampling technique whereevery 3rd patient attending the clinicbetween February 2009 to May 2009was included in the study. The studywas completed in October 2010.Informed consent of the patients toparticipate in the study was one ofthe inclusion criteria. Type 1 diabeticswere excluded from the study.Description of the experimentalmanoeuvre1. Pre-consultation questionnaire:A pre-consultation questionnairewas completed by all patients,to collect socio-demographic data.Patients were asked how well theyknew the doctor they were goingto see.2. Post-consultation questionnaire:Doctors completed informationon the time the consultationstarted and finished (time in andtime out), whether the consultationwas booked, open, and whethera student was present. After theconsultation, the patient completedthe patient enablement instrumentthat included the followingitems: Able to cope with life, Ableto understand your illness, Ableto cope with your illness, Ableto keep yourself healthy, Confidentabout your health, and Able tohelp yourself. Responses of “muchbetter,” “better,” and “same or less”or “not applicable” were scored 2,1, and 0 respectively, givinga score range of 0-12. (16-17)Patients also indicated whether theconsultation was interrupted.Some help for patients who haddifficulty completing thequestionnaire was available in thewaiting room.Statistical methodsAll statistical analyses wereperformed by using the SPSSsoftware package (SPSS, 1996) (18).Measures of central tendency anddispersion, as well as, appropriatesignificance tests were appliedaccording to the types of variables.Group t-test was computed todetect the significance of differencein the age, enablement scores,and duration of the consultationbetween males and females.Multiple regression analysis wascomputed to detect the significantlinear associations between theenablement scores of type 2diabetics as dependent variableand other independent variablesthat were included in the study. Thefollowing variables were convertedto dummy variables (coded 0.0 and1.0) sex (male and female), knowthe doctor well, interruption of theconsultation, consultation type (open20 MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 10 ISSUE 7MIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 7, ISSUE 10