Facilitators of good consultations in primary health care clinics in Botswana: a qualitative study of patients’ and doctors’ views.

Background : The behaviours and attributes of doctors affect the quality of consultations. Although good consultations improve the quality of care, there is a dearth of evidence on factors that facilitate good consultations. Aim : This study explored factors that facilitate good consultations in public primary healthcare (PHC) clinics from the perspective of doctors and patients. Setting : We conducted the study in public (PHC) clinics in four health districts of Botswana. Patients with a wide range of acute and chronic diseases sought health care from these clinics. Nurses, pharmacists, and non-specialist doctors were some of the healthcare (HCWs) who gave services to these patients. Methods : This was a qualitative study in which audiotaped structured interviews were used to collect data, until saturation. Results : Seventeen purposively selected doctors and 32 patients participated in this study. Data were analysed for themes. Participants thought the facilitators of good consultations were, creating a conducive environment for the consultation, enough time provision for the consultation, continuity of care, effective communication, and creating an environment to maintain confidentiality. Facilitators of a good consultation were influenced by health system factors such as clinic factors, high doctor workload, and high patient volumes. We further surmised that thefacilitators of a good consultation do not act independently but influence each other, in a complex health system of interacting components. Conclusion : Facilitators of a good consultation were creating a conducive environment for the consultation, providing enough time for the consultation, continuity of care, effective communication, and ensuring privacy and confidentiality. These facilitators interact and are subsumed in a complex interactive health system of many contributing factors. Facilitators of good consultations, improve the quality of care and health outcomes. However good consultations are a result of facilitators of good consultations that are undergirded by many other necessary health system factors.