Patients' evaluations of European general practice--revisited after 11 years

Satisfaction with Health Care Services in the Adult Population of the Federation of Bosnia and Herzegovina during the COVID-19 Pandemic

Background and Objectives: Patient satisfaction with health care can influence health care-seeking behavior in relation to both minor or major health problems or influence communication and compliance with medical advice, which is especially important in emergencies such as the COVID-19 pandemic. Thus, it is important to continually monitor patient satisfaction with provided care and their dynamics. The aim of this study was to assess patient satisfaction with health care during the COVID-19 pandemic in the adult population of the Federation of Bosnia and Herzegovina (FB&H) and compare it with levels of satisfaction in the same population before the COVID-19 pandemic. Materials and Methods: A representative, population-based survey was implemented in the adult population of the FB&H using the EUROPEP instrument, which measures satisfaction with health care using 23 items. The sample included 740 respondents who were 18 years or older residing in the FB&H and was implemented in December 2020. All data were collected using a system of online panels. The survey questions targeted the nine months from the beginning of the pandemic to the time of data collection, i.e., the period of March to December 2020. Results: The mean composite satisfaction score across all 23 items of the EUROPEP tool was 3.2 points in all age groups; the ceiling effect was 22% for the youngest respondents (18-34 years old), 23% for 35-54 years old, and 26% for the oldest group (55+), showing increasing satisfaction by age. The overall composite score for both females and males was 3.2. The ceiling effect was higher in those with chronic disease (29% vs. 23% in those without chronic disease). The composite mean score for respondents residing in rural vs. urban areas was 3.2 with a ceiling effect of 22% in rural and 24% in urban residents. When comparing mean composite scores surveyed at various points in time in the FB&H, it was found that the score increased from 3.3 to 3.5 between 2011 and 2017 and dropped again to 3.3 in this study. Despite these observations in the overall trends of satisfaction scores, we note that no statistically significant differences were observed between most of the single-item scores in the stratified analysis, pointing to the relative uniformity of satisfaction among the analyzed population subgroups. Conclusions: The rate of satisfaction with health care services in the FB&H was lower during the COVID-19 pandemic compared to 2011 and 2017. Furthermore, while an increasing trend in satisfaction with health care was observed in the FB&H during the years prior to 2020, the COVID-19 pandemic may have contributed to the reversal of this trend. It is important to further monitor the dynamics of patient satisfaction with health care, which could serve as a basis for planning, delivering, and maintaining quality services during the COVID-19 pandemic and other emergencies.

Patient's evaluations and expectations of primary care medicine in Israel revisited after two decades - Health Service Research

BACKGROUND

The European Task Force on Patient Evaluations of General Practice's (EUROPEP) internationally-validated questionnaire measures patients' satisfaction with their primary care physicians. A study published in 1999 showed positive evaluations of primary care among patients across Europe and included 1603 Israeli patients. Major changes have taken place during the past 20 years, in Israel's society, in the healthcare system, and particularly in primary care clinics.

OBJECTIVES

The study aims to reevaluate patients' satisfaction with their primary care physicians and care clinics in Israel and compares the results to the 1999 survey.

METHODS

A survey based on the EUROPEP questionnaire was conducted among 1617 people. Data collection was carried out by an internet panel for the Hebrew speaking population and by a phone questionnaire for the Arabic speaking population.

RESULTS

The study's results show a significant reduction in satisfaction. Notably, patients' satisfaction with physicians' support relating to emotional problems and physicians' explanations about referrals and workup plans have dramatically deteriorated.

CONCLUSIONS

The decrease in patients' satisfaction with primary care physicians and clinics found in the current study is concerning and requires recognition and further exploration.

PRACTICE IMPLICATIONS

The results may be used as a baseline for future assessments of trends in patients' satisfaction.

Are quality promotion initiatives in Austrian and Italian general practices associated with higher patient satisfaction and quality of life? Results from the interventional study 'IQuaB'

The objective was to assess the changes in quality of life (QoL) and patient satisfaction of chronically ill patients in general practices in Salzburg (Austria) and South Tyrol (Italy) after implementation of a combined intervention addressing quality of care of general practitioners (GPs). Furthermore, the correlation between QoL/patient satisfaction and quality of care provided by the GPs (measured by a quality score based on quality indicators [QIs]) was investigated. The non-controlled pre-post study involved GPs and patients with chronic conditions. The intervention consisted of self-audit, benchmarking and quality circles. QIs were extracted in the participating practices in 2012 (preintervention) and 2014 (postintervention). Before and after the intervention, a patient survey was conducted including EQ-5D (measuring health-related QoL), a patient participation scale and parts of the European Task Force on Patient Evaluations of General Practice questionnaire (measuring patient satisfaction). Mann-Whitney U-tests, chi-square tests and Spearman's rank correlation were applied for statistical analysis. Fifty-six GPs participated in the study. 1,710 patients returned the questionnaire in 2012, and 1,374 in 2014. Mean EQ-5D index (QoL) was similar in Salzburg and South Tyrol in both years: 2012 Salzburg 0.85 (95% CI 0.84-0.87), South Tyrol 0.85 (95% CI 0.84-0.86); 2014 Salzburg 0.84 (95% CI 0.83-0.86), South Tyrol 0.84 (95% CI 0.83-0.86). Patient satisfaction was higher in Salzburg than in South Tyrol at baseline (EUROPEP: mean percentage of best response 61.5% vs. 49.1%, p < 0.000) and also at follow-up (61.9% vs. 49.2%; p < 0.000). No significant correlation between quality score and QoL/patient satisfaction was detected. Thus, the impact of the intervention was not significant within the intermediate time periods analysed in the study. Improvements in quality of care do not necessarily also improve patient-relevant outcomes, which are probably more associated with other factors than with medical quality (e.g. availability of the GP, waiting times and communication-related issues).

Patients’ Shift from Public to Private Primary Health Care Providers in Lithuania: Analysis of the Main Reasons

Aims

Lithuania is one of the countries where public and private primary health care (PHC) providers compete for patients. Patients continuously shift from public to PHC providers, but an analysis of the main reasons was never performed. This study aimed to analyze the reasons why patients shift from public to private PHC providers and identify the associations between the reasons and demographic characteristics of the patients.

Methods

A cross-sectional study based on a phone questionnaire was conducted among patients who shifted from public to private primary health care (PHC) providers. A total of 810 phone calls were made, and 572 telephone surveys were completed. The response rate was 70.49%. The difference between the proportions was assessed using the Z-test. The association between categorical variables was assessed using the chi-square test.

Results

The study identified the following main reasons: long queues to obtain family physician appointments (23.6%), inconvenient location of public’s institution department (20.1%), patients relocating (19.2%), enrolment at a former family physician who transitioned from a public to private PHC institution (10.5%), and long waiting time at the family physician’s office for the appointment (9.4%). Some statistically significant correlations were found between the specific reasons for shifting from public to private PHC organizations and patients' demographic characteristics.

Conclusions

Personal reasons are the most common reasons for shifting from public to private PHC providers (43.36% of the respondents), following the reasons related exclusively to the family physician (25.17%) and related PHC institutions only (24.9%).

Is patient loyalty associated with quality of care? Results of a patient survey over primary care in Switzerland

OBJECTIVE

The study aimed to evaluate quality of care and to determine which aspects are associated with the willingness to recommend the general practitioner (GP) as a part of patient loyalty.

DESIGN

This was an exploratory study which collected patient data from ambulatory care in the German part of Switzerland between 2013 and 2016.

SETTING

Primary care in Switzerland.

PARTICIPANTS

Included patients from 79 primary care practices who volunteered to participate in the quality management system European Practice Assessment. Patients were afterwards asked to complete the European Task Force on Patient Evaluations of General Practice Care instrument.

INTERVENTIONS

Describing influencing factors of quality of care on recommendation of the GP from the perspective of the patients.

MAIN OUTCOME MEASURES

Patient perspective on quality of care.

RESULTS

Survey respondent rate was 81.3%. Over 69% of the respondents were willing to recommend their GP. 'Listening to you' (94.2%) and 'interest in your personal situation' (93.0%) as a part of the domain 'relationship and communication' were rated as the highest quality criteria. The lowest rate was found for 'being able to speak to the GP on the telephone' (30.0%) and 'waiting time in the waiting room' (50.6%). Patient loyalty, in terms of willingness to recommend the GP, was strongly associated with most of the items under the 'relationship and communication' section but also with having more physician's assistants in the practice.

CONCLUSIONS

The results are important for understanding patients' priorities with regard to general practice care. Patient assessment allows us to identify possible areas for quality improvement within the practice and could provide feedback.

Semantic and Cultural Equivalence of the Working Alliance Inventory Short-revised Scale for Therapeutic Alliance in Family Medicine: Lessons Learned in Slovenia

Introduction

Therapeutic alliance is a term most commonly associated with psychotherapeutic treatment, but recently its use has become increasingly significant in the other fields of medicine. An increasing amount of evidence implies that the quality of the therapeutic alliance between the doctor and patient substantially affects treatment outcomes. A European consensus chose the Working Alliance Inventory – Short Revised (WAI-SR) scale as the most efficient for European primary care. This paper presents the process of establishing the semantic and cultural equivalence of the two WAI-SR scales in Slovene.

Method

As a part of a larger international project, a group of four experts translated the two WAI SR scales (physician and patient versions) from English into Slovene. Twenty-six Slovenian family medicine doctors participated in the process of obtaining semantic, idiomatic, experiential and conceptual equivalence in translation using a Delphi consensus procedure. Afterward, a cultural equivalence was made to adapt the translations within the national context.

Results

Agreement on translation was achieved after two Delphi rounds. The back-translation and cultural equivalence were accomplished without major problems, with some minor additional linguistic corrections.

Conclusion

A Slovene version of the WAI-SR scale was successfully adapted and is available for further scale validation and research on therapeutic alliance.

Patients' perceptions of health system responsiveness in ambulatory care in Germany

OBJECTIVE

To identify overall levels of health system responsiveness and the associations with social determinants for ambulatory health care in Germany from a user perspective.

METHODS

This analysis drew on a 2016 health survey sample of 6113 adults in Germany. Responsiveness was measured for general practitioners (GPs) and specialists (SPs) along the domains trust, dignity, confidentiality, autonomy and communication. Bivariate and multivariate logistic regression techniques were applied.

RESULTS

Over 90% of all patients assessed their last GP and SP visit as good regarding trust, dignity, autonomy and communication, but only half for confidentiality in the doctor office (GP visits: 50.3%; SP visits: 52.4%). For GP visits, patients' young age of 18-34 years showed most associations with poor assessment of the domains, for SP visits a current health problem as the reason for the last consultation.

CONCLUSION

While overall responsiveness levels for ambulatory care are high, ratings of confidentiality are distressing. Particularly patients' young age and bad health are associated with a poor assessment of responsiveness.

PRACTICE IMPLICATIONS

Measures to improve doctor office infrastructure and to enhance responsiveness towards patients under the age of 35 years and those with health problems are vital to increase responsiveness.

Patient Satisfaction with Pre-Hospital Emergency Services. A Qualitative Study Comparing Professionals' and Patients' Views

Objective: To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors. Methods: A qualitative study was conducted in two phases. First, a systematic review following the PRISMA protocol was carried out searching publications between January 2000 and July 2016 in Medline, Scopus, and Cochrane. Second, three focus groups involving professionals (advisers and healthcare providers) and a total of 79 semi-structured interviews involving patients were conducted to obtain information about what dimensions of care were a priority for patients. Results: Thirty-three relevant studies were identified, with a majority conducted in Europe using questionnaires. They pointed out a very high level of satisfaction of callers and patients. Delay with the assistance and the ability for resolution of the case are the elements that overlap in fostering satisfaction. The published studies reviewed with satisfaction neither the overall care process nor related the measurement of the real time in responding to an emergency. The patients and professionals concurred in their assessments about the most relevant elements for patient satisfaction, although safety was not a predictive factor for patients. Response capacity and perceived capacity for resolving the situation were crucial factors for satisfaction. Conclusions: Published studies have assessed similar dimensions of satisfaction and have shown high patient satisfaction. Expanded services resolving a wide number of issues that can concern citizens are also positively assessed. Delays and resolution capacity are crucial for satisfaction. Furthermore, despite the fact that few explanations may be given due to a lack of face-to-face attention, finding the patient's location, taking into account the caller's emotional needs, and maintaining phone contact until the emergency services arrive are high predictors of satisfaction.

SATISFACTION OF PATIENTS WITH FIRST MEDICAL CARE: CROSS-SECTION STUDY (ON THE EXAMPLE OF CITY KYIV)

After reorganization of ambulatory-polyclinic net of medical institutions in city Kyiv in 2013 and creation of centers of first medical care (FMC), the necessity in monitoring of patients’ satisfaction with received first medical care appeared. Aim. To estimate satisfaction of patients of FMC Centers of city Kyiv with received first medical care, to compare it with patients’ satisfaction in rural area of Ukraine and in European Union countries. Materials and methods. The cross-section study was realized in FMC centers of city Kyiv during 6 months of 2017 year. In total 397 persons, 18 years old and more, who addressed to doctors of the first link during no less than one year, were selected for the study. The used EUROPEP instrument, the questionnaire, consists of 23 questions with their possible assessment by Likert five-point scale and includes the following aspects: doctor-patient-relationship, assessment of direct medical care, information and support of a patient by a doctor, organization aspects of care, its accessibility. The internal succession of the questionnaire Cronbach's alpha was estimated, and its reliability was checked. Main indices of research results were mean EUROPEP indices (minimum 1, maximum 5). Results. The study has established, that satisfaction of Ukrainian patients with FMC (index - 75,5 %) is statistically reliably lower than indices of European Union countries. In average, only 37,16 % of respondents estimated the level of received FMC as “perfect” and correspondingly 38,35 % of patients as “good”. There were revealed problems with an access to medical care, namely: “Time of waiting for a consultation near a cabinet” received the least mark (3,29 and 45,59 % respectively), “Possibility of registration for consultation by phone” is also low (3,47 and 59,95 % respectively). Problems in communications, the low level of trust and doctor’s authority were revealed in the decreased index “Doctor’s help in fighting against negative emotions, connected with your health status” (3,72 and 56,17 % respectively). There was studied, that in Ukraine satisfaction of patients, who live in rural area, is statistically reliably lower than Kyiv indices. Conclusion. The study of satisfaction of patients with received FMC revealed imperfection of the existing system of first medical care. The research results may be used at elaborating new functional-organizational model of activity of first medical care, including patients’ satisfaction as an important component in the integrative dimension of the medical help quality.

Patient Safety Culture in Slovenian out-of-hours Primary Care Clinics

Introduction

Patient safety culture is a concept which describes how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. We aimed to investigate patient safety culture in Slovenian out-of-hours health care (OOHC) clinics, and determine the possible factors that might be associated with it.

Methods

This was a cross-sectional study, which took place in Slovenian OOHC, as part of the international study entitled Patient Safety Culture in European Out-of-Hours Services (SAFE-EUR-OOH). All the OOHC clinics in Slovenia (N=60) were invited to participate, and 37 agreed to do so; 438 employees from these clinics were invited to participate. We used the Slovenian version of the Safety Attitudes Questionnaire – an ambulatory version (SAQAV) to measure the climate of safety.

Results

Out of 438 invited participants, 250 answered the questionnaire (57.1% response rate). The mean overall score ± standard deviation of the SAQ was 56.6±16.0 points, of Perceptions of Management 53.6±19.6 points, of Job Satisfaction 48.5±18.3 points, of Safety Climate 59.1±22.1 points, of Teamwork Climate 72.7±16.6, and of Communication 51.5±23.4 points. Employees working in the Ravne na Koroškem region, employees with variable work shifts, and those with full-time jobs scored significantly higher on the SAQ-AV.

Conclusion

The safety culture in Slovenian OOHC clinics needs improvement. The variations in the safety culture factor scores in Slovenian OOHC clinics point to the need to eliminate variations and improve working conditions in Slovenian OOHC clinics.

Satisfaction with general practice care in German patients with multimorbidity: a cross-sectional study

BACKGROUND

Little is known about the quality of general practice care received by patients suffering from multimorbidity.

OBJECTIVES

To assess how patients with multimorbidity evaluate their General Practitioners (GPs') performance and to identify factors associated with high patient satisfaction levels.

METHODS

Cross-sectional study in Germany using the EUROPEP questionnaire consisting of 23 items with a five-point Likert scale and covering two dimensions: clinical performance of the GP and organisation of care. Mixed logistic regression was used in the analysis, with the EUROPEP score as a dependent variable.

RESULTS

The study included 651 patients (54.8% female), with a mean age of 73.7 ± 4.9 years. Of 22 of 23 questionnaire items, >80% of patients rated their satisfaction as 'good' or 'excellent'. The highest level of satisfaction (excellent) varied among items between 28.0 and 73.1%. Lower age and female sex of GPs were associated with better patient evaluations in 15 and 12 of the 23 items, respectively. Patient characteristics were not associated with their satisfaction with their GP.

CONCLUSIONS

This study found high levels of satisfaction with primary care in patients with multimorbidity. However, since high levels of patient satisfaction are not necessarily equivalent to high quality of care, a broader view is necessary to integrate the subjective views of patients and objective quality indicators into a comprehensive concept of good quality of care.

Quality of Care for Patients with Chronic Respiratory Diseases: Data for Accreditation Plan in Primary Healthcare

There are scarce reports in the literature on factors affecting the assessment of the quality of care for patients with chronic respiratory diseases. Such information is relevant in the accreditation process on implementing the healthcare. The study group consisted of 133 adult patients with chronic respiratory diseases and 125 adult patients with chronic non-respiratory diseases. In the present study, the level of satisfaction from healthcare provided by the primary healthcare unit, disease acceptance, quality of life, health behaviors, and met needs were examined, as well as associations between variables with the use of correspondence analysis. The results are that in patients with chronic respiratory diseases an increase in satisfaction depends on the improvement of well-being in the mental sphere. The lack of problems with obtaining a referral to a specialist and a higher level of fulfilled needs also have a positive effect. Additionally, low levels of satisfaction should be expected in those patients with chronic respiratory diseases who wait for an appointment in front of the office for a long time, report problems with obtaining a referral to additional tests, present a low level of health behaviors, and have a low index of benefits.

The EUROPEP questionnaire for patient's evaluation of general practice care: Bulgarian experience

Aim

To validate the Bulgarian EUROPEP-questionnaire and its implementation to measure patient evaluation of general practice care in Bulgarian population.

Methods

A multicenter cross-sectional study was conducted at twenty five primary care practices from South-Central Region of Bulgaria. A total of 1000 adult patients aged over 18 years and visiting the practice for more than a year were approached consecutively to take part in the study. The internal consistency and test-retest reliability of the EUROPEP questionnaire were evaluated. To confirm the construct validity of the questionniare, еxplanatory factor analysis was performed.

Results

Cronbach’alpha for “clinical behaviour” is 0.95 and for “organisation of care” 0.81. Factor analysis identifed two factors, which accounted for 77.0% of the total variation in these items. On average, 58.7% of respondents rated the level of care received as excellent. The waiting time in the waiting room was the item most poorly rated (33.8%). The item “keeping patients' records and data confidential” was the most highly rated (88.8%). Patients were less satisfied with “providing quick services for urgent health problems” (78.5% excellent or good) and “getting an appropriate for them appointment” (76.2% excellent or good).

Conclusion

Two scales with satisfactory psychometric properties were established in the Bulgarian version of the EUROPEP-questionnaire. The study identified areas requiring improvement in general practice, such as reduction in waiting times and obtaining patient’s convenience appointment.

Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006

Background

In 2006 The Dutch Health Care system changed to a market oriented system. The GP remuneration changed from ± 2/3 capitation patients and 1/3 private patients before 2006 to a mixed payment scheme. From 2006 onward every patient was insured and the GP received partly capitation, partly fees for consultations and for specific services. This change coincided with many other organisational changes in General Practice care. Our research question was if during the years after 2006 patient experiences of Dutch family practice had changed. We also wanted to explore the influence of patient and practice characteristics on patient experiences. Data on patient experiences were available from 2007 to 2012.

Method

In a series of annual cross sectional patient surveys the performance of GPs and practices was measured. Patient sampling took place as a part of the Dutch accreditation program in 1657 practices involving 2966 GPs. Patients’ experiences, gender, age, health status, and number of annual consultations were documented as well as the type and location of practices. Linear regression analysis was used to examine time trends in patient experiences and the impact of patient and practice characteristics.

Results

78,985 patients assessed the performance of 2966 GPs, and 45,773 patients assessed the organisation of 1657 practices. The number of patients with positive experiences increased significantly between 2007 and 2012; respectively 4.8 % for GPs (beta 0.20 and p < 0.0001) and 6.6 % for practices (beta 0.10, p < 0.004). Higher age, having no chronic illness, more frequent consultations and attending single-handed practices, predicted better patient experiences.

Conclusions

In our evaluation of patient experiences with general practice care from 2007 to 2012 we found an increase of 4.8 % for GPs and 6.6 % for practices respectively. This improvement is significant. While no direct causation can be made, possible explanations may be found in the various reforms in Dutch family practice since 2006. More insight is needed into key determinants of this improvement before policymakers and care providers can attribute the improvement to these reforms.

The patient satisfaction questionnaire of EUprimecare project: measurement properties

OBJECTIVE

The measurement of patient satisfaction is considered an essential outcome indicator to evaluate health care quality. Patient satisfaction is considered a multi-dimensional construct, which would include a variety of domains. Although a large number of studies have proposed scales to measure patient satisfaction, there is a lack of psychometric information on them. This study aims to describe the psychometric properties of the Primary Care Satisfaction Scale (PCSS) of the EUprimecare project.

DESIGN

A cross-sectional survey of patient satisfaction with primary care was carried out by telephone interview.

SETTING

Primary care services of Estonia, Finland, Germany, Hungary, Lithuania, Italy and Spain.

PARTICIPANTS

A total of 3020 adult patients aged 18-65 years old attending primary care services.

METHOD

Classic psychometric properties were analysed and Rasch analysis was used to assess the following measurement properties: fit to the Rasch model; uni-dimensionality; reliability; differential item functioning (DIF) by gender, age, civil status, area of residency and country; local independency; adequacy of response scale; and scale targeting.

RESULTS

To achieve good fit to the Rasch model, the original response scales of three items (1, 2 and 6) were rescored and Item 3 (waiting time in the room) was removed. The scale was uni-dimensional and Person Separation Index was 0.79, indicating a good reliability. All items were free from bias. PCSS linear measure displayed satisfactory convergent validity with overall satisfaction with primary care.

CONCLUSIONS

PCSS, as a reliable and valid scale, could be used to measure patient satisfaction in primary care in Europe.

Patient satisfaction with family practice in Turkey: Three-year trend from 2010 to 2012

BACKGROUND

After the health reform in 2003, a need emerged to monitor patient satisfaction in Turkey.

OBJECTIVE

To evaluate patient satisfaction with family practice in Turkey and compare with some other European countries.

METHODS

The study was performed on a countrywide representative sample from all the 81 provinces of Turkey. Data were collected during the years 2010-2012 from patients visiting family practice centres. A three-year repeated cross-sectional study was conducted using the EUROPEP instrument. Twenty-six questions with a five-point Likert scale were applied. Primary outcome measures of the study were the mean EUROPEP scores (min. 1, max. 5).

RESULTS

Mean (± SD) EUROPEP scores for the years 2010 (n = 34 472), 2011 (n = 34 764), and 2012 (n = 32 667) were 4.09 ± 0.77, 4.29 ± 0.59, and 4.42 ± 0.54 respectively (F = 1565.37; P < 0.001). The mean satisfaction percentage was calculated as 88.3%. Areas of lowest satisfaction were 'Being able to speak to the GP on the telephone,' 'Getting through to the practice on the phone,' and 'Physical conditions of the family practice.'

CONCLUSION

Although in small increments, patient satisfaction with family practices in Turkey has increased during the last few years.

A cross-sectional study of socio-demographic factors associated with patient access to primary care in Slovenia

INTRODUCTION

Primary care (PC) is the provision of universally accessible, integrated, person-centred, comprehensive health and community services. Professionals active in primary care teams include family physicians and general practitioners (FP/GPs). There is concern in Slovenia that the current economic crisis might change the nature of PC services. Access, one of the most basic requirements of general practice, is universal in Slovenia, which is one of the smallest European countries; under national law, compulsory health insurance is mandatory for its citizens. Our study examined access to PC in Slovenia during a time of economic crisis as experienced and perceived by patients between 2011 and 2012, and investigated socio-demographic factors affecting access to PC in Slovenia.

METHODS

Data were collected as a part of a larger international study entitled Quality and Costs of Primary Care in Europe (QUALICOPC) that took place during a period of eight months in 2011 and 2012. 219 general practices were included; in each, the aim was to evaluate 10 patients. Dependent variables covered five aspects of access to PC: communicational, cultural, financial, geographical and organizational. 15 socio-demographic factors were investigated as independent variables. Descriptive statistics, factor analysis and multilevel analysis were applied.

RESULTS

There were 1,962 patients in the final sample, with a response rate of 89.6%. The factors with the most positive effect on access to PC were financial and cultural; the most negative effects were caused by organizational problems. Financial difficulties were not a significant socio-demographic factor. Greater frequency of visits improves patients' perception of communicational and cultural access. Deteriorating health conditions are expected to lower perceived geographical access. Patients born outside Slovenia perceived better organizational access than patients born in Slovenia.

CONCLUSIONS

Universal medical insurance in Slovenia protects most patients from PC inaccessibility. However, problems perceived by patients may indicate the need for changes in the organization of PC.

How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care

BACKGROUND

Patients' evaluation of medical care is an essential dimension of quality of care and an important aspect of the feedback cycle for health care providers. The aim of this study was to document how patients with a Turkish background evaluate primary care in Germany and determine which aspects of care are associated with language abilities.

METHODS

The study was based on an observational design. Patients with a Turkish background from German primary care practices completed the EUROPEP (European Project on Patient Evaluation of General Practice Care) questionnaire consisting of 23 items. Seventeen primary care practices were involved with either German (n=8) or Turkish (n=9) general practitioners (GPs).

RESULTS

A convenience sample of 472 patients with a Turkish background from 17 practices participated in the study (response rate 39.9%). Practices with a German GP had a lower response rate (19.6%) than those with a Turkish GP (57.5%). Items evaluated the highest were "keeping data confidential" (73.4%) and "quick services for urgent health problems" (69.9%). Subgroup analysis showed lower evaluation scores from patients with good or excellent German language abilities. Patients who consulted a Turkish GP had higher evaluation scores.

CONCLUSION

The evaluation from patients with a Turkish background living in Germany with either Turkish or German GPs showed lower scores than patients in other studies in Europe using EUROPEP. However, our results had higher evaluation scores than those of Turkish patients evaluating GPs in Turkey. Therefore, different explanation models for these findings should be explored in future studies.

Patient experience and the role of postgraduate GP training: a cross-sectional analysis of national Patient Survey data in England

BACKGROUND

Quality indicators for primary care focus predominantly on the public health model and organisational measures. Patient experience is an important dimension of quality. Accreditation for GP training practices requires demonstration of a series of attributes including patient-centred care.

AIM

The national GP Patient Survey (GPPS) was used to determine the characteristics of general practices scoring highly in responses relating to the professional skills and characteristics of doctors. Specifically, to determine whether active participation in postgraduate GP training was associated with more positive experiences of care.

DESIGN AND SETTING

Retrospective cross-sectional study in general practices in England.

METHOD

Data were obtained from the national QOF dataset for England, 2011/12 (8164 general practices); the GPPS in 2012 (2.7 million questionnaires in England; response rate 36%); general practice and demographic characteristics. Sensitivity analyses included local data validated by practice inspections.

OUTCOME MEASURES

multilevel regression models adjusted for clustering.

RESULTS

GP training practice status (29% of practices) was a significant predictor of positive GPPS responses to all questions in the 'doctor care' (n = 6) and 'overall satisfaction' (n = 2) domains but not to any of the 'nurse care' or 'out-of-hours' domain questions. The findings were supported by the sensitivity analyses. Other positive determinants were: smaller practice and individual GP list sizes, more older patients, lower social deprivation and fewer ethnic minority patients.

CONCLUSION

Based on GPPS responses, doctors in GP training practices appeared to offer more patient-centred care with patients reporting more positively on attributes of doctors such as 'listening' or 'care and concern'.

Do family physicians advise younger people on cardiovascular disease prevention? A cross-sectional study from Slovenia

Background

One of the main family practice interventions in the younger healthy population is advice on how to keep or develop a healthy lifestyle. In this study we explored the level of counselling regarding healthy lifestyle by family physicians and the factors associated with it.

Methods

A cross-sectional study with a random sample of 36 family practices, stratified by size and location. Each practice included up to 40 people aged 18–45 with low/medium risk for cardiovascular disease (CVD). Data were obtained by patient and practice questionnaires and semi-structured interviews. Several predictors on the patient and practice level for received advice in seven areas of CVD prevention were applied in corresponding models using a two-level logistic regression analysis.

Results

Less than half of the eligible people received advice for the presented risk factors and the majority of them found it useful. Practices with medium patient list-sizes showed consistently higher level of advice in all areas of CVD prevention. Independent predictors for receiving advice on cholesterol management were patients’ higher weight (regression coefficient 0.04, p=0.03), urban location of practice (regression coefficient 0.92, p=0.04), organisation of education by the practice (regression coefficient 0.47, p=0.01) and practice list size (regression coefficient 6.04, p=0.04). Patients who self-assessed their health poorly more frequently received advice on smoking (regression coefficient −0.26, p=0.03). Hypertensive patients received written information more often (regression coefficient 0.66, p=0.04). People with increased weight more often received advice for children’s lifestyle (regression coefficient 0.06, p=0.03). We did not find associations with patient or practice characteristics and advice regarding weight and physical activity. We did not find a common pattern of predictors for advice.

Conclusions

Counselling for risk diseases such as increased cholesterol is more frequently provided than basic lifestyle counselling. We found some doctors and practice factors associated with counselling behaviour, but the majority has to be explained by further studies.

Are family practice trainers and their host practices any better? Comparing practice trainers and non-trainers and their practices

Background

Family Physician (FP) trainees are expected to be provided with high quality training in well organized practice settings. This study examines differences between FP trainers and non-trainers and their practices to see whether there are differences in trainers and non-trainers and in how their practices are organized and their services are delivered.

Method

203 practices (88 non-training and 115 training) with 512 FPs (335 non-trainers and 177 trainers) were assessed using the “Visit Instrument Practice organization (VIP)” on 369 items (142 FP-level; 227 Practice level). Analyses (ANOVA, ANCOVA) were conducted for each level by calculating differences between FP trainees and non-trainees and their host practices.

Results

Trainers scored higher on all but one of the items, and significantly higher on 47 items, of which 13 remained significant after correcting for covariates. Training practices scored higher on all items and significantly higher on 61 items, of which 23 remained significant after correcting for covariates. Trainers (and training practices) provided more diagnostic and therapeutic services, made better use of team skills and scored higher on practice organization, chronic care services and quality management than non-training practices. Trainers reported more job satisfaction and commitment and less job stress than non-trainers.

Discussion

There are positive differences between FP trainers and non-trainers in both the level and the quality of services provided by their host practices. Training institutions can use this information to promote the advantages of becoming a FP trainer and training practice as well as to improve the quality of training settings for FPs.

A randomised controlled trial to improve the role of the general practitioner in cancer rehabilitation: effect on patients' satisfaction with their general practitioners

OBJECTIVE

To test whether a complex intervention facilitating early cancer rehabilitation by involvement of the general practitioner (GP) soon after diagnosis improves patients' satisfaction with their GPs.

DESIGN

A cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention or a control group before the start of the study. Patients included those with cancer who were subsequently allocated to either group based on the randomisation status of their GP.

PARTICIPANTS

Adult patients with cancer treated for incident cancer at the public regional hospital (Vejle Hospital, Denmark) were included between May 2008 and February 2009. A total of 955 patients registered with 323 practices were included, of which 486 patients were allocated to the intervention group and 469 to the control group.

INTERVENTION

The intervention included a patient interview assessing the need for rehabilitation, improved information from the hospital to GPs including information on the patients' current needs along with information about needs of patients with cancer in general. Further, GPs were encouraged to proactively contact the patients and facilitate the patients' rehabilitation course.

OUTCOME MEASURES

6 months after inclusion of the patient, patient satisfaction with their GP during the last 12 months in five different dimensions of GP care was assessed using the Danish version of the EuroPEP (European Patients Evaluate General Practice Care) questionnaire (DanPEP). 14 months after inclusion, patient satisfaction with the GP regarding the cancer course and GP's satisfaction with own contribution to the patients' rehabilitation course were assessed using ad hoc questions specifically designed for this study.

RESULTS

No overall effect of the intervention was observed. Subgroup analysis of the patients with breast cancer showed statistically significant improvement of satisfaction with the GP in two of the five DanPEP dimensions.

CONCLUSIONS

This complex intervention aiming at improving GPs' services in cancer rehabilitation had no impact on patient satisfaction.

TRIAL REGISTRATION

ClinicalTrials.gov, registration ID number NCT01021371.