Patient satisfaction with availability of general practice: an international comparison

International Journal for Quality in Health Care, Apr 2002

Objective. To identify associations between the characteristics of general practitioners and practices, and patients’ evaluations of the availability of general practice. Design. Written surveys completed by patients. Setting. General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia, and Spain. Study participants. 15 996 adults patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). Main measures. The Europep instrument to assess patients’ evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. Results. Patients’ more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69–2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners’ working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. Conclusion. Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients’ views and organizational developments can be solved.

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Patient satisfaction with availability of general practice: an international comparison

MICHEL WENSING 2 4 PETER VEDSTED 1 2 JANKO KERSNIK 0 2 WIM PEERSMAN 2 8 ANJA KLINGENBERG 2 7 HILARY HEARNSHAW 2 6 PER HJORTDAHL 2 5 DOMINIQUE PAULUS 2 10 BEAT K UNZI 2 9 JUAN MENDIVE 2 3 RICHARD GROL 2 4 0 Department of Family Medicine, University of Ljubljana , Slovenia 1 Research Unit and Department of General Practice, Aarhus University , Denmark 2 Setting. General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland , Slovenia and Spain 3 semFYC, Barcelona, Spain 4 Centre for Quality of Care Research, University Medical Centre , Nijmegen, The Netherlands 5 Department of General Practice, University of Oslo , Norway 6 Centre for Primary Health Care Studies, University of Warwick , UK 7 AQUA Institute , Go ttingen, Germany 8 Department of Population Studies and Social Science Research Methods, University of Ghent , Belgium 9 SwissPEP, Programs for the Evaluation of Medical Practice , Gumlichen, Switzerland 10 Centre Universitaire de Medecine Generale, Universite Catholique de Louvain , Belgium Objective. To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice. Design. Written surveys completed by patients. Study participants. 15 996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). Main measures. The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. Results. Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. Conclusion. Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved. Availability of the primary medical care team 24 hours a day is a core public demand, a demand that can only increase if the responsibility for patient care shifts from secondary to primary care. Delivery of out of hours services has received a great deal of attention in the past years, especially in the health care systems where family physicians/general practitioners (GPs) are no longer able to provide these Address reprint requests to Michel Wensing, WOK, UMC Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: - services on a personal basis [1]. Personal continuity of care is highly valued by patients [24], but it requires that the care provider is available for patient care most of the time. It has been suggested that the ideal of personal continuity in general practice should be replaced by that of organizational continuity [5]. The percentage of GPs working in solo practices varies between countries (for example, 16% in the UK and 69% in Belgium), but it is decreasing in most countries [6]. the national situation as closely as possible. In Denmark, Personal continuity of care may be difficult to maintain, Belgium, Switzerland, Slovenia, and Spain only one GP from given the increasing number of GPs in larger health care each practice could participate to reduce statistical clustering organizations. In this paper we examine how patients in of data. Where feasible, this GP was randomly selected. different countries evaluate the availability of general practice Short written questionnaires were mailed or given to each care. participating GP. Previous research has shown that patients are more The patient population comprised adult individuals who satisfied with general practice if they have a personal GP had recently visited the GP. We aimed at 1080 patients per and if they experience short waiting times [5,7,8]. Different country (30 per practice) to allow a reliable comparison types of out of hours services have proved to be satisfactory between countries (alpha=0.01, P=0.90, icc=0.05, standard for providers, but less satisfactory for patients [1,6,9]. Free deviation=0.8, and minimal relevant difference=0.3 on a flow of patients and administrative barriers might be five-point (...truncated)


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MICHEL WENSING, PETER VEDSTED, JANKO KERSNIK, WIM PEERSMAN, ANJA KLINGENBERG, HILARY HEARNSHAW, PER HJORTDAHL, DOMINIQUE PAULUS, BEAT KÜNZI, JUAN MENDIVE, RICHARD GROL. Patient satisfaction with availability of general practice: an international comparison, International Journal for Quality in Health Care, 2002, pp. 111-118, 14/2,