Abstract
BackgroundVariation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context. However, the extent to which differences in patients' evaluation of the GPs are associated with differences in GP and practice characteristics must also be ascertained in order to facilitate comparison of adjusted patient evaluations between GPs. The aim of this study was to determine such associations in a setting where GPs serve a list of patients and act as gatekeepers.MethodsWe carried out a patient evaluation survey among voluntarily participating GPs using the EUROPEP questionnaire, which produced 28,260 patient evaluations (response rate 77.3%) of 365 GPs. In our analyses we compared the prevalence of positive evaluations in groups of GPs.ResultsOur principal finding was a negative association between the GP's age and the evaluation of all aspects, except accessibility. We also found an association between the way the practice was organised and the patients' evaluation of accessibility, with GPs in single-handed practices getting far the most positive evaluations. Long weekly working hours were associated with more positive evaluations of all dimensions except accessibility, whereas more than 0.5 full-time employees per GP, a higher number of listed patients per GP and working in a training practice were associated with negative evaluation of accessibility.ConclusionGP characteristics are mainly associated with patients' experience of interpersonal aspects of care, while practice characteristics are associated with evaluation of accessibility. These differences need to be accounted for when comparing patient evaluations of different practices.
Highlights
Variation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context
Working in a training practice was only associated with the assessment of accessibility aspects (Table 7), where we found a negative association, while the evaluations were not associated with teaching outside the practice
* Patients who marked 100% of the answered questions in one of the two most positive answering categories. † Patients who marked less than 50% (0–49%) of the answered questions in one of the two most positive answering categories. ‡ Prevalence § Crude prevalence ratio is the unadjusted prevalence ratio adjusted for patient clustering || Patient-adjusted prevalence ratio is the prevalence ratio adjusted for patients' gender, age, frequency of attending a GP and self-rated health and patient clustering. ¶ Fully adjusted prevalence ratio is the prevalence ratio adjusted for GPs' gender, age, weekly working hours, organisation of practice and staff in addition to patients' gender, age, frequency of attending a GP, self-rated health and patient clustering
Summary
Variation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context. The extent to which differences in patients' evaluation of the GPs are associated with differences in GP and practice characteristics must be ascertained in order to facilitate comparison of adjusted patient evaluations between GPs. The aim of this study was to determine such associations in a setting where GPs serve a list of patients and act as gatekeepers. Variation in patient evaluation of general practice reflects differences in performance, which, to some extent, may be associated with GP and practice characteristics, and differences in the patients'. Studies of associations between patient evaluations and patient, GP and practice characteristics are needed to determine which characteristics to adjust for. Knowledge of such associations may serve quality improvement purposes at regional and national levels. Baker [5,6] found that being a training practice produced less positive evaluations
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