PHP4 PATIENT PREFERENCES TOWARD HEALTH SERVICES PROVIDED BY THE GENERAL PRACTIONER

Abstract

OBJECTIVES: In the Dutch health care system, like many other countries, the general practitioner (GP) plays a key role in securing equity and effectiveness in delivering health care. Nowadays, GPs are often part of primary care centers and it is foreseen that these centers will play an even more important role in future health service delivery. A European comparison in nine different countries concluded patients favour small practices and full time GPs. The percentage of GPs working in small practices varies between countries. In the UK the percentage is 16% whereas in Belgium the percentage is 69% and in Netherlands the percentage is 39%. Continuity of care and access is highly appreciated by patients. For instance, it has been shown that patients are more satisfied with primary care if they always have the same GP and if they experience short waiting times. Given the development of larger primary care centers, people are hesitant if the current GP service levels can be maintained. On the other hand, an advantage of primary care centers is that they do offer multiple medical services like pharmacy and physiotherapy. The purpose of this study was two-fold. First, it was questioned which type of services is preferred by patients in three different GP settings and if people would be willing to pay for these services. Second, we wish to investigate differences between patients in different GP settings. The selected GP settings were 1) a single person GP practice (SP); 2) a healthservice with multiple independent GPs (GP); and 3) a multi-disciplinary and comprehensive primary care center supervised by one management (PCC). METHODS: A discrete choice experiment (DCE) was carried out among 164 patients in the three different GP settings. The DCE comprised 6 attributes including 1) time to appointment; 2) choice of time; 3) access by telephone; 4) consultation time; 5) availability of other medical services and; 6) WTP. Sample size for the DCE was estimated at about 45 patients in each GP setting. The DCE included 6 attributes. The maximum number of levels for an attribute was three, allowing 72 choice combinations. The DCE survey used 15 random and 2 fixed choicesets. Following the DCE, all 164 and an extra group of 114 patients (278 in total) were interviewed by a research assistent. Sampling was carried out to obtain equal group sizes (approx. 55) in each of the GP settings (SP, GP and PCC). DCE data were analyzed using sawtooth software. This abstract reports the first preliminary analyses of the complete dataset. RESULTS: Socioeconomic (income and education) and demographic data (age and gender) of patients in each of the GP settings were comparable. The DCE showed preference for improved telephone services and time to appointment as most important attributes. Except for “time to appointment” no large differences were found between the GP settings. Only patients in the GP group accepted longer waiting times compared to SP and PCC. SP and PCC patients did prefer to have access within 24 hours, whereas GP patients accepted longer waiting times. Overall, most important attributes were “time to appointment”, “access of service by telephone” and “WTP”. The availability of pharmacy services was preferred by all patients. About 50% of all patients werent willing to pay for additional services. However, some 35% was willing to pay an extra amount of €9 for each consult if they would receive additional services. CONCLUSIONS: This study shows a similar outcome compared to previous studies on access to GP services. “Time to first appointment” and “access by telephone” are most important factors to consider by patients. However, an interesting finding was that one third of all patients were willing to pay for improved services. The DCE study didn’t show big differences in preferences between patients in the different GP settings. In some aspects (e.g. accessability) the SP scored better compared to PCC and GP.