Abstract
BackgroundIn countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise. The aim of this study was to investigate whether socioeconomic inequalities in experiences with general practice are associated with socioeconomic inequalities in access to specialist services.MethodsThe study included 6,067 participants in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006–08) who were asked to evaluate their experiences with primary care and their regular general practitioner in Norway. Self-reported data on health status and number of visits to GP and specialist services in the last 12 months were included in the study. Socioeconomic status was measured by education and household income and rescaled to relative index of inequality (RII). Relative risks were calculated using Poisson regression.ResultsWe found that a majority of patients reported positive experiences with general practice. Low socioeconomic status (SES) and male gender were associated with negative experiences. Patient experiences both directly and indirectly related to referrals were associated with the probability and quantity of specialist utilization: perception of low subjective influence on decisions about choice of medical care was associated with lower probability and quantity of specialist utilization, whereas desire to change the regular GP or to use GPs other than the regular GP and critical evaluations of the GP were associated with higher specialist consultation frequency. However, the level of education-related inequity in access to specialists was not sensitive to adjustment by survey responses.ConclusionPatient experiences with general practice were associated with the patients’ level of utilization of specialist services. There are socioeconomic inequalities in patient experiences with general practice, however the aspects measured in this study do not explain the observed socioeconomic inequity in access to specialists.
Highlights
In countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise
One study showed that Australian patients with high socioeconomic status (SES) were more likely to be assigned to diagnostic tests by general practitioners [8]
We know of no studies that have investigated socioeconomic inequalities in patient experiences with GP-patient interaction in a strict gatekeeping system and their association with referrals to specialist services
Summary
In countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise. Previous literature has identified three mechanisms for the influence of socioeconomic status on the outcomes of general practitioner consultations, excluding health status: (1) the social distance between doctor and patient, influencing communication, (2) status-dependent differences in health knowledge and beliefs influencing health related behavior among patients, and (3) the professional power of the doctor [8,11]. These mechanisms may influence patient satisfaction with GP consultations. We know of no studies that have investigated socioeconomic inequalities in patient experiences with GP-patient interaction in a strict gatekeeping system and their association with referrals to specialist services
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