The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries

M Bonciani,W Schäfer,P P Groenewegen,S Barsanti,S Heinemann

doi:10.1186/s12913-018-2913-4

Abstract

BackgroundThere is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients. The aim of this study was to identify the relationships between general practitioner (GP) co-location with other GPs and/or other professionals and the GP outcomes and patients’ experiences.MethodsWe wanted to test whether GP co-location is related to a broader range of services provided, the use of clinical governance tools and inter-professional collaboration, and whether the patients of co-located GPs perceive a better quality of care in terms of accessibility, comprehensiveness and continuity of care with their GPs. The source of data was the QUALICOPC study (Quality and Costs of Primary Care in Europe), which involved surveys of GPs and their patients in 34 countries, mostly in Europe. In order to study the relationships between GP co-location and both GPs’ outcomes and patients’ experience, multilevel linear regression analysis was carried out.ResultsThe GP questionnaire was filled in by 7183 GPs and the patient experience questionnaire by 61,931 patients. Being co-located with at least one other professional is the most common situation of the GPs involved in the study. Compared with single-handed GP practices, GP co-location are positively associated with the GP outcomes. Considering the patients’ perspective, comprehensiveness of care has the strongest negative relationship of GP co-location of all the dimensions of patient experiences analysed.ConclusionsThe paper highlights that GP mono- and multi-disciplinary co-location is related to positive outcomes at a GP level, such as a broader provision of technical procedures, increased collaboration among different providers and wider coordination with secondary care. However, GP co-location, particularly in a multidisciplinary setting, is related to less positive patient experiences, especially in countries with health systems characterised by a weak primary care structure.

Highlights

There is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients
There are only nine countries where more than 85% of general practitioner (GP) are co-located with other GPs, including Iceland, Norway and Sweden with almost all GPs working in a co-located setting
This article has shown that GP co-location is associated with a broader provision of health care services in a primary care setting and with more collaboration between GPs and other primary and secondary care professionals

Summary

Introduction

There is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients. The co-location of GPs and other professionals in the same practice, as a single point of healthcare access, is often proposed as a change in the organisation of primary care delivery that may facilitate access to services. This co-location may minimize fragmentation among the various providers involved in the patient care pathway, by reducing duplication and ensuring more responsiveness to users [9, 24, 40]. The co-location of services and professionals in primary care can facilitate integration in the delivery of healthcare, prevention and rehabilitation services [48]

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