GP Patient Survey Research Articles

Drugs causing adverse events in patients aged 45 or older: a randomised survey of Australian general practice patients

ObjectiveTo determine prevalence of adverse drug events (ADEs) in patients aged 45 years or older presenting to Australian general practitioners (GPs) and identify drug groups related to ADEs, their severity...

Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England. Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman's rank correlation and multiple linear regression were used on practice-level estimates. Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15). Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.

PP23 Variation of Primary Care Quality with Contract type: An Observational Study

BackgroundSince 2004, policy reforms in the English NHS have allowed new contracting mechanisms for provision of general practice services. A wider variety of provider organisations were allowed under the alternative...

Changing practice as a quality indicator for primary care: analysis of data on voluntary disenrollment from the English GP Patient Survey

BackgroundChanging family practice (voluntary disenrollment) without changing address may indicate dissatisfaction with care. We investigate the potential to use voluntary disenrollment as a quality indicator for primary care.MethodsData from the English national GP Patient Survey (2,169,718 respondents), the number of voluntary disenrollments without change of address, data relating to practice characteristics (ethnicity, deprivation, gender of patients, practice size and practice density) and doctor characteristics were obtained for all family practices in England (n = 8450). Poisson regression analyses examined associations between rates of voluntary disenrollment, patient experience, and practice and doctor characteristics.ResultsMean and median rates of annual voluntary disenrollment were 11.2 and 7.3 per 1000 patients respectively. Strongest associations with high rates of disenrollment were low practice scores for doctor-patient communication and confidence and trust in the doctor (rate ratios 4.63 and 4.85). In a fully adjusted model, overall satisfaction encompassed other measures of patient experience (rate ratio 3.46). Patients were more likely to move from small practices (single-handed doctors had 2.75 times the disenrollment rate of practices with 6–9 doctors) and where there were other local practices. After allowing for these, substantial unexplained variation remained in practice rates of voluntary disenrollment.ConclusionFamily practices with low levels of patient satisfaction, especially for doctor patient communication, are more likely to experience high rates of disenrollment. However substantial variation in disenrollment rates remains among practices with similar levels of patient satisfaction, limiting the utility of voluntary disenrollment as a performance indicator for primary care in England.

Drivers of overall satisfaction with primary care: evidence from the English General Practice Patient Survey

To determine which aspects of primary care matter most to patients, we aim to identify those aspects of patient experience that show the strongest relationship with overall satisfaction and examine the extent to which these relationships vary by socio-demographic and health characteristics. Data from the 2009/10 English General Practice Patient Survey including 2,169,718 respondents registered with 8362 primary care practices. Linear mixed-effects regression models (fixed effects adjusting for age, gender, ethnicity, deprivation, self-reported health, self-reported mental health condition and random practice effect) predicting overall satisfaction from six items covering four domains of care: access, helpfulness of receptionists, doctor communication and nurse communication. Additional models using interactions tested whether associations between patient experience and satisfaction varied by socio-demographic group. Doctor communication showed the strongest relationship with overall satisfaction (standardized coefficient 0.48, 95% CI = 0.48, 0.48), followed by the helpfulness of reception staff (standardized coefficient 0.22, 95% CI = 0.22, 0.22). Among six measures of patient experience, obtaining appointments in advance showed the weakest relationship with overall satisfaction (standardized coefficient 0.06, 95% CI = 0.05, 0.06). Interactions showed statistically significant but small variation in the importance of drivers across different patient groups. For all patient groups, communication with the doctor is the most important driver of overall satisfaction with primary care in England, along with the helpfulness of receptionists. In contrast, and despite being a policy priority for government, measures of access, including the ability to obtain appointments, were poorly related to overall satisfaction.

Accessing primary care: a simulated patient study

Simulated patient, or so-called 'mystery-shopper', studies are a controversial, but potentially useful, approach to take when conducting health services research. To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients' reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders' possible confusion in answering this question. Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients' satisfaction with their practice is not related to practice call handling, but is related to appointment availability.

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

The UK government has encouraged NHS services to obtain patient feedback to support the further development of patient-centred care. In 2009, the English GP Patient Survey included a sample of 5.5 million, but little is known about its potential utility in informing developments aimed at improving the quality of patients' experiences of primary care. To investigate primary care providers' response to feedback on patient experience from a national survey. Qualitative interview study in 10 general practices from four primary care trusts in England. Semi-structured interviews were conducted with GPs, practice nurses, and practice managers (n = 37). Transcripts were analysed thematically. Although some participants reported making changes to their practice in response to the survey data, many expressed doubts about the credibility of the results. Key issues included: concerns about practical aspects of the survey, such as the response rate and representativeness of the sample; the view that it gave insufficient detail to facilitate change and failed to address some salient issues; and unease about the influence of political influences underpinning its introduction and use. Although, in general, primary care professionals have positive attitudes towards patient feedback, this study suggests a mismatch between the conventional demonstration of the objectivity of a questionnaire survey and the attitudes and experiences of those receiving the data. This is likely to prevent doctors from engaging constructively with the survey. These concerns may well militate against the potential of the survey to act as a simple means of capturing, and effectively using, feedback from patients.

What aspects of primary care predict emergency admission rates? A cross sectional study

BackgroundFrom 2004 to 2009 there was almost a 12% rise in emergency admissions in England. This can be explained partly by an aging population and other socio-demographic characteristics, but much cannot be explained by these factors. We explored aspects of care, in addition to known demographic characteristics in general practice, that are associated with emergency admissions.MethodsA cross-sectional design employing hospital admission data from 76 general practices in Northamptonshire, England for 2006–08, including demographic data, quality and outcomes framework points and GP patient survey outcomes.ResultsThere were statistically significant associations between emergency admissions and age, gender, distance from hospital and proportion classified as white. There was also a statistically significant relationship between emergency admissions and being able to book an appointment with a preferred doctor; this relationship was stronger in less deprived communities.ConclusionsEnabling patients to book with a preferred doctor, particularly those in less deprived communities could have an impact on reducing emergency admissions. It is possible that being able to consult a preferred GP gives patient’s confidence to avoid an emergency admission or it facilitates consistent clinical management that helps prevent the need for admission. However the findings only explained some of the variation.

Patient-reported outcomes of cancer survivors in England 1–5 years after diagnosis: a cross-sectional survey

ObjectivesTo determine the feasibility of collecting population-based patient-reported outcome measures (PROMs) in assessing quality of life (QoL) to inform the development of a national PROMs programme for cancer and to...

Do English patients want continuity of care, and do they receive it?

Aboulghate and colleagues, in their analysis of GP Patient Survey data, conclude that most people value continuity but that practices need to flexibly balance it against speed of access.1 Asking patients whether they prefer to see a particular …

Do English patients want continuity of care, and do they receive it?

Interpersonal continuity of care is valued by patients, but there is concern that it has declined in recent years. To determine how often patients express preference for seeing a particular GP and the extent to which that preference is met. Analysis of data from the 2009/2010 English GP Patient Survey. A stratified random sample of adult patients registered with 8362 general practices in England (response rate 39%, yielding 2,169,718 responses). Weighted estimates were calculated of preference for and success in seeing a particular GP. Multilevel logistic regression was used to identify characteristics associated with these two outcomes. Excluding practices with one GP, 62% of patients expressed a preference for seeing a particular GP. Of these patients, 72% were successful in seeing their preferred GP most of the time. Certain patient groups were associated with more preference for and success in seeing a particular GP. These were older patients (preference odds ratio [OR] = 1.7, success OR = 1.8), those with chronic medical conditions (preference OR = 1.9, success OR = 1.3), those with chronic psychological conditions (preference OR = 1.6, success OR = 1.3), and those recently requesting only non-urgent versus urgent appointments (preference OR = 1.4, success OR = 1.6). Patient groups that had more frequent preference but less success in seeing a preferred GP were females (preference OR = 1.5, success OR = 0.9), patients in larger practices (preference OR = 1.3, success OR = 0.5), and those belonging to non-white ethnic groups. The majority of patients value interpersonal continuity, yet a large minority of patients and specific patient groups are not regularly able to see the GP they prefer.

English patients are mostly positive about their GPs

Most patients in England are happy with the way their GP handles consultations and trust their doctor, the annual GP patient survey for 2011-12 has found. The survey of more than a million patients in England (38% response rate), conducted by Ipsos Mori on behalf of the Department of Health, found that most respondents thought their GP was good at listening (88%), gave them enough time for their consultation (87%), treated them with care and concern (84%), explained tests and treatments (83%), and involved them in decisions about their care (76%). …

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey

ObjectivesUncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national...

Assessing the Performance of the EQ-VAS in the NHS PROMs Programme

The NHS Patient Reported Outcome Measures (PROMs) programme is a significant development in the routine collection and use of patient reported outcome data. Introduced in April 2009, it entails the routine collection of patient reported outcomes from all patients undergoing four elective surgical procedures in the NHS. The measures include both the EQ-5D and condition specific instruments. Data are collected from patients both before and after surgery. The collection of EQ-5D data will be extended gradually over a range of long term conditions and will be incorporated into a new GP Patient Survey. Longer term, the collection of patient reported health is expected to be rolled out across all NHS services, wherever practicable (DH, 2010). Once completed, this initiative could mean several million patients will complete the EQ-5D in England each year.

Prevalence and Benefits of Care Plans and Care Planning for People with Long-Term Conditions in England

Among patients with long-term conditions, to determine the prevalence and benefits of care planning discussions and of care plans. Data from the 2009/10 General Practice Patient Survey, a cross sectional survey of 5.5 million patients in England. Outcomes were patient reports of: care planning discussions; perceived benefit from care planning discussions and resultant care plans. Patient and practice variables were included in multilevel logistic regression to investigate predictors of each outcome. Half the respondents (49%) reported a long-term condition and were eligible to answer the care planning questions. Of these, 84% reported having a care planning discussion during the last 12 months and most reported some benefit. Only 12% who reported a care planning discussion also reported being told they had a care plan. Patients who reported having a care plan were more likely to report benefits from care planning discussions. Several factors predicted the reporting of care planning and care plans of which the most important was patients' reports of the quality of interpersonal care. There is a gap between policy and current practice which might reflect uncertainty as to the benefits of care plans. There is, therefore, a need for rigorous evaluation of care plans.

Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English General Practice Patient Survey

BackgroundEthnic minorities and some other patient groups consistently report lower scores on patient surveys, but the reasons for this are unclear. This study examined whether low scores of ethnic minority...

How can Health Care Organizations be Reliably Compared?

Patient experience is increasingly used to assess organizational performance, for example in public reporting or pay-for-performance schemes. Conventional approaches using 95% confidence intervals are commonly used to determine required survey samples or to report performance but these may result in unreliable organizational comparisons. We analyzed data from 2.2 million patients who responded to the English 2009 General Practice Patient Survey, which included 45 patient experience questions nested within 6 different care domains (access, continuity of care, communication, anticipatory care planning, out-of-hours care, and overall care satisfaction). For each question, unadjusted and case-mix adjusted (for age, sex, and ethnicity) organization-level reliability, and intraclass correlation coefficients were calculated. Mean responses per organization ranged from 23 to 256 for questions evaluating primary care practices, and from 1454 to 2758 for questions evaluating out-of-hours care organizations. Adjusted and unadjusted reliability values were similar. Twenty-six questions had excellent reliability (≥0.90). Seven nurse communication questions had very good reliability (≥0.85), but 3 anticipatory care planning questions had lower reliability (<0.70). Reliability was typically <0.70 for questions with <100 mean responses per practice, usually indicating questions which only a subset of patients were eligible to answer. Nine questions had both excellent reliability and high intraclass correlation coefficients (≥0.10) indicating both reliable measurement and substantial performance variability. High reliability is a necessary property of indicators used to compare health care organizations. Using the English General Practice Patient Survey as a case study, we show how reliability and intraclass correlation coefficients can be used to select measures to support robust organizational comparisons, and to design surveys that will both provide high-quality measurement and optimize survey costs.

Primary care experience of people with long-standing psychological problems: Evidence from a national survey in England

People with psychological problems face important challenges in obtaining high quality healthcare. We review evidence on the experience of primary care by people with mental health problems, including reasons why their care may be reported as worse than other groups. In the 2009 English GP Patient Survey, 5.7% of 2,163,456 respondents reported that they had a long-standing psychological or emotional condition. In an unadjusted regression model, respondents with long-standing emotional or psychological conditions rated their experiences worse than people without such problems, with scores which were up to 3 percentage points lower on individual survey items. However, after controlling for age, gender, ethnicity, deprivation and self-reported general health, people with long-standing psychological or emotional problems had slightly higher scores on 16 out of the 18 survey items, though with the equivalent of less than 2 percentage points difference for most items. Part of the reason for the difference between the adjusted and unadjusted models was the high prevalence of self-reported ‘fair’ or ‘poor’ general health among people who reported psychological problems. Overall, the results suggest that people with long-standing psychological and emotional conditions have similar experiences of English primary care compared to the rest of the population.

The GP Patient Survey for use in primary care in the National Health Service in the UK – development and psychometric characteristics

BackgroundThe UK National GP Patient Survey is one of the largest ever survey programmes of patients registered to receive primary health care, inviting five million respondents to report their experience of NHS primary healthcare. The third such annual survey (2008/9) involved the development of a new survey instrument. We describe the process of that development, and the findings of an extensive pilot survey in UK primary healthcare.MethodsThe survey was developed following recognised guidelines and involved expert and stakeholder advice, cognitive testing of early versions of the survey instrument, and piloting of the questionnaire in a cross sectional pilot survey of 1,500 randomly selected individuals from the UK electoral register with two reminders to non-respondents.ResultsThe questionnaire comprises 66 items addressing a range of aspects of UK primary healthcare. A response rate of 590/1500 (39.3%) was obtained. Non response to individual items ranged from 0.8% to 15.3% (median 5.2%). Participants did not always follow internal branching instructions in the questionnaire although electronic controls allow for correction of this problem in analysis. There was marked skew in the distribution of responses to a number of items indicating an overall favourable impression of care. Principal components analysis of 23 items offering evaluation of various aspects of primary care identified three components (relating to doctor or nurse care, or addressing access to care) accounting for 68.3% of the variance in the sample.ConclusionThe GP Patient Survey has been carefully developed and pilot-tested. Survey findings, aggregated at practice level, will be used to inform the distribution of £65 million ($107 million) of UK NHS resource in 2008/9 and this offers the opportunity for NHS service planners and providers to take account of users' experiences of health care in planning and delivering primary healthcare in the UK.

Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England

Objective To assess the robustness of patient responses to a new national survey of patient experience as a basis for providing financial incentives to doctors.Design Analysis of the representativeness of...