Family Practice Vol. 19, No. 4, 339-343
© Oxford University Press 2002
Health Services Research |
Patient and GP agreement on aspects of general practice care
a The Research Unit for General Practice and
b Department of General Practice, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark.
Peter Vedsted; E-mail: pv{at}alm.au.dk
Vedsted P, Mainz J, Lauritzen T and Olesen F. Patient and GP agreement on aspects of general practice care. Family Practice 2002; 19: 339–343.
Received 14 May 2001; Revised 30 October 2001; Accepted 11 March 2002.
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Abstract |
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Objective. The aim of the present study was to compare patient and GP priorities for general practice care.
Methods. A questionnaire survey was carried out in general practice in Denmark which included 900 consecutive patients aged over 18 years from 15 practices collected in 1995, and 919 randomly sampled GPs in 1999. The postal questionnaire, developed by the EUROPEP group, contained 40 questions about eight aspects of primary care. Participants were asked to state their priorities for each question ranging from ‘not at all important’ to ‘most important’. A reminder questionnaire was sent to non-responders after 2 weeks. Top priority percentages (‘very/ most important’) were calculated for each question as were differences between participant groups.
Results. Questionnaires were answered by 771 (85.7%) patients and 584 (64.2%) GPs. Their priorities were highly correlated (r = 0.754, P < 0.001). Patients gave higher priority than GPs to availability and accessibility of the practice and seeing the same GP. The GP should be capable of providing information on illness, investigations and treatments and patient associations, and should know the patient's history and be regularly updated through courses.
Conclusions. Patient and GP priorities for primary care were highly correlated. The higher priority awarded by patients than by GPs to specific aspects of primary care should be acknowledged when organizing and developing general practice.
Keywords. Denmark, family practice, preferences, priorities, questionnaire.
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Introduction |
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The last decade has seen a growing recognition among health care professionals, administrators and policy makers of the need for studying patient involvement in health care.1 Some of these studies have shown that patients may have specific priorities regarding technical, interpersonal and organizational aspects of care.1,2
Only very few studies have compared GPs' and patients' priorities and evaluations of general practice care3,4 even if such knowledge is crucial to the organization of general practice care. Moreover, the ability to respond favourably to health care consumers' expectations and priorities requires knowledge of where these priorities match or clash with those of the caregivers, policy makers and administrators. The aim of this study is to fill this knowledge gap by comparing patient and GP priorities for general practice care.
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Methods |
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Study populations
The patient sample consisted of patients from 15 Danish general practices who were asked in 1995 to participate in the EUROPEP study5 by including 60 consecutive patients from each practice. Patients were aged 18 years and over and all spoke and understood Danish. Patients who had not responded within 2 weeks received a reminder questionnaire.
The sample of 924 GPs was collected at random in 1999. Respondent independence was guaranteed by sampling only one GP from each practice. Five GPs were excluded because four had participated in the pilot study and one was a member of the research group. Thus, questionnaires were sent to 919 GPs. GPs who did not respond within 2 weeks received a reminder with a new questionnaire.
The questionnaire
The questionnaire was developed to assess the patient priorities for general practice care. It was developed by a European group (EUROPEP).5,6 The questionnaire contained 40 questions organized into five templates each with eight questions: medical–technical care; doctor–patient relationship; information and support; availability and accessibility; and organization of the services. The GP questionnaire had exactly the same wording as the patient questionnaire, except for the words ‘I’, ‘me’ and ‘my’ which were replaced by ‘the patient’. Patients and GPs were asked to rate each of the questions according to their importance on a 5-point Likert scale ranging from ‘not at all important’ to ‘most important’. In addition, respondents could answer ‘do not know’.
Analysis
Percentages were calculated for each question to which importance (‘very/most important’) was ascribed. Only respondents who had indicated a preference on the 5-point scale were included in the denominator. We calculated the difference between GPs' and patients' ascription of importance to each question and the 95% confidence interval (95% CIs).7 Agreement of priorities was depicted graphically in a scatter plot with the diagonal as the dividing line.
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Results |
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Study population
A total of 771 patients (Table 1
) returned a questionnaire (response rate 85.7%). A total of 633 GPs responded but, among these, nine stated that they were unable to participate because of leave, disease or closing down of practice, which reduced the number of eligible GPs to 624. Forty respondents did not wish to participate, leaving 584 (64.2%) GPs for analysis (Table 2).
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Priorities
Patients in particular gave higher priority to question nos 17, 20, 35 and 36 than the GPs who, on the other hand, gave higher priority to question nos 11, 33, 34 and 40 (Table 3
). The Spearman's rank correlation between the priorities of the two groups was .754 (P < 0.001) (Fig. 1).
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GP and patient priorities differed in all matters concerning aspects of ‘organization of the services' (Table 3
), the GPs giving higher priority to questions concerning convenient facilities, good co-operation between GP and staff and co-ordination of different types of care. Patients gave higher priority than GPs to all questions concerning aspects of ‘availability and accessibility’. The largest discrepancy between respondent groups was found for the category ‘information and support’ where patients gave much higher priority to the GP telling the patient all about the illness, explaining the purpose of investigations and treatment and providing information on patient associations. Among the top 10 patient priorities, the GPs gave lower priority to question nos 4, 20, 26, 27 and 37. |
Discussion |
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The high correlation between patient and GP priorities indicates a general agreement in their ranking of the aspects. However, patients gave higher priority than GPs to information about the purpose of investigations and treatment, about patients' associations and about their illness. They also gave higher priority to the GP having enough time during the consultation, to the GP providing quick services in the case of emergencies, to continuity of care and to the GP's participation in courses. These high patient priorities have also been found in other studies2,6 and should be remembered because the GPs tended to give lower priorities to these aspects. In contrast, GPs gave higher priority than patients to the organization of the services regarding facilities, co-operation and co-ordination. However, this might be explained by the GPs having to acknowledge organizational issues in practice.
Aspects of ‘availability and accessibility’ were consistently a higher patient than GP priority. However, GPs setting aside more time for consultations and seeking to improve doctor–patient communication on the phone tend to be mutually exclusive.
We identified a pattern of lower GP than patient priorities for aspects involving other care providers [‘specialists and different doctors' (questions 3, 12 and 38), ‘alternative treatment’ (question 13) and ‘patient associations' (question 19)]. It could be argued that general practice should take initiatives to meet some of these patient preferences.
The study revealed interesting information about aspects of ‘medical–technical care’ where the largest discrepancy between respondents was observed for priorities given to the GPs attending regular courses on recent medical developments. Despite an intense focus on quality, continuing medical education and, e.g. GP accreditation, patients still gave higher priority to regular courses.
A Dutch study based on the EUROPEP questionnaire using adjusted differences to compare patients' and GPs' priorities found very similar results.4 The similarity of these results suggests that some of the differences apply across countries, whereas others may be culture specific.
Statistical precision and validity
The large samples included allowed us to obtain good statistical precision. The questionnaires were developed according to scientific standards. The patient response rate was good. However, some of the difference found could be due to selection bias arising from the lower response rate among GPs than among patients. As we used a questionnaire developed for patients on a GP population, some of the differences in priorities may therefore be ascribed to differences in how respondent groups conceptualize the words of the questionnaire, besides to the known differences in knowledge, experience, culture, etc. Some of the differences may also be due to differences in population composition, e.g. age, gender and health, or the fact that there were 4 years between the two surveys. These aspects of the validity of the study demand a critical interpretation of the results.
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Acknowledgments |
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We thank Associate Professor Morten Frydenberg, MSc, PhD, Department of Biostatistics, University of Aarhus, for his help with the statistics. This study was supported by a grant from the EC, Biomed 2 Concerted Action as part of the EUROPEP study.
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References |
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1 Donabedian A. Quality assurance in health care: consumers' role. Qual Health Care 1992; 1: 247–251.[Medline]
2 Fletcher RH, O'Malley MS, Earp JA et al. Patients' priorities for medical care. Med Care 1983; 21: 234–242.[ISI][Medline]
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4 Jung HP, Wensing M, Grol R. What makes a good general practitioner: do patients and doctors have different views? Br J Gen Pract 1997; 47: 805–809.[ISI][Medline]
5 Grol R, Wensing M, Mainz J et al. Patients' priorities with respect to general practice care: an international comparison. European Task Force on Patient Evaluations of General Practice (EUROPEP). Fam Pract 1999; 16: 4–11.
6 Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic review of the literature on patient priorities for general practice care. Part 1: description of the research domain. Soc Sci Med 1998; 47: 1573–1588.[ISI][Medline]
7 Armitage P, Berry G. Statistical Methods in Medical Research, 3rd edn. Oxford: Blackwell Scientific Publications, 1994.
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