Differences in medical services in Nordic general practice: a comparative survey from the QUALICOPC study

International survey of people living with chronic conditions (PaRIS survey): effects of general practitioner non-participation on the representativeness of the Norwegian patient data

BACKGROUND

The International Survey of People living with Chronic Conditions (OECD-PaRIS survey), aims to systematically gather patient-reported experiences (PREMs) and - outcomes (PROMs) and potential predictors for these outcomes for persons with chronic conditions as well as information from professionals about health care provided. In such patient surveys, the advantages of a multilevel (nested) approach in which patients are sampled 'within providers' need to be balanced against the potential for bias if patient populations from participating GPs significantly differ from those of non-participating GPs. The objective was to assess the effects of general practitioner (GP) non-participation on the representativeness of the Norwegian patient data of the International Survey of People living with Chronic Conditions (OECD-PaRIS survey).

METHODS

To test all aspects of the first main PaRIS survey, it was preceded by a field trial which this paper reports on the Norwegian part of. For the Norwegian part of the field trial in 2022, we randomly sampled and surveyed 75 GPs and 125 patients 45 years and older for each GP, regardless of whether their GP were also participating in the study. GPs were sampled from a national register that included all GPs. The surveys were primarily digital, but we sent postal questionnaires to non-digital patients and non-responding digital patients. We compared GP and patient characteristics as well as patient-reported experiences and outcomes according to GP participation status in bivariate analysis, supplemented with multiple linear regressions with PREMs/PROMs as dependent variables and participation status as independent adjusting for significant patient factors.

RESULTS

17 of 75 sampled GPs participated (22.7%), of which 993 of 2,015 patients responded (49.3%). 3,347 of 7,080 patients of non-responding GPs answered (47.3%). Persons with chronic conditions from participating GPs reported significantly better patient-centred coordinated care (p = 0.017), overall experiences with the GP office the last 12 months (p = 0.004), mental well-being (p = 0.039) and mental health (p = 0.013) than patients from non-participating GPs. The raw differences between participating and non-participating GPs on patient-reported experiences and - outcomes varied from 1.5 to 2.9 points on a 0-100 scale, and from 2.2 to 3.0 after adjustment for case-mix.

CONCLUSIONS

The Norwegian field trial indicates that estimates based on participants in the PaRIS survey may modestly overestimate patient-reported experiences and -outcomes at the aggregated level and the need for more research within and across countries to identify and address this potential bias.

Exploration of the feasibility to combine patients with chronic obstructive pulmonary disease and chronic heart failure in self-management groups with focus on exercise self-efficacy

OBJECTIVE

To compare the level of exercise self-efficacy, symptoms, functional capacity and health status and investigate the association between these variables in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Additionally, to investigate how diagnosis, symptoms and patient characteristics are associated with exercise self-efficacy in these patient groups.

DESIGN

Cross-sectional study.

SETTING

Primary care.

SUBJECTS

Patients (n = 150) with COPD (n = 60), CHF (n = 60) and a double diagnosis (n = 30).

MAIN OUTCOME MEASURES

Swedish SCI Exercise Self-Efficacy score, modified Medical Research Council Dyspnea score (mMRC), fatigue score, pain severity score, Hospital Anxiety and Depression Scale, functional capacity measured as six-minute walking distance and health status measured by a Visual Analogue Scale.

RESULTS

Levels of exercise self-efficacy, health status and symptoms were alike for patients with COPD and patients with CHF. Functional capacity was similar after correction for age. Associations with exercise self-efficacy were found for slight dyspnea (mMRC = 1) (R -4.45; 95% CI -8.41- -0.50), moderate dyspnea (mMRC = 2) (-6.60;-10.68- -2.52), severe dyspnea (mMRC ≥ 3) (-9.94; -15.07- -4.80), fatigue (-0.87;-1.41- -0.32), moderate pain (-3.87;-7.52- -0.21) and severe pain (-5.32;-10.13- -0.52), symptoms of depression (-0.98;-1.42- -0.55) and anxiety (-0.65;-0,10- -0.32), after adjustment for diagnosis, sex and age.

CONCLUSION AND IMPLICATIONS

Patients with COPD or CHF have similar levels of exercise self-efficacy, symptoms, functional capacity and health status. More severe symptoms are associated with lower levels of exercise self-efficacy regardless of diagnosis, sex and age. When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider level of symptoms than the specific diagnosis of COPD or CHF.Key pointsExercise training is an important part of self-management in patients with COPD and chronic heart failure (CHF). High exercise self-efficacy is required for optimal exercise training.Patients with COPD and CHF have similar symptoms and similar levels of exercise self-efficacy, functional capacity and health status.Not the diagnosis, but symptoms of dyspnea, fatigue, pain, depression and anxiety are important factors influencing exercise self-efficacy and need to be addressed.When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider the level of symptoms than the specific diagnosis of COPD or CHF.

Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study

BACKGROUND

Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system.

METHODS

The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data.

FINDINGS

Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.

Age, sex and primary care setting differences in patients' perception of community healthcare seeking behaviour towards health services

INTRODUCTION

Understanding the potential determinants of community healthcare seeking behaviour helps in improving healthcare utilisation and health outcomes within different populations. This in turn will aid the development of healthcare policies and planning for prevention, early diagnosis and management of health conditions.

OBJECTIVE

To evaluate patients' perception of community healthcare seeking behaviour towards both acute and preventive physical and psychosocial health concerns by sex, age and type of primary care setting (as a proxy for affordability of healthcare).

METHODS

A total of 3979 patients from 221 public and 239 private clinics in Malaysia were interviewed between June 2015 and February 2016 using a patient experience survey questionnaire from the Quality and Cost of Primary Care cross-sectional study. Multivariable logistic regression analysis adjusted for the complex survey design was used.

RESULTS

After adjusting for covariates, more women than men perceived that most people would see their general practitioners for commonly consulted acute and preventive physical and some psychosocial health concerns such as stomach pain (adjusted odds ratio (AOR), 1.64; 95% confidence interval (CI), 1.22-2.21), sprained ankle (AOR, 1.29; 95% CI, 1.06-1.56), anxiety (AOR, 1.32; 95% CI, 1.12-1.55), domestic violence (AOR, 1.35; 95% CI, 1.13-1.62) and relationship problems (AOR, 1.24; 95% CI, 1.02-1.51). There were no significant differences in perceived healthcare seeking behaviour by age groups except for the removal of a wart (AOR, 1.41; 95% CI, 1.12-1.76). Patients who visited the public clinics had generally higher perception of community healthcare seeking behaviour for both acute and preventive physical and psychosocial health concerns compared to those who went to private clinics.

CONCLUSIONS

Our findings showed that sex and healthcare affordability differences were present in perceived community healthcare seeking behaviour towards primary care services. Also perceived healthcare seeking behaviour were consistently lower for psychosocial health concerns compared to physical health concerns.

Workload in Norwegian general practice 2018 - an observational study

Background

Rising workload in general practice has been a recent cause for concern in several countries; this is also the case in Norway. Long working hours and heavy workload seem to affect recruitment and retention of regular general practitioners (RGPs). We investigated Norwegian RGPs’ workload in terms of time used on patient-related office work, administrative work, municipality tasks and other professional activities in relation to RGPs, and gender, age, employment status and size of municipality.

Methods

In early 2018, an electronic survey was sent to all 4716 RGPs in Norway. In addition to demographic background, the RGP reported minutes per day used on various tasks in the RGP practice prospectively during 1 week. Working time also included additional tasks in the municipality, other professional work and on out-of-hours primary health care. Differences were analysed by chi square test, independent t-tests, and one-way ANOVA.

Results

Among 1876 RGPs (39.8%), the mean total working hours per week was 55.6, while the mean for regular number of working hours was 49.0 h weekly. Men worked 1.5 h more than women (49.7 vs. 48.2 h, p = 0.010). Self-employed RGPs work more than salaried RGPs (49.3 vs. 42.5 h, p < 0.001), and RGPs age 55–64 years worked more than RGPs at age 30–39 (51.1 vs. 47.3 h, p < 0.001). 54.1% of the regular working hours was used on face-to-face patient work.

Conclusions

Norwegian RGPs have long working hours compared to recommended regular working hours in Norway, with small gender differences. Only half of the working time is used on face-to-face consultations. There seems to be a trend of increasing workload among Norwegian GPs, at the cost of direct patient contact. Further research should address identifying factors that can reduce long working hours.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4283-y) contains supplementary material, which is available to authorized users.