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Tatsioni A, Groenewegen P, Van Poel E, Vafeidou K, Assenova R, Hoffmann K, Schaubroeck E, Stark S, Tkachenko V, Willems S. Recruitment, data collection, participation rate, and representativeness of the international cross-sectional PRICOV-19 study across 38 countries. BMC PRIMARY CARE 2024; 24:290. [PMID: 38937675 PMCID: PMC11212222 DOI: 10.1186/s12875-024-02438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Recruitment for surveys has been a great challenge, especially in general practice. METHODS Here, we reported recruitment strategies, data collection, participation rates (PR) and representativeness of the PRICOV-19 study, an international comparative, cross-sectional, online survey among general practices (GP practices) in 37 European countries and Israel. RESULTS Nine (24%) countries reported a published invitation; 19 (50%) had direct contact with all GPs/GP practices; 19 (50%) contacted a sample of GPs /GP practices; and 7 (18%) used another invitation strategy. The median participation rate was 22% (IQR = 10%, 28%). Multiple invitation strategies (P-value 0.93) and multiple strategies to increase PR (P-value 0.64) were not correlated with the PR. GP practices in (semi-) rural areas, GP practices serving more than 10,000 patients, and group practices were over-represented (P-value < 0.001). There was no significant correlation between the PR and strength of the primary care (PC) system [Spearman's r 0.13, 95% CI (-0.24, 0.46); P-value 0.49]; the COVID-19 morbidity [Spearman's r 0.19, 95% CI (-0.14, 0.49); P-value 0.24], or COVID-19 mortality [Spearman's r 0.19, 95% CI (-0.02, 0.58); P-value 0.06] during the three months before country-specific study commencement. CONCLUSION Our main contribution here was to describe the survey recruitment and representativeness of PRICOV-19, an important and novel study.
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Affiliation(s)
- Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece.
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research (Nivel), 3500 BN, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS, Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Radost Assenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Kathryn Hoffmann
- Unit Health Services Research and Telemedicine in Primary Care, Medical University of Vienna, Vienna, Austria
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen-Nuremberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen-Nuremberg, Germany
| | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
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Eggermont D, Kunst AE, Groenewegen PP, Verheij RA. Social concordance and patient reported experiences in countries with different gender equality: a multinational survey. BMC PRIMARY CARE 2024; 25:97. [PMID: 38521895 PMCID: PMC10960425 DOI: 10.1186/s12875-024-02339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concordance, age concordance and PREMs (doctor-patient communication, involvement in decision making, comprehensiveness of care and satisfaction) and to investigate whether these associations are dependent on a countries' Gender Equality Index (GEI). METHODS Secondary analysis on a multinational survey (62.478 patients, 7.438 GPs from 34 mostly European countries) containing information on general practices and the patient experiences regarding their consultation. Multi-level analysis is used to calculate associations of both gender and age concordance with four PREMs. RESULTS The female/female dyad was associated with better experienced doctor-patient communication and patient involvement in decision making but not with patient satisfaction and experienced comprehensiveness of care. The male/male dyad was not associated with more positive patient experiences. Age concordance was associated with more involvement in decision making, more experienced comprehensiveness, less satisfaction but not with communication. No association was found between a country's level of GEI and the effect of gender concordance. CONCLUSION Consultations in which both patient and GP are female are associated with higher ratings of communication and involvement in decision making, irrespective of the GEI of the countries concerned. Age concordance was associated with all PREMs except communication. Although effect sizes are small, social concordance could create a suggestion of shared identity, diminish professional uncertainty and changes communication patterns, thereby enhancing health care outcomes.
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Affiliation(s)
- D Eggermont
- School of Social and Behavioral Sciences, Tranzo Tilburg University, Heidelberglaan 1, Utrecht, 3584 CS, the Netherlands.
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands.
| | - A E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - P P Groenewegen
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands
| | - R A Verheij
- School of Social and Behavioral Sciences, Tranzo Tilburg University, Heidelberglaan 1, Utrecht, 3584 CS, the Netherlands
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands
- National Health Care Institute, Willem Dudokhof 1, 1112 ZA, Diemen, the Netherlands
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Wangler J, Jansky M. Primary care involvement in clinical research - prerequisites, motivators, and barriers: results from a study series. Arch Public Health 2024; 82:41. [PMID: 38504310 PMCID: PMC10953082 DOI: 10.1186/s13690-024-01272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now. METHODS The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research. RESULTS Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost-benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project. CONCLUSIONS Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, Mainz, 55131, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, Mainz, 55131, Germany
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Wangler J, Jansky M. Experiences with Innovation Fund healthcare models in primary care: a qualitative study amongst German general practitioners. Wien Med Wochenschr 2024; 174:53-60. [PMID: 35503146 PMCID: PMC10896771 DOI: 10.1007/s10354-022-00935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
The Innovation Fund was set up in 2015 with the aim of improving medical care in the German statutory health insurance system. Primary care needs to be involved in testing interventions and new forms of care for effectiveness and inclusion in standard care. There has so far been hardly any research on how far Innovation Fund models accommodate the primary care setting, or on the experience general practitioners have had with these models. Between September 2021 and January 2022, 36 semi-standardized individual interviews were performed with general practitioners who had already participated in Innovation Fund projects. Eleven regional physician networks in Rhineland-Palatinate, Hesse, North Rhine-Westphalia, and Schleswig-Holstein were involved in the recruitment process. Most of the interviewees associated the Innovation Fund with potential and opportunity including intensification of application-oriented healthcare research, independent financing, and general healthcare involvement. Even so, many general practitioners were unsure as to how far primary care in particular would stand to benefit from the Innovation Fund in the long term. A mostly positive balance was drawn from participation in care models-benefit of intervention as well as cost-benefit ratio. However, some also reported hurdles and stress factors such as documentation requirements and disruption in everyday office routine. Innovation Fund projects will need to be suitable for general practitioners especially regarding medical decision-making leeway, limits to documentation requirements, preserving established office routine, greater involvement in research planning, and improvements to the primary care setting to encourage willingness to participate in Innovation Fund projects amongst general practitioners.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
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Groenewegen PP, Spreeuwenberg P, Leyland AH, de Boer D, Boerma W. Case-mix adjustments for patient reported experience and outcome measures in primary care: an empirical approach to identify patient characteristics as case-mix adjusters based on a secondary analysis of an international survey among patients and their general practitioners in 34 countries. J Patient Rep Outcomes 2023; 7:127. [PMID: 38048040 PMCID: PMC10695892 DOI: 10.1186/s41687-023-00667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Case-mix adjustment of patient reported experiences (PREMs) and outcomes (PROMs) of care are meant to enable fair comparison between units (e.g. care providers or countries) and to show where improvement is possible. It is important to distinguish between fair comparison and improvement potential, as case-mix adjustment may mask improvement potential. Case-mix adjustment takes into account the effect of patient characteristics that are related to the PREMs and PROMs studied, but are outside the sphere of influence of the units being compared. We developed an approach to assess which patient characteristics would qualify as case-mix adjusters, using data from an international primary care study. RESULTS We used multilevel analysis, with patients nested in general practices nested in countries. Case-mix adjustment is indicated under the following conditions: there is a main effect of the potential case-mix adjuster on the PREM/PROM; this effect does not vary between units; and the distribution of the potential case-mix adjuster differs between units. Random slope models were used to assess whether the impact of a potential case-mix adjuster varied between units. To assess whether a slope variance is big enough to decide that case-mix adjustment is not indicated, we compared the variances in the categories of a potential case-mix adjuster. Significance of the slope variance is not enough, because small variances may be significantly different from zero when numbers are large. We therefore need an additional criterion to consider a slope variance as important. Borrowing from the idea of a minimum clinically important difference (MCID) we proposed a difference between the variances of 0.25*variance (equivalent to a medium effect size). We applied this approach to data from the QUALICOPC (Quality and costs of primary care in Europe) study. CONCLUSIONS Our approach provides guidance to decide whether or not patient characteristics should be considered as case-mix adjusters. The criterion of a difference between variances of 0.25*variance works well for continuous PREMs and PROMs, but seems to be too strict for binary PREMs and PROMs. Without additional information, it is not possible to decide whether important slope variation is the result of either differences in performance between general practices or countries, or cultural differences.
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Affiliation(s)
- Peter P Groenewegen
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, Utrecht, The Netherlands.
| | - Peter Spreeuwenberg
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, Utrecht, The Netherlands
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, Clarice Pears Building 90 Byres Road, Glasgow, G12 8TB, UK
| | - Dolf de Boer
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, Utrecht, The Netherlands
| | - Wienke Boerma
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, Utrecht, The Netherlands
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6
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Groenewegen PP, van den Muijsenbergh M, Batenburg R, Van Poel E, van den Broek S, Bussche PV, Willems S. Quick adaptation of the organisation of general practices during the COVID-19 pandemic in the Netherlands. BMC PRIMARY CARE 2023; 24:170. [PMID: 37653405 PMCID: PMC10472546 DOI: 10.1186/s12875-023-02114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND General practices have adapted the practice organisation to the circumstances of the COVID-19 pandemic. In this article we describe several adjustments in general practices in the field of patient flow management, appointments, triage, referral and infection prevention. We also examined how practices relate to the policy of the government and of the professional organisations during the pandemic. METHODS A cross-sectional online survey was conducted among a sample of 893 general practitioners (GPs) during February and March 2021. The response rate was 17%. Because the questionnaire concerns practices and not individual GPs, one practice owner per practice received an invitation with a link to the online questionnaire. One reminder has been sent. RESULTS General practices adapted their organisation during the corona pandemic, partly based on information and advice from their professional organisations. The adjustments were necessary to ensure that patient care continued as much and as safely as possible, often remotely. The use of video consultations quickly increased from 6% to 65% of the practices. The cooperation with neighbouring practices improved and practices felt supported by the professional organisations. CONCLUSIONS The pandemic itself, remote care and stricter patient flow management have put pressure on the quality of care and patient safety. The accessibility of the practices was sometimes limited. In the perception of patients, this was stronger than in reality.
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Affiliation(s)
- Peter P Groenewegen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
| | | | - Ronald Batenburg
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Quality and Safety, Ghent, Belgium
| | | | | | - Sara Willems
- Department of Public Health and Primary Care, Quality and Safety, Ghent, Belgium
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Peter S, Volkert AM, Radbruch L, Rolke R, Voltz R, Pfaff H, Scholten N. GPs’ involvement in specialised palliative home care: A mixed methods study in Germany. Eur J Gen Pract 2022; 28:224-233. [PMID: 36369760 PMCID: PMC9665080 DOI: 10.1080/13814788.2022.2139824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background General practitioners (GPs) are important providers of palliative home care (PHC). To deliver adequate palliative care, cooperation with specialised PHC teams is necessary. Specialised PHC is a type of care for severely ill patients by specialised providers. Little is known about the involvement of German GPs in specialised PHC. Objectives To analyse GPs’ experience with realised and desired involvement in specialised PHC. Realised involvement means GPs took part in specialised PHC patients’ care. Desired involvement is GPs’ hoped-for cooperation with specialised PHC teams: GPs could state whether they want to stay involved, be informed, or provide medical services themselves after referral to specialised PHC. Methods Mixed methods design (focus group with 6 GPs; survey of 445 GPs in North Rhine, Germany, about their experiences in PHC/specialised PHC): Qualitative data was interpreted using content analysis. The authors developed a questionnaire and performed descriptive analysis based on qualitative results. Results GPs are mostly satisfied with specialised PHC teams’ care, although they report cooperation is not always optimal. GPs describe a high satisfaction with quality of care by specialised PHC teams. However, physicians with higher PC knowledge are less satisfied with specialised PHC. Also, GPs are often less involved in specialised PHC than they wish, especially when they have a higher PC qualification. Conclusion In general, GPs are satisfied with the quality of care provided by specialised PHC teams but GPs do not always perceive cooperation as optimal. Involvement of GPs in specialised PHC needs to be improved.
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Affiliation(s)
- Sophie Peter
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Anna Maria Volkert
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, CIO Aachen Bonn Cologne Düsseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Cologne, Germany
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Peter S, Volkert AM, Radbruch L, Rolke R, Voltz R, Pfaff H, Scholten N. Influence of Palliative Care Qualifications on the Job Stress Factors of General Practitioners in Palliative Care: A Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14541. [PMID: 36361420 PMCID: PMC9655917 DOI: 10.3390/ijerph192114541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants' Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.
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Affiliation(s)
- Sophie Peter
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
| | - Anna Maria Volkert
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Raymond Voltz
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Department of Palliative Medicine, University Hospital Cologne, 50933 Cologne, Germany
- CIO Aachen Bonn Cologne Düsseldorf, 50937 Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
| | - Nadine Scholten
- Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany
- Faculty of Medicine, University of Cologne, 50933 Cologne, Germany
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital Cologne, 50933 Cologne, Germany
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Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Prim Health Care Res Dev 2022; 23:e60. [PMID: 36134523 PMCID: PMC9532851 DOI: 10.1017/s1463423622000470] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries. Findings: Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs’ working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.
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Groenewegen PP, Spreeuwenberg P, Siriwardena AN, Sirdifield C, Willems S. Migrant GPs and patients: a cross-sectional study of practice characteristics, patient experiences and migration concordance. Scand J Prim Health Care 2022; 40:181-189. [PMID: 35575141 PMCID: PMC9397456 DOI: 10.1080/02813432.2022.2069719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate practice type and location of native and immigrant general practitioners (GPs); effects of migration status concordance between GPs and patients on experiences of patients in key areas of primary care quality and discrimination. DESIGN AND SETTING Secondary analysis of GP and patient survey data from QUALICOPC (Quality and Costs of Primary Care), a cross-sectional study of GPs and their patients in 34 countries, performed between 2011 and 2013. MAIN OUTCOME MEASURES We explored practice type and location of native and immigrant GPs and the experiences of native patients and patients with a migration background of communication, continuity, comprehensiveness, accessibility, and discrimination, using multilevel analysis. Concordance was modelled as a cross-level interaction between migration status of GPs and patients. RESULTS Percentages of immigrant GPs varied widely. In Europe, this was highest in England and Luxemburg (40% of GPs born abroad) and lowest in Bulgaria and Romania (1%). The practice population of immigrant GPs more often included an above average proportion of people from ethnic minorities. There were no differences in main effects of patient experiences following a visit to an immigrant or native GP, in four core areas of primary care or in discrimination. However, people from first-generation migrant background more often experienced discrimination, in particular when visiting a native GP. CONCLUSION Patient experiences did not vary with GPs' migration status. Although experience of discrimination was uncommon, first-generation migrant patients experienced more discrimination. Primary care should provide non-discriminatory care, through GP awareness of unconscious bias and training to address this. Key messagesThere were large differences in percentage of migrant GPs between countries.Migrant GPs' practices had an above average proportion of people from ethnic minorities.In general, patients' experienced discrimination from GPs and practice staff was low, but first-generation migrant patients more often experienced discrimination.First-generation migrant patients more often experienced discrimination when they visited a native GP.
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Affiliation(s)
- Peter P. Groenewegen
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, Utrecht, The Netherlands
- CONTACT Peter P. Groenewegen Nivel, PO Box 1568, Utrecht, 3500, BN, The Netherlands
| | - Peter Spreeuwenberg
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - A. Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Coral Sirdifield
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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11
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Wangler J, Jansky M. [The German Innovation Fund and primary care-What expectations and experiences do general practitioners have with regard to participating in innovative care models?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:697-705. [PMID: 35476151 PMCID: PMC9132806 DOI: 10.1007/s00103-022-03533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2015, the German Innovation Fund was established to promote improvements in the quality of medical care. In order for new care models and interventions to be tested and incorporated into standard care in the future, primary care must be included. OBJECTIVES The study explores general practitioners' (GPs') attitudes, participation-relevant expectations, and experiences with regard to Innovation Fund projects. METHODS Between July and October 2021, all 13,170 general practitioners in Baden-Württemberg, Hesse, and Rhineland-Palatinate were invited to take part in an online survey. Included in the evaluation were 3556 completed questionnaires (response rate: 27%). In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups. RESULTS Of the respondents, 83% were familiar with the Innovation Fund. Most of the respondents associate it with opportunities and potential (including intensification of application-oriented healthcare research, independent financing, and inclusion of primary care). Nevertheless, many GPs are unsure to what extent primary care can benefit from the Innovation Fund in the longer term. When it comes to willingness to participate in Innovation Fund studies, the respondents are divided. Respondents who have already participated in such projects (24%) draw a positive balance (benefit of the intervention, cost-benefit ratio). However, hurdles and stress factors are also reported, such as documentation requirements and interventions in practice processes. CONCLUSIONS In order to increase the attractiveness of the Innovation Fund for GPs, it is important to ensure that projects are fully compliant with primary care, especially with regard to the scope of medical decision-making, the limitation of documentation obligations, the guarantee of practice routines, a greater involvement in research planning, and an upgrading of the GP setting.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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Groenewegen PP, Boerma WGW, Spreeuwenberg P, Seifert B, Schäfer W, Batenburg R, van Tuyl L. Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Prim Health Care Res Dev 2021; 22:e66. [PMID: 34753532 PMCID: PMC8581458 DOI: 10.1017/s1463423621000657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/02/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
AIM To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. BACKGROUND Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. METHODS Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable 'task shifting' is measured through a composite score of GPs' self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. FINDINGS Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.
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Affiliation(s)
- Peter P. Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, PO Box 80.115, 3508 TCUtrecht, The Netherlands
| | - Wienke G. W. Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
| | - Bohumil Seifert
- Institute of General Practice, Charles University, Prague, Czechia
| | - Willemijn Schäfer
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Chicago, IL60611, USA
| | - Ronald Batenburg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
| | - Lilian van Tuyl
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
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Eide TB, Straand J, Braend AM. Good communication was valued as more important than accessibility according to 707 Nordic primary care patients: a report from the QUALICOPC study. Scand J Prim Health Care 2021; 39:296-304. [PMID: 34041993 PMCID: PMC8475124 DOI: 10.1080/02813432.2021.1928837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore Nordic patients' ranking of the importance of different aspects of general practice. DESIGN Patients ranked the importance of 47 statements reflecting five quality domains: communication, involvement, accessibility, continuity, and comprehensiveness. SETTING Nordic general practice. SUBJECTS Patients ≥18 years in general practitioners waiting rooms. MAIN OUTCOME MEASURES Items rated as important or very important by ≥ 90% in all countries were identified. Associations with patient characteristics were analysed by logistic regression. RESULTS 209 Danish, 175 Norwegian, 129 Finnish, 112 Swedish and 82 Icelandic patients responded. Ten statements were ranked as important or very important by ≥90% in each country. Six pertained to communication, three to patient involvement and one to the comprehensiveness of care. No items regarding accessibility or continuity exceeded the 90% limit. The item most frequently rated as very important was 'I understand what the GP explains''. Female patients were more likely to value personal treatment (OR = 2.9; 95%CI 1.5-5.5) and receiving instructions if things went wrong (1.7; 1.2-2.2). Older patients >65 years put less emphasis than those <35 on whether the GP takes them seriously (0.4; 0.3-0.5) and on the importance of instructions (0.5; 0.4-0.7). Patients with chronic diseases were less concerned (0.6; 0.4-0.8) with receiving instructions, but valued strongly that a GP knows when to refer (2.2; 1.5-3.3). CONCLUSION Patients in all countries assigned high value to good communication. Availability was deemed important but came secondary to good communication. IMPLICATIONS Organisational framework for general practice must allow for acceptable communication quality as well as availability.Key pointsIn order to identify relevant service areas for quality improvement in primary care, we aimed to increase knowledge of patient ranked importance of different dimensions of care.Nordic primary care patients valued good communication and involvement in decisions higher than accessibility to care.A singular focus on the access of care when developing services may not be in accordance with patient preferences.
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Affiliation(s)
- Torunn Bjerve Eide
- Department. of general practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- CONTACT Torunn Bjerve Eide Department of General Practice, Institute of Health and Society, University of Oslo, PB 1130 Blindern, Oslo, 0318, Norway
| | - Jørund Straand
- Department. of general practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- General Practice Research Unit (AFE), Department of general practice, Institute of Health and Society, University of Oslo, Norway
| | - Anja Maria Braend
- Department. of general practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Lim MT, Ong SM, Tong SF, Groenewegen P, Sivasampu S. Comparison between primary care service delivery in Malaysia and other participating countries of the QUALICOPC project: a cross-sectional study. BMJ Open 2021; 11:e047126. [PMID: 33952553 PMCID: PMC8103403 DOI: 10.1136/bmjopen-2020-047126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Most countries including Malaysia have set goals to incorporate a strong primary care into the healthcare system. The aim of this study was to evaluate the strength of service delivery process dimensions in Malaysia and compare it with England, the Netherlands, Spain, North Macedonia, Romania and Turkey which participated in the Quality and Costs of Primary Care (QUALICOPC) study. METHODS This cross-sectional study utilised the QUALICOPC study data on primary care performance, which was conducted in 2011-2013 (QUALICOPC in Europe Australia, New Zealand and Canada) and 2015-2016 (Malaysia). A standardised questionnaire was completed by primary care practitioners from participating countries. Multilevel regression analysis and composite scores were constructed to compare the performance of primary care on four process dimensions: accessibility, comprehensiveness, continuity of care and coordination. RESULTS The high-income countries with strong primary care performed better in comprehensiveness, continuity and coordination but poorer in accessibility to services compared with upper-middle-income countries. Among the upper-middle-income countries, Malaysia scored the best in comprehensiveness and coordination. None of the studied countries were having consistent performance over all indicators either in their respective best or worst primary care services delivery dimensions. CONCLUSIONS There is a wide variation in primary care services delivery across and within the studied countries. The findings indicate room for quality improvement activities to strengthen primary healthcare services. This includes addressing current healthcare challenges in response to the population health needs which are essential for more integrated and efficient primary care services delivery.
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Affiliation(s)
- Ming Tsuey Lim
- Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| | - Su Miin Ong
- Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| | - Seng Fah Tong
- Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Departments of Human Geography and Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
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Stobbe EJ, Groenewegen PP, Schäfer W. Job satisfaction of general practitioners: a cross-sectional survey in 34 countries. HUMAN RESOURCES FOR HEALTH 2021; 19:57. [PMID: 33906679 PMCID: PMC8077953 DOI: 10.1186/s12960-021-00604-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Job satisfaction of general practitioners (GPs) is important because of the consequences of low satisfaction for GPs, their patients and the health system, such as higher turnover, health problems for the physicians themselves, less satisfied patients, poor clinical outcomes and suboptimal health care delivery. In this study, we aim to explain differences in the job satisfaction of GPs within and between countries. METHODS We performed a secondary analysis of cross-sectional survey data, collected between 2010 and 2012 on 7379 GPs in 34 (mostly European) countries, as well as data on country and health system characteristics from public databases. Job satisfaction is measured through a composite score of six items about self-reported job experience. Operationalisation of the theoretical constructs includes variables, such as the range of services GPs provide, working hours, employment status, and feedback from colleagues. Data were analysed using linear multilevel regression analysis, with countries and GPs as levels. We developed hypotheses on the basis of the Social Production Function Theory, assuming that GPs 'produce' job satisfaction through stimulating work that provides a certain level of comfort, adds to their social status and provides behavioural confirmation. RESULTS Job satisfaction varies between GPs and countries, with high satisfaction in Denmark and Canada (on average 2.97 and 2.77 on a scale from 1-4, respectively) and low job satisfaction in Spain (mean 2.15) and Hungary (mean 2.17). One-third of the total variance is situated on the country level, indicating large differences between countries, and countries with a higher GDP per capita have more satisfied GPs. Health system characteristics are not related to GP job satisfaction. At the GP and practice level, performing technical procedures and providing preventive care, feedback from colleagues, and patient satisfaction are positively related to GP job satisfaction and working more hours is negatively related GP job satisfaction. CONCLUSION Overall and in terms of our theoretical approach, we found that GPs are able to 'produce' work-related well-being through activities and resources related to stimulation, comfort and behavioural confirmation, but not to status.
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Affiliation(s)
- Emiel J Stobbe
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
- Trimbos Institute, Da Costakade 45, 3521VS, Utrecht, The Netherlands
| | - Peter P Groenewegen
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
- Department of Sociology, Department of Human Geography, Utrecht University, Utrecht, The Netherlands.
| | - Willemijn Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
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16
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Groenewegen PP, Kroneman M, Spreeuwenberg P. Physical accessibility of primary care facilities for people with disabilities: a cross-sectional survey in 31 countries. BMC Health Serv Res 2021; 21:107. [PMID: 33522925 PMCID: PMC7849086 DOI: 10.1186/s12913-021-06120-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/25/2021] [Indexed: 01/06/2023] Open
Abstract
Background Primary care is the first point of care, also for people with disabilities. The accessibility of primary care facilities is therefore very important. In this study we analysed comparative data on physical accessibility of general practices (GP practices) in 31 (mainly) European countries. Methods We used data from the QUALICOPC study, conducted in 2011 among GPs in 34 (mainly European) countries and constructed a physical accessibility scale. We applied multilevel analysis to assess the differences between and within countries and to test hypotheses, related to characteristics of the practices and of the countries. Results We found large differences between countries and a strong clustering of physical accessibility within countries. Physical accessibility was negatively related to the age of the GPs, and was less in single-handed and in inner city practices. Of the country variables only the length of the period of social democratic government participation during the previous decades was positively related to physical accessibility. Conclusion A large share of the variation in physical accessibility of GP practices was on the level of countries. This means that national policies can be used to increase physical accessibility of GP practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06120-0.
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Affiliation(s)
- Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500BN, Utrecht, The Netherlands. .,Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508, TC, Utrecht, The Netherlands.
| | - Madelon Kroneman
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500BN, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500BN, Utrecht, The Netherlands
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Recruitment and participation of a survey in a public-private primary care setting: experience from the QUALICOPC Malaysia. Prim Health Care Res Dev 2020; 21:e51. [PMID: 33213564 PMCID: PMC7681175 DOI: 10.1017/s1463423620000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM The purpose of this paper is to describe the recruitment strategies, the response rates and the reasons for non-response of Malaysian public and private primary care doctors in an international survey on the quality, cost and equity in primary care. BACKGROUND Low research participation by primary care doctors, especially those working in the private sector, is a challenge to quality benchmarking. METHODS Primary care doctors were sampled through multi-stage sampling. The first stage-sampling unit was the primary care clinics, which were randomly sampled from five states in Malaysia to reflect their proportions in two strata - sector (public/private) and location (urban/rural). Strategies through endorsement, personalised invitation, face-to-face interview and non-monetary incentives were used to recruit public and private doctors. Data collection was carried out by fieldworkers through structured questionnaires. FINDINGS A total of 221 public and 239 private doctors participated in the study. Among the public doctors, 99.5% response rates were obtained. Among the private doctors, a 32.8% response rate was obtained. Totally, 30% of private clinics were uncontactable by telephone, and when these were excluded, the overall response rate is 46.8%. The response rate of the private clinics across the states ranges from 31.5% to 34.0%. A total of 167 answered the non-respondent questionnaire. Among the non-respondents, 77.4 % were male and 22.6% female (P = 0.011). There were 33.6% of doctors older than 65 years (P = 0.003) and 15.9% were from the state of Sarawak (P = 0.016) when compared to non-respondents. Reason for non-participation included being too busy (51.8%), not interested (32.9%), not having enough patients (9.1%) and did not find it beneficial (7.9%). Our study demonstrated the feasibility of obtaining favourable response rate in a survey involving doctors from public and private primary care settings.
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18
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Schäfer WLA, van den Berg MJ, Groenewegen PP. The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries. HUMAN RESOURCES FOR HEALTH 2020; 18:76. [PMID: 33066776 PMCID: PMC7565810 DOI: 10.1186/s12960-020-00520-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The workload of general practitioners (GPs) and dissatisfaction with work have been increasing in various Western countries over the past decades. In this study, we evaluate the relation between the workload of GPs and patients' experiences with care. METHODS We collected data through a cross-sectional survey among 7031 GPs and 67,873 patients in 33 countries. Dependent variables are the patient experiences on doctor-patient communication, accessibility, continuity, and comprehensiveness of care. Independent variables concern the workload measured as the GP-reported work hours per week, average consultation times, job satisfaction (an indicator of subjective workload), and the difference between the workload measures of every GP and the average in their own country. Finally, we evaluated interaction effects between workload measures and what patients find important in a country and the presence of a patient-list system. Relationships were determined through multilevel regression models. RESULTS Patients of GPs who are happier with their work were found to experience better communication, continuity, access, and comprehensiveness. When GPs are more satisfied compared to others in their country, patients also experience better quality. When GPs work more hours per week, patients also experience better quality of care, but not in the area of accessibility. A longer consultation time, also when compared to the national average, is only related to more comprehensive care. There are no differences in the relationships between countries with and without a patient list system and in countries where patients find the different quality aspects more important. CONCLUSIONS Patients experience better care when their GP has more work hours, longer consultation times, and especially, a higher job satisfaction.
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Affiliation(s)
- Willemijn L. A. Schäfer
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 USA
| | | | - Peter P. Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Utrecht, The Netherlands
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Groenewegen PP, Bosmans MWG, Boerma WGW, Spreeuwenberg P. The primary care workforce in Europe: a cross-sectional international comparison of rural and urban areas and changes between 1993 and 2011. Eur J Public Health 2020; 30:iv12-iv17. [PMID: 32875316 PMCID: PMC7526766 DOI: 10.1093/eurpub/ckaa125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rural areas have problems in attracting and retaining primary care workforce. This might have consequences for the existing workforce. We studied whether general practitioners (GPs) in rural practices differ by age, sex, practice population and workload from those in less rural locations and whether their practices differ in resources and service profiles. We used data from 2 studies: QUALICOPC study collected data from 34 countries, including 7183 GPs in 2011, and Profiles of General Practice in Europe study collected data from 32 countries among 7895 GPs in 1993. Data were analyzed using multilevel analysis. Results show that the share of female GPs has increased in rural areas but is still lower than in urban areas. In rural areas, GPs work more hours and provide more medical procedures to their patients. Apart from these differences between locations, overall ageing of the GP population is evident. Higher workload in rural areas may be related to increased demand for care. Rural practices seem to cope by offering a broad range of services, such as medical procedures. Dedicated human resource policies for rural areas are required with a view to an ageing GP population, to the individual preferences and needs of the GPs, and to decreasing attractiveness of rural areas.
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Affiliation(s)
- Peter P Groenewegen
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Mark W G Bosmans
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Wienke G W Boerma
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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20
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Tolvanen E, Groenewegen PP, Koskela TH, Bjerve Eide T, Cohidon C, Kosunen E. Patient enablement after a consultation with a general practitioner-Explaining variation between countries, practices and patients. Health Expect 2020; 23:1129-1143. [PMID: 32602205 PMCID: PMC7696125 DOI: 10.1111/hex.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking. OBJECTIVE To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement. DESIGN We constructed multi-level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated. SETTING AND PARTICIPANTS A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data. RESULTS In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient-level and only a few practice-level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health-care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported. DISCUSSION AND CONCLUSIONS There are large differences in patient enablement between GPs and countries. Patient characteristics and patients' perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient-reported measures as an indicator of health-care system performance, researchers should be aware of the influence of cultural elements.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Pirkkala Municipal Health Centre, Pirkkala, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Peter P Groenewegen
- Nivel-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands.,Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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21
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg PMM, Schellevis FG, Groenewegen PP. Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries. BMC FAMILY PRACTICE 2020; 21:54. [PMID: 32183771 PMCID: PMC7079351 DOI: 10.1186/s12875-020-01124-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
Background The communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care thus achieving a higher quality of care and ensuring physicians’ and patients’ satisfaction. However, this communication is often not carried out properly. The objective of this study is to assess whether communication between GPs and medical specialists in the referral process is associated with the organisation of primary care within a country, the characteristics of the GPs, and the characteristics of the primary care practices themselves. Methods An analysis of a cross-sectional survey among GPs in 34 countries was conducted. The odds ratios of the features that were expected to relate to higher rates of referral letters sent and communications fed back to GPs were calculated using ordered logistic multilevel models. Results A total of 7183 GPs from 34 countries were surveyed. Variations between countries in referral letters sent and feedback communication received did occur. Little of the variance between countries could be explained. GPs stated that they send more referral letters, and receive more feedback communications from medical specialists, in countries where they act as gatekeepers, and when, in general, they interact more with specialists. GPs reported higher use of referral letters when they had a secretary and/or a nurse in their practice, used health information technologies, and had greater job satisfaction. Conclusions There are large differences in communication between GPs and medical specialists. These differences can partly be explained by characteristics of the country, the GP and the primary care practice. Further studies should also take the organisation of secondary care into account.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands
| | - Peter M M Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands. .,Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, Utrecht, 3508 TC, The Netherlands.
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg P, van den Berg M, Schellevis FG, Groenewegen PP. Patients' perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries. BMC Health Serv Res 2019; 19:1018. [PMID: 31888614 PMCID: PMC6937702 DOI: 10.1186/s12913-019-4848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients' perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. METHODS We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients' perceptions of communication at the interface between primary and secondary care. RESULTS In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients' perceptions of information shared by GPs with medical specialists, and the patients' perceptions of the GPs' awareness of the results of treatment by medical specialists. Patients whose GPs stated that they 'seldom or never' send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they 'seldom or never' receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. CONCLUSION Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Michael van den Berg
- Department of Public Health, Amsterdam Public Health Research Institute, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Sociology, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands. .,Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands.
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23
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Tilburgs B, Koopmans R, Vernooij-Dassen M, Adang E, Schers H, Teerenstra S, van de Pol M, Smits C, Engels Y, Perry M. Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial. J Am Med Dir Assoc 2019; 21:837-842.e4. [PMID: 31759901 DOI: 10.1016/j.jamda.2019.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Advance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care. DESIGN A single-blinded cluster randomized controlled trial. SETTING AND PARTICIPANTS In 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice. METHODS Intervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering. RESULTS 38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) [odds ratio (OR) 1.99; P = .002]. Intervention group GPs discussed 0.8 more medical [95% confidence interval (CI) 0.3, 1.3; P = .003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P < .001) preferences per person with dementia than control group GPs. CONCLUSIONS AND IMPLICATIONS Our educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown.
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Affiliation(s)
- Bram Tilburgs
- Department of IQ Healthcare, Radboud University Medical Centre Nijmegen, the Netherlands.
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; Radboudumc Alzheimer Centre, Nijmegen, the Netherlands; Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Myrra Vernooij-Dassen
- Department of IQ Healthcare, Radboud University Medical Centre Nijmegen, the Netherlands
| | - Eddy Adang
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marjolein van de Pol
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolien Smits
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Centre, Nijmegen, the Netherlands; Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
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24
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Schäfer WL, Boerma WG, van den Berg MJ, De Maeseneer J, De Rosis S, Detollenaere J, Greß S, Heinemann S, van Loenen T, Murante AM, Pavlič DR, Seghieri C, Vainieri M, Willems S, Groenewegen PP. Are people's health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries. Prim Health Care Res Dev 2019; 20:e104. [PMID: 32800009 PMCID: PMC6609545 DOI: 10.1017/s1463423619000434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/25/2019] [Accepted: 04/27/2019] [Indexed: 11/06/2022] Open
Abstract
AIM This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. BACKGROUND Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. METHODS Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. FINDINGS Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. CONCLUSIONS The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
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Affiliation(s)
- Willemijn L.A. Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL 60611, USA
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
| | - Wienke G.W. Boerma
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
| | - Michael J. van den Berg
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, 22660, 1100 DD, Amsterdam
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Sabina De Rosis
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Jens Detollenaere
- KCE – Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Stefan Greß
- Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany
| | - Stephanie Heinemann
- Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Tessa van Loenen
- Pharos – Centre of Expertise on Health Disparities, PO box 13318, 3507 LH Utrecht, The Netherlands
| | - Anna Maria Murante
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Danica R. Pavlič
- Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Chiara Seghieri
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Milena Vainieri
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Peter P. Groenewegen
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC Utrecht, The Netherlands
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25
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Põlluste K, Kosunen E, Koskela T, Mattila KJ, Schäfer WLA, Boerma WGW, Lember M. Primary health care in transition: Variations in service profiles of general practitioners in Estonia and in Finland between 1993 and 2012. Health Policy 2018; 123:37-44. [PMID: 30322719 DOI: 10.1016/j.healthpol.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/18/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Since the early 1990s, the Estonian and Finnish health systems have undergone various changes which are expected to have impacted the type and range of services provided by general practitioners (GPs). OBJECTIVE To compare GP services between Estonia and Finland in 1993 and 2012 and draw a parallel with transformations occurred in the health systems of both countries during these two decades. METHODS Data were collected through surveys among 129 and 288 GPs from Estonia and Finland in 2012 and 139 Estonian and 239 Finnish GPs in 1993. Descriptive statistics were used to compare between countries and years. RESULTS Between 1993 and 2012, the number of working hours per week and consultations per day increased in Estonia and decreased in Finland. In 2012, GPs in were more often the first contact for psychosocial and women´s and children´s in Estonia, whereas this decreased in Finland. The frequency of treating acute patients mostly decreased in both countries. We observed a decrease in medical procedures in Finland and an increase in Estonia. Finnish GPs still conducted more procedures in 2012. CONCLUSION Due to partly opposite changes, the services provided by Finnish and Estonian GPs became more similar. Still, there are large differences in services provided, possibly arising from differences in the organisation of health services, the training of doctors and patients' preferences.
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Affiliation(s)
- Kaja Põlluste
- University of Tartu, Institute of Clinical Medicine, Department of Internal Medicine, Tartu, Estonia.
| | - Elise Kosunen
- University of Tampere, School of Medicine, Department of General Practice, Tampere, Finland; Pirkanmaa Hospital District, Centre of General Practice, Finland
| | - Tuomas Koskela
- University of Tampere, School of Medicine, Department of General Practice, Tampere, Finland
| | - Kari J Mattila
- University of Tampere, School of Medicine, Department of General Practice, Tampere, Finland
| | - Willemijn L A Schäfer
- NIVEL - the Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Wienke G W Boerma
- NIVEL - the Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Margus Lember
- University of Tartu, Institute of Clinical Medicine, Department of Internal Medicine, Tartu, Estonia; Tartu University Hospital, Internal Medicine Clinic, Tartu, Estonia
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26
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Primary care workforce development in Europe: An overview of health system responses and stakeholder views. Health Policy 2018; 122:1055-1062. [PMID: 30100528 DOI: 10.1016/j.healthpol.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/20/2022]
Abstract
Better primary care has become a key strategy for reforming health systems to respond effectively to increases in non-communicable diseases and changing population needs, yet the primary care workforce has received very little attention. This article aligns primary care policy and workforce development in European countries. The aim is to provide a comparative overview of the governance of workforce innovation and the views of the main stakeholders. Cross-country comparisons and an explorative case study design are applied. We combine material from different European projects to analyse health system responses to changing primary care workforce needs, transformations in the general practitioner workforce and patient views on workforce changes. The results reveal a lack of alignment between primary care reform policies and workforce policies and high variation in the governance of primary care workforce innovation. Transformations in the general practitioner workforce only partly follow changing population needs; countries vary considerably in supporting and achieving the goals of integration and community orientation. Yet patients who have experienced task shifting in their care express overall positive views on new models. In conclusion, synthesising available evidence from different projects contributes new knowledge on policy levers and reveals an urgent need for health system leadership in developing an integrated people-centred primary care workforce.
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27
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Shared decision making between patient and GP about referrals from primary care: Does gatekeeping make a difference? PLoS One 2018; 13:e0198729. [PMID: 29889861 PMCID: PMC5995363 DOI: 10.1371/journal.pone.0198729] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/24/2018] [Indexed: 12/01/2022] Open
Abstract
Primary care faces challenging times in many countries, mainly caused by an ageing population. The GPs’ role to match patients’ demand with medical need becomes increasingly complex with the growing multiple conditions population. Shared decision-making (SDM) is recognized as ideal to the treatment decision making process. Understanding GPs’ perception on SDM about patient referrals and whether patients’ preferences are considered, becomes increasingly important for improving health outcomes and patient satisfaction. This study aims to 1) understand whether countries vary in how GPs perceive SDM, in patients’ referral, 2) describe to what extent SDM in GPs’ referrals differ between gatekeeping and non-gatekeeping systems, and 3) identify what factors GPs consider when referring to specialists and describing how this differs between gatekeeping and non-gatekeeping systems. Data were collected between October 2011 and December 2013 in 32 countries through the QUALICOPC study (Quality and Costs of Primary Care in Europe). The first question was answered by assessing GPs’ perception on who takes the referral decision. For the second question, a multilevel logistic model was applied. For the third question we analysed the GPs’ responses on what patient logistics and need arguments they consider in the referral process. We found: 1) variation in GPs reported SDM– 90% to 35%, 2) a negative correlation between gatekeeper systems and SDM—however, some countries strongly deviate and 3) GPs in gatekeeper systems more often consider patient interests, whereas in non-gatekeeping countries the GP’s value more own experience with specialists and benchmarking information. Our findings imply that GPs in gatekeeper systems seem to be less inclined to SDM than GPs in a non-gatekeeping system. The relation between gatekeeping/non-gatekeeping and SDM is not straightforward. A more contextualized approach is needed to understand the relation between gatekeeping as a system design feature and its relation with and/or impact on SDM.
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28
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Tolvanen E, Koskela TH, Mattila KJ, Kosunen E. Analysis of factors associated with waiting times for GP appointments in Finnish health centres: a QUALICOPC study. BMC Res Notes 2018; 11:220. [PMID: 29615135 PMCID: PMC5883288 DOI: 10.1186/s13104-018-3316-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Access to care is a multidimensional concept, considered as a structural aspect of health care quality; it reflects the functioning of a health care organization. The aim of this study was to investigate patients’ experiences of access to care and to analyse factors associated with waiting times to GP appointments at Finnish health centres. A questionnaire survey was addressed to Finnish GPs within the Quality and Costs of Primary Care in Europe study framework. Two to nine patients per GP completed the questionnaire, altogether 1196. Main outcome measures were waiting times for appointments with GPs and factors associated with waiting times. In addition, patients’ opinions of access to appointments were analysed. Results Of the 988 patients who had made their appointment in advance, 84.9% considered it easy to secure an appointment, with 51.9% obtaining an appointment within 1 week. Age and reason for contact were the most significant factors affecting the waiting time. Elderly patients tended to have longer waiting times than younger ones, even when reporting illness as their reason for contact. Thus, waiting times for appointments tend to be prolonged in particular for the elderly and there is room for improvement in the future. Electronic supplementary material The online version of this article (10.1186/s13104-018-3316-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Science Centre, Pirkanmaa Hospital District, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Kari J Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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29
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Bonciani M, Schäfer W, Barsanti S, Heinemann S, Groenewegen PP. The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries. BMC Health Serv Res 2018; 18:132. [PMID: 29466980 PMCID: PMC5822600 DOI: 10.1186/s12913-018-2913-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background 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 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. Methods We 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. Results The 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. Conclusions The 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.
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Affiliation(s)
- M Bonciani
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - W Schäfer
- Netherlands Institute for Health Services Research-NIVEL, Utrecht, The Netherlands
| | - S Barsanti
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S Heinemann
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Fulda, Germany
| | - P P Groenewegen
- Netherlands Institute for Health Services Research-NIVEL, Utrecht, The Netherlands.,Department of Sociology, Department of Human Geography, Utrecht University, Utrecht, The Netherlands
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30
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Schäfer WLA, Boerma WGW, Schellevis FG, Groenewegen PP. GP Practices as a One-Stop Shop: How Do Patients Perceive the Quality of Care? A Cross-Sectional Study in Thirty-Four Countries. Health Serv Res 2017; 53:2047-2063. [PMID: 29285763 DOI: 10.1111/1475-6773.12754] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To contribute to the current knowledge on how a broad range of services offered by general practitioners (GPs) may contribute to the patient perceived quality and, hence, the potential benefits of primary care. STUDY SETTING Between 2011 and 2013, primary care data were collected among GPs and their patients in 31 European countries, plus Australia, Canada, and New Zealand. In these countries, GPs are the main providers of primary care, mostly specialized in family medicine and working in the ambulatory setting. STUDY DESIGN In this cross-sectional study, questionnaires were completed by 7,183 GPs and 61,931 visiting patients. Moreover, 7,270 patients answered questions about what they find important (their values). In the analyses of patient experiences, we adjusted for patients' values in each country to measure patient perceived quality. Perceived quality was measured regarding five areas: accessibility and continuity of care, doctor-patient communication, patient involvement in decision making, and comprehensiveness of care. The range of GP services was measured in relation to four areas: (1) to what extent they are the first contact to the health care system for patients in need of care, (2) their involvement in treatment and follow-up of acute and chronic conditions, in other words treatment of diseases, (3) their involvement in minor technical procedures, and (4) their involvement in preventive treatments. EXTRACTION METHODS Data of the patients were linked to the data of the GPs. Multilevel modeling was used to construct scale scores for the experiences of patients in the five areas of quality and the range of services of GPs. In these four-level models, items were nested within patients, nested in GP practices, nested in countries. The relationship between the range of services and the experiences of patients was analyzed in three-level multilevel models, also taking into account the values of patients. PRINCIPAL FINDINGS In countries where GPs offer a broader range of services patients perceive better accessibility, continuity, and comprehensiveness of care, and more involvement in decision making. No associations were found between the range of services and the patient perceived communication with their GP. The range of GP services mostly explained the variation between countries in the areas of patient perceived accessibility and continuity of care. CONCLUSIONS This study showed that in countries where GP practices serve as a "one-stop shop," patients perceive better quality of care, especially in the areas of accessibility and continuity of care. Therefore, primary care in a country is expected to benefit from investments in a broader range of services of GPs or other primary care physicians.
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Affiliation(s)
- Willemijn L A Schäfer
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Wienke G W Boerma
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - François G Schellevis
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Peter P Groenewegen
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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31
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Chylińska J, Łazarewicz M, Rzadkiewicz M, Adamus M, Jaworski M, Haugan G, Lillefjel M, Espnes GA, Włodarczyk D. The role of gender in the active attitude toward treatment and health among older patients in primary health care-self-assessed health status and sociodemographic factors as moderators. BMC Geriatr 2017; 17:284. [PMID: 29216837 PMCID: PMC5721697 DOI: 10.1186/s12877-017-0677-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Active attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status). METHODS A cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland. RESULTS Generalised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald's χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald's χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50-74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971). CONCLUSIONS The need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50-74).
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Affiliation(s)
- Joanna Chylińska
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland.
| | - Magdalena Łazarewicz
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Marta Rzadkiewicz
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Mirosława Adamus
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Mariusz Jaworski
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Gørill Haugan
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjel
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir A Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dorota Włodarczyk
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
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Tolvanen E, Koskela TH, Helminen M, Kosunen E. Patient Enablement After a Single Appointment With a GP: Analysis of Finnish QUALICOPC Data. J Prim Care Community Health 2017; 8:213-220. [PMID: 28911251 PMCID: PMC5932738 DOI: 10.1177/2150131917730211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Patient enablement is described as patient’s ability to understand and cope with illness after a consultation. The purpose of this study was to analyze factors associated with enablement in Finnish primary health care. An additional aim was to evaluate whether a single question could be used to measure enablement. Methods: A questionnaire survey was addressed to Finnish general practitioners (GPs) within the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. A trained fieldworker contacted nine patients for every participating GP. Two to 9 patients per GP (median 9 patients) completed the questionnaire. Patient enablement was measured by a single question based on the Patient Enablement Instrument questionnaire. Multivariate and multilevel analyses were performed to find variables that have an independent association with patient enablement. Results: A total of 1196 patients completed the QUALICOPC questionnaire. A total of 898 patients (75.1%) agreed that they felt better able to cope with their health problem or illness after an appointment with a GP, reflecting patient enablement. In the theme group analyses, 11 factors were found to have a statistically significant (P < .05) association with enablement. In the final multivariable model, positive perceptions of doctor-patient communication and patient satisfaction were positively associated with enablement. Conclusions: The results, using a single question to measure enablement, are comparable to previous findings on factors associated with enablement. Further research is needed and these results should be regarded as preliminary.
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Affiliation(s)
- Elina Tolvanen
- 1 University of Tampere, Tampere, Finland.,2 Pirkkala Municipal Health Centre, Pirkkala, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
| | | | - Mika Helminen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
| | - Elise Kosunen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
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Eide TB, Straand J, Björkelund C, Kosunen E, Thorgeirsson O, Vedsted P, Rosvold EO. Differences in medical services in Nordic general practice: a comparative survey from the QUALICOPC study. Scand J Prim Health Care 2017:1-10. [PMID: 28768442 DOI: 10.1080/02813432.2017.1358856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE We aim to describe medical services provided by Nordic general practitioners (GPs), and to explore possible differences between the countries. DESIGN AND SETTING We did a comparative analysis of selected data from the Nordic part of the study Quality and Costs of Primary Care in Europe. SUBJECTS 875 Nordic GPs (198 Norwegian, 80 Icelandic, 97 Swedish, 212 Danish and 288 Finnish) answered identical questionnaires regarding their practices. MAIN OUTCOME MEASURES The GPs indicated which equipment they used in practice, which procedures that were carried out, and to what extent they were involved in treatment/follow-up of a selection of diagnoses. RESULTS The Danish GPs performed minor surgical procedures significantly less frequent than GPs in all other countries, although they inserted intrauterine devices significantly more often than GPs in Iceland, Sweden and Finland. Finnish GPs performed a majority of the medical procedures more frequently than GPs in the other countries. The GPs in Iceland reported involvement in a more narrow selection of conditions than the GPs in the other countries. The Finnish GPs had more advanced technical equipment than GPs in all other Nordic countries. CONCLUSION GPs in all Nordic countries are well equipped and offer a wide range of medical services, yet with a substantial variation between countries. There was no clear pattern of GPs in one country doing consistently more procedures, having consistently more equipment and treating a larger diversity of medical conditions than GPs in the other countries. However, structural factors seemed to affect the services offered.
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Affiliation(s)
- Torunn Bjerve Eide
- a Department of General Practice , Institute of Health and Society, University of Oslo , Oslo , Norway
| | - Jørund Straand
- a Department of General Practice , Institute of Health and Society, University of Oslo , Oslo , Norway
| | - Cecilia Björkelund
- b Department of Primary Health Care , Institute of Medicine, University of Gothenburg , Gothenburg , Sweden
| | - Elise Kosunen
- c School of Medicine , University of Tampere , Tampere , Finland
- d Centre of General Practice , Pirkanmaa Hospital District , Tampere , Finland
| | | | - Peter Vedsted
- f Research Unit for General Practice , Aarhus University , Aarhus C , Denmark
| | - Elin Olaug Rosvold
- a Department of General Practice , Institute of Health and Society, University of Oslo , Oslo , Norway
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Eide TB, Straand J, Björkelund C, Kosunen E, Thorgeirsson O, Vedsted P, Rosvold EO. Differences in medical services in Nordic general practice: a comparative survey from the QUALICOPC study. Scand J Prim Health Care 2017; 35:153-161. [PMID: 28613127 PMCID: PMC5499315 DOI: 10.1080/02813432.2017.1333323] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/30/2017] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE We aim to describe medical services provided by Nordic general practitioners (GPs), and to explore possible differences between the countries. DESIGN AND SETTING We did a comparative analysis of selected data from the Nordic part of the study Quality and Costs of Primary Care in Europe (QUALICOPC). SUBJECTS A total of 875 Nordic GPs (198 Norwegian, 80 Icelandic, 97 Swedish, 212 Danish and 288 Finnish) answered identical questionnaires regarding their practices. MAIN OUTCOME MEASURES The GPs indicated which equipment they used in practice, which procedures that were carried out, and to what extent they were involved in treatment/follow-up of a selection of diagnoses. RESULTS The Danish GPs performed minor surgical procedures significantly less frequent than GPs in all other countries, although they inserted IUDs significantly more often than GPs in Iceland, Sweden and Finland. Finnish GPs performed a majority of the medical procedures more frequently than GPs in the other countries. The GPs in Iceland reported involvement in a more narrow selection of conditions than the GPs in the other countries. The Finnish GPs had more advanced technical equipment than GPs in all other Nordic countries. CONCLUSIONS GPs in all Nordic countries are well equipped and offer a wide range of medical services, yet with a substantial variation between countries. There was no clear pattern of GPs in one country doing consistently more procedures, having consistently more equipment and treating a larger diversity of medical conditions than GPs in the other countries. However, structural factors seemed to affect the services offered.
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Affiliation(s)
- Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jørund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elise Kosunen
- School of Medicine, University of Tampere, Tampere, Finland
- Centre of General Practice, Pirkanmaa Hospital District, Pirkanmaa, Finland
| | | | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Elin Olaug Rosvold
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Van Loenen T, Faber MJ, Westert GP, Van den Berg MJ. The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries. Scand J Prim Health Care 2016; 34:5-12. [PMID: 26849246 PMCID: PMC4911022 DOI: 10.3109/02813432.2015.1132883] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. DESIGN Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. SETTING A total of 23 countries. SUBJECTS General practitioners and patients. MAIN OUTCOME MEASURES Diabetes-related avoidable hospitalizations. RESULTS Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. CONCLUSIONS Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations. KEY POINTS Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related avoidable hospitalization. Hospital bed supply is strongly associated with admission rates for uncontrolled diabetes and long-term complications. Continuity of care was associated with lower rates of diabetes-related hospitalization. Better access to care, broader task profiles for general practitioners, and more medical equipment in general practice was associated with higher rates of admissions for diabetes.
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Affiliation(s)
- Tessa Van Loenen
- CONTACT T. van Loenen, MSc Radboud University Medical Center, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands
| | - Marjan J. Faber
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Gert P. Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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