Experiences of adult patients using primary care services in Poland - a cross-sectional study in QUALICOPC study framework

Mature Adults at the GP: Length of Visit and Patient Satisfaction—Associations with Patient, Doctor, and Facility Characteristics

Background and objectives: The consultation time for more mature adults is often perceived as longer, increasing with the patient’s age and boosting their satisfaction with the visit. However, factors determining patient satisfaction (PS) or the consultation time (CT) in the population aged 50+ are not clearly identified. A cross-sectional design was used to identify factors specific to the facility (e.g., size, staff turnover), doctor (e.g., seniority, workload), and patient (e.g., self-rated health, impairment of activities) that are related to PS and the CT. Our secondary focus was on the relation of PS to the CT along with the role of the patient’s age and gender for both. Materials and Methods: Doctors (n = 178) and their 1708 patients (aged 50–97) from 77 primary care facilities participated in the study. The Patient Satisfaction with Visit Scale score and the CT were the outcome measures. Results: We identified associations with the CT in terms of the facility-related factors (number of GPs, time scheduling); doctors’ workload and health; and patients’ education, time attending GP, and impairments. PS was additionally governed by doctors’ perceived rate of patients aged 65+, as well as the patients’ hospitalization in the prior year, frequency of visits, and impairments. For adults aged 50+ the CT was unrelated to PS and both remained independent of patients’ age. Conclusions: Specific factors in terms of the facility, GP, and patient were identified as related to PS and the CT for participating adults in primary care. During visits of patients aged 50+ at their GP, there is scope for both time-savings and patient satisfaction improvements, when paying attention, e.g., to the time scheduled per visit, the number of doctors employed, and the patients’ impairments.

Expectations, values, preferences and experiences of Hungarian primary care population when accessing services: Evaluation of the patient's questionnaires of the international QUALICOPC study

Background:

Preferences and wishes of patients is an important indicator of primary health care provision, although there are differences between national primary care systems.

Aim:

The aim of this paper is to describe and evaluate the preferences and values of Hungarian primary care (PC) patients before accessing and to analyse their experiences after attending PC services.

Methods:

In the Hungarian arm of the European QUALICOPC Study, in 2013–2014, information was collected with questionnaires; the Patient Values contained 19 and the Patient Experiences had 41 multiple-choice questions.

Findings:

The questionnaires were filled by 2149 (840 men, 1309 women) using PC services, aged 49.1 (SD ± 16.7) years, 73% of them having chronic morbidities. Women preferred to be accompanied and rated their own health better. Patients in the lowest educational category and women visited their GPs more often, and they are consulted more frequently by other doctors as well. Men, older and secondary educated people reported more frequently chronic morbidities. Longer opening hours were preferred by patients with higher education. The most preferred expectations were availability and polite communication of doctors, not pressures on consultation time, clear instructions provided during consultations, shared decisions about treatments and options for consultations, the knowledge of the doctors concerning the living conditions, social and cultural backgrounds of patients, updated medical records, short waiting times, options for home visits, wide scope of professional competences and trust in the doctor.

Conclusion:

Wishes, preferences of patients and fulfilment were similar than described in other participating countries of the study. Although there are room to improve PC services, most of the questioned population were satisfied with the provision.

Do Polish primary care physicians meet the expectations of their patients? An analysis of Polish QUALICOPC data

Background

Meeting the expectations of patients is one of the most crucial criteria when assessing the quality of a healthcare system. This study aimed to compare the expectations and experiences of patients of primary care in Poland and to identify key patient characteristics affecting these outlooks.

Methods

The study was performed within the framework of the international Quality and Costs of Primary Care in Europe (QUALICOPC) cross-sectional, questionnaire-based study. In Poland, a nationally representative sample of 2218 patients were recruited to take part in the study. As a study tool, we used data from two of four QUALICOPC questionnaires: “Patient Experience” and “Patient Values”.

Results

Patients’ expectations were fulfilled in all study areas: accessibility, continuity, quality of care, and equity. We observed that the highest-met expectations indexes were in the area of quality of care, while the lowest, but still with a positive value, were in the area of accessibility. Patient-doctor communication was the aspect most valued by study participants. Elements of the patient’s own level of engagement during the consultation were ranked as less essential.

Conclusions

Comparing patient experiences to their values allows us to identify areas for improvement that are prioritized by patients. Accessibility is recognized as the most important area by Polish patients, simultaneously showing the highest level of patient-perceived improvement potential. Interpersonal care is another domain, in which the needs of patients are satisfied but are also relatively high. Strong clinician-patient relationships seem to be a priority in patients’ expectations. The continuous efforts in interpersonal communication skills training for primary care physicians should be upgraded.

Patients' preferences in selecting family physician in primary health centers: a qualitative-quantitative approach

BACKGROUND

The role of family physicians (FPs) in the metropolitan area is critical in identifying risk factors for disease prevention/control and health promotion in various age groups. Understanding patients' preferences and interests in choosing a FP can be an effective and fundamental step in the success of this program. In this study factors affecting the FP selection by Iranian patients referred to health centers in the most populous areas in the south of Tehran were assessed and ranked.

METHODS

A sequential mixed-method (qualitative-quantitative) triangulation approach was designed with three subject groups of patients, physicians, and health officials. The Framework method was used to analyze interviews transcribed verbatim. After implementing an iterative thematic process, a 26-item quantitative questionnaire with high validity and reliability was drafted to evaluate the different factors. A convenient sampling method was used to select 400 subjects on a population-based scale to quantitatively rank the most critical selection factors as a mean score of items.

RESULTS

The selection factors were divided into six centralized codes, including FPs' ethics, individual, professional and performance factors; patients' underlying disease and individual health, and disease-related factors, office's location and management factors, democracy factors, economic factors, and social factors. After filling out the questionnaires, the most important factors in selecting FP were a specialist degree in family medicine (FM) (4.49 ± 0.70), performing accurate examinations with receiving a detailed medical history (4.43 ± 0.68), and spending enough time to visit patients (4.28 ± 0.75), respectively. However, the parameters such as being a fellow-citizen, being the same gender, and physician's appearance were of the least importance.

CONCLUSION

There is a possibility to screen the most important factors affecting the FP choice through the combination of qualitative and quantitative studies. The first and last patients' priority was physicians' specialty in FM and being a fellow-citizen with them, respectively. The clinical and administrative healthcare systems should schedule the entire implementation process to oversee the doctor's professional commitment and setting the visit times of FP.

The health service capacity of primary health care in West China: different perspectives of physicians and their patients

Background

Many countries, including China, have identified the primary health care system as a reform priority. The purpose of this study is to compare the perceived service capacity of primary care from the perspectives of physicians and their patients in Sichuan province of China.

Methods

A cross-sectional survey was conducted through Quality and Costs of Primary Care (QUALICOPC) questionnaires. A representative sample of 319 primary care physicians and 641 patients in 48 primary healthcare settings were recruited to take part in the study.

Results

Physicians perceived equity of care the best, while quality of care was rated the highest from the perspective of patients. They both regarded coordination as the weakest dimension of primary care service capacity.

Conclusions

Although primary health care reform may have been effective in helping patients acquire better primary care services, our results suggest that coordination is still perceived to be problematic for both physicians and patients. Improving the coordination of care has to be one of the main goals in the future primary care reforms in China.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3964-x) contains supplementary material, which is available to authorized users.

A mixed methods study of the experience of older adults with multimorbidity in a Care Coordination Program

Introduction

Care Coordination Programs are designed to streamline services for older adults with multimorbidity. The Triple Aim, a conceptual model for the design and evaluation of healthcare models, stipulates that a balance of three aims—reducing costs, improving population health, and improving patient experience—are needed for high-quality, value-based care. Research is beginning to show that coordinating care across the continuum of care reduces costs and improves the health of the multimorbid older adult population. Yet little is known about older adults’ experience of care and their overall assessment of interactions with healthcare providers across the length of time of these interactions in a Care Coordination Program.

Methods

To gain a deeper understanding of older adults’ experience with a Care Coordination Program, this concurrent mixed methods research study analyzed 201 older adults’ assessment of their chronic illness care using the Patient Assessment of Chronic Illness Care (PACIC+). A subset of 30 older adults also participated in a telephone interview to collect qualitative data.

Results

The experience of older adults with multimorbidity in a Care Coordination Program was related to two factors: (1) professional actions and (2) professional attitudes. Actions that improved patients’ experience of care were communication, coordination, and addressing fundamental problems. Professional attitudes that improved their experience of care included being compassionate, knowledgeable and professional, mutually respectful, and positive and encouraging.

Discussion

To improve patient experience, Care Coordination Programs must design and measure their efforts related to the actions and the attitudes of their care team, especially primary care physicians and care coordinators.