Fmily Prctice Vol. 19, No. 4 Oxford University Press 2002 Printed in Gret Britin Ptient nd GP greement on spects of generl prctice cre Peter Vedsted,b, Jn Minz b, Torsten Luritzen b nd Frede Olesen Vedsted P, Minz J, Luritzen T nd Olesen F. Ptient nd GP greement on spects of generl prctice cre. Fmily Prctice 2002; 19: 339 343. Objective. The im of the present study ws to compre ptient nd GP priorities for generl prctice cre. Methods. A questionnire survey ws crried out in generl prctice in Denmrk which included 900 consecutive ptients ged over 18 yers from 15 prctices collected in 1995, nd 919 rndomly smpled GPs in 1999. The postl questionnire, developed by the EUROPEP group, contined 40 questions bout eight spects of primry cre. Prticipnts were sked to stte their priorities for ech question rnging from not t ll importnt to most importnt. A reminder questionnire ws sent to non-responders fter 2 weeks. Top priority percentges ( very/ most importnt ) were clculted for ech question s were differences between prticipnt groups. Results. Questionnires were nswered by 771 (85.7%) ptients nd 584 (64.2%) GPs. Their priorities were highly correlted (r = 0.754, P 0.001). Ptients gve higher priority thn GPs to vilbility nd ccessibility of the prctice nd seeing the sme GP. The GP should be cpble of providing informtion on illness, investigtions nd tretments nd ptient ssocitions, nd should know the ptient s history nd be regulrly updted through courses. Conclusions. Ptient nd GP priorities for primry cre were highly correlted. The higher priority wrded by ptients thn by GPs to specific spects of primry cre should be cknowledged when orgnizing nd developing generl prctice. Keywords. Denmrk, fmily prctice, preferences, priorities, questionnire. Introduction The lst decde hs seen growing recognition mong helth cre professionls, dministrtors nd policy mkers of the need for studying ptient involvement in helth cre. 1 Some of these studies hve shown tht ptients my hve specific priorities regrding technicl, interpersonl nd orgniztionl spects of cre. 1,2 Only very few studies hve compred GPs nd ptients priorities nd evlutions of generl prctice cre 3,4 even if such knowledge is crucil to the orgniztion of generl prctice cre. Moreover, the bility to respond fvourbly to helth cre consumers expecttions nd priorities requires knowledge of where these priorities mtch or clsh with those of the cregivers, policy Received 14 My 2001; Revised 30 October 2001; Accepted 11 Mrch 2002. The Reserch Unit for Generl Prctice nd b Deprtment of Generl Prctice, University of Arhus, Vennelyst Boulevrd 6, DK-8000 Arhus C, Denmrk. Correspondence to Peter Vedsted; E-mil: pv@lm.u.dk mkers nd dministrtors. The im of this study is to fill this knowledge gp by compring ptient nd GP priorities for generl prctice cre. Methods Study popultions The ptient smple consisted of ptients from 15 Dnish generl prctices who were sked in 1995 to prticipte in the EUROPEP study 5 by including 60 consecutive ptients from ech prctice. Ptients were ged 18 yers nd over nd ll spoke nd understood Dnish. Ptients who hd not responded within 2 weeks received reminder questionnire. The smple of 924 GPs ws collected t rndom in 1999. Respondent independence ws gurnteed by smpling only one GP from ech prctice. Five GPs were excluded becuse four hd prticipted in the pilot study nd one ws member of the reserch group. Thus, questionnires were sent to 919 GPs. GPs who did not respond within 2 weeks received reminder with new questionnire. 339
340 Fmily Prctice n interntionl journl The questionnire The questionnire ws developed to ssess the ptient priorities for generl prctice cre. It ws developed by Europen group (EUROPEP). 5,6 The questionnire contined 40 questions orgnized into five templtes ech with eight questions: medicl technicl cre; doctor ptient reltionship; informtion nd support; vilbility nd ccessibility; nd orgniztion of the services. The GP questionnire hd exctly the sme wording s the ptient questionnire, except for the words I, me nd my which were replced by the ptient. Ptients nd GPs were sked to rte ech of the questions ccording to their importnce on 5-point Likert scle rnging from not t ll importnt to most importnt. In ddition, respondents could nswer do not know. Anlysis Percentges were clculted for ech question to which importnce ( very/most importnt ) ws scribed. Only respondents who hd indicted preference on the 5-point scle were included in the denomintor. We clculted the difference between GPs nd ptients scription of importnce to ech question nd the 95% confidence intervl (95% CIs). 7 Agreement of priorities ws depicted grphiclly in sctter plot with the digonl s the dividing line. of prctice, which reduced the number of eligible GPs to 624. Forty respondents did not wish to prticipte, leving 584 (64.2%) GPs for nlysis (Tble 2). Priorities Ptients in prticulr gve higher priority to question nos 17, 20, 35 nd 36 thn the GPs who, on the other hnd, gve higher priority to question nos 11, 33, 34 nd 40 (Tble 3). The Spermn s rnk correltion between the priorities of the two groups ws.754 (P 0.001) (Fig. 1). GP nd ptient priorities differed in ll mtters concerning spects of orgniztion of the services (Tble 3), the GPs giving higher priority to questions concerning convenient fcilities, good co-opertion between GP nd stff nd co-ordintion of different types of cre. Ptients gve higher priority thn GPs to ll questions concerning spects of vilbility nd ccessibility. The lrgest discrepncy between respondent groups ws found for the ctegory informtion nd support where ptients gve much higher priority to the GP telling the ptient ll bout the illness, explining the purpose of investigtions nd tretment nd providing informtion on ptient ssocitions. Among the top 10 ptient priorities, the GPs gve lower priority to question nos 4, 20, 26, 27 nd 37. Results Study popultion A totl of 771 ptients (Tble 1) returned questionnire (response rte 85.7%). A totl of 633 GPs responded but, mong these, nine stted tht they were unble to prticipte becuse of leve, disese or closing down TABLE 1 Dt on ptients included in the nlyses (n = 771) Gender Mle 208 (27.4%) (n = 760) Femle 552 (72.6%) Age (yers) Mle 46.0 (36 58) (n = 766) Femle 37.0 (29 50) All 39.0 (30 52) Mritl sttus Single 108 (14.2%) (n = 759) Mrried 433 (57.0%) Co-hbiting 140 (18.4%) Divorced/widowed 78 (11.5%) Eduction Unemployed 137 (18.4%) (n = 745) Skilled 134 (18.0%) Lower rnge 104 (14.0%) Middle rnge 218 (29.3%) Higher rnge 152 (20.4%) GP ttendnce during 3.0 (1 4) lst 6 months One or more chronic No 440 (57.1%) diseses (n = 767) Yes 331 (42.9%) Discussion The high correltion between ptient nd GP priorities indictes generl greement in their rnking of the spects. However, ptients gve higher priority thn GPs to informtion bout the purpose of investigtions nd tretment, bout ptients ssocitions nd bout their illness. They lso gve higher priority to the GP hving enough time during the consulttion, to the GP providing quick services in the cse of emergencies, to continuity of cre nd to the GP s prticiption in courses. These high ptient priorities hve lso been found in TABLE 2 Chrcteristics of GPs included in the nlyses (n = 584) Gender Mle 443 (76.4%) (n = 580) Femle 137 (23.6%) Age (yers) (n = 575) 53.0 (48 57) Yers s GP (n = 577) 20.0 (10 25) Weekly working hours (n = 576) 45.0 (40 50) Ptients per GP (n = 558) 1533 (1300 1770) Prctice type (%) Solo 281 (49.0%) (n = 574) Prtnership 293 (51.0%) Geogrphic loction (%) Urbn 73 (12.8%) (n = 572) Rurl 358 (62.6%) Mixed 141 (24.7%) Medin (interqurtile rnge). Medin (interqurtile rnge).
Ptient nd GP greement on generl prctice cre 341 TABLE 3 The 40 questions nd ptient (Pt) nd GP priorities (rnk) Dimension Question Rnk % Difference importnce (95% CI) GP Pt GP Pt 1. 1 A GP should be ble to relieve my symptoms quickly 35 36 15.7 30.3 14.6 ( 19.0, 10.1) Medicl technicl cre 2 The tretment by GP should help me to perform my dily ctivities 26 32 40.3 41.9 1.7 ( 7.0, 3.7) 3 A GP should only refer me to specilist when there re serious 21 20 48.2 63.6 15.4 ( 20.7, 10.1) resons for this 4 A GP should tke courses regulrly to lern bout recent medicl 14 6 62.0 79.7 17.7 ( 22.6, 12.9) developments 5 A GP should work ccording to ccepted knowledge bout good 3 11 77.1 74.3 2.8 ( 1.6, 7.3) generl prctice cre 6 A GP should criticlly evlute the usefulness of medicl investigtions 13 18 62.8 67.8 5.0 ( 10.2, 0.2) 7 A GP should criticlly evlute the usefulness of medicines nd dvice 8 8 66.4 79.0 12.6 ( 17.4, 7.8) 8 A GP should not only cure diseses, but lso offer services in order 19 13 57.8 73.2 15.4 ( 20.5, 10.3) to prevent diseses 2. 9 A GP should understnd wht I wnt from him or her 4 17 74.5 68.1 6.4 (1.6, 11.3) Doctor ptient 10 A GP should mke me feel free to tell him or her my problems 2 3 82.5 87.3 4.8 ( 8.6, 0.9) reltionship 11 A GP should tke personl interest in me s person nd 12 27 63.4 52.8 10.6 ( 5.3, 15.8) in my life sitution 12 A GP should llow second opinion of different doctor 38 39 7.8 22.2 14.4 ( 18.2, 10.6) 13 A GP should ccept when I seek lterntive tretment 37 34 9.8 33.5 23.7 ( 27.9, 19.5) 14 A GP should be redy to discuss investigtions, tretment 24 22 44.2 62.5 18.3 ( 23.6, 13.0) or referrl tht I wnt 15 A GP should cknowledge tht I hve the finl choice regrding 15 24 62.0 59.6 2.4 ( 2.9, 7.7) investigtions nd tretments 16 A GP should gurntee the confidentility of informtion bout 1 5 86.0 84.1 1.9 ( 1.9, 5.7) ll his ptients 3. 17 A GP should explin the purpose of investigtions nd 27 15 37.0 72.2 35.2 ( 40.3, 30.2) Informtion tretment in detil nd support 18 A GP should give me written informtion bout consulttion 39 40 6.1 9.8 3.7 ( 6.6, 0.9) hours, phone number, etc. 19 A GP should provide informtion on ptient ssocitions nd 40 35 3.9 31.4 27.6 ( 31.2, 23.9) groups relevnt to the ptient nd his/her reltives 20 A GP should tell me ll I wnt to know bout my illness 22 4 48.0 85.4 37.5 ( 42.3, 32.6) 21 A GP should guide me in tking my medicines correctly 9 10 64.8 74.6 9.8 ( 14.8, 4.9) 22 A GP should help my reltives support me 25 31 43.2 42.6 0.6 ( 4.8, 5.9) 23 A GP should help me del with the emotionl problems relted 16 19 62.0 66.8 4.9 ( 10.1, 0.3) to my helth problems 24 A GP should visit me often if I m seriously ill 6 7 73.7 79.2 5.4 ( 10.1, 0.8) 4. 25 It should be possible to mke n ppointment with GP within 20 12 55.5 74.2 18.8 ( 23.8, 13.7) Avilbility short time nd ccessibility 26 During consulttion GP should hve enough time to listen, 10 1 64.4 91.0 26.6 ( 31.0, 22.2) tlk, nd explin to me 27 A GP should be ble to provide quick services in cse of emergencies 5 2 74.3 88.3 14.0 ( 18.2, 9.7) 28 A GP should be willing to mke home visits 23 21 47.6 62.5 14.9 ( 20.3, 9.6) 29 It should be esy to spek to GP by telephone 28 23 36.3 61.6 25.3 ( 30.5, 20.0) 30 When I hve n ppointment with GP, I should not hve to wit 33 33 25.3 39.7 14.3 ( 19.3, 9.4) long in the witing room Bold vlues indicte tht the confidence intervl does not include zero.
342 Fmily Prctice n interntionl journl TABLE 3 Continued Dimension Question Rnk % Difference importnce (95% CI) GP Pt GP Pt 31 A GP should be concerned bout the cost of medicl tretment 34 37 21.6 25.4 3.8 ( 8.4, 0.8) 32 It should be possible for the entire fmily to hve the sme GP 31 30 33.3 48.9 15.6 ( 20.9, 10.4) 5. 33 The fcilities in generl prctice should be convenient 30 38 35.4 23.6 11.8 (6.8, 16.7) Orgniztion of the services 34 There should be good co-opertion between the GP nd the stff 7 28 71.5 49.9 21.6 (16.5, 26.7) 35 A GP should be willing to check my helth regulrly 36 29 10.8 49.5 38.6 ( 43.0, 34.2) 36 It should be possible to see the sme GP t ech visit 29 14 36.1 72.9 36.8 ( 41.9, 31.8) 37 A GP should know my history nd erlier tretment nd 18 9 59.8 78.2 18.4 ( 23.4, 13.5) informtion given 38 A GP should guide me in my reltionship with specilist cre 32 25 33.1 57.2 24.1 ( 29.3, 18.9) 39 A GP nd other cre providers (e.g. specilists) should not give 17 16 60.9 70.7 9.8 ( 15.0, 4.6) contrdictory informtion 40 A GP should co-ordinte the different types of cre I get 11 26 64.1 53.2 10.9 (5.6, 16.3) The percentges of ptients nd GPs who nswered very/most importnt re given together with the differences with 95% CIs between the two groups. FIGURE 1 Sctter plot of ptient nd GP priorities (percentges). The plot is divided by the digonl. For questions bove this digonl, ptients quoted higher crude priorities thn GPs other studies 2,6 nd should be remembered becuse the GPs tended to give lower priorities to these spects. In contrst, GPs gve higher priority thn ptients to the orgniztion of the services regrding fcilities, co-opertion nd co-ordintion. However, this might be explined by the GPs hving to cknowledge orgniztionl issues in prctice. Aspects of vilbility nd ccessibility were consistently higher ptient thn GP priority. However, GPs setting side more time for consulttions nd seeking to improve doctor ptient communiction on the phone tend to be mutully exclusive. We identified pttern of lower GP thn ptient priorities for spects involving other cre providers [ specilists nd different doctors (questions 3, 12 nd 38), lterntive tretment (question 13) nd ptient ssocitions (question 19)]. It could be rgued tht generl prctice should tke inititives to meet some of these ptient preferences. The study reveled interesting informtion bout spects of medicl technicl cre where the lrgest discrepncy between respondents ws observed for priorities given to the GPs ttending regulr courses on recent medicl developments. Despite n intense focus on qulity, continuing medicl eduction nd, e.g. GP ccredittion, ptients still gve higher priority to regulr courses. A Dutch study bsed on the EUROPEP questionnire using djusted differences to compre ptients nd GPs priorities found very similr results. 4 The similrity of these results suggests tht some of the differences pply cross countries, wheres others my be culture specific. Sttisticl precision nd vlidity The lrge smples included llowed us to obtin good sttisticl precision. The questionnires were developed ccording to scientific stndrds. The ptient response rte ws good. However, some of the difference found could be due to selection bis rising from the lower
response rte mong GPs thn mong ptients. As we used questionnire developed for ptients on GP popultion, some of the differences in priorities my therefore be scribed to differences in how respondent groups conceptulize the words of the questionnire, besides to the known differences in knowledge, experience, culture, etc. Some of the differences my lso be due to differences in popultion composition, e.g. ge, gender nd helth, or the fct tht there were 4 yers between the two surveys. These spects of the vlidity of the study demnd criticl interprettion of the results. Acknowledgements We thnk Associte Professor Morten Frydenberg, MSc, PhD, Deprtment of Biosttistics, University of Arhus, for his help with the sttistics. This study ws supported by grnt from the EC, Biomed 2 Concerted Action s prt of the EUROPEP study. Ptient nd GP greement on generl prctice cre 343 References 1 Donbedin A. Qulity ssurnce in helth cre: consumers role. Qul Helth Cre 1992; 1: 247 251. 2 Fletcher RH, O Mlley MS, Erp JA et l. Ptients priorities for medicl cre. Med Cre 1983; 21: 234 242. 3 Rshid A, Formn W, Jgger C, Mnn R. Consulttions in generl prctice: comprison of ptients nd doctors stisfction. Br Med J 1989; 299: 1015 1016. 4 Jung HP, Wensing M, Grol R. Wht mkes good generl prctitioner: do ptients nd doctors hve different views? Br J Gen Prct 1997; 47: 805 809. 5 Grol R, Wensing M, Minz J et l. Ptients priorities with respect to generl prctice cre: n interntionl comprison. Europen Tsk Force on Ptient Evlutions of Generl Prctice (EUROPEP). Fm Prct 1999; 16: 4 11. 6 Wensing M, Jung HP, Minz J, Olesen F, Grol R. A systemtic review of the literture on ptient priorities for generl prctice cre. Prt 1: description of the reserch domin. Soc Sci Med 1998; 47: 1573 1588. 7 Armitge P, Berry G. Sttisticl Methods in Medicl Reserch, 3rd edn. Oxford: Blckwell Scientific Publictions, 1994.