title: Communication in general practice: differences between European countries.
abstract: BACKGROUND
  Based on differences in national health care system characteristics such as the gatekeeping role of GPs (at the macrolevel) and on diverging GP and patient characteristics (at the microlevel), communication may differ between countries. Knowledge of the influence of these characteristics on doctor-patient communication will be important for setting European health care policies.
  
  
  OBJECTIVE
  Our objectives were (i) to compare doctor-patient communication in general practice between European countries; and (ii) to investigate the influence of the gatekeeping system and GP and patient characteristics on doctor-patient communication in general practice.
  
  
  METHODS
  Fifteen patients per GP (in total 2825 patients) of 190 GPs in six European countries were included. Participating countries were The Netherlands, Spain, the UK (gatekeeping countries), Belgium, Germany and Switzerland (non-gatekeeping countries). Data were collected by means of patient and GP questionnaires and observation of videotaped consultations, and analysed by one-way and multilevel, multivariate analysis.
  
  
  RESULTS
  Differences in communication between countries were found in: affective and instrumental behaviour; biomedical and psychosocial talk; GPs' patient-directed gaze; and consultation length. The study showed that GPs' gatekeeping role (with registered patients) was less important for doctor-patient communication than was expected. Patient characteristics such as gender, age, having psychosocial problems, and familiarity between the doctor and the patient were the most important in explaining differences in communication.
  
  
  CONCLUSIONS
  The gatekeeping role of GPs is hardly important in explaining doctor-patient communication. The relationship is more complex than expected. Patient and GP characteristics are more important. Cultural factors should be included in future studies.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands. A.vandenbrink@nivel.nl
authors.forename: A
authors.initials: A
authors.lastname: van den Brink-Muinen
authors.forename: P F M
authors.initials: PF
authors.lastname: Verhaak
authors.forename: J M
authors.initials: JM
authors.lastname: Bensing
authors.forename: O
authors.initials: O
authors.lastname: Bahrs
authors.forename: M
authors.initials: M
authors.lastname: Deveugele
authors.forename: L
authors.initials: L
authors.lastname: Gask
authors.forename: N
authors.initials: N
authors.lastname: Mead
authors.forename: F
authors.initials: F
authors.lastname: Leiva-Fernandez
authors.forename: A
authors.initials: A
authors.lastname: Perez
authors.forename: V
authors.initials: V
authors.lastname: Messerli
authors.forename: L
authors.initials: L
authors.lastname: Oppizzi
authors.forename: M
authors.initials: M
authors.lastname: Peltenburg
mesh_terms: D000328:Adult; D003142:Communication; D005060:Europe; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D020793:Gatekeeping; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care