title: General practitioner attitudes to the care of people with epilepsy: an examination of clustering within practices and prediction of patient-rated quality of care.
abstract: BACKGROUND
  There is wide variation in the quality of care provided by primary care practices to individuals with chronic illnesses. Individual doctor attitudes and interest have been demonstrated to influence patient outcomes in some instances. Given the trend towards larger practices and part-time working, continuity of care is likely to fall and thus practice-based rather than individual general practitioner attributes and attitudes are likely to become increasingly important. The aim in this paper was to examine the extent to which individual general practitioner (G.P.) attitudes to the care of people with epilepsy cluster within practices and predict patient-rated quality of care.
  
  
  METHODS
  The sample consisted of 1255 people with active epilepsy (a recent seizure or on anti-convulsant medication for epilepsy) and 199 GPs from 82 general practices. Measures of GP attitudes (a 17-item GP attitudes questionnaire) and patient-rated quality of epilepsy care were obtained. 1210 individuals completed initial questionnaires and 975 patients filled in final questionnaires one year later. Responses were achieved from 64 practices (83% of total) and 115 GPs (60% of total).
  
  
  RESULTS
  2 main factors were found to underlie GP attitudes to the care of people with epilepsy and these demonstrated clustering within practices "epilepsy viewed as a primary care responsibility" (Eigenvalue 3.98, intra-class correlation coefficient (ICC) 0.40), and "medication skills"(Eigenvalue 2.74, ICC 0.35). GP-rated scores on "epilepsy care being a primary care responsibility" were a significant predictor of patient-rated quality of GP care (p = 0.031). Other contributory factors were seizure frequency (p = 0.044), and patient-rated "shared decision making" (p = 0.022).
  
  
  CONCLUSIONS
  Specific general practitioner attitudes to the care of people with epilepsy cluster within practices and are significantly associated with patient-rated quality of epilepsy care. It is important to take these findings into consideration when planning primary care interventions to ensure people with epilepsy receive the benefits of available medical and surgical expertise.
authors.affiliation: School of Psychology, Cardiff University, Tower Building, Park Place, Box 901, Cardiff, UK. thaparak@cf.ac.uk
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Thapar
authors.forename: Martin O
authors.initials: MO
authors.lastname: Roland
mesh_terms: D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003266:Continuity of Patient Care; D004739:England / Q000453:epidemiology; D004827:Epilepsy / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires
references.citation: J Fam Pract. 2000 Sep;49(9):796-804
references.pmid: 11032203
references.citation: Diabetes Care. 2001 Mar;24(3):423-9
references.pmid: 11289462
references.citation: BMJ. 2001 Oct 6;323(7316):784-7
references.pmid: 11588082
references.citation: Br J Gen Pract. 2002 Feb;52(475):93-8
references.pmid: 11885833
references.citation: Soc Sci Med. 2003 Oct;57(8):1515-24
references.pmid: 12927480
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: Fam Pract. 1998 Oct;15(5):437-42
references.pmid: 9848430
references.citation: Epilepsy Res. 1993 Sep;16(1):65-81
references.pmid: 8243441
references.citation: Br J Gen Pract. 1996 Jan;46(402):37-42
references.pmid: 8745851
references.citation: BMJ. 1997 Jun 28;314(7098):1870-3
references.pmid: 9224130
references.citation: Med Care. 1998 Feb;36(2):212-29
references.pmid: 9475475
references.citation: Epilepsia. 1997 Nov;38(11):1245-50
references.pmid: 9579928
references.citation: BMJ. 1993 Mar 6;306(6878):630-4
references.pmid: 8461816