title: Patient satisfaction with large-scale out-of-hours primary health care in The Netherlands: development of a postal questionnaire.
abstract: BACKGROUND
  Since the turn of the millennium, out-of-hours primary health care in The Netherlands has faced a substantial change from small locum groups towards large GP cooperatives. Improving the quality of care requires evaluation of patient satisfaction.
  
  
  OBJECTIVE
  To develop a reliable postal questionnaire for wide-scale use by patients contacting their out-of-hours GP cooperative and to present the results of a national survey.
  
  
  METHODS
  Literature review and interviews with both patients and health carers were carried out to identify issues of potential relevance, followed by two postal pilot studies and additional interviews to remove or rephrase items. Finally, postal questionnaires were sent to 14,400 people who contacted one of 24 GP cooperatives in The Netherlands.
  
  
  RESULTS
  Overall response was 52.2% for all types of contact. Three scales were identified prior to the field phase and confirmed by principal components analysis: telephone nurse, doctor and organization. Reliability was high, with Cronbach's alphas and intraclass correlation coefficients exceeding 0.70 for all scales. Only items in the organization scale showed clear differences among the participating cooperatives. Respondents receiving telephone advice showed lower levels of satisfaction than respondents with other types of contact (P < 0.001); centre consultation scored lower than home visit (P < 0.030 or less for all differences).
  
  
  CONCLUSIONS
  A reliable measure of patient satisfaction has been developed that can also be used for the comparison of GP cooperatives on an organizational level. Overall satisfaction was high, showing highest levels for home visit and lowest levels for telephone advice.
authors.affiliation: Department of General Practice, Academic Medical Centre-University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. e.p.mollvancharante@amc.uva.nl
authors.forename: Eric
authors.initials: E
authors.lastname: Moll van Charante
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.forename: Henk
authors.initials: H
authors.lastname: Mokkink
authors.forename: Frans
authors.initials: F
authors.lastname: Oort
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Niek
authors.initials: N
authors.lastname: Klazinga
authors.forename: Patrick
authors.initials: P
authors.lastname: Bindels
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration* / Q000592:standards; D000368:Aged; D002648:Child; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011177:Postal Service; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D025341:Principal Component Analysis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires