title: Patients' evaluation of quality of care in general practice: what are the cultural and linguistic barriers?
abstract: OBJECTIVE
  Increased migration implies increased contacts for physicians with patients from diverse cultural backgrounds who have different expectations about healthcare. How satisfied are immigrant patients, and how do they perceive the quality of care? This study investigated which patient characteristics (such as cultural views and language proficiency) are related to patients' satisfaction and perceived quality of care.
  
  
  METHODS
  Patients (n=663) from 38 general practices in Rotterdam (The Netherlands) were interviewed. General satisfaction with the general practitioner (GP) was measured by a report mark. Perceived quality of care was measured using the 'Quote-mi' scale (quality of care through the patient's eyes-for migrants), which contains an ethnic-specific subscale and a communication process subscale. Using multilevel regression techniques, the relation between patient characteristics (ethnicity, age, education, Dutch language proficiency, cultural views) and satisfaction and perceived quality of care was analysed.
  
  
  RESULTS
  In general, patients seemed fairly satisfied. Non-Western patients perceived less quality of care and were less satisfied than Dutch-born patients. The older the patients and the more modern cultural views they had, the more satisfied they were about the GP in general, as well as about the communication process. However, non-Western patients holding more modern views were the most critical regarding the ethnic-specific quality items. The poorer patients' Dutch language proficiency, the more negative they were about the communication process.
  
  
  CONCLUSIONS
  It is concluded that next to communication aspects, especially when the patient's proficiency in Dutch is poor, physician awareness about the patient's cultural views is very important during the consultation. This holds especially true when the immigrant patient seems to be more or less acculturated.
  
  
  CONCLUSIONS
  Medical students and physicians should be trained to become aware of the relevance of patients' different cultural backgrounds. It is also recommended to offer facilities to bridge the language barrier, by making use of interpreters or cultural mediators.
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. j.harmsen@erasmusmc.nl
authors.forename: J A M
authors.initials: JA
authors.lastname: Harmsen
authors.forename: R M D
authors.initials: RM
authors.lastname: Bernsen
authors.forename: M A
authors.initials: MA
authors.lastname: Bruijnzeels
authors.forename: L
authors.initials: L
authors.lastname: Meeuwesen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000523:psychology*; D005194:Family Practice / Q000193:education / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D008037:Linguistics; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction / Q000208:ethnology*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education / Q000458:organization & administration / Q000523:psychology; D011787:Quality of Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D012111:Residence Characteristics; D011795:Surveys and Questionnaires