Patient evaluations of accessibility and co-ordination in general practice in Europe.
OBJECTIVE
To determine whether patient evaluations of the accessibility to general practice and co-ordination with other care providers were associated with characteristics of general practice organizations.


BACKGROUND
In 1998 patients across Europe perceived that small general practices have better accessibility than large practices. Since then a number of changes in primary care have had impact on accessibility and co-ordination of care.


METHODS
The study was based on data from the European Practice Assessment study, an observational study in 284 general practices in 10 countries in 2004.


METHODS
Patient evaluations of general practice were measured with the 23-item Europep instrument, from which seven items on accessibility and co-ordination were selected in a principal factor analysis. Six practice characteristics were examined: percentage of female general practitioners, mean age of physicians, mean number of physician hours worked per week, number of general practitioners, number of care providers, urbanization level. Mixed regression models were applied, in which patients were clustered within practices, and practices within countries.


RESULTS
Practices with a higher numbers of care providers received less positive patient evaluations (b= -0.112, P=0.004). The other practice characteristics were not related to patient evaluations. Only a small proportion of the total variation in patient evaluations of accessibility and co-ordination (1.8%) was explained by characteristics of the general practice organizations.


CONCLUSIONS
General practices have become larger in most developed countries in recent years, but patients seemed to prefer general practice organizations with fewer health professionals.
Wensing
Michel
M
Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.wensing@kwazo.umcn.nl
Hermsen
Jan
J
Grol
Richard
R
Szecsenyi
Joachim
J
D000328:Adult; D001071:Appointments and Schedules; D003266:Continuity of Patient Care / Q000592:standards*; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005060:Europe; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011216:Practice Management, Medical / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011594:Psychometrics; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D000078329:Workforce