Patient experience of access to primary care: identification of predictors in a national patient survey.
BACKGROUND
The 2007/8 GP Access Survey in England measured experience with five dimensions of access: getting through on the phone to a practice, getting an early appointment, getting an advance appointment, making an appointment with a particular doctor, and surgery opening hours. Our aim was to identify predictors of patient satisfaction and experience with access to English primary care.


METHODS
8,307 English general practices were included in the survey (of 8,403 identified). 4,922,080 patients were randomly selected and contacted by post and 1,999,523 usable questionnaires were returned, a response rate of 40.6%. We used multi-level logistic regressions to identify patient, practice and regional predictors of patient satisfaction and experience.


RESULTS
After controlling for all other factors, younger people, and people of Asian ethnicity, working full time, or with long commuting times to work, reported the lowest levels of satisfaction and experience of access. For people in work, the ability to take time off work to visit the GP effectively eliminated the disadvantage in access. The ethnic mix of the local area had an impact on a patient's reported satisfaction and experience over and above the patient's own ethnic identity. However, area deprivation had only low associations with patient ratings. Responses from patients in small practices were more positive for all aspects of access with the exception of satisfaction with practice opening hours. Positive reports of access to care were associated with higher scores on the Quality and Outcomes Framework and with slightly lower rates of emergency admission. Respondents in London were the least satisfied and had the worst experiences on almost all dimensions of access.


CONCLUSIONS
This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given the increasing tendency for small practices to combine into larger units. Consideration needs to be given to ways of retaining these and other benefits of small practice size when primary care services are reconfigured. Differences between population groups (e.g. younger people, ethnic minorities) may be due to differences in actual care received or different response tendencies of different groups. Further analysis is needed to determine whether case-mix adjustment is required when comparing practices serving different populations.
Kontopantelis
Evangelos
E
National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, UK. e.kontopantelis@manchester.ac.uk
Roland
Martin
M
Reeves
David
D
D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D044466:Asian People / Q000523:psychology / Q000706:statistics & numerical data; D001294:Attitude to Health; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011336:Probability; D013222:State Medicine / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
Br J Gen Pract. 2001 Aug;51(469):644-50
11510394
BMJ. 2009 Sep 29;339:b3851
19808811
BMJ. 2001 Oct 6;323(7316):784-7
11588082
Health Serv Res. 2009 Apr;44(2 Pt 1):501-18
19317857
Soc Sci Med. 1997 Dec;45(12):1829-43
9447632
Qual Health Care. 1992 Sep;1(3):171-7
10136859
JAMA. 2003 Feb 26;289(8):1042-6
12597761
Health Serv Res. 2005 Dec;40(6 Pt 2):2162-81
16316443
Br J Gen Pract. 2007 Aug;57(541):615-21
17688755
Qual Health Care. 2001 Jun;10(2):90-5
11389317
N Engl J Med. 1996 May 30;334(22):1441-7
8618584
Soc Sci Med. 2000 Dec;51(11):1611-25
11072882
Eval Program Plann. 1981;4(2):139-50
10253404
Health Technol Assess. 2002;6(32):1-244
12925269
JAMA. 2003 Feb 26;289(8):1035-40
12597760
N Engl J Med. 2009 Jul 23;361(4):368-78
19625717
Int J Qual Health Care. 2006 Sep;18 Suppl 1:5-13
16954510
JAMA. 1995 Jul 26;274(4):305-11
7609259
BMJ. 2009 Sep 16;339:b3450
19762416
Stat Med. 2008 Jul 10;27(15):2865-73
17960576
Fam Pract. 2005 Feb;22(1):20-7
15640293