title: Do the organizational reforms of general practice care meet users' concerns? The contribution of the Delphi method.
abstract: BACKGROUND
  The debate over primary care reform in France, as in most OECD countries, centres on questions about efficacy and accessibility. Do these reforms actually respond to the users' concerns?
  
  
  OBJECTIVE
  The objective of this study was to identify the importance that users attribute to different aspects of general practice (GP) care.
  
  
  METHODS
  The method used was a variant of the classical Delphi approach, called Delphi 'ranking-type'. Between May and September 2009, 74 experts aged over 18 were recruited by 'snowballing' sampling. Three iterative rounds were required to identify the core aspects through a consensus-building approach.
  
  
  RESULTS
  It is shown that users attribute a very high importance to the 'doctor-patient relationship' dimension. The following aspects 'GP patient information about his/her illness', 'Clarity of communication and explanation', and 'Whether the GP seemed listen to the patient' were evaluated by 96% of the experts as being of high importance. The coordination of GP was also considered as a very important aspect for 85% of the experts. In contrast, the aspects that belong to the organizational dimension appeared to be of relatively low importance for users.
  
  
  CONCLUSIONS
  Our results support a comprehensive approach of care and argue in favour of care reorganization following the patient-centred model. To promote organizational care reforms through the prism of the doctor-patient relationship could thus be a fruitful way to insure a better quality of care and the social acceptability of the reforms.
authors.affiliation: Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France. krucien@vjf.cnrs.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Krucien
authors.forename: Marc
authors.initials: M
authors.lastname: Le Vaillant
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pelletier-Fleury
mesh_terms: D003697:Delphi Technique; D005260:Female; D058006:General Practice / Q000458:organization & administration* / Q000592:standards; D018166:Health Care Reform / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards; D010817:Physician-Patient Relations