title: Comparing importance and performance from a patient perspective in English general practice: a cross-sectional survey.
abstract: BACKGROUND
  Patient experience and satisfaction are important indicators of quality in health care. Little is known about where to prioritize efforts to improve patient satisfaction.
  
  
  OBJECTIVE
  To investigate patient satisfaction with primary care, as part of the Quality and Costs of Primary Care in Europe study in England, identifying areas where improvements could be made from patients' perspectives.
  
  
  METHODS
  We conducted a questionnaire survey of general practice patients in three English regions. Patient Values questionnaires assessed what patients thought was important, and Patient Experience questionnaires rated performance of primary care. Fifteen attributes of care were compared using Importance Performance Analysis, a method that simultaneously represents data on importance and performance of a service, enabling identification of its strengths and weaknesses.
  
  
  RESULTS
  Patients rated both 'relational' and 'functional' aspects of care as important. Satisfaction with general practice could be improved by concentrating on specific aspects of access (ensuring that patients know how to access out-of-hours services and find it easy to get an appointment), and one aspect of empowerment (after their visit, patients feel able to cope better with their health problem/illness). However, for other attributes (e.g. proximity of the practice to a patient's house or, a short waiting time when contacting the practice), investing additional resources is not likely to increase patient satisfaction.
  
  
  CONCLUSIONS
  Attributes needing most improvement concerned access to primary care and patient empowerment. More research is needed to identify how to improve access without generating unnecessary additional demand or compromising continuity of care.
authors.affiliation: School of Health and Social Care and.
authors.forename: Coral
authors.initials: C
authors.lastname: Sirdifield
authors.affiliation: School of Health and Social Care and.
authors.forename: Ana
authors.initials: A
authors.lastname: Godoy Caballero
authors.affiliation: School of Health and Social Care and.
authors.forename: Karen
authors.initials: K
authors.lastname: Windle
authors.affiliation: School of Health and Social Care and.
authors.forename: Christine
authors.initials: C
authors.lastname: Jackson
authors.affiliation: School of Social and Political Sciences, University of Lincoln, Lincoln, UK and.
authors.forename: Stephen
authors.initials: S
authors.lastname: McKay
authors.affiliation: NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Willemijn
authors.initials: W
authors.lastname: Schäfer
authors.affiliation: School of Health and Social Care and nsiriwardena@lincoln.ac.uk.
authors.forename: A Niroshan
authors.initials: AN
authors.lastname: Siriwardena
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D058006:General Practice / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011320:Primary Health Care; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: Family practice; patient satisfaction; patient-centered care; primary care; quality improvement.