Are people's health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries.
Australia
Canada
Europe
Female
Health Services Accessibility
/ statistics & numerical data
Hospitalization
/ statistics & numerical data
Humans
Internationality
Male
New Zealand
Patient Satisfaction
/ statistics & numerical data
Physician-Patient Relations
Primary Health Care
/ methods
Quality of Health Care
/ statistics & numerical data
Surveys and Questionnaires
Health Services Research
primary care
Journal
Primary health care research & development
ISSN: 1477-1128
Titre abrégé: Prim Health Care Res Dev
Pays: England
ID NLM: 100897390
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
entrez:
18
8
2020
pubmed:
18
8
2020
medline:
22
10
2020
Statut:
epublish
Résumé
This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
Sections du résumé
AIM
This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study.
BACKGROUND
Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences.
METHODS
Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling.
FINDINGS
Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care.
CONCLUSIONS
The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
Identifiants
pubmed: 32800009
pii: S1463423619000434
doi: 10.1017/S1463423619000434
pmc: PMC6609545
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e104Références
Soc Sci Med. 2017 Aug;186:139-147
pubmed: 28647664
Health Serv Res. 2003 Jun;38(3):831-65
pubmed: 12822915
Health Serv Res. 2018 Aug;53(4):2047-2063
pubmed: 29285763
Health Policy. 2015 Dec;119(12):1576-83
pubmed: 26319096
Qual Prim Care. 2013;21(2):67-79
pubmed: 23735688
Health Serv Res. 2017 Dec;52(6):2099-2120
pubmed: 28217969
BMC Fam Pract. 2015 Feb 18;16:20
pubmed: 25879427
BMC Fam Pract. 2015 Dec 02;16:172
pubmed: 26631138
Lancet. 2016 Apr 30;387(10030):1811
pubmed: 27203497
Br J Gen Pract. 2012 Jul;62(600):e522-4
pubmed: 22782000
Int J Public Health. 2016 May;61(4):443-54
pubmed: 27032868
Aust J Prim Health. 2015;21(2):254-8
pubmed: 24581281
Br J Gen Pract. 2013 Nov;63(616):e742-50
pubmed: 24267857
Scand J Prim Health Care. 2016;34(1):97-110
pubmed: 26862927
Med Care Res Rev. 2018 Jun;75(3):292-311
pubmed: 27927838
Health Policy. 2018 Oct;122(10):1070-1077
pubmed: 30041912
Lancet. 1994 Oct 22;344(8930):1129-33
pubmed: 7934497
Bull World Health Organ. 2015 Mar 1;93(3):161-8
pubmed: 25883409
Milbank Q. 2005;83(3):457-502
pubmed: 16202000
BMC Med Inform Decis Mak. 2015 Aug 22;15:70
pubmed: 26296994
BMC Health Serv Res. 2018 Feb 21;18(1):132
pubmed: 29466980
Fam Pract. 2016 Feb;33(1):42-50
pubmed: 26511726
Int J Qual Health Care. 2018 Feb 01;30(1):9-15
pubmed: 29281026
BMC Fam Pract. 2011 Oct 20;12:115
pubmed: 22014310
Scand J Prim Health Care. 2016;34(1):5-12
pubmed: 26849246
Lancet. 2015 Nov 28;386(10009):2119-21
pubmed: 26638948
BMC Fam Pract. 2020 Mar 17;21(1):54
pubmed: 32183771
BMC Health Serv Res. 2010 Mar 13;10:65
pubmed: 20226084
BMC Fam Pract. 2014 Sep 02;15:149
pubmed: 25183554
Int J Family Med. 2016;2016:4929432
pubmed: 27047689
JAMA. 1988 Sep 23-30;260(12):1743-8
pubmed: 3045356