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Access to the general practitioner: a study examining the access to the general practitioner from the patient's point of view, a comparison of three forms of organizations

Pezij, Jan-willem (2009) Access to the general practitioner: a study examining the access to the general practitioner from the patient's point of view, a comparison of three forms of organizations.

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Abstract:(GP) plays a key role in securing equity and effectiveness in delivering health care. Nowadays, GPs are often part of primary care centres and it is foreseen that these centres will play an even more important role in future health service delivery. A European comparison in nine different countries concluded patients favour small practices and full time GPs. The percentage of GPs working in small practices varies between countries. In the UK the percentage is 16% whereas in Belgium the percentage is 69% and in the Netherlands the percentage is 39%. Continuity of care and access is highly appreciated by patients. For instance, it has been shown that patients are more satisfied with primary care if they always have the same GP and if they experience short waiting times. Given the development of larger primary care centres, people are hesitant if the current GP service levels can be maintained. On the other hand, an advantage of primary care centres is that they do offer multiple medical services like pharmacy and physiotherapy. The purpose of this study was two-fold. First, it was questioned which type of services is preferred by patients in three different GP settings and if people would be willing to pay for these services. Second, we wish to investigate differences between patients in different GP settings. The selected GP settings were (1) a single handed practice (SHP), (2) a shared facility practice (GP) and (3) a comprehensive primary care centre (CPCC). A discrete choice experiment (DCE) was carried out among 164 patients in the three different GP settings. The DCE comprised 6 attributes including (1) time to appointment, (2) choice of time, (3) access by telephone, (4) consultation time, (5) availability of other medical services and (6) WTP. Sample size for the DCE was estimated at about 50 patients in each GP setting. The DCE included 6 attributes. The maximum number of levels for an attribute was three, allowing 72 choice combinations. The DCE survey used 15 random and 2 fixed choice sets. Following the DCE, all 164 and an extra group of 114 patients (278 in total) were interviewed. DCE data were analyzed using sawtooth software. Demographic data of patients in each in the three GP settings were comparable. The DCE showed preference for improved telephone services and time to appointment as most important attributes. Except for "availability of other medical services" no large differences were found between the GP settings. Only patients in the SFP group accepted longer waiting times compared to SHP and CPCC. SHP and CPCC patients did prefer to have access within 24 hours, whereas SHP patients accepted longer waiting times. Overall, most important attributes were "time to appointment", "access of service by telephone" and "WTP". The availability of pharmacy services was preferred by all patients. This study shows a similar outcome compared to previous studies on access to GP services. "Time to first appointment" and "access by telephone" are most important factors to consider by patients. However, an interesting finding was that one third of all patients were willing to pay for improved services. The DCE study didn't show big differences in preferences between patients in the different GP settings. In some aspects the CPCC scored better compared to SHP and SFP. As a result according to the patients the CPCC provides the best access to the GP. But the organizational form is not the key to good access. The most important factor is the way a GP-practice is organized, regardless of the organizational form.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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