NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands.
Health Serv Res. 2018 Aug;53(4):2047-2063. doi: 10.1111/1475-6773.12754. Epub 2017 Dec 29.
To contribute to the current knowledge on how a broad range of services offered by general practitioners (GPs) may contribute to the patient perceived quality and, hence, the potential benefits of primary care.
Between 2011 and 2013, primary care data were collected among GPs and their patients in 31 European countries, plus Australia, Canada, and New Zealand. In these countries, GPs are the main providers of primary care, mostly specialized in family medicine and working in the ambulatory setting.
In this cross-sectional study, questionnaires were completed by 7,183 GPs and 61,931 visiting patients. Moreover, 7,270 patients answered questions about what they find important (their values). In the analyses of patient experiences, we adjusted for patients' values in each country to measure patient perceived quality. Perceived quality was measured regarding five areas: accessibility and continuity of care, doctor-patient communication, patient involvement in decision making, and comprehensiveness of care. The range of GP services was measured in relation to four areas: (1) to what extent they are the first contact to the health care system for patients in need of care, (2) their involvement in treatment and follow-up of acute and chronic conditions, in other words treatment of diseases, (3) their involvement in minor technical procedures, and (4) their involvement in preventive treatments.
Data of the patients were linked to the data of the GPs. Multilevel modeling was used to construct scale scores for the experiences of patients in the five areas of quality and the range of services of GPs. In these four-level models, items were nested within patients, nested in GP practices, nested in countries. The relationship between the range of services and the experiences of patients was analyzed in three-level multilevel models, also taking into account the values of patients.
In countries where GPs offer a broader range of services patients perceive better accessibility, continuity, and comprehensiveness of care, and more involvement in decision making. No associations were found between the range of services and the patient perceived communication with their GP. The range of GP services mostly explained the variation between countries in the areas of patient perceived accessibility and continuity of care.
This study showed that in countries where GP practices serve as a "one-stop shop," patients perceive better quality of care, especially in the areas of accessibility and continuity of care. Therefore, primary care in a country is expected to benefit from investments in a broader range of services of GPs or other primary care physicians.
为当前关于全科医生（GP）提供的广泛服务如何有助于患者感知质量，进而有助于初级保健潜在效益的知识做出贡献。
2011 年至 2013 年间，在 31 个欧洲国家以及澳大利亚、加拿大和新西兰，收集了全科医生及其患者的初级保健数据。在这些国家，全科医生是初级保健的主要提供者，他们大多专门从事家庭医学，并在门诊环境中工作。
在这项横断面研究中，7183 名全科医生和 61931 名就诊患者完成了问卷调查。此外，7270 名患者回答了他们认为重要的问题（他们的价值观）。在分析患者体验时，我们根据每个国家的患者价值观进行了调整，以衡量患者感知的质量。感知质量在五个方面进行了衡量：医疗服务的可及性和连续性、医患沟通、患者参与决策以及医疗服务的全面性。全科医生服务的范围在四个方面进行了衡量：（1）他们是否是需要医疗服务的患者接触医疗保健系统的第一联系人；（2）他们在急性和慢性疾病的治疗和随访中的参与程度，即疾病的治疗；（3）他们在小型技术操作中的参与程度；（4）他们在预防治疗中的参与程度。
将患者的数据与全科医生的数据相关联。使用多水平模型为患者在五个质量领域的体验和全科医生服务范围构建量表得分。在这些四水平模型中，项目嵌套在患者内，嵌套在全科医生实践内，嵌套在国家内。在三级多水平模型中分析了服务范围与患者体验之间的关系，同时考虑了患者的价值观。
在全科医生提供更广泛服务的国家，患者感知到更好的医疗服务可及性、连续性和全面性，以及更多的参与决策。在患者感知与他们的 GP 沟通方面，服务范围与服务范围之间没有关联。全科医生服务范围主要解释了患者感知的可及性和连续性在国家之间的差异。
本研究表明，在全科医生诊所充当“一站式服务”的国家，患者感知到更好的医疗服务质量，特别是在可及性和连续性方面。因此，预计国家的初级保健将受益于对全科医生或其他初级保健医生提供的更广泛的服务范围进行投资。
