Senior Research Associate, Department of Public Health and Primary Care, University of Cambridge, UK.
MPhil Student, Department of Public Health and Primary Care, University of Cambridge, UK; Resident Physician, Department of Medicine, University of California San Francisco, USA.
J Health Serv Res Policy. 2021 Jul;26(3):198-207. doi: 10.1177/1355819620986814. Epub 2021 Jan 31.
Younger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England.
We considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends.
We included 5,241,408 responses over 11 survey waves from 2011-2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio-economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas.
There have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.
年轻人、少数族裔、性少数群体和社会经济地位较低的人群报告称，他们在初级保健方面的体验较差。鉴于国民保健制度有减少护理服务中不必要的差异的目标，我们旨在利用英格兰全科医生患者调查的数据，调查初级保健患者体验的不平等是否在 2011 年至 2017 年间发生了变化。
我们考虑了在五个患者体验维度（总体体验、医生沟通、护士沟通、获得护理的机会和护理的连续性）方面，与年龄、性别、贫困程度、种族、性取向和地理位置相关的不平等。我们使用线性回归来探索 2011 年至 2017 年间不平等程度是否发生了变化，使用混合模型评估实践内的变化，并在不考虑实践的情况下评估国家趋势的模型。
我们纳入了 2011-2017 年 11 次调查中的 5241408 个回应。有证据表明不平等状况随时间发生了变化（27/30 个模型的 p 值均<0.05），但变化的方向和幅度有所不同。体验差距的变化范围从性少数群体获得护理机会的体验增加 1.6 个百分点，到连续性的体验恶化 5.6 个百分点不等，年龄越大体验越差。同一全科医生就诊的患者中，社会经济地位与获得护理机会之间的不平等相对稳定；在来自较贫困/较富裕地区的受访者中，全国范围内获得护理机会的不平等增加了 2.1 个百分点（p<0.0001），这表明在较贫困地区的实践中，获得护理的机会下降最快。
2011 年至 2017 年间，初级保健患者体验方面的不平等变化不大。
