Dataset Information

Doctor and practice characteristics associated with differences in patient evaluations of general practice.

ABSTRACT:

Background

Variation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context. However, the extent to which differences in patients' evaluation of the GPs are associated with differences in GP and practice characteristics must also be ascertained in order to facilitate comparison of adjusted patient evaluations between GPs. The aim of this study was to determine such associations in a setting where GPs serve a list of patients and act as gatekeepers.

Methods

We carried out a patient evaluation survey among voluntarily participating GPs using the EUROPEP questionnaire, which produced 28,260 patient evaluations (response rate 77.3%) of 365 GPs. In our analyses we compared the prevalence of positive evaluations in groups of GPs.

Results

Our principal finding was a negative association between the GP's age and the evaluation of all aspects, except accessibility. We also found an association between the way the practice was organised and the patients' evaluation of accessibility, with GPs in single-handed practices getting far the most positive evaluations. Long weekly working hours were associated with more positive evaluations of all dimensions except accessibility, whereas more than 0.5 full-time employees per GP, a higher number of listed patients per GP and working in a training practice were associated with negative evaluation of accessibility.

Conclusion

GP characteristics are mainly associated with patients' experience of interpersonal aspects of care, while practice characteristics are associated with evaluation of accessibility. These differences need to be accounted for when comparing patient evaluations of different practices.

SUBMITTER: Heje HN

PROVIDER: S-EPMC1855053 | biostudies-literature | 2007 Apr

REPOSITORIES: biostudies-literature

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Publications

Doctor and practice characteristics associated with differences in patient evaluations of general practice.

Heje Hanne N HN Vedsted Peter P Sokolowski Ineta I Olesen Frede F

BMC health services research 20070403

<h4>Background</h4>Variation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context. However, the extent to which differences in patients' evaluation of the GPs are associated with differences in GP and practice characteristics must also be ascertained in order to facilitate comparison of adjusted patient evaluations between GPs. The aim of this study was to determine such associations in a setting where GPs s ...[more]

PMID: 17407605

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Project description:BACKGROUND: It has now for many years been recognised that patient evaluations should be undertaken as an integral part of the complex task of improving the quality of general practice care. Yet little is known about the general practitioners' (GPs') benefit from patient evaluations. Aim 1 was to study the impact on the GPs of a patient evaluation and subsequent feedback of results presented at a plenary session comprising a study guide for the results and group discussions. Aim 2 was to study possible facilitators and barriers to the implementations of the results raised by the patient evaluation process. METHODS: A patient evaluation survey of 597 voluntarily participating GPs was performed by means of the EUROPEP questionnaire. Evaluation results were fed back to the GPs as written reports at a single feedback meeting with group discussions of the results. Between 3 and 17 months after the feedback, the 597 GPs received a questionnaire with items addressing their experience with and perceived benefit from the evaluations. RESULTS: 79.4% of the GPs responded. 33% of the responding GPs reported that the patient evaluation had raised their attention to the patient perspective on the quality of general practice care. Job satisfaction had improved among 26%, and 21% had developed a more positive attitude to patient evaluations. 77% of the GPs reported having learnt from the evaluation. 54% had made changes to improve practice, 82% would recommend a patient evaluation to a colleague and 75% would do another patient evaluation if invited. 14% of the GPs had become less positive towards patient evaluations, and job satisfaction had decreased among 3%. CONCLUSIONS: We found a significant impact on the GPs regarding satisfaction with the process and attitude towards patient evaluations, GPs' attention to the patients' perspective on care quality and their job satisfaction. Being benchmarked against the average seemed to raise barriers to the concept of patient evaluations and difficulties interpreting the results may have formed a barrier to their implementation which was partly overcome by adding qualitative data to the quantitative results. The GPs' significant willingness to share and discuss the results with others may have served as a facilitator.

Project description:ImportanceBiosimilars, or highly similar versions of complex biologic drugs, have the potential to slow drug spending growth; however, biosimilar uptake in the United States has been slow. Little is known about barriers to biosimilar uptake following drug launch.ObjectiveTo examine the patient, physician, and practice characteristics associated with biosimilar use in the Medicare population.Design, setting, and participantsThis cross-sectional study used regression analysis to estimate the association between biosimilar use and various characteristics. Medicare fee-for-service beneficiaries who received a filgrastim product or an infliximab product between the launch of a class's first biosimilar (quarter 3 2015 for filgrastim-sndz and quarter 4 2016 for infliximab-dyyb) and December 2018. Data analysis was conducted from March to November 2020.ExposuresPatient demographic characteristics and product clinical indications; physician demographic characteristics, specialty, and volume of filgrastim or infliximab biologic administration; hospital size, ownership, 340B status, academic medical center status, and system affiliation; physician office size and multispecialty status.Main outcomes and measuresAdministration of a filgrastim or infliximab biosimilar.ResultsThe final filgrastim sample included 25 870 patients (11 857 [45.8%] men; 14 224 [55.0%] aged 65-74 years; 22 617 [87.4%] White individuals) who had 259 178 administrations (79 017 [30.5%] biosimilar administrations), and the final infliximab sample included 14 786 patients (4765 [32.2%] men; 8773 [59.3%] aged 65-74 years; 13 467 [91.1%] White individuals) who had 174 973 administrations (9012 [5.2%] biosimilar administrations). In adjusted analyses, no patient demographic characteristics and 2 of 9 clinical indications (22.2%) were associated with biosimilar use (filgrastim, neutropenia: adjusted difference, -2.0 [95% CI, -3.9 to -0.2] percentage points; P = .03; infliximab, Crohn disease: adjusted difference, -1.8 [95% CI, -2.9 to -0.8] percentage points; P = .001). Several physician characteristics were associated with biosimilar administrations, including high filgrastim or infliximab prescribing volume (high vs low volume, filgrastim: adjusted difference, 3.6 [95% CI, 1.5 to 5.8] percentage points; P = .001; infliximab: adjusted difference, 1.2 [95% CI, 0.3 to 2.2] percentage points; P = .007) and specialty (eg, hematologist-oncologists vs primary care, filgrastim: adjusted difference, -3.0 [95% CI, -5.4 to -0.5] percentage points; P = .02). Numerous practice characteristics were associated with biosimilar use, including practice setting (outpatient hospital department vs office practice, filgrastim: adjusted difference, -16.1 [95% CI, -18.1 to -14.1] percentage points; P < .001; infliximab: adjusted difference, 3.0 [95% CI, 2.2 to 3.7] percentage points; P < .001) and hospital outpatient department ownership status (for-profit vs not-for-profit, filgrastim: adjusted difference, -17.4 [95% CI, -21.6 to -13.3] percentage points; P < .001; infliximab: adjusted difference, 10.8 [95% CI, 6.7 to 14.9] percentage points; P < .001).Conclusions and relevanceIn this study, practice setting and hospital ownership status had the largest associations with biosimilar usage, suggesting practices play a role in steering physicians toward certain medications. However, the types of practices with high biosimilar use differed by drug class. Further research is needed to understand the reasons for these differences across drug classes.

Project description:BACKGROUND:Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients' medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). METHODS:This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon's Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. RESULTS:Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical staff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP's preference for their children's practice (p?<?0.05). Most MPs hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. CONCLUSION:The MP's and GP's views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.

Project description:PurposeThe aim of this study was to identify patient-related characteristics that affect the predictive validity of the FCE assessment ELA.MethodsA prospective multicenter study was conducted on 303 patients with musculoskeletal disorders (MSD) recruited from eleven rehabilitation centers. The ELA-based estimation of the participants' ability to cope with physical work demands was considered valid if RTW was paired with a positive ELA outcome (≥ moderate) as well as if non-RTW was accompanied by a negative ELA outcome (rather or very poor). In the remaining cases, the ELA result was judged as non-valid. To reduce the risk of false conclusions, the rating was performed inversely in participants that (1) reported severe limitations regarding their productivity at work, (2) attributed RTW to a change in job resp. a reduction of their physical work demands and in those that (3) attributed non-RTW to non-physical reintegration barriers only. Using questionnaires, 28 patient-related characteristics were collected. Logistic regression models were calculated to identify characteristics that affected the predictive validity of ELA.ResultsELA was considered valid in 208 of 303 (69%) participants. A moderate and strong pain-related disability at work were associated with a 0.15-fold (95% confidence interval (95% CI) 0.05-0.46), respectively, 0.19-fold (95% CI 0.05-0.72) chance for a valid outcome. In addition, a negative influence was found in participants that reported psychosocial distress (odds ratio (OR) 0.35; 95% CI 0.15-0.82), a native language different from the national language (OR 0.16; 95% CI 0.05-0.56) as well as in those that expected to return to work, but not within one month (OR 0.17; 95% CI 0.06-0.46). Further variables-including age, employment status, fear-avoidance beliefs and the level of physical work demands-did not affect the predictive validity of ELA.ConclusionsThe results suggest that the predictive validity of ELA is primarily limited by patients that report a moderate or strong pain-related disability at work, psychosocial distress as well as the expectation to return to work, but not within one month. Furthermore, a negative influence can be assumed for language barriers.

Project description:BackgroundAccounting for justifiable variance is important for fair comparisons of treatment quality. The variance between general practices in treatment quality of type 2 diabetes (T2DM) patients may be attributed to the underlying patient population and practice characteristics. The objective of this study is to describe the between practice differences in treatment, and identify patient and practice level characteristics that may explain these differences.MethodsThe data of 24,607 T2DM patients from 183 general practices in the Netherlands were used. Treatment variance was assessed in a cross-sectional manner for: glucose-lowering drugs/metformin, lipid-lowering drugs/statins, blood pressure-lowering drugs/ACE-inhibitor or ARB. Patient characteristics tested were age, gender, diabetes duration, comorbidity, comedication. Practice characteristics were number of T2DM patients, practice type, diabetes assistant available. Multilevel logistic regression was used to examine the between practice variance in treatment and the effect of characteristics on this variance.ResultsTreatment rates varied considerably between practices (IQR 9.5-13.9). The variance at practice level was 7.5% for glucose-lowering drugs, 3.6% for metformin, 3.1% for lipid-lowering drugs, 10.3% for statins, 8.6% for blood pressure-lowering drugs, and 3.9% for ACE-inhibitor/ARB. Patient and practice characteristics explained 19.0%, 7.5%, 20%, 6%, 9.9%, and 13.4% of the variance respectively. Age, multiple chronic drugs, and ≥3 glucose-lowering drugs were the most relevant patient characteristics. Number of T2DM patients per practice was the most relevant practice characteristic.DiscussionConsiderable differences exist between practices in treatment rates. Patients' age was identified as characteristic that may account for justifiable differences in especially lipid-lowering treatment. Other patient or practice characteristics either do not explain or do not justify the differences.

Dataset Information

Doctor and practice characteristics associated with differences in patient evaluations of general practice.

Background

Methods

Results

Conclusion

Publications

Doctor and practice characteristics associated with differences in patient evaluations of general practice.

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