ABSTRACT

This PhD-study was carried out at the Research Unit for General Practice, University of Aarhus, in close cooperation with the local committees for quality improvement in general practice. The project aimed to study aspects of patients' evaluation of their general practitioner (GP). Associations between evaluations and patient and GP characteristics were examined, the GPs' experience with the evaluations were evaluated, and the impact of the questionnaire distribution method and the use of reminders were studied.

The study was performed as a national survey among patients listed with the participating GPs. The patients replied to an internationally validated questionnaire designed to evaluate 23 aspects of general practice, the EUROPEP-instrument. The GPs eventually received individual written feedback of their patients' evaluations. Finally, a survey was carried out among the evaluated GPs.

All in all 597 GPs representing 12 out of 16 Danish regions were evaluated. Replies from 48,530 patients were included in the analyses. The results showed that there was an increasing satisfaction with an increasing age of the patients and with an increasing frequency of attending a GP. Patients suffering from a chronic disease were more satisfied with their care than patients, who did not. Positive patient evaluations of the GPs' interpersonal and medical skills were associated with young GPs and GPs working long weekly hours, while a high number of practice staff and listed patients were associated with less positive evaluations of practice' accessibility. Regarding this aspect GPs in single-handed practices gained far the most positive evaluations.

More than 3/4 of the evaluated GPs reported to have learnt something from their patient evaluation that they could apply to daily practice. More than 1/2 the GPs had made changes in practice or other activities in order to improve practice, and 1/3 reported that the patient evaluation had raised their attention to the patient perspective on the quality of general practice care. More than 3/4 would recommend a patient evaluation to a colleague and would do another patient evaluation if invited.

We found the evaluations following a reminder to be more critical than primary evaluations, but with no significant impact on the aggregated individual GP evaluations. Furthermore, mail distribution of the questionnaires produced slightly, but statistically significantly more critical evaluations compared to the handing out by the GPs themselves.

The results are applicable to future quality improvement in general practice in the patient perspective. Further studies of factors underlying the found associations may improve this applicability. In addition, we still need knowledge about how to implement the individual GPs' evaluation results in their practice.