Association between family doctors' practices characteristics and patient evaluation of care

BackgroundPatients' evaluations of primary care are influenced by three major dimensions: patients', family doctors' and practices' characteristics. A lot of primary care practices use possibilities of new information technologies, such as chronic patients' electronic registers, clinical guideline support systems, electronic medical records and clinical decision system. The aim of this study was to determine possible effects of quality characteristics of family doctors' practices on patients' satisfaction.MethodsThis observational cross-sectional study in 36 randomly selected family doctors' practices, stratified to practices' size and urbanization was performed between 2008 and 2009. Each practice included 100 randomly selected adult patients: 30 high-risk patients for CVD, but without a history of CVD, 30 patients with an established coronary disease, and 40 healthy adult patients (aged 18-45 years). Data was collected with a questionnaire, used in European Practice Assessment of Cardiovascular risk management (EPA Cardio study), and with European Patients Evaluation of general practice care (EUROPEP) questionnaire.ResultsFinal sample consisted of 2482 patients (68.9% response rate). Higher satisfaction scores were associated with worse self-rated patients' health status, with patients visiting practices where quality report was provided, where clinical audit in the past 12 months existed, where number of population attending practice quarterly was lower, where systematic reviewing of prescribed medication was not available, where annual report was not provided, where doctor did not have access to medical literature, and where patients' attendance rate for preventive check-ups was not available. Patients with higher risk for CVD were also more satisfied.ConclusionThe effect of practice characteristics associated with organisational access to services, chronic patients' management and some quality improvement factors is unclear and not always in favour of higher satisfaction score. Further studies are needed.