Internal 2010 - Patient Satisfaction with Primary Care

The GP Patient Survey (GPPS)Analysis

ResulsSummary

Patient Satisfaction with Primary CareAn analysis of the 2007-08 GP patient survey data

Evangelos Kontopantelis1 Martin Roland2

David Reeves1

1National Primary Care Research and Development CentreUniversity of Manchester

2General Practice and Primary Care Research UnitUniversity of Cambridge

NPCRDC Internal Seminar, 9th March 2010

Kontopantelis GP patient satisfaction


ResulsSummary

Outline

1 The GP Patient Survey(GPPS)

General Information2 Analysis

Descriptive statisticsObjectivesThe dataThe method

3 ResulsModel AModel BModel COverview

4 SummaryConclusionsDiscussion



ResulsSummary

General Information

Background

Annual national survey, starting in2006/07.Set out to measure patientexperience/satisfaction with accessto their GP.Ipsos MORI conducted the surveyon behalf of the DoH.Questionnaire mailed directly topatients randomly selected frompractices’ registered lists.Practicipating practices were/arerewarded, based on the outcome ofthe survey.



ResulsSummary

General Information

The second year: 2007/08

DoH budgeted around£10million.8,307 English generalpractices were included (of8,403 identified, participationof 98.9%).A total of 1,999,523 validresponses was received froma total sample of 5 millionpeople, a response rate of41%.



ResulsSummary

General Information

The main outcomes

Five main outcomes on experience and opinions of theservice patients received from their general practice, overthe last 6 months:

Satisfaction with getting through to someone on the phone.Ability to get an appointment on the same day or on thenext 2 days the surgery was open.Ability to get an appointment more than 2 full days inadvance.Ability to make an appointment with a particular doctor(even if it meant waiting for longer).Satisfaction with the hours the surgery was open.



ResulsSummary


Patient information

Numbers of missing valueswere low (1-4%).57% of respondents werefemale.52% aged 55 or over.78% described themselvesas White British.40% of respondentsreported at least onelong-term condition.

6%3%

6%7%

EthnicityWhite British Other White Black Asian Other

78%

6%3%

6%7%

EthnicityWhite British Other White Black Asian Other



ResulsSummary


Patient information...continued

48% were working & 55% ofthese worked typical officehours.69% of the workingrespondents could take timeaway from work to visit theirGP surgery.48% had visited their GPsurgery in the last 3 months.Only 12% had not made anyappointments in the last 12months.

9% 2%

EmploymentFull‐time paid work Part‐time paid work

Full‐time education Unemployed

Permanently sick or disabled Fully retired from work

Looking after home Doing something else

37%

12%2%3%6%

29%

9% 2%

EmploymentFull‐time paid work Part‐time paid work

Full‐time education Unemployed

Permanently sick or disabled Fully retired from work

Looking after home Doing something else



ResulsSummary


Overall levels of satisfaction & positive experiencegetting through on the phone, in the last 6 months (satisfaction item)

Patients were verysatisfied with howeasy it was to getthrough tosomeone on thephone at theirpractice (86%).

0

10

20

30

40

50

60

70

80

90

100

%

Whit

e Brit

ish

Other

whit

eBlac

kAsia

nOth

er

by ethnicity

In general, are you satisfied with how easy it is to get throughto someone on the phone at your doctor’s surgery?

No Yes

050

010

00F

requ

ency

20 40 60 80 100Satisfied with getting through on the phone

practice means



ResulsSummary


Overall levels of satisfaction & positive experienceurgent appointment, in the last 6 months (experience item)

60% ofrespondents hadtried to get anappointment with adoctor fairlyquickly and 85%were successful intheir attempt.

0

10

20

30

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50

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100

%

Whit

e Brit

ish

Other

whit

eBlac

kAsia

nOth

er

by ethnicity

Think about the last time you tried to get an appointment with a doctorfairly quickly: Were you able to get the appointment on the same day

or on the next 2 days the surgery was open?

No Yes

020

040

060

080

0F

requ

ency

20 40 60 80 100Able to get the appointment on the same day or on the next 2 days

practice means



ResulsSummary


Overall levels of satisfaction & positive experienceadvance appointment, in the last 6 months (experience item)

45% ofrespondentswanted to bookahead for anappointment withany doctor in theirpractice, with alarge percentagebeing successful(75%).

0

10

20

30

40

50

60

70

80

90

100

%

Whit

e Brit

ish

Other

whit

eBlac

kAsia

nOth

er

by ethnicity

Last time you wanted to, were you able to get an appointmentwith a doctor more than 2 full days in advance?

No Yes

020

040

060

0F

requ

ency

0 20 40 60 80 100Able to get an appointment more than 2 full days in advance

practice means



ResulsSummary


Overall levels of satisfaction & positive experienceappointment with a particular doctor, in the last 6 months (experience item)

49% ofrespondentswanted to make anappointment with aparticular doctor intheir practice, and86% weresuccessful, even ifit meant waitinglonger.

0

10

20

30

40

50

60

70

80

90

100

%

Whit

e Brit

ish

Other

whit

eBlac

kAsia

nOth

er

by ethnicity

Last time you wanted to, were you able to make an appointmentwith a particular doctor − even if it meant waiting longer?

No Yes

050

010

00F

requ

ency

0 20 40 60 80 100Able to make an appointment with a particular doctor

practice means



ResulsSummary


Overall levels of satisfaction & positive experienceopening hours, in the last 6 months (satisfaction item)

Satisfaction withpractices’ openinghours was high(80%) with themost prevalentreasons fordissatisfactionbeing practice notopen on Saturdays(32%) and notopen late enough(23%).

0

10

20

30

40

50

60

70

80

90

100

%

Whit

e Brit

ish

Other

whit

eBlac

kAsia

nOth

er

by ethnicity

Over the last 6 months or so, were you satisfied with the hoursyour GP surgery was open?

No Yes

020

040

060

080

0F

requ

ency

40 60 80 100Satisfied with the hours your GP surgery was open in last 6 months

practice means



ResulsSummary


Overall levels of satisfaction & positive experienceopening hours, in the last 6 months (satisfaction item)

Satisfaction withpractices’ openinghours was high(80%) with themost prevalentreasons fordissatisfactionbeing practice notopen on Saturdays(32%) and notopen late enough(23%).

0

10

20

30

40

50

60

70

80

90

100

%

Full−t

ime

paid

work

Part−

time

paid

work

Full−t

ime

educ

ation

Unem

ploye

d

Perm

anen

tly si

ck o

r disa

bled

Fully r

etire

d fro

m w

ork

Look

ing a

fter h

ome

Doing

som

ethin

g els

e

by employment status

Over the last 6 months or so, were you satisfied with the hoursyour GP surgery was open?

No Yes

0102030405060708090

100

%

Full−t

ime

paid

work

Part−

time

paid

work

Full−t

ime

educ

ation

Unem

ploye

d

Perm

anen

tly si

ck o

r disa

bled

Fully r

etire

d fro

m w

ork

Look

ing a

fter h

ome

Doing

som

ethin

g els

e

by employment status

I was dissatisfied with the opening hours of my practice, because...

Not open early enough Not open at lunchtimesNot open late enough Not open on SaturdaysNot open on Sunday Of some other reason



ResulsSummary


Aim of the analysisSatisfaction was high but we really want to...

Understand the factors that drive patient satisfaction andexperience with access to primary care.Measure the variability in practice performance that can beexplained by the characteristics of:

The patients.The practices.The region.



ResulsSummary


Three levels of dataPatient: Practice: Region

The patient level data from the survey were combined withpractice and region level data, from other sources:

General Medical Services (GMS) database 2006.Super Output Area Indices of Multiple Deprivation (SOAIMD) 2004.Quality and Outcomes Framework (QOF), results for2006/07.Census 2001.Primary Care Trust data.



ResulsSummary


Three levels of dataPatient: Practice: Region

Patient level:Gender, age, number of appointments, parent, employmentstatus, duration of journey from home to work, typicalworking hours, ability to take time away from work to visitGP, limiting longterm conditions, carer, ethnicity.

Practice level:Deprivation, rurality, list size, contract type, FTE ratio, QOFyear 3 reported achievement, total hours, extendedopening, emergency admissions, GP referrals, SMR, newregistrations.

Regional level:PCT practice staff number, PCT walk in centre attendance(for only 31.8% of the PCTs), Strategic Health Authority.



ResulsSummary


Analysis approachGeneral information

Multilevel multivariate regression was used to investigaterelationships between each domain ofsatisfaction-experience and patient, practice and regionalcharacteristics.We began with univariate analyses, which examined eachpredictor separately, and followed these up with amultivariate analysis which controlled for inter-relationshipsbetween predictors.Since the outcome variables were binary (e.g. satisfied -not satisfied) in nature, we adopted a logistic regressionapproach.



ResulsSummary


Analysis approach...some details

Large sample allowed a listwise deletion approach for theanalysis, avoiding less robust approaches.Removed variables where the variance inflation factor wasgreater than 4.Total practice opening hours and extended opening wereexcluded (were only available for 53% of the sample).The full hierarchical nature of the data could not bemodelled, therefore we compromised by using a two-levelmodel that took account of the nesting of respondentswithin practices, and effectively assigned the regionalvariables to the individual practices.



ResulsSummary


Analysis approach...the models

Three different multilevel regression models......on all respondends (model A)....on respondends working full- or part-time (model B)....on all respondents but including patient/practice levelinteractions for the variables found to be the strongestpredictors in model A (model C).



ResulsSummary

Model AModel BModel COverview

Logistic multilevel regression on all respondentsPatient-level predictors

Only three patient-level variables impacted all five domainsof satisfaction and experience to a notable degree: age,employment status and ethnicity.Satisfaction and positive experience...

increased in level with increasing age.was lower amongst those working full-time than in anyother group.was in most instances lower for ethnic minority groups, andin particularly amongst the Asian community.



ResulsSummary


Logistic multilevel regression on all respondentsPractice-level predictors

All domains ofsatisfaction &experience wereheavily influencedby practice sizewith the exceptionof satisfaction withpractice surgeryhours.

0

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%

2000

4000

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1000

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1800

0

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064

57

Practice list size

Satisfaction with the ability to get through to someone on the phone

Able to gen an appointment on the same or next 2 days

Able to get an appointment more than 2 full days in advance

Able to make an appointment with a particular doctor

all other regression parameters are assumed fixed to their mean valuesvertical grid line corresponds to mean observed listsize

Using results from multivariate regression with all respondents

Satisfaction/experience as affected by practice listsize



ResulsSummary


Logistic multilevel regression on all respondentsPractice-level predictors

All domains ofsatisfaction &experience wereheavily influencedby practice sizewith the exceptionof satisfaction withpractice surgeryhours.

0

20

40

60

80

100

% o

f pos

itive

res

pons

es

<1 1−2

2−3

3−4

4−6

6−88−

10

10−1

2>=

12

Phone access

0

20

40

60

80

100

% o

f pos

itive

res

pons

es

<1 1−2

2−3

3−4

4−6

6−88−

10

10−1

2>=

12

Appointment within 2 days

0

20

40

60

80

100%

of p

ositi

ve r

espo

nses

<1 1−2

2−3

3−4

4−6

6−88−

10

10−1

2>=

12

Advance appointment (>2 days)

0

20

40

60

80

100

% o

f pos

itive

res

pons

es

<1 1−2

2−3

3−4

4−6

6−88−

10

10−1

2>=

12

Appointment with a particular GP

Practice size in 1,000s of patients

by practice list sizeSatisfaction & positive experience



ResulsSummary


Logistic multilevel regression on all respondentsRegion-level predictors

Strategic HealthAuthority was the onlypredictor of note.Patients in the NE werethe most satisfied andwith better experiences.Variability was large forgetting through on thephone and advanceappointments but smallfor same or next dayappointments.



ResulsSummary


Logistic multilevel regression on all respondentsRegion-level predictors

Strategic HealthAuthority was the onlypredictor of note.Patients in the NE werethe most satisfied andwith better experiences.Variability was large forgetting through on thephone and advanceappointments but smallfor same or next dayappointments.

£2.26 on average

Lowest in the UK

£2.72 on average

Highest in the UK



ResulsSummary


Logistic multilevel regression on working respondentsErm...why?

Employment status was the most important patient-levelpredictor in the main analysis.The sub-analysis gives us the opportunity to explore theimportance of variables specific to working respondents,which were necessarily excluded from the main analysis:

Travel time to work.Work pattern (Typical working hours).Can take time away from work to visit GP.



ResulsSummary


Logistic multilevel regression on working respondentsPredictors

Patient-level:The most notable predictor, in all domains, was the ability totake time off work to visit the GP.The effect of age and ethnicity remained undiminished.Travel time to work and work pattern had a sizeable effecton satisfaction with surgery hours.

Practice-level:Practice size’s strong effect was unchanged.Emergency admission rates were notably related tosatisfaction with telephone access and experience ofadvance appointments.

Regional-level:Strategic Health Authority again displayed a strong effect.



ResulsSummary


Logistic multilevel regression on all respondents...including patient/practice-level interactions

Are patient responses related to the distribution of certaincharacteristics in the practice population?The size of the area non-white population reducedsatisfaction and experience ratings amongst both whiteand non-whites, on all 5 domains. Greatest reduction fornon-white patients.Ratings of phone access, advance appointments andopening hours for both ’younger’ (<45) and ’older’ peopleslightly higher in areas with mainly young population.Rating of phone access,urgent appointments and openinghours were reduced amongst people working FT, andthose not, in areas of high FT employment.



ResulsSummary


Satisfaction/experience predictors (Models A&B)Moderate, strong and very strong

Phone Same,next day Advance Particular

GPOpeninghours

Age + + + ++ +Ethnicity + + + ++ +Employment ++ ++ ++ ++ +++Time away +++ +++ +++ +++ +++Travel time + + ++Work hours +++Practice size +++ ++ +++ +++Emerg. adm. ++ ++SHA +++ + +++ ++ ++



ResulsSummary


Estimated % of satisfaction/experience (Model C)Etnicity

77%80%

67%

83%

76%

89% 88%

79%

89%

82%

White respondentPractice 20% White Practice 80% White

phone urgent app advance app particular doc app opening hours



ResulsSummary


Estimated % of satisfaction/experience (Model C)Etnicity

73%

78%

64%

76%73%

87% 86%

76%

83%80%

non‐White respondentPractice 20% White Practice 80% White




ResulsSummary


Estimated % of satisfaction/experience (Model C)Age

85% 85%

73%

83%

75%

89%

85%

77%

84%

80%

'Young' (<45y) respondentPractice 20% 'young' Practice 80% 'young'




ResulsSummary


Estimated % of satisfaction/experience (Model C)Age

90% 90% 90%

84%

93%

90%

83%

91%

87%

'Old' (>=45y) respondentPractice 20% 'young' Practice 80% 'young'

80%




ResulsSummary


Estimated % of satisfaction/experience (Model C)Employment

90%

85%

77%

85%

76%

85%82%

73%

84%

73%

Working FT respondentPractice 20% WFT Practice 80% WFT




ResulsSummary


Estimated % of satisfaction/experience (Model C)Employment

92%

91%

83%

91%

88%88%

89%

90%

87%

non‐WFT respondentPractice 20% WFT Practice 80% WFT

83%

80%




ResulsSummary


Selected unadjusted percentages...of satisfaction and positive experience

Phone Same,next d Advance Particular

GPOpeninghours

Overall 86% 85% 75% 86% 80%

Ethnicity White Br 87% 87% 77% 88% 83%Asian 77% 80% 68% 77% 73%

Time awayYes 89% 87% 77% 87% 83%No 77% 74% 61% 76% 58%

Prac. size

< 2,000 94% 92% 87% 89% 85%(2K ,6K ] 90% 87% 79% 88% 83%(6K ,10K ] 86% 85% 74% 86% 82%≥ 10K 83% 85% 71% 85% 82%

SHA NE 90% 87% 78% 88% 86%London 84% 82% 75% 83% 78%



ResulsSummary

ConclusionsDiscussion

To sum it up

Patients reported high levels of satisfaction and positiveexperience, across all domains.The patient-level variables with the most notable impactswere age, ethnicity and employment status.For those in employment, being able to take time off workto visit the GP had a very large effect, and effectivelyremoved the disadvantage across all domains.So did other factors that freed up time, such as workingonly part-time or having a short commute time.Satisfaction and experience did vary by geographical area,as represented by Strategic Health Authority.



ResulsSummary


To sum it upContinued...

Practice size was the only practice-level factor of real note,with a substantial impact in all domains bar surgery hours.Patients at small practices were more satisfied andreported easier access, especially in telephone accessand obtaining appointments in advance.In the univariate analyses, single-handed practicesreceived the highest satisfaction and experience ratings onmost domains.Opening & extended hours did not appear to influencesatisfaction/experience, even for patients working FT.Individual patient responses were related to thecharacteristics of the practice population, with the effectbeing particularly strong for ethnicity.



ResulsSummary


Some disadvantages involved with small practices......but bigger is not always better!

QOF year

Ove

rall

repo

rted

achi

evem

ent

04/05 05/06 06/07

020

4060

8010

0

list size 1,000-1,9992,000 - 2,9993,000 - 3,9994,000 - 5,9996,000 - 7,9998,000 - 9,99910,000 - 11,99912,000 or more

Practices split by list size in each year, (n=7502)

Comments: [email protected]


Internal 2010 - Patient Satisfaction with Primary Care

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Transcript of Internal 2010 - Patient Satisfaction with Primary Care