Changing practice as a quality indicator for primary care: analysis of data on voluntary disenrollment from the English GP Patient Survey

BMC Family Practice

Research Article

Martin Roland¹  Shobhana Nagraj¹  Gary Abel¹  Charlotte Paddison¹  Rupert Payne¹  John Campbell²  Marc Elliott³ 

[1] Cambridge Centre for Health Services Research, Primary Care Unit, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK;Primary Care Research Group, Peninsula Medical School, St Lukes, Smeall Building, St Lukes Campus, Magdalen Road, EX1 2LU, Exeter, England;RAND Corporation, 1776 Main Street, 90401-3208, Santa Monica, California, USA;

关键词: Patient Satisfaction;    Rate Ratio;    Patient Experience;    Family Practice;    Primary Care Practice;   

DOI  :  10.1186/1471-2296-14-89

 received in 2013-01-25, accepted in 2013-06-20,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundChanging family practice (voluntary disenrollment) without changing address may indicate dissatisfaction with care. We investigate the potential to use voluntary disenrollment as a quality indicator for primary care.MethodsData from the English national GP Patient Survey (2,169,718 respondents), the number of voluntary disenrollments without change of address, data relating to practice characteristics (ethnicity, deprivation, gender of patients, practice size and practice density) and doctor characteristics were obtained for all family practices in England (n = 8450). Poisson regression analyses examined associations between rates of voluntary disenrollment, patient experience, and practice and doctor characteristics.ResultsMean and median rates of annual voluntary disenrollment were 11.2 and 7.3 per 1000 patients respectively. Strongest associations with high rates of disenrollment were low practice scores for doctor-patient communication and confidence and trust in the doctor (rate ratios 4.63 and 4.85). In a fully adjusted model, overall satisfaction encompassed other measures of patient experience (rate ratio 3.46). Patients were more likely to move from small practices (single-handed doctors had 2.75 times the disenrollment rate of practices with 6–9 doctors) and where there were other local practices. After allowing for these, substantial unexplained variation remained in practice rates of voluntary disenrollment.ConclusionFamily practices with low levels of patient satisfaction, especially for doctor patient communication, are more likely to experience high rates of disenrollment. However substantial variation in disenrollment rates remains among practices with similar levels of patient satisfaction, limiting the utility of voluntary disenrollment as a performance indicator for primary care in England.

【 授权许可】

Unknown   
© Nagraj et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.