Primary care in 34 countries: perspectives of general practitioners and their patients

Abstract

This study aimed to evaluate primary care in 34 countries from the perspectives of GPs and their patients. For the study, data were collected through surveys among around 7,000 GPs and 70,000 patients. Patients were invited to complete questionnaires after their consultation to gain insight in their experiences and what they find important. Data were analyzed using multilevel models in which patients are nested in GPs, which are nested in countries. The range of the services of GPs were measured in four areas: the extent to which GPs are the first contact to care, the treatment of chronic diseases, minor technical procedures and prevention. During the past two decades, GPs have become more involved in the treatment of chronic diseases, but less active in prevention. In countries with a stronger growth in health care expenditures, the range of services provided by GPs have expanded more during the past decades. A broad range of services can be supported by the way GPs organize their practices. For example, GPs who keep their patients records routinely offer more preventive services. This confirms that the patient record can be of support in these tasks. In this study the experiences of patients were measured regarding different areas, such as the communication with their GP. The communication with GPs is perceived as good in all countries. In countries with better financial and economic conditions for primary care, such as higher relative expenditures on primary care and better insurance coverage for primary care, patients see less potential for improvement regarding the accessibility, continuity and comprehensiveness of primary care. In addition, the range of the services provided by GPs was found to be important. Patients who visited GPs who offered a broader range of services experienced better accessibility, continuity and comprehensiveness of primary care and they experienced to be more involved by the GP in decisions about their treatment.