scholarly journals Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data

2018 ◽  
Vol 27 (8) ◽  
pp. 643-654 ◽  
Author(s):  
Thomas E Cowling ◽  
Azeem Majeed ◽  
Matthew J Harris
Keyword(s):  
Time Series ◽  
General Practice ◽  
Regression Analysis ◽  
Patient Experience ◽  
Sensitivity Analyses ◽  
Hospital Services ◽  
Cross Sectional ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Practice Level

BackgroundThe UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England.MethodsThe study included 8124 general practices between 2011–2012 and 2013–2014. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours and overall experience (on 0–100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification.ResultsMean practice-level rates of A&E visits and emergency admissions increased from 2011–2012 to 2013–2014 (310.3–324.4 and 98.8–102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011–2012 and 76.6 in 2013–2014. In the adjusted regression analysis, an SD increase in experience of making appointments (equal to 9 points) predicted decreases of 1.8% (95% CI −2.4% to −1.2%) in A&E visit rates and 1.4% (95% CI −1.9% to −0.9%) in admission rates. This equalled 301 174 fewer A&E visits and 74 610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses.ConclusionsAssociations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions.

scholarly journals How to implement patient experience surveys and use their findings for service improvement: a qualitative expert consultation study in Australian general practice

2020 ◽  
Vol 2 (1) ◽  
pp. e000033
Author(s):  
Hyun Jung Song ◽  
Sarah Dennis ◽  
Jean-Frédéric Levesque ◽  
Mark Harris
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Patient Experience ◽  
Qualitative Content Analysis ◽  
System Level ◽  
Service Improvement ◽  
Expert Consultation ◽  
Cross Sectional ◽  
Practice Level ◽  
Australian General Practice

ObjectiveTo identify barriers (patient, provider, practice and system levels) to consider when implementing patient experience surveys in Australian general practice and enablers of their systematic use to inform service improvement in clinical practice as well as the broader health system.Methods and analysisAn expert consultation and qualitative content analysis of cross-sectional, open-text survey data. Data were collected from key international and Australian experts in the areas of measurement and quality improvement in general practice.ResultsResponses from 20 participants from six countries were included in the study. Participants discussed the importance of ensuring value and relevance of surveys to stakeholders. Lack of resources, IT infrastructure, capacity building and sustained funding were identified as barriers to implementing surveys. Participants discussed the importance of clearly defining and communicating the purpose of surveys and agreed on the value of using patient experience to inform reflective, team-based learning at the practice level. Opinions differed on the use of patient experience data at the system level, with some questioning its utility or fairness for external performance reporting. Others recommended the aggregation and reporting of these data under certain conditions, including for the purpose of triangulation with other quality and outcome data. The study identified an evidence gap in the assessment and interpretation of patient experience data at the practice and system levels, including the analysis and contextualisation of survey findings at the system level.ConclusionPatient experience surveys have potential for guiding practice level quality improvement, but many barriers to their implementation remain. There is need for greater research and policy efforts to understand how this information can be used at the system level for improving Australian general practice.

scholarly journals How to implement and use findings from patient experience surveys in Australian general practice: A qualitative expert consultation study

2020 ◽  
Author(s):  
Hyun Jung Song ◽  
Sarah Dennis ◽  
Jean-Frederic Levesque ◽  
Mark Harris
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Patient Experience ◽  
Qualitative Content Analysis ◽  
System Level ◽  
Service Improvement ◽  
Expert Consultation ◽  
Cross Sectional ◽  
Practice Level ◽  
Australian General Practice

Objective To identify barriers (patient, provider, practice, and system levels) to consider when implementing patient experience surveys in Australian general practice, and enablers of their systematic use to inform service improvement in clinical practice as well as the broader health system. Methods and Analysis An expert consultation and qualitative content analysis of cross-sectional, open-text survey data. Data was collected from key international and Australian experts in the areas of measurement and quality improvement in general practice. Results Participants discussed the importance of ensuring value and relevance of surveys to stakeholders. Lack of resources, IT infrastructure, capacity building, and sustained funding were identified as barriers to implementing surveys. Participants discussed the importance of clearly defining and communicating the purpose of surveys and agreed on the value of using patient experience to inform reflective, team-based learning at the practice level. Opinions differed on the use of patient experience data at the system-level, with some questioning its utility or fairness for external performance reporting. Others recommended the aggregation and reporting of this data under certain conditions, including for the purpose of triangulation with other quality and outcome data. The study identified an evidence gap in the assessment and interpretation of patient experience data at all levels, including the analysis and contextualisation of survey findings at the system level. Conclusion Patient experience surveys have potential for guiding practice level quality improvement but many barriers to their implementation remain. There is need for greater research and policy efforts to understand how this information can be used at the system level for improving Australian primary care.

scholarly journals Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Montserrat Rué ◽  
Xavier Cabré ◽  
Jorge Soler-González ◽  
Anna Bosch ◽  
Mercè Almirall ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Hospital Services ◽  
Sectional Study ◽  
Cross Sectional ◽  
Services Utilization ◽  
Emergency Hospital

scholarly journals Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales

2019 ◽  
pp. tobaccocontrol-2018-054584 ◽  
Author(s):  
Britt Hallingberg ◽  
Olivia M Maynard ◽  
Linda Bauld ◽  
Rachel Brown ◽  
Linsay Gray ◽  
...  
Keyword(s):  
Time Series ◽  
Young People ◽  
Rapid Growth ◽  
Time Series Data ◽  
Sensitivity Analyses ◽  
Series Data ◽  
Youth Smoking ◽  
Interrupted Time Series Analysis ◽  
Cross Sectional ◽  
Rate Of Decline

ObjectivesTo examine whether during a period of limited e-cigarette regulation and rapid growth in their use, smoking began to become renormalised among young people.DesignInterrupted time-series analysis of repeated cross-sectional time-series data.SettingGreat BritainParticipants248 324 young people aged approximately 13 and 15 years, from three national surveys during the years 1998–2015.InterventionUnregulated growth of e-cigarette use (following the year 2010, until 2015).Outcome measuresPrimary outcomes were prevalence of self-reported ever smoking and regular smoking. Secondary outcomes were attitudes towards smoking. Tertiary outcomes were ever use of cannabis and alcohol.ResultsIn final models, no significant change was detected in the pre-existing trend for ever smoking (OR 1.01, CI 0.99 to 1.03). There was a marginally significant slowing in the rate of decline for regular smoking (OR 1.04, CI 1.00 to 1.08), accompanied by a larger slowing in the rate of decline of cannabis use (OR 1.21, CI 1.18 to 1.25) and alcohol use (OR 1.17, CI 1.14 to 1.19). In all models and subgroup analyses for smoking attitudes, an increased rate of decline was observed after 2010 (OR 0.88, CI 0.86 to 0.90). Models were robust to sensitivity analyses.ConclusionsThere was a marginal slowing in the decline in regular smoking during the period following 2010, when e-cigarettes were emerging but relatively unregulated. However, these patterns were not unique to tobacco use and the decline in the acceptability of smoking behaviour among youth accelerated during this time. These analyses provide little evidence that renormalisation of youth smoking was occurring during a period of rapid growth and limited regulation of e-cigarettes from 2011 to 2015.Trial registration numberResearch registry number: researchregistry4336

scholarly journals Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey

2018 ◽  
Vol 68 (672) ◽  
pp. e469-e477 ◽  
Author(s):  
Thomas E Cowling ◽  
Azeem Majeed ◽  
Matthew J Harris
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Patient Survey ◽  
Cross Sectional ◽  
National Patient ◽  
General Practices ◽  
The Uk ◽  
Multilevel Linear Regression ◽  
Practice Patient

BackgroundThe UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.AimTo examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and settingAnalysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.MethodData from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.ResultsIn total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.ConclusionPatient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

scholarly journals Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

2017 ◽  
Vol 110 (11) ◽  
pp. 440-451 ◽  
Author(s):  
Thomas E Cowling ◽  
Anthony A Laverty ◽  
Matthew J Harris ◽  
Hilary C Watt ◽  
Felix Greaves ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Linear Regression Analysis ◽  
Patient Survey ◽  
Medical Services ◽  
Cross Sectional Survey ◽  
Ownership Type ◽  
Cross Sectional ◽  
Patient Reports ◽  
General Practices

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013–2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014.

scholarly journals Assessment of user embracement with risk rating in emergency hospital services

2014 ◽  
Vol 35 (3) ◽  
pp. 21-28 ◽  
Author(s):  
Gelena Lucinéia Gomes da Silva Versa ◽  
Dagmar Wilamowius Vituri ◽  
Aline Aparecida Buriola ◽  
Carlos Aparecido de Oliveira ◽  
Laura Misue Matsuda
Keyword(s):  
Health System ◽  
Quantitative Study ◽  
Physical Space ◽  
Low Complexity ◽  
Hospital Services ◽  
Cross Sectional ◽  
Basic Health ◽  
Emergency Hospital ◽  
Risk Rating ◽  
Nursing Professionals

Cross-sectional and quantitative study, conducted in 2013, aiming to evaluate the implementation of User Embracement with Risk Rating (ACCR) in four Emergency Hospital Services. One hundred fifty six nurses participated and answered the questionnaire "User Embracement with Risk Rating". The data were treated through descriptive and inferential statistics, from the Kruskal-Wallis test. The implementation of ACCR was assessed as precarious, mainly due to the lack of referral of low complexity cases to the basic health system, the inadequate physical space for companions and the lack of discussion and periodic assessment of the flow of care in ACCR. The dimension Result of Implementation obtained a slightly higher score and Structure was the dimension with the lowest score. It was concluded that the negative assessments by nursing professionals of the referred dimensions in the investigated sites suggests the need for improvements, especially in the dimension Structure.

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