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Tables
- Table 1. Summary of methodological characteristics of the survey studies by Schers et al 1,2
GPs’ views on continuity of care Continuity of care in general practice: a survey of patients’ views Study aim To investigate GPs’ views on the importance of personal contact with their own patients, on their responsibility to demonstrate unsolicited concern/empathy, and personal availability outside of office hours. To explore patients’ anticipated needs for contact with their GP Setting Netherlands Institute for Health Research database 35 GP practices throughout The Netherlands Sampling Random sample of 500 GPs, no snowballing 25 patients per practice who consecutively visited the practice on a specified day Inclusion criteria None >18 years, GPs could not exclude patients Survey type Postal Postal Reminder After 3 weeks After 2 weeks GPs (n = 249) Patients (n = 582) Characteristic n (%) Characteristic n (%) Sex Sex Male 99 (40) Male 248 (43) Female 149 (60) Female 317 (54) Missing 1 (0) Missing 17 (3) Employment status Age, years Partner 185 (74) 65–74 234 (40) Salaried 31 (12) 75–84 180 (31) Locum 20 (8) ≥85 57 (10) Other 13 (5) Missing 111 (19) Working experience, years Period registered at practice, years 1–10 47 (19) <1 3 (1) 11–20 103 (41) 1–2 26 (4) 21–30 74 (30) 3–4 50 (9) >30 years 25 (10) 5–10 77 (13) >10 395 (68) Missing 31 (5) Time in clinical activities per week, hours Living situation <16 83 (33) Alone 138 (24) 16–30 147 (60) Widowed 76 (13) 31–38 12 (5) Married/living together 346 (59) >38 7 (3) Other 10 (2) Missing 12 (2) Number of GPs in employment of practice* Nationality 1 35 (14) Dutch 562 (97) 2 95 (38) Other 8 (1) ≥3 131 (53) Missing 12 (2) Urbanisation of practice area* Number of GP contacts in the past 12 months Very rural 35 (14) 0 33 (6) Rural 51 (20) 1–2 142 (24) Average 62 (25) 3–4 179 (31) Urban 39 (16) 5–10 149 (26) Very urban 78 (31) >10 54 (9) Missing 25 (4) Number of registered patients* Number of chronic diseases <1750 9 (4) 0 253 (43) 1750–1999 12 (5) 1–2 276 (47) 2000–2249 13 (5) ≥3 33 (6) 2250–2500 38 (15) Missing 20 (3) >2500 177 (71) Disability due to a chronic disease Yes 97 (17) No 442 (76) Missing 43 (7) *Practice characteristics on which GPs could give more than one answer.
- Table 3. Views of GPs and patients on when it is important to have contact with a personal GP
GPs (n = 249) Patients (n = 582) Scenarios Important or very important n % n % Discussing future when seriously ill 248/249 99.6 519/529 98.1 Problems in the family 242/249 97.2 424/460 92.2 Problems at work 230/249 92.4 383/421 91.0 Anxiety about specific abdominal symptoms 222/249 89.2 507/539 94.1 Unexpected blood in stools 161/249 64.7 459/536 85.6 Sudden, severe chest pain 76/249 30.5 427/538 79.4 Regular blood pressure check 47/249 18.9 290/524 55.3 Sprained ankle 25/249 10.0 243/541 44.9 Splinter in the eye 17/249 6.8 162/540 30.0 - Table 4. Top five perceived barriers and facilitators for personal continuity in general practice
GPs who perceived decreased personal continuity (n = 135)* Patients who perceived decreased personal continuity (n = 98)* Response 135/135 Response94/98 Barriers There are too many healthcare providers involved with one patients' care 81% It takes too long before I get an appointment with my own GP 52% GPs work part-time 59% My own GP is often not available for me 47% Increased scale of primary care (for example, group practices) 51% My appointments are rarely scheduled with my own GP 34% High staff turnover rate 43% High GP turnover prevents me from making a connection with any GP 28% Receptionist schedule patients on the first available spot, rather than at the patients' own GP 36% I recently changed GPs and do not yet know my current GP 18% GPs who perceived increased personal continuity ( n = 8)* Patients who perceived increased personal continuity ( n = 142)* Response8/8 Response130/142 Facilitators Retaining a small-scale practice 100% I place great value on seeing my own GP 76% Low staff turnover rate 75% I ask for my own GP when making an appointment 72% Practice assistants schedule patients with the regular GP, rather than with the first available GP 63% I will reschedule my agenda in order to get an appointment with my own GP 46% Sufficient staff 63% I have known my own GP for a long time 36% Every GP working in the practice has at least 3 days of patient care 63% My appointments are always scheduled with my own GP 30% ↵* Only participants who perceived change (that is, 143 GPs and 240 patients) were asked to provide information on barriers and facilitators.
- Table 5. Suggestions for improvement of personal continuity by GPs and patients (in no particular order)
Origin Domains Quote GP Patient 1. Personal connection X X Organise introductory meetings P: ‘When I visit my GP, he does not look at me and constantly looks at his screen. My husband and I both had this experience. Is my GP really interested in me and my problem?’ X Improve open consultation and listening skills X Perform home visits X Ensure the EMR is up to date and is read by GPs X Have a personal connection between GP and patient 2. GP accessibility and availability X Implement e-health: consultation by video calls and emails GP: ‘Personally, I am available to terminal patients directly or via colleagues. If this is not possible due to circumstances, I communicate this with my patient. In my experience, the thought that your expertise is within reach is comforting to these patients.’ X Organise walk-in hours with own GP X Ensure direct GP accessibility and availability outside office hours for own patients with complex needs, particularly palliative care needs X Reduce waiting times for own GP X X Reduce part-time employment 3. Communication about (dis)continuity X X Communicate GP availability and staff changed to the patients of the practice P: ‘I would consider it very pleasant if the website showed the office hours of our GP and the availability, that is, holidays. Preferably a notification well ahead of the absence so that I am not unexpectedly confronted with my GP’s absence when I call my practice for an appointment.’ X Encourage patients to ask for their own GP when scheduling appointment X Inform patients about the aim and structure of the out-of-office hours care 4. GP responsibility X X Promote a proactive GP attitude by periodically, or on occasion, initiating contact instead of depending on patient initiative P: ‘Unfortunately, we do not have a “total body doctor”. However, an annual check-up combined with a positive consultation experience would be appreciated. In particular for older people, just like a technical examination for cars!’ X Stimulate GPs to only prescribe recurrent prescriptions for their own patients X X Instruct assistants to schedule patients with follow-up consultations with same doctor, barring emergency consultations 5. Triage dependent on severity and urgency X X Instruct assistants to schedule complex patients with same doctor, barring emergency consultations P: ‘The role of the practice assistant is crucial in my opinion. She has to compromise between a (too) busy schedule and the (non)importance of seeing your own GP.’ X Optimise the EMR to help assistants with scheduling, that is, preferred GP pop-up X Plan small medical issues or emergencies with locums or nurse physicians to give regular GP more time for complex cases 6. Time for the patient X Increase the compensation per consultation GP: ‘Improve the organisation of out-of-office hours care, in particular with regard to GP with practices. During the day, continuity is essential, emergency care is less continuity-dependent. Enable combining out-of-office hours care with day care, and so create a small workload and provide flexibility.’ X X Reduce administrative burden and work load X Reform organisation of out-of-office hours care X X Increase the time per consultation X Increase GP availability for direct patient care to at least 3 days a week 7. Actions by third parties X Introduce a nationwide EMR GP: ‘Sufficient transfer of care between inside and outside office care. For example, by having a nationwide EMR [...] In my opinion, the IT should be adapted drastically to the 21st century.’ X X Optimise collaborations with hospitals and mental healthcare organisations 8. Team continuity X X Promote small-scale practices: fewer patients and fewer GPs per practices and stimulate regular employment GP: ‘In a small-scale practice, personal continuity is better ensured, because the assistants know their patients and the lines of communication are shorter. In a large health centre, I supervised several nurse physicians, medical trainees, GP trainees etc. Although I liked these collaborations, the continuity of care was limited.’ X X Reduce changes of doctors by stimulating regular employment X X Improve working atmosphere X Increase pay of support staff to improve job attractiveness X X Ensure a sufficient number of staff 9. GP vocational training X Include importance of personal continuity in GP education GP: ‘[…] More attention in education programmes that being a GP is not ‘just’ a job, that it requires a certain dedication and servitude (like judges). This should be a part of the application procedure.’ EMR = electronic medical record.
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