Programme no. 403-SY
Quality Improvement
Differences on the organisation and provision of general practice in Europe, Australia, Canada and New Zealand: what are the consequences in terms of quality and equity?
Willemijn L.A. Schäfer*1, Lise G.M. Hanssens*2, Jens D.J. Detollenaere3, Stefan Greß 4, Peter P. Groenewegen5, Werner Hofmann 6, Amelie Van Pottelberge 7, Peter Spreeuwenberg8, Sara Willems9, Tessa van Loenen*10, Stephanie Heinemann*11, Stijn Baert12, Wienke G.W. Boerma13, Michael van den Berg14
1NIVEL - the Netherlands Institute for Health Services Research,Utrecht,Netherlands, 2Department of Family Medicine and Primary Health Care,Ghent University,Ghent,Belgium, 3Department of Family Medicine and Primary Health Care,Ghent University,Ghent,Belgium, 4Department of Nursing and Health Sciences,University of Applied Sciences Fulda,Fulda,Germany, 5NIVEL - the Netherlands Institute for Health Services Research,Utrecht,Netherlands, 6Department of Nursing and Health Sciences,University of Applied Sciences Fulda,Fulda,Germany, 7Department of Sociology,Ghent University,Ghent,Belgium, 8NIVEL - the Netherlands Institute for Health Services Research,Utrecht,Netherlands, 9Department of Family Medicine and Primary Health Care,Ghent University,Ghent,Belgium, 10National Institute for Public Health and the Environment(RIVM),Bilthoven,Netherlands, 11Department of Nursing and Health Sciences,University of Applied Sciences Fulda ,Fulda,Germany, 12Department of Social Economics,Ghent University,Ghent,Belgium, 13NIVEL - the Netherlands Institute for Health Services Research,Utrecht,Netherlands, 14National Institute for Public Health and the Environment(RIVM),Bilthoven,Netherlands
* = Presenting author
Symposium
Objectives: To show how the variation in characteristics of organisation on delivery of general practice in 34 countries relates to quality and equity.
Background: European countries, Australia, Canada and New Zealand are characterised by a variety of models of organisation and provision of general practice. This rich diversity makes this setting a laboratory for comparative research. It allows us to study the relationship between these various models of organisation and outcomes in terms of quality and equity.
Content: This symposium entails a combination of presentations. Specific attention will be paid to the relevance of results for Nordic countries. The first presentation will focus on the workload of GPs: how does this vary between and within countries and how does this affect the quality as perceived by patients? This currently an important issue in many countries due to an increasing complexity of patient care. The second presentation goes into avoidable hospitalisation for chronic ambulatory care sensitive conditions (ACSC), which are often used as quality indicators of primary care. Which aspects of the process in general practice (accessibility, continuity, comprehensiveness and coordination) are associated with the rates of avoidable hospitalisation for ACSCs? The third presentation goes into an important equity issue: social differences in patient perceived discrimination. Research studying perceived discrimination has, up until now, focused mainly on the outcomes of discrimination. This presentation provides insight in the differences between social groups regarding perceived discrimination in general practice. Finally, an overarching presentation will provide insight in models of organisation which could be identified in the 34 countries. How do these different models relate to outcomes of quality (e.g. waiting times for an appointment) and equity (e.g. the postponement of a needed GP visit)?
Method: A cross-sectional survey was held among around 7,000 GPs and 70,000 patients in European countries - including the Nordic countries-, Australia, Canada and New Zealand in the framework of the QUALICOPC study. The study entails a multilevel design in which the information of patients can be linked to the information collected among the GPs they visited.
Other considerations: This symposium is linked to another QUALICOPC symposium (by Kosunen et al) which goes into specific issues for the Nordic countries.