Factors associated with enablement in general practice: cross-sectional study using routinely-collected data

Mead, Nicola; Bower, Peter; Roland, Martin

doi:10.3399/bjgp08x280218

Cited by 53 publications

(104 citation statements)

References 14 publications

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“…One of the strongest associations in our study was found between the continuity of care and enablement; patients achieving the lowest enablement scores were those who knew their physician the least. This result mirrors previous findings (3,4,15). Primary care system in Croatia is currently organized as a Table 5.…”

Section: Discussionsupporting

confidence: 80%

“…Research has demonstrated that health status is an important independent predictor of enablement, with patients having a longstanding illness or disability reporting significantly lower enablement scores (15). Our findings partially reflect the "inverse care law," which states that the increased burden of ill health and multimorbidity in the socially-deprived areas results in high demands on consultations in primary care, but is also related to generally shorter consultation times and lower patient enablement for psychosocial problems (21).…”

Section: Discussionsupporting

confidence: 65%

“…Patient expectations in terms of health benefits have been reported as a key determinant of enablement (16). Also, Mead et al (15) have suggested that patient needs are most likely to be met when the cultural contexts of the physician and patient are well matched. One of the strongest associations in our study was found between the continuity of care and enablement; patients achieving the lowest enablement scores were those who knew their physician the least.…”

Section: Discussionmentioning

confidence: 99%

“…Although at this point our data are 4 to 5 years old, we believe they represent a significant contribution to continuing research on patient enablement and other consultation outcome measures of interpersonal care in general practice (15,25). These data also present a solid base for our upcoming national follow-up study using Consultation Quality Index -2 (CQI-2) (25), a new measure of holistic interpersonal care in primary care consultations.…”

Section: Discussionmentioning

confidence: 99%

“…Howie et al (4) found significantly higher enablement scores in "other language patients," while Freeman et al (14) found even higher enablement scores (mean 5.0) when these patients had consultations in their own language. Ethnic differences in enablement could be explained by different primary care needs in different populations, cultural differences in willingness to report unfavorable responses, different interpretation of the "enablement" concept, or actual differences in the quality of delivered care (15). Croatia is a country with a strong tradition of comprehensive and community-oriented primary health care, based on the principles of equity, accessibility, continuity, and integrated care (9).…”

Section: Discussionmentioning

confidence: 99%

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Patient, Physician, and Practice Characteristics Related to Patient Enablement in General Practice in Croatia: Cross-sectional Survey Study

et al. 2008

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AimTo investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics.Methods A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged ≥18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice.Results In 5527 patients, the mean score (±standard deviation) for enablement at consultation was 6.6 ± 3.3 and the mean consultation length was 11.5 ± 5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P < 0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P < 0.05 for each).Conclusion Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 65%