Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors

Roberts, Martin; Campbell, John; Abel, Gary; Davey, Antoinette; Elmore, Natasha; Maramba, Inocencio; Carter, Mary; Elliott, Marc N.; Roland, Martín; Burt, Jenni

doi:10.1136/bmj.g6034

Cited by 49 publications

(58 citation statements)

References 24 publications

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“…Previous research has demonstrated that the GP Patient Survey communication questions can differentiate between the performance of GPs and practices, as long as an adequate sample size is used to achieve acceptable statistical reliability. 129,141 This was confirmed by our simulation: with sufficient patient scores a strong correlation between patient ratings and competency will be observed. In the use of patient experience scores as quality indicators, our findings suggest that it is, therefore, possible to (1) trust aggregated patient scores that meet traditional standards of reliability as valid measures of comparative performance with respect to communication and (2) trust relatively low mean patient ratings.…”

Section: Discussionsupporting

confidence: 68%

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Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionsupporting

confidence: 68%

“…In line with previous work, we calculated communication scores by linearly rescaling responses between 0 and 100 and taking the mean of all responses when four or more informative answers were given. [129][130][131] Ratings by trained external raters…”

Section: Methodsmentioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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“…As per previous work, the authors calculated a doctor–patient communication score by linearly rescaling responses between 0 and 100 and taking the mean of all responses where four or more informative answers were given 20 , 31…”

Section: Methodsmentioning

confidence: 99%

Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care

et al. 2016

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BackgroundLonger consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience.AimTo examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction.Design and settingAnalysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England.MethodPatients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length.ResultsThere was no evidence that consultation length was associated with any of the three measures of patient experience (P >0.3 for all). Adjusted changes on a 0–100 scale per additional minute of consultation were: communication score 0.02 (95% confidence interval [CI] = −0.20 to 0.25), trust and confidence in the doctor 0.07 (95% CI = −0.27 to 0.41), and satisfaction −0.14 (95% CI = −0.46 to 0.18).ConclusionThe authors found no association between patient experience measures of communication and consultation length, and patients may sometimes report good experiences from very short consultations. However, longer consultations may be required to achieve clinical effectiveness and patient safety: aspects also important for achieving high quality of care. Future research should continue to study the benefits of longer consultations, particularly for patients with complex multiple conditions.

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“…A recent U.K. study indicates that variance between individual doctor communication scores could be greater than variance between practices. 29 Due to lack of separation between doctors in the patients' data, this effect could not be tested for in this study but could be investigated in subsequent studies. Also, the missing value rate varies considerably between items (Fig.…”

Section: Discussionmentioning

confidence: 90%

Patient Experience of Australian General Practices

Narayanan

Greco

2016

Big Data

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The number of data-based research articles focusing on patient sociodemographic profiling and experience with healthcare practices is still relatively small. One of the reasons for this relative lack of research is that categorizing patients into different demographic groups can lead to significant reductions in sample numbers for homogeneous subgroups. The aim of this article is to identify problems and issues when dealing with big data that contains information at two levels: patient experience of their general practice, and scores received by practices. The Practice Accreditation and Improvement Survey (PAIS) consisting of 27 five-point Likert items and 11 sociodemographic questions is a Royal Australian College of General Practitioners (RACGP)-endorsed instrument for seeking patient views as part of the accreditation of Australian general practices. The data were collected during the 3-year period May 2011-July 2014, during which time PAIS was completed for 3734 individual general practices throughout Australia involving 312,334 anonymous patients. This represents over 60% of practices in Australia, and ∼75% of practices that undergo voluntary accreditation. The sampling method for each general practice was convenience sampling. The results of our analysis show how sociodemographic profiles of Australian patients can affect their ratings of practices and also how the location of the practice (State/Territory, remote access area) can affect patient experience. These preliminary findings can act as an initial set of results against which future studies in patient experience trends can be developed and measured in Australia. Also, the methods used in this article provide a methodological framework for future patient experience researchers to use when dealing with data that contain information at two levels, such as the patient and practice. Finally, the outcomes demonstrate that different subgroups can experience healthcare provision differently, especially indigenous patients and young patients. The implications of these findings for healthcare policy and priorities will need to be further investigated.

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Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors

Cited by 49 publications

References 24 publications

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care

Patient Experience of Australian General Practices

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