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Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling

Objective To explore whether responses to questions in surveys of patients that purport to assess the performance of general practices or doctors reflect differences between practices, doctors, or the patients themselves. Design Secondary analysis of data from a study of access to general practice,...

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Autores principales: Salisbury, Chris, Wallace, Marc, Montgomery, Alan A
Formato: Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954274/
https://www.ncbi.nlm.nih.gov/pubmed/20940212
http://dx.doi.org/10.1136/bmj.c5004
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author Salisbury, Chris
Wallace, Marc
Montgomery, Alan A
author_facet Salisbury, Chris
Wallace, Marc
Montgomery, Alan A
author_sort Salisbury, Chris
collection PubMed
description Objective To explore whether responses to questions in surveys of patients that purport to assess the performance of general practices or doctors reflect differences between practices, doctors, or the patients themselves. Design Secondary analysis of data from a study of access to general practice, combining data from a survey of patients with information about practice organisation and doctors consulted, and using multilevel modelling at practice, doctor, and patient level. Setting Nine primary care trusts in England. Participants 4573 patients who consulted 150 different doctors in 27 practices. Main outcome measures Overall satisfaction; experience of wait for an appointment; reported access to care; satisfaction with communication skills. Results The experience based measure of wait for an appointment was more discriminating between practices (practice level accounted for 20.2% (95% confidence interval 9.1% to 31.3%) of variance) than was the overall satisfaction measure (practice level accounted for 4.6% (1.6% to 7.6%) of variance). Only 6.3% (3.8% to 8.9%) of the variance in the doctors’ communication skills measure was due to differences between doctors; 92.4% (88.5% to 96.4%) of the variance occurred at the level of the patient (including differences between patients’ perceptions and random variation). At least 79% of the variance on all measures occurred at the level of the patient, and patients’ age, sex, ethnicity, and housing and employment status explained some of this variation. However, adjustment for patients’ characteristics made very little difference to practices’ scores or the ranking of individual practices. Conclusions Analyses of surveys of patients should take account of the hierarchical nature of the data by using multilevel models. Measures related to patients’ experience discriminate more effectively between practices than do measures of general satisfaction. Surveys of patients’ satisfaction fail to distinguish effectively between individual doctors because most of the variation in doctors’ reported performance is due to differences between patients and random error rather than differences between doctors. Although patients’ reports of satisfaction and experience are systematically related to patients’ characteristics such as age and sex, the effect of adjusting practices’ scores for the characteristics of their patients is small.
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spelling pubmed-29542742011-09-26 Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling Salisbury, Chris Wallace, Marc Montgomery, Alan A BMJ Research Objective To explore whether responses to questions in surveys of patients that purport to assess the performance of general practices or doctors reflect differences between practices, doctors, or the patients themselves. Design Secondary analysis of data from a study of access to general practice, combining data from a survey of patients with information about practice organisation and doctors consulted, and using multilevel modelling at practice, doctor, and patient level. Setting Nine primary care trusts in England. Participants 4573 patients who consulted 150 different doctors in 27 practices. Main outcome measures Overall satisfaction; experience of wait for an appointment; reported access to care; satisfaction with communication skills. Results The experience based measure of wait for an appointment was more discriminating between practices (practice level accounted for 20.2% (95% confidence interval 9.1% to 31.3%) of variance) than was the overall satisfaction measure (practice level accounted for 4.6% (1.6% to 7.6%) of variance). Only 6.3% (3.8% to 8.9%) of the variance in the doctors’ communication skills measure was due to differences between doctors; 92.4% (88.5% to 96.4%) of the variance occurred at the level of the patient (including differences between patients’ perceptions and random variation). At least 79% of the variance on all measures occurred at the level of the patient, and patients’ age, sex, ethnicity, and housing and employment status explained some of this variation. However, adjustment for patients’ characteristics made very little difference to practices’ scores or the ranking of individual practices. Conclusions Analyses of surveys of patients should take account of the hierarchical nature of the data by using multilevel models. Measures related to patients’ experience discriminate more effectively between practices than do measures of general satisfaction. Surveys of patients’ satisfaction fail to distinguish effectively between individual doctors because most of the variation in doctors’ reported performance is due to differences between patients and random error rather than differences between doctors. Although patients’ reports of satisfaction and experience are systematically related to patients’ characteristics such as age and sex, the effect of adjusting practices’ scores for the characteristics of their patients is small. BMJ Publishing Group Ltd. 2010-10-12 /pmc/articles/PMC2954274/ /pubmed/20940212 http://dx.doi.org/10.1136/bmj.c5004 Text en © Salisbury et al 2010 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Research
Salisbury, Chris
Wallace, Marc
Montgomery, Alan A
Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
title Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
title_full Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
title_fullStr Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
title_full_unstemmed Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
title_short Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
title_sort patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954274/
https://www.ncbi.nlm.nih.gov/pubmed/20940212
http://dx.doi.org/10.1136/bmj.c5004
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