QUALICOPC in the UK, the patient perspective

1. CaHRU@lincoln.ac.uk QUALICOPC in the UK, the patient perspective Prof. Niro Siriwardena, Dr Coral Sirdifield, Ana Godoy Caballero

2. CaHRU@lincoln.ac.uk Introduction & Aims • To discuss various approaches for defining and measuring patient satisfaction with primary care • To present an approach for measuring satisfaction • To show patients’ perspectives of primary care for: • All patients participating in QUALICOPC UK • Different population subgroups, such as age, health status and education • To discuss how the levels of satisfaction that patients report could be improved

3. CaHRU@lincoln.ac.uk What is patient satisfaction? ? How is it measured?

4. CaHRU@lincoln.ac.uk What is patient satisfaction? • Satisfaction’ is defined in numerous ways in the literature • Used interchangeably with ‘experience’ (Ahmed et al., 2014) • Differentiated from ‘experience’ (Coulter et al., 2009) • Viewed as “a multidimensional concept, based on a relationship between experiences and expectations” (Delnoij, 2009)

5. CaHRU@lincoln.ac.uk How is it measured? • Surveys • Interviews • Focus groups • Patient forums • Formal complaints • Comments on websites • Feedback in appraisals • Compliments received by staff

6. CaHRU@lincoln.ac.uk Our approach • We follow Delnoij’s definition “a multidimensional concept, based on a relationship between experiences and expectations” • We defined ‘expectations’ as what a patient desires – ideal expectations • We defined ‘experiences’ as what patients report occurred in the consultation (as opposed to their feelings about them)

7. CaHRU@lincoln.ac.uk Our approach Maintain performance Attributes are highly valued by patients, and patients report good experiences with regard to these attributes after they have seen their GP, so the performance should be kept as it is Concentrate here Attributes that patients value very highly but that currently receive a low (poor) experience rating after service users see their GP. Providers should concentrate on these attributes to optimise patients’ experience of primary care services IMPORTANCE High PERFORMANCE Low High Low Low priority Attributes that are relatively unimportant to patients and also receive low (poor) experience ratings. From a patient perspective we should not concentrate on these attributes Possible overkill Attributes that are rated as relatively unimportant to patients but nevertheless receive high (good) experience ratings. As these attributes are not that important, efforts could be made to use these “idle” resources in other aspects of the service

8. CaHRU@lincoln.ac.uk Our approach • Where we obtained the data from • QUALICOPC study • 3 English regions • It includes 4 types of questionnaires: • Fieldworker • GP • Patient experience • Patient values (expectations)

9. CaHRU@lincoln.ac.uk Attributes Used in the Analysis

10. CaHRU@lincoln.ac.uk What we found

11. CaHRU@lincoln.ac.uk What we found

12. CaHRU@lincoln.ac.uk Questions • How does this compare with experiences and values in your settings? • How does this compare with policies in your countries?

13. CaHRU@lincoln.ac.uk The IPA 1. Doctor has the patient’s medical records at hand 2. Doctor is polite 3. Doctor listens carefully to patients 4. Doctor takes sufficient time/doesn’t make the patient feel under pressure 5. Doctor involves patients in making treatment decisions 6. Doctor asks patients about other possible problems besides the one s/he came for 7. Doctor knows important information about the patient’s background 8. Doctor knows about the patient’s living situation 9. After the visit the patient feels s/he can cope better with his/her health problem/illness 10. Extensive opening hours 11. Proximity of the practice to the patient’s house 12. Short waiting time when contacting the practice 13. The patient knows how to get evening, night and weekend services 14. Reception staff are polite and helpful 15. Ease of getting an appointment

14. CaHRU@lincoln.ac.uk Possible Overkill Quadrant • Extensive opening hours • Proximity of the practice to the patient’s house • Short waiting time when contacting the practice

15. CaHRU@lincoln.ac.uk Low Priority Quadrant • Doctor knows about the patient’s living situation

16. CaHRU@lincoln.ac.uk Maintain Performance Quadrant • Doctor has patient’s medical records at hand • Doctor listens carefully to patients • Doctor is polite • Reception staff are polite and helpful

17. CaHRU@lincoln.ac.uk Concentrate Here Quadrant • The patient knows how to get evening, night and weekend services • Ease of getting an appointment • After the visit the patient feels that s/he can cope better with his/her health problem/illness • Doctor involves patients in making decisions about treatment • Doctor know important information about the patient’s background • Doctor asks patients about other possible problems besides the one s/he came for • Doctor takes sufficient time/doesn’t make the patient feel under pressure

18. CaHRU@lincoln.ac.uk Questions • How could you change policy/practice based on these findings?

19. CaHRU@lincoln.ac.uk ANALYSES BY PATIENT CHARACTERISTICS BY HEALTH STATUS Good health Poor health BY AGE Patients aged < 65 Patients aged ≥ 65

20. CaHRU@lincoln.ac.uk What do the patients expect?

21. CaHRU@lincoln.ac.uk What experiences do patients report?

22. CaHRU@lincoln.ac.uk ANALYSES BY PATIENT CHARACTERISTICS BY AGE Patients aged < 65 Patients aged ≥ 65

23. CaHRU@lincoln.ac.uk What do the patients expect?

24. CaHRU@lincoln.ac.uk What experiences do patients report?

25. CaHRU@lincoln.ac.uk Differences in the IPA charts Age < 65 Age ≥ 65

26. CaHRU@lincoln.ac.uk Differences in the IPA charts Age < 65 Age ≥ 65

27. CaHRU@lincoln.ac.uk Differences in the IPA charts Age < 65 Age ≥ 65

28. CaHRU@lincoln.ac.uk Differences in the IPA charts Age < 65 Age ≥ 65

29. CaHRU@lincoln.ac.uk Summary of changes

30. CaHRU@lincoln.ac.uk ANALYSES BY PATIENT CHARACTERISTICS BY HEALTH STATUS Good health Poor health

31. CaHRU@lincoln.ac.uk What do the patients expect?

32. CaHRU@lincoln.ac.uk What experiences do patients report?

33. CaHRU@lincoln.ac.uk Differences in the IPA charts Good health Poor health

34. CaHRU@lincoln.ac.uk Differences in the IPA charts Good health Poor health

35. CaHRU@lincoln.ac.uk Differences in the IPA charts Good health Poor health

36. CaHRU@lincoln.ac.uk Differences in the IPA charts Good health Poor health

37. CaHRU@lincoln.ac.uk Differences in the IPA charts Good health Poor health

38. CaHRU@lincoln.ac.uk Summary of changes

39. CaHRU@lincoln.ac.uk How satisfaction could be improved • In all analyses focusing on these three aspects of accessibility and empowerment is likely to improve patient satisfaction: • The patient knows how to get evening, night and weekend services • Ease of getting an appointment • After the visit the patient feels that s/he can cope better with his/her health problem/illness • Item 5 (doctor involves patients in making treatment decisions) also needs improvement for those age ≥ 65

40. CaHRU@lincoln.ac.uk Implications for practice • Measuring satisfaction as patients’ subjective perceptions of the quality of aspects of care often results in high reported satisfaction levels • This makes it difficult for practices to decide where they should focus their improvement efforts • Instead we could use patient questionnaires with questions on both ideal expectations and experiences • This would make it easier to identify areas for improvement for the whole practice population and for patients with particular characteristics

41. CaHRU@lincoln.ac.uk Thank you for listening! Find out more about our research at: www.CaHRU.org.uk