Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007.

Publisher: Annals of Family Medicine, Inc Country of Publication: United States NLM ID: 101167762 Publication Model: Print Cited Medium: Internet ISSN: 1544-1717 (Electronic) Linking ISSN: 15441709 NLM ISO Abbreviation: Ann Fam Med Subsets: MEDLINE

Original Publication: Leawood, KS : Annals of Family Medicine, Inc., c2003-

Continuity of Patient Care/*trends ; Health Care Reform/*trends ; Patient Care/*trends ; Quality of Health Care/*trends; Angina Pectoris ; Asthma ; Confidence Intervals ; Cross-Sectional Studies ; Diabetes Mellitus ; England ; Humans ; Logistic Models ; Odds Ratio ; Patient Satisfaction ; Surveys and Questionnaires

Purpose: Major primary care reforms have been introduced in recent years in the United Kingdom, including financial incentives to improve clinical quality and provide more rapid access to care. Little is known about the impact of these changes on patient experience. We examine patient reports of quality of care between 2003 and 2007, including random samples of patients on practice lists and patients with long-term conditions.
Methods: We conducted a cross-sectional design study of family practices in which questionnaires were sent to serial samples of patients in 42 representative general practices in England. Questionnaires sent to samples of patients with chronic disease (asthma, angina, and diabetes) and random samples of adult patients (excluding patients who reported any long-term condition) in 2003, 2005, and 2007 addressed issues of access, communication, continuity of care, coordination, nursing care, and overall satisfaction.
Results: There were no significant changes in quality of care reported by either group of patients between 2003 and 2007 for communication, nursing care, coordination, and overall satisfaction. Some aspects of access improved significantly for patients with chronic disease, but not for the random samples of patients. Patients in both samples reported seeing their usual physician less often and gave lower satisfaction ratings for continuity of care. Most scores were significantly higher for the chronic illness samples than for the random samples of patients in 2003, even after adjusting for age.
Conclusions: There was a modest improvement in access to care for patients with chronic illness, but all patients now find it somewhat harder to obtain continuity of care. This outcome may be related to the incentives to provide rapid appointments or to the increased number of specialized clinics in primary care. The possibility of unintended effects needs to be considered when introducing pay for performance schemes.

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MC_PC_13042 United Kingdom MRC_ Medical Research Council; MR/K006665/1 United Kingdom MRC_ Medical Research Council; United Kingdom DH_ Department of Health

Date Created: 20101110 Date Completed: 20110224 Latest Revision: 20211020

20240628

PMC2975684

10.1370/afm.1145

21060119