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Human Resources for Health
Published in: Human Resources for Health 1/2020

01-12-2020 | Care | Research

The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries

Authors: Willemijn L. A. Schäfer, Michael J. van den Berg, Peter P. Groenewegen

Published in: Human Resources for Health | Issue 1/2020

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Abstract

Background

The workload of general practitioners (GPs) and dissatisfaction with work have been increasing in various Western countries over the past decades. In this study, we evaluate the relation between the workload of GPs and patients’ experiences with care.

Methods

We collected data through a cross-sectional survey among 7031 GPs and 67,873 patients in 33 countries. Dependent variables are the patient experiences on doctor-patient communication, accessibility, continuity, and comprehensiveness of care. Independent variables concern the workload measured as the GP-reported work hours per week, average consultation times, job satisfaction (an indicator of subjective workload), and the difference between the workload measures of every GP and the average in their own country. Finally, we evaluated interaction effects between workload measures and what patients find important in a country and the presence of a patient-list system. Relationships were determined through multilevel regression models.

Results

Patients of GPs who are happier with their work were found to experience better communication, continuity, access, and comprehensiveness. When GPs are more satisfied compared to others in their country, patients also experience better quality. When GPs work more hours per week, patients also experience better quality of care, but not in the area of accessibility. A longer consultation time, also when compared to the national average, is only related to more comprehensive care. There are no differences in the relationships between countries with and without a patient list system and in countries where patients find the different quality aspects more important.

Conclusions

Patients experience better care when their GP has more work hours, longer consultation times, and especially, a higher job satisfaction.
Appendix
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Literature
1.
van Oostrom SH, Gijsen R, Stirbu I, Korevaar JC, Schellevis FG, Picavet HS, et al. Time trends in prevalence of chronic diseases and multimorbidity not only due to aging: data from general practices and health surveys. PLoS One. 2016;11(8):e0160264.PubMedPubMedCentralCrossRef
2.
Remington PL, Brownson RC. Centers for disease C, prevention. Fifty years of progress in chronic disease epidemiology and control. MMWR Suppl. 2011;60(4):70–7.PubMed
3.
Busse R, Blümel M, Scheller-Kreinsen D, Zentner A. Tackling chronic diseases in Europe: strategies, interventions and challenges. United Kingdom: World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2010.
4.
World Health Organization. Global status report on noncommunicable diseases 2010. World Health Organization, 2011.
5.
World Health Organization. The World Health Report 2008: primary health care - now more than ever. Geneva 2008.
6.
European Commission EXpert Panel on effective ways of investing in health. Definition of a frame of reference in relation to primary care with a special emphasis on financing systems and referral systems. Brussels: European Commission: DG Health & Copnsumers; 2014.
7.
Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017;7(10):e017902.PubMedPubMedCentralCrossRef
8.
Flinterman LKJ, de Bakker D. Zorggebruik in de huisartspraktijk : impact van beleidsmaatregelen op het zorggebruik van oudere patiënten [health care utilization in family physician practices: impact of policy measures on the health care utilization of elderly patients]. Utrecht: NIVEL; 2016.
9.
Groenewegen PP, Hutten JBF. Workload and job satisfaction among general practitioners: a review of the literature. Soc Sci Med. 1991;32(10):1111–9.PubMedCrossRef
10.
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13.PubMedCrossRef
11.
Gibson J, Checkland K, Coleman A, Hann M, McCall R, Spooner S, et al. Eighth national GP Worklife survey. Machester, U.K.: PRUComm; 2015.
12.
Kairys J, Zebiene E, Sapoka V, Zokas I. Satisfaction with organizational aspects of health care provision among Lithuanian physicians. Cent Eur J Public Health. 2008;16(1):29–33.PubMedCrossRef
13.
Behmann M, Schmiemann G, Lingner H, Kuhne F, Hummers-Pradier E, Schneider N. Job satisfaction among primary care physicians: results of a survey. Dtsch Arztebl Int. 2012;109(11):193–200.PubMedPubMedCentral
14.
Ostbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3(3):209–14.PubMedPubMedCentralCrossRef
15.
Beasley JW, Karsh BT, Hagenauer ME, Marchand L, Sainfort F. Quality of work life of independent vs employed family physicians in Wisconsin: a WReN study. Ann Fam Med. 2005;3(6):500–6.PubMedPubMedCentralCrossRef
16.
Laurant MGH, Hermens RPMG, Braspenning JCC, Sibbald B, Grol RPTM. Impact of nurse practitioners on workload of general practitioners: randomised controlled trial. British Med J. 2004;328(7445):927–30.CrossRef
17.
Merilind E, Vǒstra K, Salupere R, Kolde A, Kalda R. The impact of pay-for-performance on the workload of family practices in Estonia. Quality Primary Care. 2014;22(2):109–14.
18.
Salisbury C, Montgomery AA, Simons L, Sampson F, Edwards S, Baxter H, et al. Impact of advanced access on access, workload, and continuity: controlled before-and-after and simulated-patient study. British J Gen Practice. 2007;57(541):608–14.
19.
Šter MP, Švab I, Kalan GŽ. Factors related to consultation time: experience in Slovenia. Scand J Primary Health Care. 2008;26(1):29–34.CrossRef
20.
Wilson AD, Childs S, Goncalves-Bradley DC, Irving GJ. Interventions to increase or decrease the length of primary care physicians’ consultation. Cochrane Database Syst Rev. 2016;8:CD003540.
21.
Zantinge EM, Verhaak PFM, De Bakker DH, Van Der Meer K, Bensing JM. Does the attention general practitioners pay to their patients’ mental health problems add to their workload? A cross sectional national survey. BMC Fam Pract. 2006;7.
22.
Sarma S, Hajizadeh M, Thind A, Chan R. The association between health information technology adoption and family physicians’ practice patterns in Canada: evidence from 2007 and 2010 national physician surveys. Healthcare Policy. 2013;9(1):89.PubMedPubMedCentral
23.
Babbott S, Manwell LB, Brown R, Montague E, Williams E, Schwartz M, et al. Electronic medical records and physician stress in primary care: results from the MEMO study. J Am Med Inform Assoc. 2014;21(E2):e100–e6.PubMedCrossRef
24.
Mercer SW, Fitzpatrick B, Gourlay G, Vojt G, McConnachie A, Watt GCM. More time for complex consultations in a high-deprivation practice is associated with increased patient enablement. Br J Gen Pract. 2007;57(545):960–6.PubMedPubMedCentralCrossRef
25.
Van Den Hombergh P, Künzi B, Elwyn G, Van Doremalen J, Akkermans R, Grol R, et al. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands. BMC Health Services Res. 2009;9.
26.
Zantinge EM, Verhaak PFM, de Bakker DH, Kerssens JJ, van der Meer K, Bensing JM. The workload of general practitioners does not affect their awareness of patients’ psychological problems. Patient Educ Couns. 2007;67(1-2):93–9.PubMedCrossRef
27.
Heje HN, Vedsted P, Sokolowski I, Olesen F. Doctor and practice characteristics associated with differences in patient evaluations of general practice. BMC Health Serv Res. 2007;7.
28.
Schafer WLA, Boerma WGW, Murante AM, Sixma HJM, Schellevis FG, Groenewegen PP. Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey. WHO Bulletin. 2015.
29.
Schäfer WLA, Van den Berg MJ, PP G. De werkbelasting van huisartsen in internationaal perspectief [the workload of GPs in international perspective]. Huisarts en Wetenschap. 2016;59(3):94–101.CrossRef
30.
Groenewegen PP, Greẞ S, Schäfer W. General practitioners’ participation in a large, multi-country combined general practitioner – patient survey: recruitment procedures and participation rate. International Journal of Family Medicine. 2016;2016:1–9.CrossRef
31.
Schäfer WL, Boerma WG, Kringos DS, De Maeseneer J, Gress S, Heinemann S, et al. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care. BMC Fam Pract. 2011;12:115.PubMedPubMedCentralCrossRef
32.
Schäfer WL, Boerma WG, Kringos DS, De Ryck E, Greß S, Heinemann S, et al. Measures of quality, costs and equity in primary care instruments developed to analyse and compare primary care in 35 countries. Qual Prim Care. 2013;21(2):67–79.PubMed
33.
Pavlic DR, Sever M, Klemenc-Ketis Z, Svab I. Process quality indicators in family medicine: results of an international comparison. BMC Fam Pract. 2015;16(1):172.PubMedPubMedCentralCrossRef
34.
Raudenbush S. The quantitative assessment of neighborhood social environments. In: Kawachi I BL, editor. Neighborhoods and Health: Oxford Press; 2003.CrossRef
35.
Leyland AH, Groenewegen PP. Multilevel modelling for public health and health services research: health in context. SpringerOpen. 2020.
36.
Boerma WG, van der Zee J, Fleming DM. Service profiles of general practitioners in Europe. European GP task profile study. Br J Gen Pract. 1997;47(421):481–6.PubMedPubMedCentral
37.
Schäfer WLA, Boerma WGW, Schellevis FG, PP G. GP practices as a one stop shop: how do patients perceive the quality of care? Accepted for publication by Health Services Research. 2018.
38.
Damman OC, Stubbe JH, Hendriks M, Arah OA, Spreeuwenberg P, Delnoij DM, et al. Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care. Med Care. 2009;47(4):496–503.PubMedCrossRef
39.
de Boer D, van der Hoek L, Rademakers J, Delnoij D, van den Berg M. Do effects of common case-mix adjusters on patient experiences vary across patient groups? BMC Health Serv Res. 2017;17(1):768.PubMedPubMedCentralCrossRef
40.
41.
Hedden L, Barer ML, Cardiff K, McGrail KM, Law MR, Bourgeault IL. The implications of the feminization of the primary care physician workforce on service supply: a systematic review. Human Res Health. 2014;12:32.CrossRef
42.
Hutton C, Gunn J. Do longer consultations improve the management of psychological problems in general practice? A systematic literature review. BMC Health Serv Res. 2007;7.
43.
Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al. Working conditions in primary care: physician reactions and care quality. Annals Internal Med. 2009;151(1):28–36.CrossRef
44.
Tsiga E, Panagopoulou E, Sevdalis N, Montgomery A, Benos A. The influence of time pressure on adherence to guidelines in primary care: an experimental study. BMJ Open. 2013;3(4).
45.
Pelletier-Fleury N, Le Vaillant M, Hebbrecht G, Boisnault P. Determinants of preventive services in general practice. A multilevel approach in cardiovascular domain and vaccination in France. Health Policy. 2007;81(2-3):218–27.PubMedCrossRef
46.
Van Den Berg MJ, De Bakker DH, Spreeuwenberg P, Westert GP, Braspenning JC, Van Der Zee J, et al. Labour intensity of guidelines may have a greater effect on adherence than GPs’ workload. BMC Fam Pract. 2009;10.
47.
van Hassel D, van de Velden L, Batenburg R. Landelijk SMS-tijdsbestedingsonderzoek huisartsen [Dutch national SMS study on time allocation of family physicians]. Utrecht: NIVEL; 2014.
48.
Giesen P, Smits M, Huibers L, Grol R, Wensing M. Quality of after-hours primary care in the Netherlands: a narrative review. Ann Intern Med. 2011;155(2):108–13.PubMedCrossRef
49.
Smits M, Keizer E, Huibers L, Giesen P. GPs’ experiences with out-of-hours GP cooperatives: a survey study from the Netherlands. European Journal of General Practice. 2014;20(3):196–201.PubMedCrossRef
50.
Huber CA, Rosemann T, Zoller M, Eichler K, Senn O. Out-of-hours demand in primary care: frequency, mode of contact and reasons for encounter in Switzerland. J Eval Clin Pract. 2011;17(1):174–9.PubMedCrossRef
51.
Huibers L, Giesen P, Wensing M, Grol R. Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009;9.
52.
Whalley D, Gravelle H, Sibbald B. Effect of the new contract on GPs’ working lives and perceptions of quality of care: a longitudinal survey. Br J Gen Pract. 2008;58(546):8–14.PubMedPubMedCentralCrossRef
53.
McGrail MR, Humphreys JS, Scott A, Joyce CM, Kalb G. Professional satisfaction in general practice: does it vary by size of community? Med J Aust. 2010;193(2):94–8.PubMedCrossRef
54.
Granja M, Ponte C, Cavadas LF. What keeps family physicians busy in Portugal? A multicentre observational study of work other than direct patient contacts. BMJ Open. 2014;4(6).
55.
Karsh BT, Beasley JW, Brown RL. Employed family physician satisfaction and commitment to their practice, work group, and health care organization. Health Serv Res. 2010;45(2):457–75.PubMedPubMedCentralCrossRef
56.
Vanagas G, Bihari-Axelsson S. The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study. BMC Health Serv Res. 2005;5:45.PubMedPubMedCentralCrossRef
Metadata
Title
The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries
Authors
Willemijn L. A. Schäfer
Michael J. van den Berg
Peter P. Groenewegen
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
Human Resources for Health / Issue 1/2020
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-020-00520-9

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