Abstract
BACKGROUND: Within the context of general practice, continuity of care creates an opportunity for a personal doctor-patient relationship to develop which has been associated with significant benefits for patients and general practitioners (GPs). Continuity of care is, however, threatened by trends in the organisational development of primary health care in the United Kingdom and its intrinsic role within general practice is currently the subject of debate. AIMS: To determine how many patients report having a personal doctor and when this is most valued, to compare the value of a personal doctor-patient relationship with that of convenience, and to relate these findings to a range of patient, GP, and practice variables. DESIGN OF STUDY: Cross sectional postal questionnaire study. SETTING: Nine hundred and ninety-six randomly selected adult patients from a stratified random sample of 18 practices and 284 GP principals in Oxfordshire. METHOD: Qualitative interviews with patients and GPs were conducted and used to derive a parallel patient and GP questionnaire. Each patient (100 from each practice) was invited to complete a questionnaire to evaluate their experience and views concerning personal care. All GP principals currently practising in Oxfordshire were sent a similar questionnaire, which also included demographic variables. RESULTS: Overall, 75% of patients reported having at least one personal GP. The number of patients reporting a personal GP in each practice varied from 53% to 92%. Having a personal doctor-patient relationship was highly valued by patients and GPs, in particular for more serious, psychological and family issues when 77-88% of patients and 80-98% of GPs valued a personal relationship more than a convenient appointment. For minor illness it had much less value. CONCLUSIONS: Patients and GPs particularly value a personal doctor-patient relationship for more serious or for psychological problems. Whether a patient has a personal GP is associated with their perception of its importance and with factors which create an opportunity for a relationship to evolve.
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Selected References
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- Baker R., Streatfield J. What type of general practice do patients prefer? Exploration of practice characteristics influencing patient satisfaction. Br J Gen Pract. 1995 Dec;45(401):654–659. [PMC free article] [PubMed] [Google Scholar]
- Baker R. Will the future GP remain a personal doctor? Br J Gen Pract. 1997 Dec;47(425):831–833. [PMC free article] [PubMed] [Google Scholar]
- De Maeseneer J., Hjortdahl P., Starfield B. Fix what's wrong, not what's right, with general practice in Britain. BMJ. 2000 Jun 17;320(7250):1616–1617. doi: 10.1136/bmj.320.7250.1616. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Di Blasi Z., Harkness E., Ernst E., Georgiou A., Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001 Mar 10;357(9258):757–762. doi: 10.1016/s0140-6736(00)04169-6. [DOI] [PubMed] [Google Scholar]
- Ettlinger P. R., Freeman G. K. General practice compliance study: is it worth being a personal doctor? Br Med J (Clin Res Ed) 1981 Apr 11;282(6271):1192–1194. doi: 10.1136/bmj.282.6271.1192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Flocke S. A. Measuring attributes of primary care: development of a new instrument. J Fam Pract. 1997 Jul;45(1):64–74. [PubMed] [Google Scholar]
- Freeman G., Hjortdahl P. What future for continuity of care in general practice? BMJ. 1997 Jun 28;314(7098):1870–1873. doi: 10.1136/bmj.314.7098.1870. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gray D. J. The key to personal care. J R Coll Gen Pract. 1979 Nov;29(208):666–678. [PMC free article] [PubMed] [Google Scholar]
- Gulbrandsen P., Fugelli P., Hjortdahl P. Psychosocial problems presented by patients with somatic reasons for encounter: tip of the iceberg? Fam Pract. 1998 Feb;15(1):1–8. doi: 10.1093/fampra/15.1.1. [DOI] [PubMed] [Google Scholar]
- Guthrie B., Wyke S. Does continuity in general practice really matter? BMJ. 2000 Sep 23;321(7263):734–736. doi: 10.1136/bmj.321.7263.734. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hjortdahl P. Continuity of care: general practitioners' knowledge about, and sense of responsibility toward their patients. Fam Pract. 1992 Mar;9(1):3–8. doi: 10.1093/fampra/9.1.3. [DOI] [PubMed] [Google Scholar]
- Hjortdahl P., Laerum E. Continuity of care in general practice: effect on patient satisfaction. BMJ. 1992 May 16;304(6837):1287–1290. doi: 10.1136/bmj.304.6837.1287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hjortdahl P. The influence of general practitioners' knowledge about their patients on the clinical decision-making process. Scand J Prim Health Care. 1992 Dec;10(4):290–294. doi: 10.3109/02813439209014076. [DOI] [PubMed] [Google Scholar]
- Horton R. Evidence and primary care. Lancet. 1999 Feb 20;353(9153):609–610. doi: 10.1016/S0140-6736(99)00056-2. [DOI] [PubMed] [Google Scholar]
- Howie J. G., Heaney D. J., Maxwell M., Walker J. J., Freeman G. K., Rai H. Quality at general practice consultations: cross sectional survey. BMJ. 1999 Sep 18;319(7212):738–743. doi: 10.1136/bmj.319.7212.738. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olesen F., Dickinson J., Hjortdahl P. General practice--time for a new definition. BMJ. 2000 Feb 5;320(7231):354–357. doi: 10.1136/bmj.320.7231.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sox H. C. Decision-making: a comparison of referral practice and primary care. J Fam Pract. 1996 Feb;42(2):155–160. [PubMed] [Google Scholar]
- Starfield B. Is primary care essential? Lancet. 1994 Oct 22;344(8930):1129–1133. doi: 10.1016/s0140-6736(94)90634-3. [DOI] [PubMed] [Google Scholar]