w hat do the p atients w ant ? jacqueline swan john russell susan dovey
Post on 17-Dec-2015
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WHAT DO THE PATIENTS WANT?
Jacqueline Swan
John Russell
Susan Dovey
GP RESEARCH REGISTRAR
RNZCGP Research Registrar Programme Mix of clinical and research work, plus
academic study Alternative pathway to fellowship Sponsored by Comprehensive Care Ltd,
Auckland Mentorship Susan Dovey
BACKGROUND
“Better, Sooner, More Convenient”
Any changes to existing models of care should have patient participation and be responsive to what patients want
OBJECTIVES
How do patients view current primary care services?
What changes do patients want to improve those services?
METHODS
Mixed Methods Focus Groups to inform questionnaire
development GPs, nurses, Practice Managers, patients
Survey of Patients Random selection of PHO patients, stratified by
ethnicity NSH ECC, patients presenting without a GP
referral Ethics approval
RESULTS
485 responses 380 PHO patients (19.3%) 105 ECC patients (83%)
Respondents were more likely to be female (63%), European (48%) and older in age
02
04
06
08
0F
req
ue
ncy
20 40 60 80 100Age
Age Distribution of all Respondents
MAJOR CONCLUSIONS AND RECOMMENDATIONS
Patient’s presentation to the emergency department is more around the seriousness of the condition than poor access to GP services, although for one in five patients access and cost is a factor
WHAT INFLUENCED YOU TO COME TO THE ED TODAY?
66% considered medical condition to be serious 50% did not think their medical condition could be
managed by the GP 20% could not get an appt with their GP 22% could not afford to see the GP 17% GP was closed
Patients are satisfied with their general practice
ALL THINGS CONSIDERED, HOW SATISFIED ARE YOU WITH YOUR OWN GP CLINIC?
Compl
etel
y sa
tisfie
d
Fairl
y sa
tisfie
d
Neutra
l
Fairl
y di
ssat
isfie
d
Compl
etel
y di
ssat
isfied
0
10
20
30
40
50
60
Satisfaction with GP clinic
ED Patients PHO Patients Total
Perc
enta
ge
The majority of patients feel cost is about right and not a barrier to them seeking GP services, although when asked about improving services lower cost is the top choice.
FOR THE SERVICE I RECEIVE I BELIEVE THE COST IS
Too high About Right Too low0
10
20
30
40
50
60
70
Cost for Service Received
Perc
en
tag
e
Present costs are a barrier to my seeking general practitioner services
True 36% False 64%
NziDep <5 NziDep 5 (Most deprived)
0
20
40
60
80
100
120
Cost is a barrier, by de-privation score
FALSETRUE
Perc
enta
ge
RECOMMENDATION
Efforts regarding subsidies should be concentrated towards those most deprived
Patients want secure internet access to their medical information and information on reliable medical internet sites, particularly those less than 50 years of age
Stro
ngly a
gree
Agre
e
Neutra
l
Disag
ree
Stro
ngly d
isag
ree
05
1015202530354045
I would like to be given information on reliable medical Internet sites
ED Patients PHO PatientsTotal
Perc
en
tag
e
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
5
10
15
20
25
30
35
40
45
I would find it useful to have secure In-ternet access to a list of my ongoing
medications
ED PatientsPHO PatientsTotal
Perc
enta
ge
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
5
10
15
20
25
30
35
40
I would find it useful to have secure Inter-net access to my own
lab tests
ED PatientsPHO PatientsTotal
Perc
enta
ge
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
10
20
30
40
50
60
I would find it useful to have secure inter-
net access to my med-ical notes
ED PatientsPHO PatientsTotal
Perc
enta
ge
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
5
10
15
20
25
30
35
40
45
I would find it useful to have secure In-
ternet access to re-minders and recalls
ED PatientsPHO PatientsTotal
Perc
enta
ge
RECOMMENDATIONS
The PHO and its practices should consider the use of a patient portal system
The PHO and its practices should consider links via their websites to reliable medical internet sites for patient’s reference
Patients want longer appointments as an option when booking but not as routine
I WOULD LIKE LONGER APPOINTMENT TIMES 50% yes, as an option when I book 8% yes, as routine Rest no / neutral
91% of those who wanted longer appointments didn’t want to pay for them!
RECOMMENDATION
Practices should continue to offer longer appointments as an option, but alert patients that this will incur an additional cost
Relationship and choice of doctor are more important to patients than facilities or speed of access
PLEASE INDICATE WHICH IS OF MORE IMPORTANCE TO YOU
86% relationship with my doctor more important than practice facilities
53% choice of doctor more important than the speed at which they can get an appointment
While most patients agree it is important to know about quality standards and qualifications, only 9% have heard of cornerstone and 43% of FRNZCGP
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
10
20
30
40
50
60
It is important for me to know about the
quality standards that my clinic has met
ED PatientsPHO PatientsTotal
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
10
20
30
40
50
60
It is important for me to know about the
qualifications that my doctor has
ED PatientsPHO PatientsTotal
Perc
enta
ge
9% of patients had heard of Cornerstone Of those, 59% indicated understanding
43% of patients had heard of FRNZCGP Of those, 72% indicated understanding
RECOMMENDATION
Practices, PHOs and the Royal New Zealand College of General Practitioners should embrace, educate patients and promote Cornerstone and Fellowship
Most patients would be happy to see the nurse for more minor conditions and for separate consultations
Strongly agree Agree Neutral Disagree Strongly disagree
0
10
20
30
40
50
60
I am happy seeing the nurse for more minor conditions
ED PatientsPHO PatientsTotal
Perc
enta
ge
RECOMMENDATION
Looking into the future, changes to care models should make use of nursing consultations and should be careful not to erode the relationship factor of General Practice, this needs to be considered ahead of co-location and facilities
Patients would like a drop in clinic and weekend clinic times, however access seems satisfactory, with 67% of patients agreeing or strongly agreeing that they can easily get an appointment at their clinic within 24 hours.
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
5
10
15
20
25
30
35
40
45
50
My clinic should have "drop in" times when I don't need an ap-
pointment
ED PatientsPHO PatientsTotal
Perc
enta
ge
Stro
ngly
agr
ee
Agree
Neutra
l
Disag
ree
Stro
ngly
disa
gree
0
5
10
15
20
25
30
35
40
45
I find it easy to get an appointment at my
clinic within 24 hours
ED PatientsPHO PatientsTotal
Perc
enta
ge
RECOMMENDATION
Practices should offer some weekend and evening clinic times, and consider the use of drop-in clinics
For the majority of services additional to the GP clinic, location is not deemed important. However, over half of all respondents would like the chemist to be within a five minute walk or closer, and approximately 40% of respondents would like laboratory and x-ray services within a five minute walk or closer.
Labo
rato
ry
Chem
ist
X-ray
Optom
etris
t
Priv
ate
spec
ialis
t
Audio
logy
Phys
io
Couns
ello
r
Dentis
t
Podi
atris
t
Dietit
ian
0
10
20
30
40
50
60
70
Preference for location of additional services in reference to the GP clinic
Location does not matterWithin a 15 minute drive Within a 5 minute drive Within a 5 minute walk In the same set of shops In the same building
Perc
enta
ge
RECOMMENDATION
When considering location, practices should be close in proximity to laboratory, x-ray and pharmacy services
THANK-YOU
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