What do the Patients Want?

What do the Patients Want?Jacqueline SwanJohn RussellSusan Dovey

GP Research RegistrarRNZCGP Research Registrar ProgrammeMix of clinical and research work, plus academic studyAlternative pathway to fellowship Sponsored by Comprehensive Care Ltd, AucklandMentorship 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?

MethodsMixed MethodsFocus Groups to inform questionnaire developmentGPs, nurses, Practice Managers, patients Survey of Patients Random selection of PHO patients, stratified by ethnicityNSH ECC, patients presenting without a GP referralEthics 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

One in five patients does not understand what enrolling in a PHO means 6

Major Conclusions and Recommendations Patients 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 factorWhat influenced you to come to the ED today?66% considered medical condition to be serious50% did not think their medical condition could be managed by the GP20% could not get an appt with their GP22% could not afford to see the GP17% GP was closed Patients are satisfied with their general practice

All things considered, how satisfied are you with your own GP clinic?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.

61% chose lower cost 13For the service I receive I believe the cost is Present costs are a barrier to my seeking general practitioner servicesTrue 36%False 64%

RecommendationEfforts regarding subsidies should be concentrated towards those most deprivedPatients want secure internet access to their medical information and information on reliable medical internet sites, particularly those less than 50 years of age

RecommendationsThe 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 patients reference

Patients want longer appointments as an option when booking but not as routine

I would like longer appointment times50% yes, as an option when I book8% yes, as routineRest no / neutral

91% of those who wanted longer appointments didnt 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 you86% relationship with my doctor more important than practice facilities53% 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

9% of patients had heard of CornerstoneOf those, 59% indicated understanding

43% of patients had heard of FRNZCGPOf 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

Refer improving services also (49% Seeing the nurse for separate consultations)32RecommendationLooking 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.

34Refer improving services also (49% A drop in clinic where appointments arent necessary)

35RecommendationPractices 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.

For those most deprived, SS difference to all others in preference for physio, counselling and midwifery to be closer to GP clinic 38RecommendationWhen considering location, practices should be close in proximity to laboratory, x-ray and pharmacy services

Thank-you