1. QUALICOPC in the UK, the patient perspective Prof. Niro Siriwardena, Dr Coral Sirdifield, Ana Godoy Caballero CaHRU@lincoln.ac.uk

2. Introduction & Aims To discuss various approaches for defining and measuring patient satisfaction with primary care To present an approach for measuring satisfaction To show patients’ perspectives of primary care for: o All patients participating in QUALICOPC UK o Different population subgroups, such as age, health status and education To discuss how the levels of satisfaction that patients report could be improved CaHRU@lincoln.ac.uk

3. What is patient satisfaction? ? CaHRU@lincoln.ac.uk How is it measured?

4. What is patient satisfaction? Satisfaction’ is defined in numerous ways in the literature – Used interchangeably with ‘experience’ (Ahmed et al., 2014) – Differentiated from ‘experience’ (Coulter et al., 2009) – Viewed as “a multidimensional concept, based on a relationship between experiences and expectations” (Delnoij, 2009) CaHRU@lincoln.ac.uk

5. How is it measured? Surveys Interviews Focus groups Patient forums Formal complaints Comments on websites Feedback in appraisals Compliments received by staff CaHRU@lincoln.ac.uk

6. Our approach We follow Delnoij’s definition “a multidimensional concept, based on a relationship between experiences and expectations” We defined ‘expectations’ as what a patient desires – ideal expectations We defined ‘experiences’ as what patients report occurred in the consultation (as opposed to their feelings about them) CaHRU@lincoln.ac.uk

7. Our approach IMPORTANCE PERFORMANCE Low High Concentrate here Attributes that patients value very highly but that currently receive a low (poor) experience rating after service users see their GP. Providers should concentrate on these attributes to optimise patients’ experience of primary care services Maintain performance Attributes are highly valued by patients, and patients report good experiences with regard to these attributes after they have seen their GP, so the performance should be kept as it is Low priority Attributes that are relatively unimportant to patients and also receive low (poor) experience ratings. From a patient perspective we should not concentrate on these attributes Possible overkill Attributes that are rated as relatively unimportant to patients but nevertheless receive high (good) experience ratings. As these attributes are not that important, efforts could be made to use these “idle” resources in other aspects of the service CaHRU@lincoln.ac.uk

8. Our approach Where we obtained the data from QUALICOPC study o 3 English regions o It includes 4 types of questionnaires: o Fieldworker o GP o Patient experience o Patient values (expectations) CaHRU@lincoln.ac.uk

9. Attributes Used in the Analysis AttributeTheme 1. Doctor has the patient’s medical records at handInformational continuity 2. Doctor is politeCommunication 3. Doctor listens carefully to patientsCommunication 4. Doctor takes sufficient time/doesn’t make the patient feel under pressureCommunication 5. Doctor involves patients in making treatment decisionsEmpowerment 6. Doctor asks patients about other possible problems besides the one s/he came forComprehensiveness 7. Doctor knows important information about the patient’s backgroundInformational continuity 8. Doctor knows about the patient’s living situationContinuity 9. After the visit the patient feels s/he can cope better with his/her health problem/illnessEmpowerment 10. Extensive opening hoursAccessibility 11. Proximity of the practice to the patient’s houseAccessibility 12. Short waiting time when contacting the practiceAccessibility 13. The patient knows how to get evening, night and weekend servicesAccessibility 14. Reception staff are polite and helpfulCommunication 15. Ease of getting an appointmentAccessibility CaHRU@lincoln.ac.uk

10. What we found CaHRU@lincoln.ac.uk Most valued itemsLeast valued items Ease of getting an appointmentDoctor knows about the patient’s living situation Doctor knows important information about the patient’s background Doctor asks patients about other possible problems besides the one s/he came for Doctor has the patient’s medical records at handShort waiting time when contacting the practice Doctor listens carefully to patientsExtensive opening hours Doctor takes sufficient time/doesn’t make the patient feel under pressure Proximity of the practice to the patient’s house Doctor involves patients in making treatment decisions Doctor is polite After the visit the patient feels s/he can cope better with his/her health problem/illness The patient knows how to get evening, night and weekend services Reception staff are polite and helpful

11. What we found CaHRU@lincoln.ac.uk Most positive experiencesLeast positive experiences Doctor is politeDoctor knows about the patient’s living situation Doctor listens carefully to patientsDoctor asks patients about other possible problems besides the one s/he came for Doctor has patients’ medical records at handThe patient knows how to get evening, night and weekend services Proximity of practice to patient’s houseAfter the visit the patient feels that s/he can cope better with his/her health problem/illness Reception staff are polite and helpfulEase of getting an appointment Doctor takes sufficient time/doesn’t make the patient feel under pressure Doctor knows important information about the patient’s background Short waiting time when contacting the practice Doctor involves patients in making treatment decisions Extensive opening hours

12. Questions How does this compare with experiences and values in your settings? How does this compare with policies in your countries? CaHRU@lincoln.ac.uk

13. The IPA 1. Doctor has the patient’s medical records at hand 2. Doctor is polite 3. Doctor listens carefully to patients 4. Doctor takes sufficient time/doesn’t make the patient feel under pressure 5. Doctor involves patients in making treatment decisions 6. Doctor asks patients about other possible problems besides the one s/he came for 7. Doctor knows important information about the patient’s background 8. Doctor knows about the patient’s living situation 9. After the visit the patient feels s/he can cope better with his/her health problem/illness 10. Extensive opening hours 11. Proximity of the practice to the patient’s house 12. Short waiting time when contacting the practice 13. The patient knows how to get evening, night and weekend services 14. Reception staff are polite and helpful 15. Ease of getting an appointment CaHRU@lincoln.ac.uk

14. Possible Overkill Quadrant o Extensive opening hours o Proximity of the practice to the patient’s house o Short waiting time when contacting the practice CaHRU@lincoln.ac.uk

15. Low Priority Quadrant o Doctor knows about the patient’s living situation CaHRU@lincoln.ac.uk

16. Maintain Performance Quadrant o Doctor has patient’s medical records at hand o Doctor listens carefully to patients o Doctor is polite o Reception staff are polite and helpful CaHRU@lincoln.ac.uk

17. Concentrate Here Quadrant o The patient knows how to get evening, night and weekend services o Ease of getting an appointment o After the visit the patient feels that s/he can cope better with his/her health problem/illness o Doctor involves patients in making decisions about treatment o Doctor know important information about the patient’s background o Doctor asks patients about other possible problems besides the one s/he came for o Doctor takes sufficient time/doesn’t make the patient feel under pressure CaHRU@lincoln.ac.uk

18. Questions How could you change policy/practice based on these findings? CaHRU@lincoln.ac.uk

19. ANALYSES BY PATIENT CHARACTERISTICS BY AGE Patients aged < 65 Patients aged ≥ 65 CaHRU@lincoln.ac.uk BY HEALTH STATUS Good health Poor health

20. What do the patients expect? CaHRU@lincoln.ac.uk Patients < 65/Good healthPatients ≥ 65/Poor health Most valued ? Most valued ? Least valued ? Least valued ?

21. What experiences do patients report? CaHRU@lincoln.ac.uk Patients < 65/Good healthPatients ≥ 65/Poor health Best experience ? Best experience ? Worst experience ? Worst experience ?

22. ANALYSES BY PATIENT CHARACTERISTICS BY AGE Patients aged < 65 Patients aged ≥ 65 CaHRU@lincoln.ac.uk

23. What do the patients expect? CaHRU@lincoln.ac.uk Patients < 65Patients ≥ 65 Most valued Ease of getting an appointment Most valued Ease of getting an appointment Doctor knows important information about the patient’s background Least valued Doctor knows about the patient’s living situation Least valued Doctor knows about the patient’s living situation

24. What experiences do patients report? CaHRU@lincoln.ac.uk Patients < 65Patients ≥ 65 Best experience Doctor is polite Doctor listens carefully to patients Best experience Staff at the reception are polite and helpful Worst experience Doctor know about the patient’s living situation Worst experience Doctor know about the patient’s living situation

25. Differences in the IPA charts CaHRU@lincoln.ac.uk Age < 65 Age ≥ 65

26. Differences in the IPA charts CaHRU@lincoln.ac.uk Age < 65 Age ≥ 65

27. Differences in the IPA charts CaHRU@lincoln.ac.uk Age < 65 Age ≥ 65

28. Differences in the IPA charts CaHRU@lincoln.ac.uk Age < 65 Age ≥ 65

29. Summary of changes CaHRU@lincoln.ac.uk AttributeAge < 65Age ≥ 65 Doctor has the patient’s medical records at handConcentrate hereMaintain performance Doctor listens carefully to patientsConcentrate hereMaintain performance Extensive opening hoursPossible overkillLow priority

30. ANALYSES BY PATIENT CHARACTERISTICS CaHRU@lincoln.ac.uk BY HEALTH STATUS Good health Poor health

31. What do the patients expect? CaHRU@lincoln.ac.uk Good healthPoor health Most valued Doctor listens carefully to patients Ease of getting an appointment Most valued Ease of getting an appointment Doctor knows important information about the patient’s background Least valued Doctor know about the patient’s living situation Least valued Doctor know about the patient’s living situation

32. What experiences do patients report? CaHRU@lincoln.ac.uk Good healthPoor health Best experience Doctor is polite Best experience Doctor is polite Doctor has patient’s medical records at hand Staff at the reception are polite and helpful Worst experience Doctor know about the patient’s living situation Worst experience Doctor know about the patient’s living situation

33. Differences in the IPA charts CaHRU@lincoln.ac.uk Good health Poor health

34. Differences in the IPA charts CaHRU@lincoln.ac.uk Good health Poor health

35. Differences in the IPA charts CaHRU@lincoln.ac.uk Good health Poor health

36. Differences in the IPA charts CaHRU@lincoln.ac.uk Good health Poor health

37. Differences in the IPA charts CaHRU@lincoln.ac.uk Good health Poor health

38. Summary of changes CaHRU@lincoln.ac.uk Attribute Good healthPoor health Doctor has patient’s medical records at handConcentrate hereMaintain performance Doctor listens carefully to patientsConcentrate hereMaintain performance Extensive opening hoursPossible overkillLow priority Proximity of practicePossible overkillMaintain performance

39. How satisfaction could be improved In all analyses focusing on these three aspects of accessibility and empowerment is likely to improve patient satisfaction: o The patient knows how to get evening, night and weekend services o Ease of getting an appointment o After the visit the patient feels that s/he can cope better with his/her health problem/illness o Item 5 (doctor involves patients in making treatment decisions) also needs improvement for those age ≥ 65 CaHRU@lincoln.ac.uk

40. Implications for practice Measuring satisfaction as patients’ subjective perceptions of the quality of aspects of care often results in high reported satisfaction levels This makes it difficult for practices to decide where they should focus their improvement efforts Instead we could use patient questionnaires with questions on both ideal expectations and experiences This would make it easier to identify areas for improvement for the whole practice population and for patients with particular characteristics CaHRU@lincoln.ac.uk

41. Thank you for listening! Find out more about our research at: www.CaHRU.org.uk CaHRU@lincoln.ac.uk