Having a Family Doctor is Associated with Some Better Patient-Reported Outcomes of Primary Care Consultations

Cindy L K Lam, Esther Y T Yu, Yvonne Y C Lo, Carlos K H Wong, Stewart M Mercer, Daniel Y T Fong, Albert Lee, Tai Pong Lam, Gabriel M Leung, Cindy L K Lam, Esther Y T Yu, Yvonne Y C Lo, Carlos K H Wong, Stewart M Mercer, Daniel Y T Fong, Albert Lee, Tai Pong Lam, Gabriel M Leung

Abstract

Background: Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference.

Methods: We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient's concerns.

Results: One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient's concerns.

Conclusion: People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations.

Keywords: family doctor; patient enablement; patient-centered care; patient-reported outcomes; primary care.

References

    1. Starfield B. Is primary care essential? Lancet (1994) 344:1129–3310.1016/S0140-6736(94)90634-3
    1. Leung GM, Wong IOL, Chan WS, Choi S, Lo SV, Health Care Financing Study et al. The ecology of health care in Hong Kong. Soc Sci Med (2005) 61:577–90.10.1016/j.socscimed.2004.12.029
    1. Howie JG, Heaney DJ, Maxwell M. Measuring quality in general practice. Pilot study of a needs, process and outcome measure. Occas Pap R Coll Gen Pract (1997) 75:1–32.
    1. Boon H, Stewart M. Patient-physician communication assessment instruments: 1986 to 1996 in review. Patient Educ Couns (1998) 35:161–76.10.1016/S0738-3991(98)00063-9
    1. Andén A, Andersson S-O, Rudebeck C-E. Concepts underlying outcome measures in studies of consultations in general practice. Scand J Prim Health Care (2006) 24:218–23.10.1080/02813430600853271
    1. Levenstein JH, Mccracken EC, Mcwhinney IR, Stewart MA, Brown JB. The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine. Fam Pract (1986) 3:24–30.10.1093/fampra/3.1.24
    1. McWhinney I. A Textbook of Family Medicine. New York, NY: Oxford University Press; (1989).
    1. Weston WW, Brown JB, Stewart MA. Patient-centred interviewing part I: understanding patients’ experiences. Can Fam Physician (1989) 35:147–51.
    1. Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res (2008) 17:179–93.10.1007/s11136-007-9295-0
    1. Stewart MA, Brown JB, Weston WW. Patient-Centered Medicine Transforming the Clinical Method. Thousand Oaks, CA: Sage; (1995).
    1. Stewart MA. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J (1995) 152:1423–33.
    1. Stewart M, Brown JB, Donner A, Mcwhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. J Fam Pract (2000) 49:796–804.
    1. Stewart M. Towards a global definition of patient centred care – the patient should be the judge of patient centred care. BMJ (2001) 322:444–510.1136/bmj.322.7284.444
    1. Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ (2001) 323:908–11.10.1136/bmj.323.7318.908
    1. Parchman M, Culler S. Primary care physicians and avoidable hospitalizations. J Fam Pract (1994) 39:123–8.
    1. Campbell RJ, Ramirez AM, Perez K, Roetzheim RG. Cervical cancer rates and the supply of primary care physicians in Florida. Fam Med (2003) 35:60–4.
    1. Lam CLK, Leung GM, Mercer SW, Fong DYT, Lee A, Lam TP, et al. Utilisation patterns of primary health care services in Hong Kong: does having a family doctor make any difference? Hong Kong Med J (2011) 17:S28–32.
    1. Food and Health Bureau Hksar Government. Your Health Your Life – Health Care Reform Consultation Document. Hong Kong: Food and Health Bureau, Hong Kong SAR Government; (2008).
    1. Health and Medical Development Advisory Committee, Health, Welfare and Food Bureau. Building a Healthy Tomorrow – Discussion Paper on the Future Service Delivery Model for Our Health Care System. Hong Kong: Hong Kong SAR Government; (2005).
    1. Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H. Quality at general practice consultations: cross sectional survey. BMJ (1999) 319:738–43.10.1136/bmj.319.7212.738
    1. Lam CLK, Wong CKH, Lam ETP, Lo YYC, Huang WW. Population norm of Chinese (HK) SF-12 health survey version 2 of Chinese adults in Hong Kong. Hong Kong Pract (2010) 32:77–86.
    1. Lam CL, Yuen NY, Mercer SW, Wong W. A pilot study on the validity and reliability of the patient enablement instrument (PEI) in a Chinese population. Fam Pract (2010) 27:395–403.10.1093/fampra/cmq021
    1. Howie JG, Heaney DJ, Maxwell M, Walker JJ. A comparison of a patient enablement instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract (1998) 15:165–71.10.1093/fampra/15.2.165
    1. Mercer SW, Watt GC. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med (2007) 5:503–10.10.1370/afm.778
    1. Mead N, Bower P, Roland M. Factors associated with enablement in general practice: cross-sectional study using routinely-collected data. Br J Gen Pract (2008) 58:346–52.10.3399/bjgp08x280218
    1. Mercer SW, Neumann M, Wirtz M, Fitzpatrick B, Vojt G. General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland – a pilot prospective study using structural equation modeling. Patient Educ Couns (2008) 73:240–5.10.1016/j.pec.2008.07.022
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials (1989) 10:407–15.10.1016/0197-2456(89)90005-6
    1. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol (1994) 47:81–7.10.1016/0895-4356(94)90036-1
    1. Wong W, Lam LKC, Li R, Ho SH, Fai LK, Li Z. A comparison of the effectiveness between Western medicine and Chinese medicine outpatient consultations in primary care. Complement Ther Med (2011) 19:264–75.10.1016/j.ctim.2011.07.001
    1. Wong CKH, Lam CLK, Law WL, Poon JTC, Kwong DLW, Tsang J, et al. Condition-specific measure was more responsive than generic measure in colorectal cancer: all but social domains. J Clin Epidemiol (2013) 66:557–65.10.1016/j.jclinepi.2012.11.010
    1. Wong CKH, Mulhern B, Wan YF, Lam CLK. Responsiveness was similar between direct and mapped SF-6D in Chinese colorectal cancer patients who declined. J Clin Epidemiol (2014) 67:219–27.10.1016/j.jclinepi.2013.08.011
    1. Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med (1997) 45:1829–43.10.1016/S0277-9536(97)00128-7
    1. Baker R. Development of a questionnaire to assess patients’ satisfaction with consultations in general practice. Br J Gen Pract (1990) 40:487–90.
    1. Hjortdahl P, Lærum E. Continuity of care in general practice: effect on patient satisfaction. BMJ (1992) 304:1287–90.10.2307/29715601
    1. Kinnersley P, Stott N, Peters T, Harvey I, Hackett P. A comparison of methods for measuring patient satisfaction with consultations in primary care. Fam Pract (1996) 13:41–51.10.1093/fampra/13.1.41
    1. Cheng SH, Yang MC, Chiang TL. Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care. Int J Qual Health Care (2003) 15:345–55.10.1093/intqhc/mzg045
    1. Grol R, De Maeseneer J, Whitfield M, Mokkink H. Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and The Netherlands. Fam Pract (1990) 7:100–3.10.1093/fampra/7.2.100
    1. Winefield H, Murrell T, Clifford J, Farmer E. The search for reliable and valid measures of patient-centredness. Psychol Health (1996) 11:811–2410.1080/08870449608400277
    1. Census and Statistics Department. 2006 Population By-census. Hong Kong: Government Printing Department; (2007).
    1. HKCFP Research Committee. What sort of primary healthcare service does the public want? Hong Kong Pract (2008) 30:24–8.
    1. Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med (2005) 3:159–6610.1370/afm.285
    1. Sans-Corrales M, Pujol-Ribera E, Gené-Badia J, Pasarín-Rua MI, Iglesias-Pérez B, Casajuana-Brunet J. Family medicine attributes related to satisfaction, health and costs. Fam Pract (2006) 23:308–16.10.1093/fampra/cmi112
    1. Hsiao C-J, Boult C. Effects of quality on outcomes in primary care: a review of the literature. Am J Med Qual (2008) 23:302–10.10.1177/1062860608315643
    1. Mercer SW, Siu JY, Hillier SM, Lam CL, Lo YY, Lam TP, et al. A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong. BMC Fam Pract (2010) 11:46.10.1186/1471-2296-11-46
    1. Mercer SW, Griffiths SM, Lam CLK, Wong WCW, Lam TP, Hillier S, et al. Incentives and barriers to adopting the family doctor model in Hong Kong: an in-depth qualitative study of the views, knowledge, and attitudes of patients. Hong Kong Med J (2011) 17:S25–7.
    1. Pawlikowska T, Nowak P, Szumilo-Grzesik W, Walker J. Primary care reform: a pilot study to test the evaluative potential of the patient enablement instrument in Poland. Fam Pract (2002) 19:197–201.10.1093/fampra/19.2.197
    1. Bikker AP, Mercer SW, Reilly D. A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. J Altern Complement Med (2005) 11:591–600.10.1089/acm.2005.11.591
    1. Lewis JR. Patient views on quality care in general practice: literature review. Soc Sci Med (1994) 39:655–7010.1016/0277-9536(94)90022-1
    1. Blasi ZD, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet (2001) 357:757–62.10.1016/S0140-6736(00)04169-6
    1. Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract (2002) 15:25–38.
    1. Lo YYC, Lam CLK, Mercer SW, Fong DYT. Does vocational training in family medicine have an impact on antibiotic prescribing pattern? Fam Pract (2011) 28:56–62.10.1093/fampra/cmq065
    1. Lo YYC, Lam CLK, Mercer SW, Fong DYT, Lee A, Lam TP, et al. Patient morbidity and management patterns of community-based primary health care services in Hong Kong. Hong Kong Med J (2011) 17:S33–7.
    1. Hong Kong Census and Statistics Department. Publications and Products of the 2006 Population By-Census. Hong Kong: Government Printing Department; (2007).
    1. Ong LML, De Haes JCJM, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med (1995) 40:903–1810.1016/0277-9536(94)00155-M
    1. Mercer SW, Reilly D, Watt GC. The importance of empathy in the enablement of patients attending the Glasgow Homoeopathic Hospital. Br J Gen Pract (2002) 52:901–5.10.1186/1471-2296-13-6
    1. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract (2002) 52(Suppl):S9–1210.1177/1062860612464731

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