W HAT DO THE P ATIENTS W ANT ? Jacqueline Swan John Russell Susan Dovey

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

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40

50

60

Satisfaction with GP clinic

ED Patients PHO Patients Total

Perc

enta

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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

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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

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en

tag

e

Stro

ngly

agr

ee

Agree

Neutra

l

Disag

ree

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disa

gree

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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

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ngly

disa

gree

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5

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35

40

I would find it useful to have secure Inter-net access to my own

lab tests

ED PatientsPHO PatientsTotal

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enta

ge

Stro

ngly

agr

ee

Agree

Neutra

l

Disag

ree

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ngly

disa

gree

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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

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disa

gree

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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

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ngly

disa

gree

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10

20

30

40

50

60

It is important for me to know about the

qualifications that my doctor has

ED PatientsPHO PatientsTotal

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enta

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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

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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

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Disag

ree

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ngly

disa

gree

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5

10

15

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25

30

35

40

45

50

My clinic should have "drop in" times when I don't need an ap-

pointment

ED PatientsPHO PatientsTotal

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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

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RECOMMENDATION

When considering location, practices should be close in proximity to laboratory, x-ray and pharmacy services

THANK-YOU