Primary care in a post-communist country 10 years later:Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004

Objectives: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. Methods: A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians’ involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. Results: In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. Conclusions: Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition

Primary care in a post-communist country 10 years later : Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004

Objectives: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. Methods: A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians’ involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. Results: In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. Conclusions: Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition.

Unity or diversity? Task profiles of general practitioners in Central and Eastern Europe

Background: The countries of Central and Eastern Europe, where – until the end of the 1980s – the Semashko health care system prevailed, are often perceived as a homogeneous group. If this highly centralized system, with its tight state control, together with the ‘equalizing’ influence of communism, has led to a uniformity in the provision of health services, this could be reflected in the service profiles of general practitioners (GPs). The aim of this paper was to find out whether this picture is justified and investigate differences between the former communist countries. Methods: In 1993 and 1994, standardized questionnaires were sent to (mostly random) samples of GPs (7,233 in total) in 30 European countries. Four areas of service provision were measured: the GPs’ position in first contact with health problems and their involvement in the application of medical techniques, disease management and preventive medicine. Variation patterns and mean scores were analyzed by way of multilevel analysis. Results: There is no more uniformity in Central and Eastern Europe than in Western Europe. In Eastern Europe there are in fact considerable differences: GPs in former Yugoslavia have the most comprehensive service profile, whereas the lowest scores were found among doctors in the former Soviet Union. The countries which had a social insurance system before the Second World War, such as the Czech republic and Hungary, are situated in between. Conclusions: There are distinctive national differences in GPs’ task profiles in Central and Eastern Europe, which provide clues for the country-specific design and implementation of primary care-oriented reforms.

GP Practices as a One-Stop Shop: How Do Patients Perceive the Quality of Care? A Cross-Sectional Study in Thirty-Four Countries

Objective: To contribute to the current knowledge on how a broad range of services offered by general practitioners (GPs) may contribute to the patient perceived quality and, hence, the potential benefits of primary care. Study Setting: Between 2011 and 2013, primary care data were collected among GPs and their patients in 31 European countries, plus Australia, Canada, and New Zealand. In these countries, GPs are the main providers of primary care, mostly specialized in family medicine and working in the ambulatory setting. Study Design: In this cross-sectional study, questionnaires were completed by 7,183 GPs and 61,931 visiting patients. Moreover, 7,270 patients answered questions about what they find important (their values). In the analyses of patient experiences, we adjusted for patients' values in each country to measure patient perceived quality. Perceived quality was measured regarding five areas: accessibility and continuity of care, doctor-patient communication, patient involvement in decision making, and comprehensiveness of care. The range of GP services was measured in relation to four areas: (1) to what extent they are the first contact to the health care system for patients in need of care, (2) their involvement in treatment and follow-up of acute and chronic conditions, in other words treatment of diseases, (3) their involvement in minor technical procedures, and (4) their involvement in preventive treatments. Extraction Methods: Data of the patients were linked to the data of the GPs. Multilevel modeling was used to construct scale scores for the experiences of patients in the five areas of quality and the range of services of GPs. In these four-level models, items were nested within patients, nested in GP practices, nested in countries. The relationship between the range of services and the experiences of patients was analyzed in three-level multilevel models, also taking into account the values of patients. Principal Findings: In countries where GPs offer a broader range of services patients perceive better accessibility, continuity, and comprehensiveness of care, and more involvement in decision making. No associations were found between the range of services and the patient perceived communication with their GP. The range of GP services mostly explained the variation between countries in the areas of patient perceived accessibility and continuity of care. Conclusions: This study showed that in countries where GP practices serve as a "one-stop shop," patients perceive better quality of care, especially in the areas of accessibility and continuity of care. Therefore, primary care in a country is expected to benefit from investments in a broader range of services of GPs or other primary care physicians

Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries

OBJECTIVES: To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. METHODS: Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. FINDINGS: Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. CONCLUSIONS: Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems