Coping better with health problems after a visit to the family physician: associations with patients and physicians characteristics

Abstract

BackgroundGood patient experience is recognized as an important component of a strong primary care system. Among the dimensions related to experience in family medicine, the ability to cope better with health problems is considered to be a measure of the quality of a consultation with a family physician (FP). The objective is to identify factors related to patients, physicians and practice, associated with patients’ ability to cope better with their health problems after a family medicine consultation.MethodsThe data stemmed from the Swiss part of the Quality and Costs of Primary Care (QUALICOPC) study, an international cross sectional survey aiming to compare quality, cost and equity in primary care. In Switzerland, a random sample of 199 FPs and 1791 patients participated. The negative answer to the question: “After this visit, I feel I can cope better with my health problems” was modeled using multilevel logistic regressions.ResultsDifficulty to cope better with health problems was positively associated with the following: younger age (OR: 1.58, 95% CI [1.03–2.41]), cultural aspects related to the Swiss area of language (French speaking people declared higher inability than German and Italian ones), presence of chronic disease (OR: 1.54 95% CI [1.00–2.39]). Conversely an intermediate number (1–4) of visits during the last 6 months (OR: 0.37 95% CI [0.23–0.62]) and the satisfaction with the physician (OR: 0.18 95% CI [0.08–0.44]) are negative predictors of the patient inability to cope better with his health problems. A self-reported effort-reward imbalance at work (OR: 0.64 95% CI [0.41–1.00]) was the only predictive FP characteristic (negatively associated).ConclusionsAlthough the design of the study does not allow causal inference, this study showed that the predictors of patient difficulties to cope better with health problem are mainly centered on the patients’ characteristics. The patient-physician relationship both in terms of quality and frequency of visits is probably also important. Organizational practice characteristics do not seem to play a major role but stress at work among physicians should be further investigated.

The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres

“…However, there are contradictory results [10,13,14,17]. Having one [10,18] or several chronic diseases [19], or lower self-perceived health status [11,17,19] have been associated with lower enablement in previous studies. PEI scores also seem to vary according to the patients' ethnic background [9,10,20,21].…”

Patient enablement after a consultation with a general practitioner—Explaining variation between countries, practices and patients

“…20,24,25 Patients' culturally conditioned attitudes towards authorities (eg doctors) might influence the way patients evaluate the consultation. Considering patient health, lower self-perceived health, 8,17,19 the presence of a chronic illness 7,22 or multimorbidity 17 has been associated with lower enablement.…”

“…Furthermore, patient satisfaction has shown a rather strong positive association with enablement. 20,22,28,29 In general, enablement may be higher when there is a clear problem to solve in the consultation. Having an appointment due to long-standing conditions 17 or complex reasons 5,30 is found to be associated with lower enablement.…”

“…42 In an analysis of the QUALICOPC data for Switzerland, enablement was linked with the linguistic area. 22 Otherwise, there are no publications that link patient enablement with cultural differences.…”

“…However, only one study directly compares patient enablement between countries 15 and only a few report on comparisons of patient enablement between practices or doctors. [18][19][20][21][22] Furthermore, to our knowledge there are no publications that consider the possible effect of cultural aspects on enablement.…”