How do clinical quality and patient satisfaction vary with provider size in primary care? Evidence from English general practice panel data

Gravelle, Hugh; Liu, Dan; Santos, Rita

doi:10.1016/j.socscimed.2022.114936

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…Regarding practice size, a systematic review and meta-analysis by Riordan et al published in 2020 [ 52 ] reported that the results of a relation between practice size and actual quality of care were inconsistent, although larger practices were associated with more structured care. The reason for a smaller practice size being associated with better performance in our study should be investigated more, and differences in results could be due to the specific characteristics of the primary healthcare system in each country or due to different variables within the medical consultation (e.g., spending more time with patients, continuity of care, knowing the patient better) [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Performance of Primary Care Physicians in the Management of Glycemia, Lipids, and Blood Pressure among People with Type 2 Diabetes: A Cross-Sectional Study

Vlacho,

Fernandez-Camins,

Canudas-Ventura

et al. 2024

JCM

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Background: Our study aimed to evaluate the performance of primary healthcare physicians (PCPs) in managing glycemia, lipids, and blood pressure in people with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. Methods: We included 3267 PCPs with 367,132 T2DM subjects in a cross-sectional analysis of the SIDIAP (Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària) database for the year 2017. Results: 63.1% of PCPs were female, with an average practice size of 1512 subjects. T2DM individuals had a mean (standard deviation) age of 70 (±12.2) years old, a mean body mass index (BMI) of 30.2 (±5.21) kg/m2, and a median diabetes duration of 8.8 years. Overall, 42.6% of subjects achieved target glycemic control (glycated hemoglobin < 7%). Notably, 59.2% maintained blood pressure < 140/90 mmHg during the 12-month study period. The multivariable analysis identified positive associations between glycemic control and female PCPs, practice sizes (1000–1500 people), a higher proportion of patients aged ≥ 65 years, and rural practices. Combined glycemic, lipid, and blood pressure target attainment was associated with medium-sized practices and those with a higher proportion of patients aged ≥ 65 years. Conclusions: Practice size, patient age distribution, and rurality are factors associated with the performance of PCPs in the control of glycemia, lipids, and blood pressure in T2DM subjects in primary health care centers in our region.

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Section: Discussionmentioning

confidence: 99%

Performance of Primary Care Physicians in the Management of Glycemia, Lipids, and Blood Pressure among People with Type 2 Diabetes: A Cross-Sectional Study

Vlacho,

Fernandez-Camins,

Canudas-Ventura

et al. 2024

JCM

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“…This sample restriction is commonplace in the literature analyzing associations between primary care characteristics. 32 , 33 We achieved a final sample of 59 218 GP practice-year observations from 7881 GP practices across nine financial years with complete cases in the outcome and predictors.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with cervical screening coverage: a longitudinal analysis of English general practices from 2013 to 2022

Urwin,

Gillibrand,

Davies

et al. 2023

Journal of Public Health

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Background Cervical cancer remains an important global public health concern. Understanding the factors contributing to a decline in screening uptake in high-income countries is fundamental to improving screening rates. We aimed to identify general practice and patient characteristics related to cervical screening coverage in England between 2013 and 2022. Methods We analyzed a panel of 59 271 General Practice (GP)-years from 7881 GP practices. We applied correlated random effects regression to examine the association between cervical screening uptake and a rich set of GP practice workforce, size, quality and patient characteristics. Results Our results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. We find GP workforce and list size characteristics are strongly related to screening rates. An increase in 1 FTE Nurse per 1000 patients is related to a 1.94 percentage point increase in cervical screening rates. GP practices located in more deprived areas have lower screening rates. Conclusions GP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The implementation of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities.

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“…However, some evidence suggests that these larger practices may have poorer continuity of care, with working at scale not in itself improving patient access or clinical performance. 11,12 When ceasing to exist, practices will hand their contract back to the NHS (commissioner) who will then be responsible for offering an alternative practice. In practice, patients will then register at alternative local practices, who may be forced to accept them.…”

Section: Main Text Introductionmentioning

confidence: 99%

“…In practice, patients will then register at alternative local practices, who may be forced to accept them. 11 Ownership change is likely to be more complicated, but principally involves the consolidation of multiple contracts into one, with negotiation between the constituent providers.…”

Section: Main Text Introductionmentioning

confidence: 99%

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Consequences of the closure of general practices: a retrospective cross-sectional study

et al. 2023

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Background: Two general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet we know little about the consequences. Closure refers to when a practice ceases to exist, merges or is taken over. Aim: Does practice funding, list size, workforce composition and quality change in surviving practices, when surrounding general practices close? Design and Setting: Cross-sectional study of English general practices, using data from 2016-20. Method: The exposure to closure for all practices existing on 31.03.2020 was estimated. This is the estimation proportion of a practice’s patient list that had been through a closure in the preceding three years, between 01.04.2016 and 31.03.2019. The interaction between our exposure to closure estimate and the outcome variables (list size, funding, workforce and quality) was analysed through multiple linear regression, whilst controlling for confounders (age profile, deprivation, ethnicity and rurality). Results: 694 (8.41%) practices closed. A 10% increase in exposure to closure results in 1925.6 (1675.8, 2175.4) more patients in the practice with £2.37 (£4.22, £0.51) less funding per patient. Whilst numbers of all staff types increased, there were 86.9 (50.5, 123.3), 4.3%, more patients per GP. Increases for other staff types were proportionate to increases in patients. Patient satisfaction with services declines across all domains. No significant difference in QOF scores was identified. Conclusion: Higher exposure to closure was leading to larger practice sizes in remaining practices. Closure changes workforce composition and reduces patient satisfaction with services.

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How do clinical quality and patient satisfaction vary with provider size in primary care? Evidence from English general practice panel data

Cited by 5 publications

References 20 publications

Performance of Primary Care Physicians in the Management of Glycemia, Lipids, and Blood Pressure among People with Type 2 Diabetes: A Cross-Sectional Study

Performance of Primary Care Physicians in the Management of Glycemia, Lipids, and Blood Pressure among People with Type 2 Diabetes: A Cross-Sectional Study

Factors associated with cervical screening coverage: a longitudinal analysis of English general practices from 2013 to 2022

Consequences of the closure of general practices: a retrospective cross-sectional study

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