Identifying predictors of high quality care in English general practice: observational study

Abstract

Objectives To assess variation in the quality of care in general practice and identify factors associated with high quality care. Design Observational study. Setting Stratified random sample of 60 general practices in six areas of England. Outcome measures Quality of management of chronic disease (angina, asthma in adults, and type 2 diabetes) and preventive care (rates of uptake for immunisation and cervical smear), access to care, continuity of care, and interpersonal care (general practice assessment survey). Multiple logistic regression with multilevel modelling was used to relate each of the outcome variables to practice size, routine booking interval for consultations, socioeconomic deprivation, and team climate. Results Quality of clinical care varied substantially, and access to care, continuity of care, and interpersonal care varied moderately. Scores for asthma, diabetes, and angina were 67%, 21%, and 17% higher in practices with 10 minute booking intervals for consultations compared with practices with five minute booking intervals. Diabetes care was better in larger practices and in practices where staff reported better team climate. Access to care was better in small practices. Preventive care was worse in practices located in socioeconomically deprived areas. Scores for satisfaction, continuity of care, and access to care were higher in practices where staff reported better team climate. Conclusions Longer consultation times are essential for providing high quality clinical care. Good teamworking is a key part of providing high quality care across a range of areas and may need specific support if quality of care is to be improved. Additional support is needed to provide preventive care to deprived populations. No single type of practice has a monopoly on high quality care: different types of practice may have different strengths.

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

“…[14][15][16] Compared with people living in the community, those living in care homes receive poorer care for conditions like heart disease and diabetes, and potentially harmful medications (for example, antipsychotics) are overprescribed. [17][18][19] Practice characteristics such as small list size, low level of socioeconomic deprivation, 20 and a large number of GPs 21 have also been associated with better quality of care for people with dementia.…”

Variations in process and outcomes of diabetes care by socio-economic status in Salford, UK

“…However, this was potentially confounded by an increased prevalence of Type 2 diabetes among the people with diabetes from more deprived groups [4]. Another study found that deprivation scores did not predict the quality of care for diabetes, as measured by a complex score encompassing a wide range of process of care measures and intermediate outcomes [16].…”

A survey of primary and specialised health care provision to prisons in England and Wales

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