Is patient satisfaction in primary care dependent on structural and organizational characteristics among providers? Findings based on data from the national patient survey in Sweden

Abstract

In parallel to market-like reforms in Swedish primary care, the gathering and compilation of comparative information about providers, for example through survey tools, has been improved. Such information is increasingly being used to guide individuals' choice of provider and payers' assessments of provider performance, often without critically reflecting about underlying factors affecting the results. The purpose of this study was to analyze variation in patient satisfaction, with respect to organizational and structural factors, including the mix of registered individuals, among primary care providers, based on information from a national patient survey in primary care and register data in three Swedish county councils. Systematic variation in patient satisfaction was found with respect to both organizational and structural factors, including characteristics of registered individuals. Smaller practices and practices where a high proportion of all visits were with a doctor were associated with higher patient satisfaction. Also practices where registered individuals had a low level of social deprivation and a high overall illness on average were associated with higher patient satisfaction. Factors that are of relevance for how well providers perform according to patient surveys are more or less possible to control for providers. This adds to the complexity for the use of such information by individuals and payers to assess provider performance.

Process measures or patient reported experience measures (PREMs) for comparing performance across providers? A study of measures related to access and continuity in Swedish primary care

“…The models with PREMs as the dependent variables confirm that patient views about accessibility and continuity vary with respect to both controllable and uncontrollable factors for providers. The results from the regression analysis are in line with those in a previous study based on data from the national patient survey and data about providers in the same county councils as in the current study (Glenngård, 2013). Similar to the previous study in the Swedish setting and studies in other contexts (Campbell et al, 2001a;2001b;Kontopantelis et al, 2010), smaller practices and practices where a high proportion of all visits were with a doctor, a low level of social deprivation (for accessibility) and a high overall illness (for continuity) on average were individual factors associated with positive opinion about quality among patients.…”

Management practices and the quality of primary care

“…Another notable result is that higher social deprivation among enrolled individuals is associated with higher management quality. An interesting aspect of this is that social deprivation is also associated with less satisfied patients, in line with previous studies from Sweden and the UK (Campbell et al, 2001;Kontopantelis et al, 2010;Glenngård, 2012;Glenngård and Anell, 2017). Individuals with a poor socioeconomic situation are expected to have greater needs for primary care, especially preventive measures and coordination with social services and relatives.…”

Patient choice, Internet based information sources, and perceptions of health care: Evidence from Sweden using survey data from 2010 and 2013

“…The finding that relatively few people appear to use the Internet as a source of health care information is an important one and is in line with those of other studies [ 17 , 22 , 46 ]. In the current choice-based reforms across European and other health systems, much of the information needed to make an informed choice across provider options is Internet-based.…”

“…The evidence base for the extent to which these sources of provider information is used and whether it affects patient experiences is currently limited [ 19 , 20 ]. While it has been found that patient satisfaction is partly determined by institutional and context factors (like waiting times, geographic access, and provider friendliness) [ 21 , 22 ], less is known about the actual use of Internet based information sources (IBIS) such as those identified above and patients’ experiences of health care [ 23 ].…”