Mutual influences of general practitioners in partnerships

Abstract

The aim of this study was to find out whether or not general practitioners (GPs) within the same partnership show more similarities in attitudes and behaviour than GPs in different partnerships, and what the causes of these similarities might be. Knowledge of the causes of patterns of similarities within medical teams contributes to understanding medical practice variation, which is crucial in developing effective health care policies.Data were used from the Dutch National Survey of General Practice ('87/'88), consisting of a stratified sample of 161 Dutch GPs, who served 335,000 patients in total.To find out whether GPs in the same partnership are indeed more similar than GPs randomly chosen from different partnerships, we constructed two kinds of pairs: all possible pairs of GPs working in the same partnership (actual pairs), and randomly constructed pairs of GPs who are not working in the same partnership (random pairs). For each pair difference scores were computed for a variety of attitudes and behaviour. Difference scores for actual and random pairs were analysed using multi-level analysis.Most differences in attitudes and behaviour were smaller for actual pairs than for random pairs. Furthermore, in the majority of the cases differences were no longer statistically significant after explanatory variables indicating selection, gradual adaptation and rapid adaptation through shared circumstances were taken into account.It was found that Dutch GPs working in the same partnership showed more resemblance in attitudes and behaviour than GPs not working in the same partnership. Most indications point towards circumstances, and to a lesser extent towards adaptation, as an explanation of similarities within partnerships. The implication of this study is that medical practice variations are not merely individual differences in preferred practice style, but are patterned by social processes in partnerships and local circumstances. r

Patient involvement and medical practice variation

“…Research showed that it depends upon the type of behaviour which health literacy skills are required. Different types of health literacy, be they functional, communicative or interactive, or critical, have a different impact upon different outcome measures [45,46]. Our results are in line with this.…”

“…One possible explanation for this might be that our respondents in general scored quite high on these lower order competences. It has also been suggested that the functional, communicative or interactive and critical components of health literacy can be seen as complementary [45]. Research showed that it depends upon the type of behaviour which health literacy skills are required.…”

“…Health literacy is defined by the Institute of Medicine as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" [41]. Yet, several studies have examined the relation between health literacy and involvement in medical decision-making [42][43][44][45][46][47][48]. Future research is recommended to further examine the relation between health literacy and involvement in medical decision-making.…”

“…Some subfertile couples and professionals regard twin pregnancies as a success; however, this could also be considered as a side effect or even a complication [45]. Twin pregnancies are associated with higher morbidity and mortality rates for mother and child compared with singleton pregnancies [34].…”

“…Subsequently, twin pregnancies are increasingly regarded as undesirable. To prevent twin pregnancies, professionals and couples could choose SET instead of DET [34,45]. However, this may be disadvantageous since it could result in a lower pregnancy rate per IVF cycle [33].…”