Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Abstract

Background Patient experience is an important indicator of quality of health care. In Norway, little is known about the quality of health care for immigrants. The aim of this study was to compare patient-reported experiences with general practice between the Norwegian-born population and immigrant groups. Methods We performed secondary analyses of data from a national survey on patient experiences with general practice, including assessments of general practitioners (GPs) and their GP offices. The survey was carried out in Norway in 2018–19. The total number of respondents was 2029, with a response rate of 42.6%. Region of birth was available for 1981 participants, and these were included in the analyses (“Norway” (N = 1756), “Asia, Africa or South America” (N = 95), “Eastern Europe” (N = 70) and “Western Europe, North America or Oceania” (N = 60)). Five indicators of patient experiences were used as dependent variables in bivariate and multivariate analyses, with region of birth as the main exposure variable and other background variables about the patient as adjustment variables: “the GP” (measures related to communication and competency), “auxiliary staff” (politeness, competency, organization), “accessibility” (waiting times), “coordination” (with other services) and `enablement` (GP facilitates coping with/understanding illness). Results Immigrants as a whole reported poorer experiences with general practice than the majority population, with significantly poorer scores on four of five patient experience indicators. Patients from Asia/Africa/South America reported poorer experiences than those from Norway on the indicators “GP”, “auxiliary staff”, “accessibility” and “coordination”: on a scale from 0 to 100 where 100 is the best, the difference ranged from 7.8 (GP) to 20.3 (accessibility). Patients from Eastern Europe reported lower scores on “GP” and patients from Western Europe/North America/Oceania reported lower scores on “auxiliary staff”. These associations were still significant after adjustment for sex, age, self-rated physical and mental health, number of contacts with the GP and education. Conclusions For countries with a substantial proportion of foreign-born patients in the health system, immigrant background is an important parameter in quality improvement work. Immigrant background is also an important parameter in health service research.

Ethnic inequalities in patient satisfaction with primary health care in the UK: evidence from recent General Practitioner Patient Surveys (GPPS)

“…This is consistent with the findings of other studies reporting lower patient overall satisfaction scores among younger and ethnic minority groups [2,4,6]. However, further research is required to establish a potential link between access and overall satisfaction which remains debatable [5,8,11,16-18].…”

“…However, there have been limited substantial changes in inequalities in patient experience in primary health care within England during the period 2011 to 2017 [2]. Patient satisfaction is an important indicator of the quality of care and may help relevant policy makers identify and address limitations with the health care system [7,8]. Good patient experience and satisfaction usually translates into better health outcomes as patients are likely to be more engaged during consultations, better collaborate with General Practice (GP) staff and more likely to adhere to treatment plans.…”

“…An earlier analysis of the English GP survey data 2012 – 2014 by Burt et al [6] found that groups specifically of older, Pakistani and Bangladeshi female and younger individuals who identified as other white (other European countries) were associated with issuing the lowest ratings with regards to their doctors’ communication. Southeast Asians and younger patients have consistently been linked to reporting lower patient satisfaction scores in other studies [4,8]. In the context of determining how communication among different ethnic groups may influence the quality of care they receive, it is often grouped with acculturation, perceived as the modification of attitudes and behaviours when people come into contact with a different culture [6].…”

Navigating the care between two distinct cultures: a qualitative study of the experiences of Arabic-speaking immigrants in Norwegian hospitals

“…Some studies investigated various dimensions of unmet needs and experiences of diverse populations within advanced western health-care systems, such as that in Norway. These studies include consideration of the cultural competency of the nursing staff [ 2 , 8 , 9 ], inclusionary and exclusionary organizational practices [ 1 ], cultural diversity [ 10 ],comparative experiences between the indigenous people and immigrants [ 11 ], normative and ethical debates regarding immigrant patients [ 3 , 12 , 13 ] and familial involvement [ 14 – 16 ].…”

Ethnic inequalities in patient satisfaction with primary health care in England: Evidence from recent General Practitioner Patient Surveys (GPPS)

“…However, there have been limited substantial changes in inequalities in patient experience in primary health care within England during the period 2011 to 2017 [ 2 ]. Patient satisfaction is an important indicator of the quality of care and may help relevant policy makers identify and address limitations with the health care system [ 7 , 8 ]. Good patient experience and satisfaction usually translates into better health outcomes as patients are likely to be more engaged during consultations, better collaborate with General Practice (GP) staff and more likely to adhere to treatment plans [ 9 ].…”