Patients in 34 countries reflecting on possible improvements in primary care

Worldwide, strong primary care seems to become the standard for good health care. In countries where the government has better organised the structure of primary care, patients see less potential for improvement, as shown in a NIVEL study in 34 countries, recently published in the Bulletin of the World Health Organization (WHO).

For this study almost 70.000 patients in 34 countries have answered questions on their experiences with care provided by the General Practitioners. Most people are quite positive about the communication with their general practitioner (GP), but still there are possibilities for improvement in many countries. In some countries patients see more options for improvement than in other.
Presenting more problems in one consultation
In Cyprus, Portugal, Slovakia, Spain and Turkey, for instance, patients see space for improvement of the accessibility of care. Furthermore, patients in many countries feel the need to discuss multiple problems during a consultation with the GP and to discuss personal problems. In southern European countries, like Greece, Malta, Turkey and Cyprus, patients see possibilities to improve the continuity of care. In Cyprus, Bulgaria and Poland patients would like to be more involved by their GP in decision making related to the treatment.
Primary care structure and patient experiences
The researchers also investigated to what extent a stronger structure of primary care is associated with the experiences of patients. In countries with a stronger governance on primary care, for example, reflected in a clear policy vision and a better coverage of primary care services, patients turn out to be more positive about continuity of primary care than in other countries.
Room for improvement
In countries where financial and economic conditions for primary care are better, for instance through higher relative expenditures for primary care and a better coverage of primary care services, patients appear to perceive less room to improve the accessibility, continuity and breadth of the delivered services in primary care. The same goes for the communication between patient and GP and the room for joint decision making.
Stimulation works
NIVEL-researcher Willemijn Schäfer: “Pro-primary care policies turn out to make a difference in the patients perceived possibilities for improvement.”
The study was co-funded by the European Commission 
Cooperating partners
StANNA- Sant’Anna School of Advanced Studies, Pisa (Italy)
Ghent University- Department of Family Medicine and Primary Health Care, Ghent (Belgium)
RIVM- National Institute for Public Health and the Environment
ULMF- University of Ljubljana, Ljubljana (Slovenia)
Hochschule Fulda - University of Applied Sciences, Fulda (Germany)