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Community orientation of general practitioners in 34 countries.

Groenewegen, P. Community orientation of general practitioners in 34 countries. European Journal of Public Health: 2017, 27(s3) . Abstracts: 10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017
Background
General practitioners (GPs) differ roughly speaking in whether they care for patients that visit their practice or whether they have a responsibility for a population. As a consequence of changes in demography (aging populations), epidemiology (multimorbidity) and healthcare policy, an orientation on the community becomes more important. Our research question is: to what extent does community orientation of GPs vary between countries and how can this variation be explained?

Methods
We use data from the QUALICOPC study, conducted among approximately 7,000 GPs in 34 (mainly European) countries. Community orientation was measured in the GP survey through three questions (combined into a scale) on whether they would take action when confronted with the following situations: repeated accidents in an industrial setting, frequent respiratory problems in patients living near a certain industry, and repeated cases of food poisoning. Independent variables are at healthcare system level and GP or practice level. Data were analysed using linear multilevel regression analysis, with countries and GPs as levels.

Results
Community orientation varies between GPs and between countries. GPs in Norway, Turkey, Greece, Italy and The Netherlands most often say that they react to the described situations, whilst GPs in Cyprus, Estonia, Hungary, Germany and Latvia least.

Conclusions
Stronger community orientation is becoming more important, but it is not common practice in many countries. It is both related to healthcare system characteristics and GP or practice characteristics. Education of the future health workforce should give attention to community orientation, including ways to involve the local population in primary care. Optimal regulatory conditions should be brought in place.

Key message
European countries largely vary in community orientation of GPs Education should give attention to community orientation and involvement of local population in primary care.