What matters for patients’ experiences with primary care? A study of variation in patient reported experience measures with regard to structural and organisational characteristics of primary care centres in a Swedish region.

Abstract

Previous research on variation in patient reported experience measures (PREMs) suggest that it is important to be cautious when using comparative information about patients’ experiences, collected via patient surveys, to assess provider performance. Not all factors associated with variation in PREMs are related to factors that providers themselves can control. This study explores if structural characteristics of primary care practices (PCCs), that are difficult to control, and the way that providers manage and organise their work matter for patients’ experiences with care. The purpose was to analyse variation in PREMs at the PCC level in Swedish primary care, with regard to structural characteristics of PCCs, including patient mix, and variables representing how providers organise and manage their work. Since the choice reform in 2007-2010, there is a mix of public and private providers, all with public funding and operating under the same overall requirements. The analysis is based on data from a national patient survey in primary care and registry data from a large Swedish region. OLS regression analysis was used to study variation in seven PREM-dimensions in regards to variables representing structural and organisational characteristics and processes of work at PCCs, covering the years 2018-2019 (N=281 PCC year observations). The results imply that variables that can be changed by providers themselves matter more for patients’ experiences with care than factors that providers cannot control. The most significant associations were found between PREMs and proportion and continuity of GP visits and adherence to clinical guidelines regarding treatment of risk groups. However, it is a challenge for providers to offer a high proportion of visits with GPs and good continuity due to a persisting shortage of GPs in Sweden. Recent policy initiatives have been introduced in this area. From a policy perspective, variation in patients’ experiences with regard to socioeconomic conditions is also a concern. Published: Online August 2021