Patients’ preferences and evaluations regarding general practice care
241
very important. Aspects related to the doctor–patient
relationship were mostly found to be important and
evaluated positively. Aspects related to the co-ordination
of care were found to be less important and mostly
evaluated less positively. Our conclusion is that patients’
preferences and patients’ evaluations are to a large
extent autonomous and, if preferences and evaluations
do influence each other, the effects are small.
and patients’ evaluations would therefore seem to be
generalizable.
If quality of care could be seen as a comparison of
patients’ evaluations of experienced actual care with the
care that they preferred, then those aspects of care most
important to patients and evaluated least positively
would be the best candidates for quality improvement.
In particular, ‘getting through to the practice on the
phone’, ‘explaining what to do if you are not getting
better’ and ‘referring you (to a specialist or hospital)’ are
aspects requiring attention. Although it was evaluated
quite positively, ‘providing quick services for urgent
health problems’ might also be a candidate for quality
improvement, because of its importance (first in rank
order). Measuring and interpreting patients’ prefer-
ences and evaluations in this way could be seen as a first
step towards closing the gap between what patients want
and what they get.
The moment of filling in the questionnaires, however,
seemed to influence both preferences and evaluations.
Evaluations were significantly lower and preferences
significantly higher when more time had elapsed between
the consultation and the completion of the questionnaire.
It seems unlikely that the completion of the first ques-
tionnaire, whether on preferences or on evaluations,
could be responsible for this effect on the evaluations or
preferences of a second questionnaire, because we inten-
tionally incorporated an interval of at least 3 weeks
between the completion of each questionnaire in order
to reduce this influence. One could argue that evalu-
ations expressed immediately after a consultation might
be influenced more by the fresh impressions of that
particular consultation, while evaluations expressed
some time after the consultations might be more of a
mixture of respondents’ own general experiences and
the experience of others. Personal care experiences have
been shown to be evaluated more positively than general
care experiences.7,16 Why should this be the case?
References
1
Williams B. Patient satisfaction: a valid concept? Soc Sci Med 1994;
38: 509–516.
2
Kravitz RL. Patients’ expectations for medical care: an expanded
formulation based on review of the literature. Med Care Res
Rev 1996; 53: 3–27.
Attkinson CC, Roberts RE, Pascoe GC. The evaluation ranking
3
scale: clarification of methodological and procedural issues.
One explanation could be that patients’ evaluations of
care they have experienced themselves are enhanced,
because the idea that the care one has received is not of
the highest quality would be threatening.17 (The theory
of cognitive dissonance suggests this mechanism.) It is
more difficult to understand why aspects of care are
considered more important when more time has passed
since the last consultation. This variation of patients’
preferences with the passage of time has been encoun-
tered previously.18 Perhaps there is some influence from
the evaluations of patients’ preferences which leads
aspects evaluated less positively to become more
important and when they are evaluated more positively
to become less important. Thompson and Sunol4 and
Ross et al.19 describe how psychological mechanisms
could lead to preferences and evaluations influencing
each other.
This study explored patients’ evaluations and prefer-
ences in five solo rural general practices in one region of
The Netherlands. It is, therefore, difficult to extrapolate
these findings. However, 23 of the 44 items in this
questionnaire were also used in a national study.15
Comparing the rank order of the evaluations of these
aspects yielded a high correlation (0.88 Spearman
rank order), so the patients’ evaluations in this
study strongly resemble those in the national study.
Furthermore, their preferences also resemble those
found in a national study of patients’ preferences.20 The
results of this comparison of patients’ preferences
Eval Program Plann 1983; 6: 349–358.
Thompson AGH, Sunol R. Expectations as determinants of patient
satisfaction: concepts, theory and evidence. Int J Qual Health
Care 1995; 7: 127–141.
Linder-Pelz S. Social psychological determinants of patient satis-
faction: a test of five hypotheses. Soc Sci Med 1982; 16:
583–589.
Segall A, Burnett M. Patient evaluation of physician role
performance. Soc Sci Med 1980; 14A: 269–278.
Pascoe GC, Attkinson CC, Robert RE. Comparison of indirect and
direct approaches to measuring patient satisfaction. Eval
Program Plann 1983; 6: 359–371.
Ross CK, Steward CA, Sinacore JM. The importance of patient
preferences in the measurement of health care satisfaction. Med
Care 1993; 31: 1138–1149.
Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter:
social psychological determinants. Soc Sci Med 1987; 24:
351–357.
Brown SW, Swartz TA. A gap analysis of professional service
quality. J Marketing 1989; 53: 92–98.
Wensing M, Grol R, Smits A. Quality judgements by patients on
general practice care: a literature analysis. Soc Sci Med 1994; 38:
45–53.
Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic
4
5
6
7
8
9
10
11
12
review of the literature on patients’ priorities for general
practice care: description of the research domain. Soc Sci Med
1998; 47: 1573–1588.
13
Grol R, Wensing M, Mainz J et al. Patients’ priorities with respect to
general practice care: an international comparison. Fam Pract
1999; 16: 4–11.
Bland JM, Altman DG. Multiple significance tests: the Bonferroni
method. Br Med J 1995; 310: 170.
Jung HP, Wensing M, Olesen F, Grol R. A comparison of patients’
14
15
and general practitioners’ evaluations of general practice care.
In: Quality of care in general practice. The patient perspective.
Jung HP. Thesis. Nijmegen, 1999.