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      Sociodemographic inequalities in patients’ experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017


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          Younger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England.


          We considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends.


          We included 5,241,408 responses over 11 survey waves from 2011–2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio-economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas.


          There have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.

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          Most cited references19

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          Interpersonal continuity of care and care outcomes: a critical review.

          We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care. A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to find original English language articles focusing on interpersonal continuity of patient care. The articles were then screened to select those articles focusing on the relationship between interpersonal continuity and the outcome or cost of care. These articles were systematically reviewed and analyzed by both authors for study method, measurement technique, and quality of evidence. Forty-one research articles reporting the results of 40 studies were identified that addressed the relationship between interpersonal continuity and care outcome. A total of 81 separate care outcomes were reported in these articles. Fifty-one outcomes were significantly improved and only 2 were significantly worse in association with interpersonal continuity. Twenty-two articles reported the results of 20 studies of the relationship between interpersonal continuity and cost. These studies reported significantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity. Although the available literature reflects persistent methodologic problems, it is likely that a significant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specific and measurable outcomes and more direct costs and should seek to define and measure interpersonal continuity more explicitly.
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            Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

             To assess whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients.
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              Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care.

              Patients' evaluations are an important means of measuring aspects of primary care quality such as communication and interpersonal care. This study aims to examine variations in assessments of primary care according to age, gender, socioeconomic, and ethnicity variables. A cross sectional survey of consecutive patients attending 55 inner London practices was performed over a 2 week period using the General Practice Assessment Survey (GPAS) instrument which assesses 13 important dimensions of primary care provision. Variations in scale scores were investigated for differences relating to age, gender, socioeconomic, and ethnic status as reported by respondents. A total of 7692 questionnaires were returned (71% response rate). Valid information on age, gender, socioeconomic status, and ethnicity was available for 4819 out of 5496 adult respondents. Approximately half the respondents reported their ethnic group as "white" and most of the remaining respondents reported belonging to "black" or South Asian groups. Significant differences existed between groups of patients defined by age or ethnicity for most of the scale scores examined. Black, South Asian, and Chinese respondents reported lower scores (representing less favourable assessments) than white respondents; older respondents reported more favourable evaluations of care than younger respondents; and less affluent groups reported lower scores than more affluent groups for two of the 13 dimensions. There was no significant difference between gender groups with respect to assessment of primary care. Age and ethnicity were independent predictors of respondents' assessments of primary care. Differences exist between identifiable subgroups of the population in their assessments of primary health care measured using the GPAS instrument. This work adds to the literature on variation in healthcare experience and the potential for patient assessment of primary care. Further work is required to investigate these differences in more detail and to relate them to differences in the nature and process of primary care provision. Primary care providers need to ensure that services provided are appropriate for all patient groups within their communities.

                Author and article information

                J Health Serv Res Policy
                J Health Serv Res Policy
                Journal of Health Services Research & Policy
                SAGE Publications (Sage UK: London, England )
                31 January 2021
                July 2021
                : 26
                : 3
                : 198-207
                [1 ]Senior Research Associate, Department of Public Health and Primary Care, University of Cambridge, UK
                [2 ]MPhil Student, Department of Public Health and Primary Care, University of Cambridge, UK; Resident Physician, Department of Medicine, University of California San Francisco, USA
                [3 ]Research Associate, Department of Public Health and Primary Care, University of Cambridge, UK
                [4 ]Professor of Cancer Epidemiology, Epidemiology of Cancer Healthcare and Outcomes (ECHO), Department of Behavioural Sciences and Health, Institute of Epidemiology and Health Care (IEHC), University College London, UK
                [5 ]Associate Professor, University of Exeter Medical School (Primary Care), University of Exeter, UK
                [6 ]Senior Social Scientist, The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, UK *These authors (CLS and SF) contributed equally to this work.
                Author notes
                [*]Katie Saunders, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK. Email: ks659@ 123456medschl.cam.ac.uk
                Author information
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Funded by: Economic and Social Research Council, FundRef https://doi.org/10.13039/501100000269;
                Award ID: ES/S007253/1
                Original Research
                Custom metadata

                Social policy & Welfare
                general practice patient survey, longitudinal, patient experience


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