A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain
Introduction
Patients can offer valuable contributions to the improvement of health care. They can be definers of good quality, evaluators of health care delivery and reporters of their experiences (Donabedian, 1992). As participants in health care delivery, they can influence the quality of care in more direct ways as well, for example by means of involvement in decisions concerning medical treatment. So it is important to know which aspects of care are important for patients and which aspects are less important. This knowledge helps health care providers to set priorities in their efforts to make health care more responsive to patients' wants and needs. Furthermore, using patients' perspectives for assessing the quality of care focuses on aspects that proved to be important for patients. A literature review of patient satisfaction studies in primary care showed that patients were rarely involved in the selection of indicators (Wensing et al., 1994). Therefore valid and reliable documentation is needed of the importance of different aspects of health care from patients' point of view.
Priorities can be defined as statements that indicate the importance of specific aspects of clinical behavior of care providers or the organization of care. Priorities are “normative expectations”: ideas about what should or ought to happen (Thompson and Sunol, 1995). Patient priorities differ from their reported experiences and from their satisfaction ratings with care delivery (Kaplan and Ware, 1989). Reported experiences are perceptions of actual events or episodes of care, such as the number of health check-ups in the last year. Satisfaction expresses an evaluation of actual experiences for which expectations or priorities are a frame of reference.
Studies on patient priorities have been published in many different sources, including health care and social science journals. We decided to make a systematic literature review of these studies. To the authors' knowledge, this is the first systematic literature review in this research field. It focuses on primary care, since this review is part of a large international study on patient priorities and evaluations concerning the quality of general practice care, called EUROPEP (Grol, 1993). Primary care was defined “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and participating in the context of family and community” (Donaldson et al., 1994).
The following research questions were formulated:
⋅ Which aspects of care have been included and which research methods have been used in studies on patient priorities with regard to primary health care or health care in general?
⋅ Which aspects of care are seen by patients as important for the quality of primary health care?
Section snippets
Literature search and inclusion
In order to find studies we applied several systematic search strategies: (1) computerized searches in Medline (1966–September 1995), Psychlit (1977–June 1995) and Sociofile (1974–August 1995), using the keywords “patient” or “consumer” combined with “expectation”, “priority” or “preference” and combined with “care” (“primary health care” in Medline). (2) We searched 30 international scientific journals for health care, general practice or family medicine care manually (1980–September 1995),
Results
In sum 57 studies met our inclusion criteria (marked with an asterisk in the reference list). Most studies were carried out in the U.S.A. (29 studies) or the United Kingdom (11 studies). The other studies were from Australia (6 studies), the Netherlands (4 studies), Canada (2 studies) or other countries (5 studies). Most studies were focused on general/family practice, either office-based (31 studies) or hospital-based (4 studies). Three studies concentrated on other primary care providers. The
Discussion
An overview has been provided of 57 studies on patient priorities with regard to primary care or health care in general, which are patients' subjective standards for good quality of care. It revealed a wide variation in the methodology and aspects of care included, which made it difficult to compare the results of different studies. The overall importance rank-order, based on an analysis of 19 studies, suggested that both technical and interpersonal quality are important for patients. In
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