Home and Community Care Digest

Home and Community Care Digest 8(2) November -0001

What Do Canadians Want in Primary Care?

Abstract

The study's objectives were to: 1) rank ten primary care performance priorities important to Canadians; 2) determine how stable these priorities were from 2001 to 2004; and 3) examine whether priority ratings vary according to population subgroups. The top three performance priorities were: (1) the extent to which physicians keeps their knowledge and skills up to date, (2) skill in identifying and treating problems, and (3) ability to explain things in a way that the patient can understand. The orders of importance ascribed to primary care priorities in 2001 and 2004 were identical. The identified primary care performance priorities can inform efforts to prioritize among performance indicators valued by Canadians.
Background: The identification of primary care performance indicators may enhance public reporting of progress and policy-makers of wise future investment in reform. While several indicators have been identified to measure primary health care reform, no clear mechanism has been developed to prioritize performance indicators. The study's objectives were to: 1) rank ten primary care performance priorities important to Canadians; 2) determine how stable these priorities were from 2001 to 2004; and 3) examine whether priority ratings vary according to population subgroups. The findings can offer the basis for a meaningful, feasible, national public performance reporting strategy for primary care where measures are predicated on ten performance priorities highly valued by Canadians.

Methods: A sample of the general Canadian population was asked in 2001 and 2004 (1,162 and 1,099 Canadians 15 years of age, respectively) to rank ten performance priorities on their importance for evaluating primary care services where the priorities would hypothetically serve as the bases for public performance reporting. Trained professionals administered a telephone survey with a scale ranked from "of critical importance" to "not at all important". The ten primary care performance priorities were identified beforehand in another study, where the researchers conducted a literature review on health care performance from the perspectives of both consumers and potential consumers of health care. Analyses were conducted to determine whether there were significant differences in respondent characteristics and their ratings of each priority between the two observation years.

Findings: The study participants were more educated than national levels reported in the Canadian census. The orders of importance ascribed to the priorities in 2001 and 2004 were identical. Priorities with top rankings related to technical and communications skills of physicians, while those related to practice management ranked lowest. The top five performance priorities were: (1) the extent to which physicians keep their knowledge and skills up to date, (2) skill in identifying and treating problems, (3) ability to explain things in a way that the patient can understand, (4) referrals to specialist when needed, and (5) patient satisfaction with care. Priorities rated ninth and tenth were: reminder of upcoming visit and waiting time to appointment. It was notable that access to care was consistently given low priority, whereby referrals to specialist and access to urgent care where given higher priorities. Population characteristics, such as education and income, played a significant role in explaining ratings for performance priorities. For example, a respondent earning less than $20,000 without secondary education ranked appointment reminders higher than a respondent with postsecondary education earning $50,000 per year. Sex explained variation in 8 of 10 priorities, suggesting that women are more frequent users and manage dependents' use of primary health care.

Conclusions: This study offers insights to policy makers on a primary care performance measurement strategy. Findings may reflect the public's view of important issues in primary care. The stability of the primary care performance priorities (between the two observation times) offers a promising foundation upon which to develop performance measures. Moreover, information on how the population characteristics relate to the ten priorities can serve as a comparator for changes in population priorities for primary care that may arise in the future. The primary care performance priorities identified can inform efforts to prioritize among performance measures, valued by Canadians.

References

Berta W, Barnsley J, Brown A, Murray M. In the eyes of the beholder: Population perspectives on performance priorities for primary care in Canada. Healthcare Policy. 2008; 2(4): 86-100.

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