Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey.


Cowling, TE; Harris, M; Majeed, A; (2016) Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey. BMJ quality & safety, 26 (5). pp. 360-371. ISSN 2044-5415 DOI: https://doi.org/10.1136/bmjqs-2016-005233

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Abstract

The UK government plans to extend the opening hours of general practices in England. The 'extended hours access scheme' pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week. To determine the association between extended hours access scheme participation and patient experience. Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013-2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis. Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63). Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 27343274
URI: http://researchonline.lshtm.ac.uk/id/eprint/4503987

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