Abstract
BACKGROUND: We aimed to: (i) examine to what extent care experiences and perceived outcomes among persons with chronic conditions depend on the GPs they are registered with and (ii) map the associations between patient and GP-level determinants of patient-reported experience and outcome measures. METHODS: Cross-sectional general practice nested survey of patients (n = 6691). We estimated the amount of variation at the GP level and conducted multilevel regression analyses to test hypothesized associations between potential predictors (mostly registry-based) and the six Patient-Reported Experience Measures and five Patient-Reported Outcome Measures as dependent variables. RESULTS: The ICC for four of six PREMs varied from 0.035 to 0.091, while the ICCs for the PROMs varied from 0.014 to 0.022. The main predictors of patients' care experiences were health literacy (P < 0.001 for all measures) and the number of years on the GP list (P < 0.001 for five of six measures). The main predictors for patient-reported outcomes were the number of chronic conditions (P < 0.001 for all), income (P < 0.001 for all indicators for low income compared to high), health literacy (P < 0.001 for all) and the number of consultations in the last 24 months (P < 0.001 for all), and the number of years on the GP list was also significantly associated with all PROMs. CONCLUSIONS: Most PREMs demonstrated substantial variation between GPs, warranting GP-level initiatives to improve care experiences for persons with chronic conditions. Health literacy and continuity of care were important determinants of patient-reported experiences and outcomes, demonstrating the importance of these factors for health system performance.