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

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Title: Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey
Authors: Cowling, T
Harris, M
Majeed, F
Item Type: Journal Article
Abstract: Background 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. Objective To determine the association between extended hours access scheme participation and patient experience. Methods 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. Results 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). Conclusions 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.
Issue Date: 24-Jun-2016
Date of Acceptance: 30-May-2016
URI: http://hdl.handle.net/10044/1/34088
DOI: https://dx.doi.org/10.1136/bmjqs-2016-005233
ISSN: 2044-5423
Publisher: BMJ Publishing Group
Start Page: 360
End Page: 371
Journal / Book Title: BMJ Quality & Safety
Volume: 26
Copyright Statement: © 2016 The Authors. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: DRF-2013-06-142
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
DISCRETE-CHOICE EXPERIMENT
CROSS-SECTIONAL ANALYSIS
PRIMARY-CARE EVIDENCE
HOSPITAL ADMISSIONS
HIGHER QUALITY
ACCESS
ORGANIZATIONS
ASSOCIATION
PREFERENCES
ACCIDENT
General practice
Health policy
Health services research
Patient satisfaction
Primary care
Publication Status: Published
Appears in Collections:School of Public Health