What do the Patients Want?

1. What do the Patients Want? Jacqueline Swan John Russell Susan Dovey

2. GP Research Registrar • RNZCGP Research Registrar Programme • Mix of clinical and research work, plus academic study • Alternative pathway to fellowship • Sponsored by Comprehensive Care Ltd, Auckland • Mentorship Susan Dovey

3. Background “Better, Sooner, More Convenient” Any changes to existing models of care should have patient participation and be responsive to what patients want

4. Objectives • How do patients view current primary care services? • What changes do patients want to improve those services?

5. Methods • Mixed Methods • Focus Groups to inform questionnaire development • GPs, nurses, Practice Managers, patients • Survey of Patients • Random selection of PHO patients, stratified by ethnicity • NSH ECC, patients presenting without a GP referral • Ethics approval

6. Results • 485 responses • 380 PHO patients (19.3%) • 105 ECC patients (83%) Respondents were more likely to be female (63%), European (48%) and older in age

8. Major Conclusions and Recommendations

9. Patient’s presentation to the emergency department is more around the seriousness of the condition than poor access to GP services, although for one in five patients access and cost is a factor

10. What influenced you to come to the ED today? • 66% considered medical condition to be serious • 50% did not think their medical condition could be managed by the GP • 20% could not get an appt with their GP • 22% could not afford to see the GP • 17% GP was closed

11. Patients are satisfied with their general practice

12. All things considered, how satisfied are you with your own GP clinic?

13. The majority of patients feel cost is about right and not a barrier to them seeking GP services, although when asked about improving services lower cost is the top choice.

14. For the service I receive I believe the cost is

15. Present costs are a barrier to my seeking general practitioner services True 36% False 64%

16. Recommendation Efforts regarding subsidies should be concentrated towards those most deprived

17. Patients want secure internet access to their medical information and information on reliable medical internet sites, particularly those less than 50 years of age

21. Recommendations The PHO and its practices should consider the use of a patient portal system The PHO and its practices should consider links via their websites to reliable medical internet sites for patient’s reference

22. Patients want longer appointments as an option when booking but not as routine

23. I would like longer appointment times • 50% yes, as an option when I book • 8% yes, as routine • Rest no / neutral • 91% of those who wanted longer appointments didn’t want to pay for them!

24. Recommendation Practices should continue to offer longer appointments as an option, but alert patients that this will incur an additional cost

25. Relationship and choice of doctor are more important to patients than facilities or speed of access

26. Please indicate which is of more importance to you • 86% relationship with my doctor more important than practice facilities • 53% choice of doctor more important than the speed at which they can get an appointment

27. While most patients agree it is important to know about quality standards and qualifications, only 9% have heard of cornerstone and 43% of FRNZCGP

29. 9% of patients had heard of Cornerstone • Of those, 59% indicated understanding • 43% of patients had heard of FRNZCGP • Of those, 72% indicated understanding

30. Recommendation Practices, PHOs and the Royal New Zealand College of General Practitioners should embrace, educate patients and promote Cornerstone and Fellowship

31. Most patients would be happy to see the nurse for more minor conditions and for separate consultations

33. Recommendation Looking into the future, changes to care models should make use of nursing consultations and should be careful not to erode the relationship factor of General Practice, this needs to be considered ahead of co-location and facilities

34. Patients would like a drop in clinic and weekend clinic times, however access seems satisfactory, with 67% of patients agreeing or strongly agreeing that they can easily get an appointment at their clinic within 24 hours.

36. Recommendation Practices should offer some weekend and evening clinic times, and consider the use of drop-in clinics

37. For the majority of services additional to the GP clinic, location is not deemed important. However, over half of all respondents would like the chemist to be within a five minute walk or closer, and approximately 40% of respondents would like laboratory and x-ray services within a five minute walk or closer.

39. Recommendation • When considering location, practices should be close in proximity to laboratory, x-ray and pharmacy services

40. Thank-you