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Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation.

Piribauer F, Thaler K, Harris MF - BMJ Open (2012)

Bottom Line: To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking.No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found.Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data.

View Article: PubMed Central - PubMed

Affiliation: International Screening Committee for Austria, Austrian Public Health Association, Vienna, Austria.

ABSTRACT

Objective: To assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking.

Design: Secondary data analysis of a clustered cross-sectional direct observation survey.

Setting: General practitioners (GPs) in Vienna, Austria, visited unannounced by mystery shoppers (incognito standardised patients (ISPs)).

Participants: 21 randomly selected GPs were visited by two different ISPs each. 40 observation protocols were realised.

Main outcome measures: Robustness of sampling and data collection by the consumer organisation. GPs consultation and waiting times, guideline adherence in history taking.

Results: The double stratified random sampling method was robust and representative for the private and contracted GPs mix of Vienna. The clinical scenarios presented by the ISPs were valid and believable, and no GP realised the ISPs were not genuine patients. The average consultation time was 46 min (95% CI 37 to 54 min). Waiting times differed more than consultation times between private and contracted GPs. No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found. According to the analysis, 20% of the GPs took a perfect history (95% CI 9% to 39%).

Conclusions: The analysis of secondary data collected by a consumer organisation was a valid method for drawing conclusions about GPs preventive practice. Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data.

No MeSH data available.


Results of Verein für Konsumenteninformation (VKI) sampling comparedwith our simulation sampling of private general practitioners (GPs). In2008, 21 GPs were sampled by VKI, seven of them “private GPs”.All seven were located in the richer part of Vienna. Among the“contracted GPs”, four of 14 were located in the richer Viennadistricts. GP workforce data of 2002, published in a health report of thecity of Vienna administration, provided the most recent information ondistribution of private GPs among the Vienna city districts. As we were notprovided with data, beyond totals, on the two sampling population lists ofVKI. n.a., could not access the district distribution data; PHE, periodichealth examination.
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fig1: Results of Verein für Konsumenteninformation (VKI) sampling comparedwith our simulation sampling of private general practitioners (GPs). In2008, 21 GPs were sampled by VKI, seven of them “private GPs”.All seven were located in the richer part of Vienna. Among the“contracted GPs”, four of 14 were located in the richer Viennadistricts. GP workforce data of 2002, published in a health report of thecity of Vienna administration, provided the most recent information ondistribution of private GPs among the Vienna city districts. As we were notprovided with data, beyond totals, on the two sampling population lists ofVKI. n.a., could not access the district distribution data; PHE, periodichealth examination.

Mentions: The primary sampling unit for our data analysis was the GP (see figure 1). Each of 21 practitioners wereoffered a visit by the two different ISPs. Two of the practice visits wererejected by two GPs—one private and one contracted (because of anadministrative error and because laboratory results were not ordered by the GP).Both GPs were visited by the other ISP. The visits resulted in a total of 40observations on 21 GPs, belonging either to the ‘private’ or to the‘contracted’ GP group. The clustering at the GP was accounted for inour statistical analysis by survey/panel data methods and additionally bymultilevel data analysis.36 The reasons forthe multilevel analysis are explained below in the appraisal of sampling byVKI.


Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation.

Piribauer F, Thaler K, Harris MF - BMJ Open (2012)

Results of Verein für Konsumenteninformation (VKI) sampling comparedwith our simulation sampling of private general practitioners (GPs). In2008, 21 GPs were sampled by VKI, seven of them “private GPs”.All seven were located in the richer part of Vienna. Among the“contracted GPs”, four of 14 were located in the richer Viennadistricts. GP workforce data of 2002, published in a health report of thecity of Vienna administration, provided the most recent information ondistribution of private GPs among the Vienna city districts. As we were notprovided with data, beyond totals, on the two sampling population lists ofVKI. n.a., could not access the district distribution data; PHE, periodichealth examination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4400678&req=5

fig1: Results of Verein für Konsumenteninformation (VKI) sampling comparedwith our simulation sampling of private general practitioners (GPs). In2008, 21 GPs were sampled by VKI, seven of them “private GPs”.All seven were located in the richer part of Vienna. Among the“contracted GPs”, four of 14 were located in the richer Viennadistricts. GP workforce data of 2002, published in a health report of thecity of Vienna administration, provided the most recent information ondistribution of private GPs among the Vienna city districts. As we were notprovided with data, beyond totals, on the two sampling population lists ofVKI. n.a., could not access the district distribution data; PHE, periodichealth examination.
Mentions: The primary sampling unit for our data analysis was the GP (see figure 1). Each of 21 practitioners wereoffered a visit by the two different ISPs. Two of the practice visits wererejected by two GPs—one private and one contracted (because of anadministrative error and because laboratory results were not ordered by the GP).Both GPs were visited by the other ISP. The visits resulted in a total of 40observations on 21 GPs, belonging either to the ‘private’ or to the‘contracted’ GP group. The clustering at the GP was accounted for inour statistical analysis by survey/panel data methods and additionally bymultilevel data analysis.36 The reasons forthe multilevel analysis are explained below in the appraisal of sampling byVKI.

Bottom Line: To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking.No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found.Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data.

View Article: PubMed Central - PubMed

Affiliation: International Screening Committee for Austria, Austrian Public Health Association, Vienna, Austria.

ABSTRACT

Objective: To assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking.

Design: Secondary data analysis of a clustered cross-sectional direct observation survey.

Setting: General practitioners (GPs) in Vienna, Austria, visited unannounced by mystery shoppers (incognito standardised patients (ISPs)).

Participants: 21 randomly selected GPs were visited by two different ISPs each. 40 observation protocols were realised.

Main outcome measures: Robustness of sampling and data collection by the consumer organisation. GPs consultation and waiting times, guideline adherence in history taking.

Results: The double stratified random sampling method was robust and representative for the private and contracted GPs mix of Vienna. The clinical scenarios presented by the ISPs were valid and believable, and no GP realised the ISPs were not genuine patients. The average consultation time was 46 min (95% CI 37 to 54 min). Waiting times differed more than consultation times between private and contracted GPs. No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found. According to the analysis, 20% of the GPs took a perfect history (95% CI 9% to 39%).

Conclusions: The analysis of secondary data collected by a consumer organisation was a valid method for drawing conclusions about GPs preventive practice. Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data.

No MeSH data available.