Do the organizational reforms of general practice care meet users' concerns? The contribution of the Delphi method

  • Krucien N
  • Le Vaillant M
  • Pelletier-Fleury N
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Abstract

CONTEXT: The debate over primary care reform in France, as in most OECD countries, centres on questions about efficacy and accessibility. Do these reforms actually respond to the users' concerns?

OBJECTIVE: The objective of this study was to identify the importance that users attribute to different aspects of general practice (GP) care.

DESIGN: The method used was a variant of the classical Delphi approach, called Delphi 'ranking-type'. Between May and September 2009, 74 experts aged over 18 were recruited by 'snowballing' sampling. Three iterative rounds were required to identify the core aspects through a consensus-building approach.

RESULTS: It is shown that users attribute a very high importance to the 'doctor-patient relationship' dimension. The following aspects 'GP patient information about his/her illness', 'Clarity of communication and explanation', and 'Whether the GP seemed listen to the patient' were evaluated by 96% of the experts as being of high importance. The coordination of GP was also considered as a very important aspect for 85% of the experts. In contrast, the aspects that belong to the organizational dimension appeared to be of relatively low importance for users.

CONCLUSIONS: Our results support a comprehensive approach of care and argue in favour of care reorganization following the patient-centred model. To promote organizational care reforms through the prism of the doctor-patient relationship could thus be a fruitful way to insure a better quality of care and the social acceptability of the reforms.

Author-supplied keywords

  • Delphi technique
  • Doctor-patient relationship
  • General practice care
  • Health care reforms
  • Patients' priorities

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