PubMed · 4641969
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C R Playfair. 1972-11-30. Practice attachment--how yet another did it.. https://pubmed.ncbi.nlm.nih.gov/4641969/
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BACKGROUND: We wanted to chart telephone accessibility in 100 randomly selected general practices in Norway and to define a standard against which others could compare themselves. MATERIAL AND METHODS: During one week, the telephone company recorded all calls to each practice and how many were answered, unanswered, or blocked. Mean waiting time for answer and mean conversation time were also registered. Each practice received a report, comparing its own results to those of other practices. An accessibility index was calculated by dividing the percentage of answered calls with mean holding time on the line (waiting time plus conversation time). Background variables about the practices were collected by questionnaires. RESULTS: There were 266 calls (95 % confidence interval 219 - 312) per week per 1000 patients on the list. 66 % (61 - 71) were answered. Mean waiting time was 25 seconds (20 - 30), conversation time 119 seconds (111 - 127). It is estimated that 7.0 calls (6.4 - 7.5) are answered per patient on a list per year. The accessibility index showed large variations, mostly independent of background variables. INTERPRETATION: Compared with earlier registrations, telephone accessibility has improved despite a strong increase in traffic. Structural aspects of the practices do not explain the variation in telephone accessibility; interest and attitudes are probably just as important.
BACKGROUND: The practice setting is, next to the GP and staff, an important determinant of the quality of care. Differences between single-handed practices and group practices in practice management and organization could therefore provide clues for improvement. An explorative, cross sectional survey was conducted in 766 general practices in The Netherlands comparing single-handed practices with group practices. OBJECTIVE: The study is looking for answers on aspects of the organization and management that are lost or gained when single-handed GPs and practices are replaced by group practices. METHODS: Between 1999 and 2003 GPs and their practices were assessed using a validated practice visit method (VIP) consisting of 303 indicators describing 56 dimensions of practice management. Instruments used consisted of questionnaires for patients, GPs, practice assistant and a direct observer in the practice. Single-handed practices (1 GP) were compared to group practices or health centres (>2.0 GPs) comparing raw scores on dimensions of practice management. In addition, data were analysed in a regression model with specific aspects of practice management as dependent variables using a general linear model procedure. Independent variables included 'single-handed/group practice', 'rural/ urban' 'part-time/full-time' and 'male/female'. RESULTS: Group practices scored better on nearly all aspects of infrastructure except those rated by patients. Patients gave single-handed practices higher marks for service, accessibility and even for the facilities. In single-handed practices GPs reported that they worked more and experienced higher levels of job stress. They delegated less of the medical technical tasks but there is no difference in delegation of preventive tasks/treatment of chronic diseases. Group practices had more computerized medical information and more quality assurance activities, but gave less patient information. Single-handed practices spent more hours on continuous medical education. DISCUSSION AND CONCLUSION: The quality of the practice infrastructure and the team scored better in group practices, but patients appreciated the single-handed practice better. The advantages of single-handed practices could be a challenge for group practices to give better personal, continuous care and to put the patient perspective before organizational considerations. This is underlined by the better score on patient information of single-handed practices. Single-handed practices can reduce their vulnerability and openness to high demand by opening up to the requirements of organised primary care.
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