• Open Access

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

Authors

  • Nicolas Krucien MSPH,

    1. PhD Student in Public Health, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre
    2. Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 988
    3. Statistician, Centre National de la Recherche Scientifique (CNRS), UMR 8211, Villejuif
    4. Researcher in Public Health, Ecole des Hautes Etudes en Sciences Sociales (EHESS)
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  • Marc Le Vaillant MS,

    1. Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 988
    2. Statistician, Centre National de la Recherche Scientifique (CNRS), UMR 8211, Villejuif
    3. Researcher in Public Health, Ecole des Hautes Etudes en Sciences Sociales (EHESS)
    4. Université Paris Descartes, Paris, France
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  • Nathalie Pelletier-Fleury MD PhD

    1. Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 988
    2. Statistician, Centre National de la Recherche Scientifique (CNRS), UMR 8211, Villejuif
    3. Researcher in Public Health, Ecole des Hautes Etudes en Sciences Sociales (EHESS)
    4. Université Paris Descartes, Paris, France
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Nicolas Krucien, MSPH
CERMES
CNRS UMR8211 – Inserm U988 – EHESS
Site CNRS
7, rue Guy Môquet
94801 Villejuif Cedex
France
E-mail: krucien@vjf.cnrs.fr

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.

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