Strengths and limitations
Shedding light on patient experiences with health care is becoming increasingly important as health systems strive to be more responsive to the needs of the people using their services (OECD 2018). A recent literature review by the Australian Commission on Safety and Quality in Health Care reported growing international evidence that measures of patient experience of care:
- contribute to a more people-centred view of health system performance
- can lead to an improvement in the quality and safety of the services provided
- can help with understanding the relative effectiveness of different treatments and interventions
- enhance processes in the patient-clinician interaction (Williams et al. 2016).
The Coordination of Health Care Study was designed to fill a data gap in the reporting of nationally consistent and local-level information on experiences with health care providers using patient-reported information, where data have previously been limited. It is the first national study designed to provide robust samples from each PHN area of:
- people aged 45 and over who had seen a GP in the previous 12 months
- people with high health care needs. The study over-sampled high users of GP visits (those who had seen a GP 12 or more times in the previous 12 months) as these people are more likely to have complex and chronic conditions and have experiences with multiple providers, including hospitals, specialists and allied health professionals.
A key strength of this report is the potential for PHNs to explore the way patients use GP care in their area (and their experiences of this care), as well as helping to identify predictors of patient-centeredness of care.
As with survey data in general, the survey model chosen for this study has both strengths and limitations. Due to data in this report being collected from a cross-sectional survey, report findings are subject to limitations including:
- their generalisability (to whom they apply in the wider population outside of those surveyed)
- their implications for assessment of causality.
Findings in this report cannot be generalised to apply to those outside the scope of the survey—that is, to other than people aged 45 and over who had at least one GP visit in the 12 months between November 2014 and November 2015. For example, the following people would be out of scope:
- people who did not see a GP in the 12 months before selection of the sample as they had been in good health and had not needed to see a GP
- people getting care elsewhere (exclusively), where services were not billed to Medicare
- people who are not getting any care at all.
This survey returned a 29% response rate, which may have introduced non-response bias (that is, survey respondents and non-respondents may differ with respect to their use of and experiences with GP care). In this survey, however, it is not possible to distinguish between non-response and sample loss. For example, a person may have been selected to participate, but might not have received any survey materials due to an out-of-date address on the Medicare Enrolment Database.
While the collection is subject to non-response bias, it is not possible to reliably quantify this. The magnitude of any bias depends on the rate of non-response and the extent of the differences in characteristics between those people who responded to the survey and those who did not (ABS 2016).
To try to understand whether the sample is representative of the in-scope population, an investigation was carried out to compare the sample distribution from the 2016 Survey of Health Care with other Australian surveys conducted by the ABS—namely the Patient Experience 2015–16 survey, and the National Health Survey 2014–15.
Some factors that differed between survey sample distributions—such as age, sex, socioeconomic group and PHN—were accounted for in the weighting process (see the technical note accompanying this report for more information on this process). Other variables not taken into account with weighting that were compared across survey sample distributions (for the same scope population—over 45 years and at least one GP visit in the previous 12 months) included things like ‘proportion who reported having a long-term health condition’. For ‘level of education’ and whether the person ‘had private health insurance’, the proportions were similar across the different sources. For some health-related variables, the 2016 Survey of Health Care generally had a higher proportion of people with poorer health. No adjustment to the weighting has been made for this potential bias.
For more information on the results of this investigation, see the explanatory notesExternal link, opens in a new window.[http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4343.0Explanatory%20Notes12016?OpenDocument] to the ABS Survey of Health Care Australia 2016 (ABS 2016).
Assessments of causality
Data presented in this report have been collected from a cross-sectional (rather than a longitudinal) survey. As such, relationships between factors such as self-assessed health status and patient-reported care experiences can be assessed only as correlations, rather than as causal associations. That is, we do not know whether it is the excellent self-reported health status that is associated with better care experiences, or whether this is confounded by other factors. For example, it could be that those with a higher level of education and/or health literacy are healthier because they can ask for what they need from their GP; their required care might be more straightforward; or their perspective and mental health might be better, so they perceive better care. Future modelling work with these data could better clarify the nature of relationships between patient attributes and experiences of care.
Similarly, it is not possible to know whether correlations between the duration of the patient-GP relationship and care experiences are due to patients choosing to keep seeing their GP due to good experiences of patient-centred care, or whether they have better experiences of care with increased duration of time spent as a patient of their usual GP.