The association between patient experience and prescribing quality in primary care

RA Payne, GA Abel. University of Cambridge, Cambridge, UK

Patient experience in primary care is associated with a range of clinical measures, but the relationship with prescribing quality is unknown. This is important because patient experience may influence factors related to medicines’ use (e.g. adherence), and good experience may not necessarily reflect high-quality prescribing. The aim of the current study was to examine the association between different aspects of prescribing quality and measures of patient experience.

We used data from 7832 English GP surgeries, linking practice-level patient experience data from the 2009/10 GP Patient Survey to National prescription dispensing (ePACT) data. Logistic and Poisson regression models were used to examine practice-level associations between four prescribing indicators (overall prescribing rate, antibiotic use per STAR-PU, inhaled corticosteroids per STAR-PU, % low-cost statin use) and various patient experience measures (doctor-patient communication, confidence/trust in the doctor, advanced appointment availability, continuity of care, overall satisfaction). Patient experience was adjusted for age, sex, ethnicity, deprivation and self-rated health. The rate ratios (RR) and odds ratios (OR) presented are for the 95% mid-range of practice variation, comparing percentile 97.5 with percentile 2.5. Point estimates are presented alongside the 95% confidence interval (CI).

Results are shown in Figure 1. There was strong evidence (p≤0.001) that increased overall prescribing was associated with improved doctor-patient communication (RR=1.17, 1.14-1.20), confidence/trust (RR=1.15, 1.12-1.18) and overall satisfaction (RR=1.10, 1.08-1.13), and worse advanced appointment availability (RR=0.89, 0.87-0.90) and continuity of care (RR=0.96, 0.94-0.99). Similar findings were observed for inhaled corticosteroids and antibiotics, but the reverse was generally the case for prescribing of low-cost statins.

Fig 1. Association between patient experience and 4 prescribing indicators (point estimate and 95% CI)

In summary, increasing patient satisfaction appears associated with increased prescribing, which may be favourable (inhaled corticosteroids) but also unfavourable (higher-cost statins, antibiotics) in nature. Access to GP services may also adversely influence certain prescribing. Interventions to improve prescribing quality should consider patient perceptions of care and accessibility of services.