Patient, Physician, and Practice Characteristics Related to Patient Enablement in General Practice in Croatia: Cross-sectional Survey Study Public Health Public Health

Aim To investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. Methods A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged ≥18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice. Results In 5527 patients, the mean score (±standard deviation) for enablement at consultation was 6.6 ± 3.3 and the mean consultation length was 11.5 ± 5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P < 0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P < 0.05 for each). Conclusion Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice