GENERAL-PRACTICE IN URBAN AND RURAL EUROPE - THE RANGE OF CURATIVE SERVICES

The variation in the range of services provided by general practitione rs (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circu mstances of the practice location. In conurbations health services are more widely available than in the countryside, where GPs often are th e only providers. With highly mobile populations and a plentiful suppl y of doctors, in cities the prevailing regulations for access and use of services are more difficult to maintain. It is also more difficult to control access and thus opportunities for inappropriate use are gre ater. Against this background an international study was conducted on variation in task profiles of GPs, especially focusing on differences between urban and rural practices. In 1993 standardised questionnaires in the national languages were sent to samples of GPs in 30 countries . Various aspects of service provision were measured as well as practi ce organisation, location of the practice and personal backgrounds of the GP. Completed questionnaires were received from 7,233 respondents, an overall response rate of 47%. Sources of variation have been analy sed by using a tv:level model. Rural practices provided more comprehen sive services regardless of the health care system. Approximately half of the variation was explained by features of a country's health care system. The GP's position at the point of access to health care was s trongly associated with the gatekeeper function controlling access to secondary care. In western countries where the GPs were self employed they had greater involvement in technical procedures and chronic disea se management. There was a considerable gap between the task profiles of GPs in eastern and western Europe. We found evidence of a reduced g atekeeper role in inner cities in those countries where GPs held this position. GPs with an estimated overrepresentation of socially deprive d people and elderly in the practice population reported a wider range of services. Differences also appeared to be related to factors which are largely controlled by the individual doctor. such as level of tra ining and education, availability of equipment and practice staff. The results have important implications for education. policy development and health care planning both in eastern and western Europe. (C) 1998 Elsevier Science Ltd. All rights reserved.