Wgw. Boerma et al., GENERAL-PRACTICE IN URBAN AND RURAL EUROPE - THE RANGE OF CURATIVE SERVICES, Social science & medicine (1982), 47(4), 1998, pp. 445-453
Citations number
47
Categorie Soggetti
Social Sciences, Biomedical","Public, Environmental & Occupation Heath
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
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