SERVICE PROFILES OF GENERAL-PRACTITIONERS IN EUROPE

Background. General practice is the focal point of primary care. There are national differences in the structure and organization of practic e, the relationship with secondary care is being redefined, and in som e countries major changes are taking place. Aim. To describe and exami ne differences in the service profiles of general practitioners (GPs) in European countries. Method. Standardized questionnaires in the nati onal languages were sent to samples of GPs in 1993. Four areas of serv ice provision were measured: the GP's position in the first contact wi th selected health problems, the involvement in minor surgery and the application of medical procedures, disease management and preventive c are. The importance of the gatekeeping role, remuneration system, and geographical region in Europe was examined by comparing scores in appr opriate national groupings. Results. Data were received from 7233 GPs in 30 countries. Most national samples were random and the average res ponse rate was 47%. In countries where GPs have a gatekeeping role, th ey had a relatively stronger position as doctors of first contact. In those countries where GPs were usually self-employed, they had a stron ger role in disease management and screening for blood cholesterol. In the examination of the three structural elements of health care, the most striking differences were evident in the comparison between easte rn and western Europe. GPs throughout Europe had a comparatively small role in organized health education. Conclusion. The position of GPs i s weak in eastern Europe and some Mediterranean countries, where servi ce profiles have a limited range. General practice was more comprehens ive where the doctors had a gatekeeping role.