Patient experience with ambulatory care

Delivering health care that is responsive and patient-centred is playing a greater role in health care policy across OECD countries. Considering the health care user as a direct source of information is becoming more prevalent. Since the mid-1990s, there have been efforts to institutionalise measurement and monitoring of patient experiences. This empowers patients and the public, involves them in decisions on health care delivery and governance, and provides insight to the extent to which they are health-literate and have control over the treatment they receive

In many countries, responsible organisations have been established or existing institutions have been identified for measuring and reporting patient experiences. They develop survey instruments for regular collection of patient experience data and standardise procedures for analysis and reporting. An increasing number of countries collect not only Patient-Reported Experience Measures (PREMs) but also Patient-Reported Outcome Measures (PROMs) which collect patients’ perception on their specific medical conditions and general health, including mobility, pain/discomfort and anxiety/depression, before and after a specific medical intervention such as cancer and hip and knee replacement. Given the importance of utilising people’s voice for developing health systems and improving quality of care, international efforts to develop and monitor patient-reported measures has been intensified in recent years (OECD, 2017a; OECD, 2017b).

Countries use patient-reported data differently to drive quality improvements in health systems. To promote quality of health care through increased provider accountability and transparency, many countries report patient experience data in periodic national health system reports or on public websites, showing differences across providers, regions and over time. Korea and Norway use patient experience measures in payment mechanisms or for fund allocations to promote quality improvement and patient-centred care, and Australia, Canada, the Czech Republic, Denmark, France and the United Kingdom use them to inform health care regulators for inspection, regulation and/or accreditation. Patient-reported measures are also used in some Canadian jurisdictions, Denmark, France and the Netherlands to provide specific feedback for provider’s quality improvement (Fujisawa and Klazinga, 2017).

Patients generally report positive experiences when it comes to communication and autonomy in the ambulatory health care system. Across countries, the majority of patients report that they spent enough time with a doctor during consultation (Figure 6.1), a doctor provided easy-to-understand explanations (Figure 6.2), as well as involved them in care and treatment decisions (Figure 6.3). For all three aspects of patient experience, Belgium and Luxembourg score high at above 95% of patients with positive experiences while Poland has lower rates and for instance, only one in two patients report having been involved in their care and treatment during consultation. Japan also has a low rate for patient’s perception on time spent with doctor, which can be inferred at least partly by a high number of consultations both per population and doctor (see indicator “Consultations with doctors” in Chapter 9).

6.1. Doctor spending enough time with patient in consultation, 2010 and 2016 (or nearest year)
picture

Note: 95% confidence intervals have been calculated for all countries, represented by grey areas.

1. National sources.

2. Data refer to patient experiences with regular doctor.

Source: Commonwealth Fund International Health Policy Survey 2016 and other national sources.

 http://dx.doi.org/10.1787/888933603355

6.2. Doctor providing easy-to-understand explanations, 2010 and 2016 (or nearest year)
picture

Note: 95% confidence intervals have been calculated for all countries, represented by grey areas.

1. National sources.

2. Data refer to patient experiences with regular doctor.

Source: Commonwealth Fund International Health Policy Survey 2016 and other national sources.

 http://dx.doi.org/10.1787/888933603374

6.3. Doctor involving patient in decisions about care and treatment, 2010 and 2016 (or nearest year)
picture

Note: 95% confidence intervals have been calculated for all countries, represented by grey areas.

1. National sources.

2. Data refer to patient experiences with regular doctor.

Source: Commonwealth Fund International Health Policy Survey 2016 and other national sources.

 http://dx.doi.org/10.1787/888933603393

In several countries, the proportion of patients with positive experience has decreased in recent years. For example, in Poland the share of patients reporting that a doctor spent enough time with them during consultation fell between 2010 and 2016. However, some countries such as Australia and Estonia have improved some aspects of patient experiences recently.

Definition and comparability

In order to measure and monitor general patient experience in the health system, the OECD recommends collecting data on patient experience with any doctor in ambulatory settings. An increasing number of countries have been collecting patient experience data based on this recommendation through nationally representative population surveys while Japan and Portugal collect them through nationally-representative service user surveys. About half of the countries presented, however, collect data on patient experience with a regular doctor. In 11 countries, the Commonwealth Fund’s International Health Policy Surveys 2010 and 2016 were used as a data source, even though there are critiques relating to the sample size and response rates. Data from this survey refer to patient experience with a regular doctor rather than any doctor. In 2016, the Netherlands which participates in this survey developed a national population survey and this resulted in improved response rates and data quality.

Rates are age-sex standardised to the 2010 OECD population, to remove the effect of different population structures across countries.

References

Fujisawa, R. and N. Klazinga (2017), “Measuring Patient Experiences (PREMs): Progress Made by the OECD and its Member Countries 2006-2015”, OECD Health Working Papers, Paris.

OECD (2017a), “Ministerial Statement: The Next Generation of Health Reforms”, OECD Health Ministerial Meeting, Paris, http://www.oecd.org/health/ministerial/ministerial-statement-2017.pdf.

OECD (2017b), “Patient-Reported Indicators Survey (PaRIS)”, OECD Publishing, Paris, http://www.oecd.org/health/paris.htm.