Methods
The research includes data from one of the largest primary care centres
in Cyprus serving the urban and semi-rural population of Nicosia, the
capital of Cyprus. Apostolos Loukas Medical Centre performed a local
quality improvement initiative in 2020 using the Greek version of the
EUROPEP. The centre has 5 GPs, 15 specialist physicians, healthcare
administrators and nurses. The study was performed only to assess the
patient satisfaction of primary care therefore only beneficiaries
registered on GPs lists were included. The beneficiaries on the GP lists
range from 1,000 to 2,500 which is the maximum allowable according to
the Health Insurance Organisation (HIO), the managing body of the new
Cyprus universal NHS. The GPs’ ages range from 35-47 and their years in
practice from 10-20.
In their effort of continuous quality improvement registered
beneficiaries were invited to share their opinion about the services
provided by GPs, thus primary care, and the Medical Center. Due to the
pandemic restrictions the questionnaire was transferred to an online
platform. Questionnaires were distributed to the beneficiaries of the
centre via emails and through the centre’s newsletter. 5,000 emails were
sent to registered beneficiaries of the centre.
EUROPEP tool
EUROPEP is a multidimensional tool that consists of 23 items concerning
five aspects of care (i.e., relation and communication; medical care;
information and support; continuity and cooperation; facilities,
availability, and accessibility). The tool asks the beneficiaries to
assess their GP, taking into account experiences over the preceding
year. The Greek version of EUROPEP was used for surveying the patient
satisfaction in regards to GPs and the primary care centre. The Greek
version of the tool has been developed and validated by the Clinic of
Social and Family Medicine of the University of Crete. The translated
version uses the original five-point Likert scale (1=bad, 5=excellent,
which corresponds to very dissatisfied and very satisfied, respectively)
for the 23 item describing the patient satisfaction. Additional emphasis
on patient satisfaction is provided by two more items; “I strongly
recommend the GP to family and friends” and “I have no reason to
change my GP” (five-point response scale: 1=strongly disagree to
5=strongly agree). The tool also collects sociodemographic
characteristics such as gender, age, educational level, the number of
consultations during the last year.
Statistical analyses
Extensive data cleaning was performed before data analyses. If
participants responded that they have not seen their doctor at all in
the last 12 months then that response was omitted from the analysis as
the questionnaires clearly states that they had to had a contact with
their doctor in the last 12 months. In addition, responses with more
than 12 responses being “not applicable” were excluded from the
analysis.
Items were assessed for mean (SD), median (IQR), missing data, floor,
and ceiling effects. The internal consistency reliability of the
questionnaire was assessed using Cronbach’s alpha. The data where
further explored for the potential extraction of underlying factors. A
total satisfaction percentage was calculated using the formula below.
Potential associations and with overall satisfaction was assessed by
demographic characteristics collected through the tool and the
appropriate statistical test was used. All analyses were performed using
STATA 14.1.
\begin{equation}
\%\ of\ satisfied\ customers=100\ x\ \frac{\text{Number\ of\ satisfied\ benetfitiaries\ }}{\text{Number\ of\ survey\ responses}}\nonumber \\
\end{equation}