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}