Do the Organizational Reforms of General Practice Care Meet Users’ Concerns? The Contribution of the Delphi Method

CONTEXT: The debate over primary care reform in France, as in most OECD countries, centres on questions about efficacy and accessibility. Do these reforms actually respond to the users' concerns?
OBJECTIVE: The objective of this study was to identify the importance that users attribute to different aspects of general practice (GP) care.
DESIGN: The method used was a variant of the classical Delphi approach, called Delphi 'ranking-type'. Between May and September 2009, 74 experts aged over 18 were recruited by 'snowballing' sampling. Three iterative rounds were required to identify the core aspects through a consensus-building approach.
RESULTS: It is shown that users attribute a very high importance to the 'doctor-patient relationship' dimension. The following aspects 'GP patient information about his/her illness', 'Clarity of communication and explanation', and 'Whether the GP seemed listen to the patient' were evaluated by 96% of the experts as being of high importance. The coordination of GP was also considered as a very important aspect for 85% of the experts. In contrast, the aspects that belong to the organizational dimension appeared to be of relatively low importance for users.
CONCLUSIONS: Our results support a comprehensive approach of care and argue in favour of care reorganization following the patient-centred model. To promote organizational care reforms through the prism of the doctor-patient relationship could thus be a fruitful way to insure a better quality of care and the social acceptability of the reforms.