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Factors affecting GPs workload in the period 1987-2001.
Kolthof, E.D., Berg, M.J. van den, Bakker, D.H. de. Factors affecting GPs workload in the period 1987-2001. European Journal of Public Health: 2003, 13(4 sup) 88. Abstract. 11th Annual Eupha Meeting 'Globalisation and Health in Europe: Harmonising Public Health Practices'. Rome, Italy, 20-22 November 2003.
Background: Like in other countries, Dutch general practitioners (GPs) perceive an increase in workload. Too much work pressure will affect the quality of care and threats the accessibility of health care provided by GPs. Factors on organisational-level, patient-level as well as on GP-level may affect the objective and subjective workload of GPs.
Some factors are beyond control of GPs (like e.g. ageing of patients), whereas other factors can be used by GPs to regulate workload. Insight in factors that affect the objective and subjective workload of GPs is important to guarantee a high quality health care system in the future. Aim: To describe a change in objective and subjective workload in general practice in the Netherlands between 1987-2001. Furthermore to provide a comprehensive insight into the factors that cause this change in objective and subjective workload. Methods: Data used in this study originate from the second Dutch National Survey of General Practice (DNSGP-2). This survey was carried out in 2001 in 104 general practices, amongst 195 GPs and 400,000 listed patients. Objective workload measures were derived from consultation registration, video observations and diaries (kept by GPs and practice assistants); subjective workload measures from questionnaires filled out by GPs. Factors on the organisational-level were measured by questionnaires, on the GP-level by diaries and questionnaires and factors on the patient-level by consultation registration and registration of socio-demographic characteristics. Cross-sectional, longitudinal and multilevel analyses were carried out. Data from the DNSGP-1 (1987) were used for the longitudinal analyses. Results: Hours worked by GPs per listed patient decreased between 1987 and 2001 despite the fact that consultation rate rose with 8%, mostly due to changes in patient demand. Gains in efficiency were reached by organisational changes like substituting home visits by office consultations and telephone consultations and by delegating more tasks to practice assistants. Furthermore, changes in GP-attitude, like a stricter task definition with respect to psychosocial activities, reduced workload. The percentage of GPs (partly) dissatisfied with their work in general doubled however (12% to 26%). Although the introduction of large scale out of hours (ooh) services significantly reduced time spent in ooh shifts (with 75%) it did not affect the subjective workload. Conclusions: By introducing organisational interventions and a more strict task orientation GPs seem to manage rising patient demands. The price paid for this seems to be a decrease in job satisfaction. Future interventions should not be restricted to lowering objective workload but take subjective workload into account as well. (aut.ref.)
Some factors are beyond control of GPs (like e.g. ageing of patients), whereas other factors can be used by GPs to regulate workload. Insight in factors that affect the objective and subjective workload of GPs is important to guarantee a high quality health care system in the future. Aim: To describe a change in objective and subjective workload in general practice in the Netherlands between 1987-2001. Furthermore to provide a comprehensive insight into the factors that cause this change in objective and subjective workload. Methods: Data used in this study originate from the second Dutch National Survey of General Practice (DNSGP-2). This survey was carried out in 2001 in 104 general practices, amongst 195 GPs and 400,000 listed patients. Objective workload measures were derived from consultation registration, video observations and diaries (kept by GPs and practice assistants); subjective workload measures from questionnaires filled out by GPs. Factors on the organisational-level were measured by questionnaires, on the GP-level by diaries and questionnaires and factors on the patient-level by consultation registration and registration of socio-demographic characteristics. Cross-sectional, longitudinal and multilevel analyses were carried out. Data from the DNSGP-1 (1987) were used for the longitudinal analyses. Results: Hours worked by GPs per listed patient decreased between 1987 and 2001 despite the fact that consultation rate rose with 8%, mostly due to changes in patient demand. Gains in efficiency were reached by organisational changes like substituting home visits by office consultations and telephone consultations and by delegating more tasks to practice assistants. Furthermore, changes in GP-attitude, like a stricter task definition with respect to psychosocial activities, reduced workload. The percentage of GPs (partly) dissatisfied with their work in general doubled however (12% to 26%). Although the introduction of large scale out of hours (ooh) services significantly reduced time spent in ooh shifts (with 75%) it did not affect the subjective workload. Conclusions: By introducing organisational interventions and a more strict task orientation GPs seem to manage rising patient demands. The price paid for this seems to be a decrease in job satisfaction. Future interventions should not be restricted to lowering objective workload but take subjective workload into account as well. (aut.ref.)
Background: Like in other countries, Dutch general practitioners (GPs) perceive an increase in workload. Too much work pressure will affect the quality of care and threats the accessibility of health care provided by GPs. Factors on organisational-level, patient-level as well as on GP-level may affect the objective and subjective workload of GPs.
Some factors are beyond control of GPs (like e.g. ageing of patients), whereas other factors can be used by GPs to regulate workload. Insight in factors that affect the objective and subjective workload of GPs is important to guarantee a high quality health care system in the future. Aim: To describe a change in objective and subjective workload in general practice in the Netherlands between 1987-2001. Furthermore to provide a comprehensive insight into the factors that cause this change in objective and subjective workload. Methods: Data used in this study originate from the second Dutch National Survey of General Practice (DNSGP-2). This survey was carried out in 2001 in 104 general practices, amongst 195 GPs and 400,000 listed patients. Objective workload measures were derived from consultation registration, video observations and diaries (kept by GPs and practice assistants); subjective workload measures from questionnaires filled out by GPs. Factors on the organisational-level were measured by questionnaires, on the GP-level by diaries and questionnaires and factors on the patient-level by consultation registration and registration of socio-demographic characteristics. Cross-sectional, longitudinal and multilevel analyses were carried out. Data from the DNSGP-1 (1987) were used for the longitudinal analyses. Results: Hours worked by GPs per listed patient decreased between 1987 and 2001 despite the fact that consultation rate rose with 8%, mostly due to changes in patient demand. Gains in efficiency were reached by organisational changes like substituting home visits by office consultations and telephone consultations and by delegating more tasks to practice assistants. Furthermore, changes in GP-attitude, like a stricter task definition with respect to psychosocial activities, reduced workload. The percentage of GPs (partly) dissatisfied with their work in general doubled however (12% to 26%). Although the introduction of large scale out of hours (ooh) services significantly reduced time spent in ooh shifts (with 75%) it did not affect the subjective workload. Conclusions: By introducing organisational interventions and a more strict task orientation GPs seem to manage rising patient demands. The price paid for this seems to be a decrease in job satisfaction. Future interventions should not be restricted to lowering objective workload but take subjective workload into account as well. (aut.ref.)
Some factors are beyond control of GPs (like e.g. ageing of patients), whereas other factors can be used by GPs to regulate workload. Insight in factors that affect the objective and subjective workload of GPs is important to guarantee a high quality health care system in the future. Aim: To describe a change in objective and subjective workload in general practice in the Netherlands between 1987-2001. Furthermore to provide a comprehensive insight into the factors that cause this change in objective and subjective workload. Methods: Data used in this study originate from the second Dutch National Survey of General Practice (DNSGP-2). This survey was carried out in 2001 in 104 general practices, amongst 195 GPs and 400,000 listed patients. Objective workload measures were derived from consultation registration, video observations and diaries (kept by GPs and practice assistants); subjective workload measures from questionnaires filled out by GPs. Factors on the organisational-level were measured by questionnaires, on the GP-level by diaries and questionnaires and factors on the patient-level by consultation registration and registration of socio-demographic characteristics. Cross-sectional, longitudinal and multilevel analyses were carried out. Data from the DNSGP-1 (1987) were used for the longitudinal analyses. Results: Hours worked by GPs per listed patient decreased between 1987 and 2001 despite the fact that consultation rate rose with 8%, mostly due to changes in patient demand. Gains in efficiency were reached by organisational changes like substituting home visits by office consultations and telephone consultations and by delegating more tasks to practice assistants. Furthermore, changes in GP-attitude, like a stricter task definition with respect to psychosocial activities, reduced workload. The percentage of GPs (partly) dissatisfied with their work in general doubled however (12% to 26%). Although the introduction of large scale out of hours (ooh) services significantly reduced time spent in ooh shifts (with 75%) it did not affect the subjective workload. Conclusions: By introducing organisational interventions and a more strict task orientation GPs seem to manage rising patient demands. The price paid for this seems to be a decrease in job satisfaction. Future interventions should not be restricted to lowering objective workload but take subjective workload into account as well. (aut.ref.)
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