How community based is general practice?

Background: One of the potentially strong points of general-practice-based primary care is that it is accessible within local communities. As the arm of clinical medicine with the broadest reach into the community, primary care clinicians are well-positioned to understand local needs and design programmes that address community health. This paper analyses variations in the degree to which general practices indeed work community based. Geographical factors, patient factors, and practice factors are taken into consideration. Methods: Data are derived from a computerized general practice network (the Dutch National Information Network in general practice for the year 2004 with 349 000 patients in 161 000 households in 86 practices). Patient and practice location are known at 4-digit ZIP-code level. Multilevel analysis is performed at household level (taking in account demographic factors and migration history), ZIP-code level (degree of urbanization), and practice level (GP and practice characteristics). Results: On average 42% of the GP’s practice population lives in the ZIP-code area where the practice is located. The practice covers on average 31% of the total population of that area. In urban areas these percentages are 31 and 11%, respectively. There is significant variation at all levels. On the household level single males and females live farther from the practice. At practice level list size is positively correlated with distance to the practice but group practices are on average closer to their patients. Conclusions: Especially in urban areas a substantial part of the GP’s practice population lives outside the practice’s neighbourhood, which makes community-oriented action more difficult. Group practices work more community based than single handed practices. The trend towards more group practices makes prospects for a more community-based primary care favourable.(aut. ref.)