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Background: Numerous studies have shown that during out-of-hours vulnerable patients (regarding low-education and unemployment) are more likely to seek medical help in the emergency department (ED). However, little is known about why patients seek help in the ED during daytime hours and if these reasons differ among self-referring socioeconomic groups. Objectives: To identify the reasons why patients opt for the ED during daytime hours when primary care services are available and identify possible social differences between socioeconomic groups. Methods: In 2014–2015, trained fieldworkers surveyed 723 patients visiting four EDs in Flanders using a structured interview. These quantitative data were analysed using descriptive and logistic regression analyses. Results: More than one-third of the self-referring patients reported that they attend the ED during daytime hours because they perceive their (health) problem as urgent and expect they need advanced diagnostic testing. Self-referred and low-educated patients have a 1.8 higher chance (compared to their higher-educated counterparts) of attending the ED because they expect advanced diagnostic testing. Self-referred and unemployed patients have a 3.6, 2.5 and 4.4 higher chance (compared to their employed counterparts) to opt for the ED because it is their usual source of care, family/friends refer them or they postpone care too long, respectively. Conclusion: We found sociodemographic differences in motives why self-referring patients in Flanders opt for the ED during daytime hours. In general, self-referring patients attend the ED because they perceive their condition as urgent and think they may need advanced diagnostic testing.

Aim: This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. Background: Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. Methods: Survey data were collected during 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. Findings: Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. Conclusions: The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor–patient relationship as well as a broad range of services offered by PC physicians.

Recent figures show that discrimination in healthcare is still persistent in the European Union. Research has confirmed these results but focused mainly on the outcomes of perceived discrimination. Studies that take into account socioeconomic determinants of discrimination limit themselves to either ethnicity, income or education. This article explores the influence of several socioeconomic indicators (e.g. gender, age, income, education and ethnicity) on perceived discrimination in 30 European countries. Data from the QUALICOPC study were used. These data were collected between October 2011 and December 2013 in the participating countries. In total, 7183 GPs (general practitioners) and 61932 patients participated in the study, which had an average response rate of 74.1%. Data collection was co-ordinated by NIVEL (Dutch Institute for Research of Health Care). Bivariate binomial logistic regressions were used to estimate the impact of each socioeconomic indicator on perceived discrimination. Multivariate logistic regressions were used to estimate the unique effect of each indicator. Results indicate that in Europe, overall 7% of the respondents felt discriminated, ranging between 1.4% and 12.8% at the country level. With regard to socioeconomic determinants in perceived discrimination, income and age are both important indicators, with lower income groups and younger people having a higher chance to feel discriminated. In addition, we find significant influences of education, gender, age and ethnicity in several countries. In most countries, higher educated people, older people, women and the indigenous population appeared to feel less discriminated. In conclusion, perceived discrimination in healthcare is reported in almost all European countries, but there is large variation between European countries. A high prevalence of perceived discrimination within a country also does not imply a correlation between socioeconomic indicators and perceived discrimination.

Recent research has shown that ethnic minorities still have less access to medical care and are less satisfied with the treatment they receive and the outcomes of the health care process. This article assesses how migrants in Europe experience access, treatment and outcomes in the European health care systems. Data were obtained from the QUALICOPC study (Quality and Costs of Primary Care in Europe). Regression analyses were used to estimate the access, treatment and outcomes of care for ethnic minorities. In several countries, migrants experience that the opening hours of their GP practice were too limited and indicate that the practice was too far away from their work or home (lower access). They are more likely to report negative patient–doctor communication and less continuity of care than native patients (worse treatment). In addition, they are less satisfied with the care they received and are more likely to postpone care (worse outcomes). In general, migrants are still disadvantaged during the health care process. However, our results also indicate that satisfaction with the health care process improves for second-generation migrants in comparison with first-generation migrants.

Background Patient safety is a quality indicator for primary care and it should be based on individual needs, and not differ among different social groups. Nevertheless, the attention on social disparities in patient safety has been mainly directed towards the hospital care, often overlooking the primary care setting. Therefore, this paper aims to synthesise social disparities in patient safety in the primary care setting. Methods The Databases PubMed and Web of Science were searched for relevant studies published between January 1st 2006 and January 31st 2017. Papers investigating racial, gender and socioeconomic disparities in regards to administrative errors, diagnostic errors, medication errors and transition of care errors in primary care were included. No distinction in terms of participants’ age was made. Results Women and black patients are more likely to experience patient safety events in primary care, although it depends on the type of disease, treatment, and healthcare service. The available literature largely describes gender and ethnic disparities in the different patient safety domains whilst income and educational level are studied to a lesser extent. Conclusions The results of this systematic review suggest that vulnerable social groups are likely to experience adverse patient safety events in primary care. Enhancing family doctors’ awareness of these inequities is a necessary first step to tackle them and improve patient safety for all patients. Future research should focus on social disparities in patient safety using socioeconomic indicators, such as income and education.

Item does not contain fulltext OBJECTIVE: To describe social differences in postponing a general practitioner visit in 31 European countries and to explore whether primary care strength is associated with postponement rates. DATA SOURCES: Between October 2011 and December 2013, the multicountry QUALICOPC study collected data on 61,931 patients and 7,183 general practitioners throughout Europe. STUDY DESIGN: Access to primary care was measured by asking the patients whether they postponed a general practitioner visit in the past year. Social differences were described according to patients' self-rated household income, education, ethnicity, and gender. DATA COLLECTION/EXTRACTION METHODS: Data were analyzed using multivariable and multilevel binomial logistic regression analyses. PRINCIPAL FINDINGS: According to the variance-decomposition in the multilevel analysis, most of the variance can be explained by patient characteristics. Postponement of general practitioner care is higher for patients with a low self-rated household income, a low education level, and a migration background. In addition, although the point estimates are consistent with a substantial effect, no statistically significant association between primary care strength and postponement in the 31 countries is determined. CONCLUSIONS: Despite the universal and egalitarian goals of health care systems, access to general practitioner care in Europe is still determined by patients' socioeconomic status (self-rated household income and education) and migration background.

Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC) system, because in many European countries PC is the first entry point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013) and the Primary Healthcare Activity Monitor for Europe (2010). The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country's PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce) as this can influence inequity in unmet need.

Background: Overcrowding of emergency departments (ED) during out-of-hours health care is a common problem in many Western countries. An appealing alternative for ED’s is the general practices cooperatives (GPC): regional networks of GP’s during the out-of-hours. The aim of this study is to investigate the socio-economic determinants of patients’ choice to opt for one of both health care providers. Methods: We gathered patient level data between May and December 2012 in Flanders (Belgium) from three emergency departments and three general practices cooperatives. Chi square analyses were used in order to study the bivariate relationship between opting for a health care facility (ED or GPC) and various socio-economic factors. To determine the independent association, a logistic regression analysis was conducted. Results: Self-referral to the ED is significantly associated with: being male, being younger, being less educated, having a (lower educated) partner and living in a rural area. Conclusion: The results of this study show that opting for the ED during the out-of-hours is, in general, related to a lower socio-economic status. Therefore the government should focus on patients with a lower socio-economic status when disseminating information on the organisation of health care with an emphasis on the accessibility of the primary health care during out-of-hours. To meet the needs for health care during these out-of-hours, a possible solution could be an integrated facility of GPC and ED with one access to medical care for all patients.