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Introduction Due to the increased prevalence of comorbid conditions, people often have more than one disease that needs to be managed consistently over time. (1,2) Health-care providers can do this [...], Objective To investigate patients' perceptions of improvement potential in primary care in 34 countries. Methods We did a cross-sectional survey of 69201 patients who had just visited general practitioners at primary-care facilities. Patients rated five features of person-focused primary care--accessibility/availability, continuity, comprehensiveness, patient involvement and doctor-patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. We calculated the potential for improvement by multiplying the proportion of negative patient experiences with the mean importance score in each country. Scores were divided into low, medium and high improvement potential. Pair-wise correlations were made between improvement scores and three dimensions of the structure of primary care--governance, economic conditions and workforce development. Findings In 26 countries, one or more features of primary care had medium or high improvement potentials. Comprehensiveness of care had medium to high improvement potential in 23 of 34 countries. In all countries, doctor-patient communication had low improvement potential. An overall stronger structure of primary care was correlated with a lower potential for improvement of continuity and comprehensiveness of care. In countries with stronger primary care governance patients perceived less potential to improve the continuity of care. Countries with better economic conditions for primary care had less potential for improvement of all features of person-focused care. Conclusion In countries with a stronger primary care structure, patients perceived that primary care had less potential for improvement. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Examiner la perception des patients quant au potentiel d'amelioration des soins de sante primaires dans 34 pays. Methodes Nous avons mene une enquete transversal sur 69 201 patients qui venaient juste de consulter des medecins generalistes dans des etablissements de soins de sante primaires. Les patients ont evalue cinq caracteristiques des soins de sante primaires axes sur la personne: accessibilite/disponibilite, continuite, exhaustivite, implication du patient et communication entre le medecin et le patient. Un dixieme des patients ont classe l'importance de chaque caracteristique sur une echelle allant d'un a quatre, et neuf dixiemes ont note leur experience des soins recus. Nous avons calcule le potentiel d'amelioration en multipliant la proportion d'experiences negatives des patients avec le score moyen d'importance danschaque pays. Les scores ont ete repartis en potentiels d'amelioration faible, moyen et eleve. Nous avons effectue des correlations par paire entre les scores d'amelioration et les trois dimensions de la structure des soins de sante primaires: gouvernance, conditions economiques et constitution de la main-d'ceuvre. Resultats Dans 26 pays, une ou plusieurs caracteristiques des soins de sante primaires presentaient des potentiels d'amelioration moyen ou eleve. L'exhaustivite des soins avait un potentiel d'amelloration moyen a eleve dans 23 des 34 pays. Dans tous les pays, la communication entre le medecin et le patient presentait un potentiel d'amelloration faible. Une structure globale plus forte des soins de sante primaires etait correlee avec un potentiel plus faible d'amelioration pour la continuite et l'exhaustivite des soins. Dans les pays avec une gouvernance plus forte des soins de sante primaires, les patients percevaient un moindre potentiel pour ameliorer la continuite des soins. Les pays presentant de meilleures conditions economiques pour les soins de sante primaires avalent un moindre potentiel pour l'amelioration de toutes les caracteristiques des soins de sante axes sur la personne. Conclusion Dans les pays avec une structure plus forte des soins de sante primaires, les patients percoivent un moindre potentiel d'amelioration pour les soins de sante primaires. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Investigar las percepciones de los pacientes acerca de la mejora en la atencion primarla en 34 paises. Metodos Se realizo una encuesta transversal de 69 201 pacientes que acababan de visitar medicos generales en centros de atencion primaria. Los pacientes evaluaron cinco caracteristicas de la atencion primarla centrada en la persona: accesibilidad y disponibilidad, continuidad, exhaustividad, implicacion del paciente, asi como comunicacion entre medico y paciente. Una decima parte de los pacientes clasifico la Importancia de cada caracteristica en una escala de uno a cuatro y nueve de cada diez pacientes evaluaron sus experiencias de la atencion recibida. Se calculo el potencial de mejora multiplicando la proporcion de experiencias negativas de pacientes con la puntuacion media de la importancia en cada pais. Las puntuaciones se dividieron en potencial de mejora bajo, medio y alto. Se realizaron correlaciones por pares entre las puntuaciones de mejora y las tres dimensiones de la estructura de atencion primarla, a saber, gestion, condiciones economicas y desarrollo laboral. Resultados En 26 paises, una o mas caracteristicas de la atencion primaria tenian potenciales de mejora medios o altos. El caracter Integral de la atencion tenia un potencial de mejora entre medio y alto en 23 de 34 paises. En todos los paises, la comunicacion entre medico y paciente tenia un potencial de mejora bajo. Una estructura global mas fuerte de la atencion primaria se correlaciono con un menor potencial de mejora en la continuidad y exhaustividad de la atencion. En los paises con una politica de direccion de la atencion primaria mas solida, los pacientes percibieron un potencial menor de mejora de la continuidad de la atencion. Los paises con mejores condiciones economicas para la atencion primarla presentaron un potencial menor para la mejora de todas las caracteristicas de la atencion centradas en la persona. Conclusion En paises con una estructura de atencion primaria mas solida, los pacientes perciben un menor potencial de mejora de la atencion primaria.

Objectives. We sought to determine whether sexual orientation is related to mental and physical health and health behaviors in the general population. Methods. Data was derived from a health interview survey that was part of the second Dutch National Survey of General Practice, carried out in 2001 among an all-age random sample of the population. Of the 19685 persons invited to participate, 65% took part in the survey. Sexual orientation was assessed in persons aged 18 years and older and reported by 98.2% of 9684 participants. The respondents' characteristics are comparable with those of the Dutch general population. Results. Gay/lesbian participants reported more acute mental health symptoms than heterosexual people and their general mental health also was poorer. Gay/lesbian people more frequently reported acute physical symptoms and chronic conditions than heterosexual people. Differences in smoking, alcohol use, and drug use were less prominent. Conclusions. We found that sexual orientation was associated with mental as well as physical health. The causal processes responsible for these differences by sexual orientation need further exploration. doi:10.2105/AJPH.2004.058891)