Factors associated with enablement in general practice: cross-sectional study using routinely-collected data.

BACKGROUND Quality-improvement activities are most often focused on clinical quality indicators. However, patient evaluations are important additional indicators of the quality of general practice consultations, including measures of satisfaction or enablement (that is, the extent to which the consultation enhances the patient's feelings of confidence and ability to cope). There is limited evidence concerning factors associated with enablement in UK general practice. AIM To identify patient and practice characteristics associated with enablement scores following general practice consultations. DESIGN OF STUDY Cross-sectional survey using a large routinely-collected dataset of patient evaluations of general practice (190,038 individual patient responses). SETTING A total of 1031 UK general practices. METHOD Relationships between health, demographic factors, evaluations of general practice care, and patient self-reported enablement were estimated using multiple regression. RESULTS The primary predictor of enablement was positive patient evaluation of the GPs' communication. Reported continuity of care accounted for a lower proportion of the variance. Of the included patient demographic variables, ethnicity was a key predictor, with patients from minority ethnic groups reporting greater enablement once other factors were controlled. CONCLUSION The current results provide support for the construct validity of the enablement measure. However, if enablement is to become a valid and useful measure of quality, it is necessary to understand the mechanisms by which enablement is increased in certain patients and practices. Detailed qualitative research may also be required to explain the relatively high scores of ethnic minority responders, despite lower overall satisfaction scores, and to understand why some items included in the enablement measure are regarded as 'not applicable' by a substantial minority of patients.