ReferenceFamily Practice 2005; 23: 210–219
Authors and institutionsInger von Bültzingslöwen, Swedish National Board of Health and Welfare, Goteborg, Sweden; Gosta Eliasson, Institute for Family Medicine, Stockholm, Sweden; Anneli Sarvimaki, Age Institute, Helsinki, Finland; Bengt Mattssond, Department of Primary Health Care, Goteborg University, Sweden; Per Hjortdahle, Department of General Practice and Community Medicine, University of Oslo, Norway
BackgroundGiven apparent differences in the supposed value of having a personal doctor and continuity of care, and observed changes that might threaten these ideals, the team wanted to ‘… consider how patients perceive having a personal doctor in primary care and to form a theoretical model to clarify the concept and facilitate further research’
SettingThree primary healthcare centres (two in small towns, one in a bigger city) in Sweden
AimsTo acquire a comprehensive understanding of the core values of having a personal doctor in a continuing doctor–patient relationship in primary care among patients with long-term chronic illness
Research design‘Open individual interviews’. Working definition of personal doctor: a doctor at the primary health care centre that patients consulted and regarded as their own
SamplingPrimary healthcare centres had to have at least one permanent GP and at least one short-term locum; 14 patients with chronic illness (with conditions such as diabetes, rheumatoid arthritis, coronary heart disease, depression, and lower back pain) and 16 healthcare professionals (three permanent GPs, one locum GP and 11 others: nurses, counsellors and receptionists). Patients were recruited by nurses at each centre who, on a randomly chosen day, asked consecutive patients seeing a doctor to take part. Patients had to: have visited the healthcare centre for at least 5 years; have any long-term chronic disease; and have experienced both periods of having a personal GP and periods of seeing short-term locum doctors. All but one patient agreed to participate. ‘Interviews were performed until saturation was reached.’ Twelve patients with experience, both from periods of having a personal GP and periods with visits to short-term doctors, were interviewed. Two patients with experience from only having a personal doctor were included to ‘add further experiences and deepen the understanding’
Data collectionAll interviews lasted 30–45 minutes. Patients were asked initially about their preference for having a personal doctor or not, and encouraged to elaborate freely about what they found important about seeing a personal doctor. Interviews were recorded on audiotape and transcribed verbatim after each interview
ReflexivityNot discussed. We are told IvB ‘is a health care professional [without] in-depth knowledge of primary health care’, and that GE, PH, and BM are ‘experienced GPs’
Ethical issuesStudy approved by the Ethics Committee of the Swedish Board of Health and Welfare
Data analysisNotes were ‘continuously made on preliminary ideas and reflections’, and interviews continued ‘until further data collection did not provide any additional information’. Content analysis was performed: responders' statements were concentrated into smaller meaningful units, which were then grouped into subcategories. From subcategories expressing related concepts, larger units emerged which were termed categories. This was done iteratively so that provisional coding was modified in the light of newly gathered data. Analysis was led by IvB and co-assessment was done by the other authors. ‘Triangulation was done by analysing the interviews with the doctors and other staff on what patients convey to them’