Intended for healthcare professionals


Patients' own assessments of quality of primary care compared with objective records based measures of technical quality of care: cross sectional study

BMJ 2006; 333 doi: (Published 29 June 2006) Cite this as: BMJ 2006;333:19
  1. Mala Rao, honorary professor1,
  2. Aileen Clarke, honorary reader in public health (aileen.clarke{at},
  3. Colin Sanderson, reader in health services research3,
  4. Richard Hammersley, director4
  1. 1 Department of Health and Human Sciences, University of Essex, Colchester CO4 3SQ,
  2. 2 Public Health and Policy Research Unit, Queen Mary, University of London, London E1 2AT,
  3. 3 London School of Hygiene and Tropical Medicine, London WC1E 7HT,
  4. 4 Centre for Behavioural Aspects of Health and Disease, Glasgow Caledonian University, Glasgow G4 OBA
  1. Correspondence to: A Clarke
  • Accepted 9 May 2006


Objective To investigate the relation between older patients' assessments of the quality of their primary care and measures of good clinical practice on the basis of data from administrative and clinical records.

Design Cross sectional population based study using the general practice assessment survey.

Setting 18 general practices in the Basildon primary care trust area, south east England.

Participants 3487 people aged 65 or more.

Main outcome measures Correlations between mean practice scores on the general practice assessment survey and three evidence based measures on survey of case records (monitoring for, and control of, hypertension, and vaccination against influenza).

Results 76% of people (3487/4563) responded to the general practice assessment survey. Correlations between patient assessed survey scores for technical quality and the objective records based measures of good clinical practice were 0.22 (95% confidence interval −0.28 to 0.62) for hypertension monitored, 0.30 (−0.19 to 0.67) for hypertension controlled, and −0.05 (−0.50 to 0.43) for influenza vaccination.

Conclusions Older patients' assessments are not a sufficient basis for assessing the technical quality of their primary care. For an overall assessment both patient based and records based measures are required.


  • Contributors MR conceived the study, obtained funding, designed the protocol, recruited participants, and collected and analysed the data. AC helped design the study and interpreted and analysed the data. CS helped design the study and carried out statistical analysis. RH helped design the study, interpret data, and carry out statistical analysis. AC will act as guarantor. All authors helped write the manuscript.

  • Funding North Thames regional health authority.

  • Competing interests At the time of the study MR was employed first as director of public health for South Essex Health Authority and subsequently as director of the Essex Public Health network.

  • Ethical approval This study was approved by south Essex research ethics committee.

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