A standardised instrument for patient evaluations of general practice care in Europe

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Abstract
Objective: International comparisons of health care systems may provide important insights, but they require internationally standardised and validated instruments. This paper describes the validity and reliability of the EUROPEP instrument for patient evaluation of general practice care. Methods: Surveys were performed in 16 countries among patients who visited the general practice (n=23892), using the 23-item EUROPEP questionnaire. Data were analysed with respect to content validity, reliability, criterion validity, construct validity and sensitivity of the instrument. Results: The item response among responders was good or acceptable for most items. Two internally consistent dimensions were identified, 'clinical behaviour' (17 items) and 'organisation of care' (6 items). The answers to the 23 questions predicted the overall attitudes regarding the general practitioner. Higher age, more visits to the GP and better health status predicted more positive evaluations of care, as was expected beforehand. Differences between countries were significant but moderate for most of the questions. In specific countries problems with respect to validity and reliability were found. Conclusions: An internationally standardised and validated instrument for patients' evaluations of general practice care is now available for international comparisons. Future research should improve its validity to solve the problems that were found in some countries. Eur J Gen Pract 2000;6:82–7.