Patients' perceptions of need for primary health care services: useful for priority setting?

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Abstract
Objectives: To assess the feasibility of using patients' perceptions of need for primary health care services to develop priorities. Design: A postal survey of a random sample of 3478 patients registered with five general practices. Setting: Lothian, Scotland. Main outcome measures: Comparison of rankings of 36 different kinds of help or advice according to (a) popularity in the sample size as a whole and in healthy and unhealthy subgroups and (b) health status (severity of need) of potential service users. Results: Popularity rankings differed between the healthy and unhealthy subgroups and the whole sample. Popularity rankings were almost the inverse of rankings based on health status. The analysis identified two areas of substantial need both in terms of popularity and severity: pain management and advice about welfare benefits. Conclusions: Methodological efforts to ensure equal participation in the processes of assessing health needs and of priority setting do not in themselves promote equity. To promote equity some opinions may need to be given greater weight. Key messages The ranked popularity of services was different for a group of healthy people than for a group of unhealthy people Priorities for services based on popularity were different from those based on severity of need A great danger exists that the needs of minority groups are neglected if too much emphasis is placed on giving everyone an equal say All methods of assessment of health needs and priority setting should be explicit about principles of equity