{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T09:02:17Z","timestamp":1780477337144,"version":"3.54.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We aimed to: (i) examine to what extent care experiences and perceived outcomes among persons with chronic conditions depend on the GPs they are registered with and (ii) map the associations between patient and GP-level determinants of patient-reported experience and outcome measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross-sectional general practice nested survey of patients (n = 6691). We estimated the amount of variation at the GP level and conducted multilevel regression analyses to test hypothesized associations between potential predictors (mostly registry-based) and the six Patient-Reported Experience Measures and five Patient-Reported Outcome Measures as dependent variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ICC for four of six PREMs varied from 0.035 to 0.091, while the ICCs for the PROMs varied from 0.014 to 0.022. The main predictors of patients\u2019 care experiences were health literacy (P &amp;lt; 0.001 for all measures) and the number of years on the GP list (P &amp;lt; 0.001 for five of six measures). The main predictors for patient-reported outcomes were the number of chronic conditions (P &amp;lt; 0.001 for all), income (P &amp;lt; 0.001 for all indicators for low income compared to high), health literacy (P &amp;lt; 0.001 for all) and the number of consultations in the last 24 months (P &amp;lt; 0.001 for all), and the number of years on the GP list was also significantly associated with all PROMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most PREMs demonstrated substantial variation between GPs, warranting GP-level initiatives to improve care experiences for persons with chronic conditions. Health literacy and continuity of care were important determinants of patient-reported experiences and outcomes, demonstrating the importance of these factors for health system performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/fampra\/cmag017","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:51:11Z","timestamp":1774615871000},"source":"Crossref","is-referenced-by-count":0,"title":["Identifying patient and provider determinants of primary care experiences and outcomes for persons with chronic conditions: a multilevel analysis of a nation-wide survey in Norway"],"prefix":"10.1093","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4261-5455","authenticated-orcid":false,"given":"\u00d8yvind","family":"Bjertn\u00e6s","sequence":"first","affiliation":[{"name":"Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health , Oslo 0473 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mieke","family":"Rijken","sequence":"additional","affiliation":[{"name":"Primary Care Research Program at NIVEL, Netherlands Institute for Health Services Research (NIVEL) , Utrecht ,","place":["Netherlands"]},{"name":"Department of Health and Social Management, University of Eastern Finland , Kuopio ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Health & Community Sciences, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter , Exeter ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7503-2048","authenticated-orcid":false,"given":"Rebecka M","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health , Oslo 0473 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingeborg S","family":"Sjetne","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health , Oslo 0473 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6191-416X","authenticated-orcid":false,"given":"Hilde H","family":"Iversen","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health , Oslo 0473 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guri","family":"R\u00f8rtveit","sequence":"additional","affiliation":[{"name":"Norwegian Institute of Public Health , Oslo 0473 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M","family":"Valderas","sequence":"additional","affiliation":[{"name":"Department of Health & Community Sciences, Exeter Collaboration for Academic Primary Care (APEx), University of Exeter , Exeter ,","place":["United Kingdom"]},{"name":"Department of Family Medicine, National University Health System , Level 9, Singapore ,","place":["Singapore"]},{"name":"Centre for Research in Health Systems Performance, National University of Singapore ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"2026060304034025700_cmag017-B1","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.mayocpiqo.2023.08.005","article-title":"The burden of chronic disease","volume":"8","author":"Hacker","year":"2024","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"2026060304034025700_cmag017-B2","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1097\/JOM.0000000000000981","article-title":"Effect of chronic diseases on work productivity: a propensity score analysis","volume":"59","author":"Fouad","year":"2017","journal-title":"J Occup Environ Med"},{"key":"2026060304034025700_cmag017-B3","doi-asserted-by":"publisher","first-page":"e061424","DOI":"10.1136\/bmjopen-2022-061424","article-title":"Assessing the outcomes and experiences of care from the perspective of people living with chronic conditions, to support countries in developing people-centred policies and practices: study protocol of the International Survey of People Living with Chronic Conditions (PaRIS survey)","volume":"12","author":"de Boer","year":"2022","journal-title":"BMJ Open"},{"key":"2026060304034025700_cmag017-B4","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1186\/s12913-016-1684-z","article-title":"Patient experiences and the association with organizational factors in general practice: results from the Norwegian part of the international, multi-centre, cross-sectional QUALICOPC study","volume":"16","author":"Eide","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2026060304034025700_cmag017-B5","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1186\/s12875-024-02495-1","article-title":"Multimorbidity and patient experience with general practice: a national cross-sectional survey in Norway","volume":"25","author":"Norman","year":"2024","journal-title":"BMC Prim Care"},{"key":"2026060304034025700_cmag017-B6","doi-asserted-by":"publisher","DOI":"10.1787\/c8af05a5-en","volume-title":"Does Healthcare Deliver?: Results from the Patient-Reported Indicator Surveys (PaRIS)","author":"OECD","year":"2025"},{"key":"2026060304034025700_cmag017-B7","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1136\/bmjqs-2024-017301","article-title":"Development of the Patient-Reported Indicator Surveys (PaRIS) conceptual framework to monitor and improve the performance of primary care for people living with chronic conditions","volume":"34","author":"Valderas","year":"2025","journal-title":"BMJ Qual Saf"},{"key":"2026060304034025700_cmag017-B8","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/MLR.0b013e3181bd4dc3","article-title":"Meaningful variation in performance: a systematic literature review","volume":"48","author":"Fung","year":"2010","journal-title":"Med Care"},{"key":"2026060304034025700_cmag017-B9","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/j.1525-1497.2005.00311.x","article-title":"Measuring patients\u2019 experiences with individual primary care physicians. Results of a statewide demonstration project","volume":"21","author":"Safran","year":"2006","journal-title":"J Gen Intern Med"},{"key":"2026060304034025700_cmag017-B10","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1093\/fampra\/cmq098","article-title":"The Norwegian EUROPEP questionnaire for patient evaluation of general practice: data quality, reliability and construct validity","volume":"28","author":"Bjertnaes","year":"2011","journal-title":"Fam Pract"},{"key":"2026060304034025700_cmag017-B11","author":"The Norwegian Health Economics Administration"},{"key":"2026060304034025700_cmag017-B12","first-page":"1","article-title":"Norway: health system review","volume":"22","author":"Saunes","year":"2020","journal-title":"Health Syst Transit"},{"key":"2026060304034025700_cmag017-B13","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1186\/s12875-024-02375-8","article-title":"International cross-cultural development and field testing of the primary care practice questionnaire for the Paris survey (PaRIS-PCPQ)","volume":"25","author":"Bloemeke-Cammin","year":"2024","journal-title":"BMC Prim Care"},{"key":"2026060304034025700_cmag017-B14","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1093\/fampra\/cmab133","article-title":"Patient experiences with general practitioners: psychometric performance of the generic PEQ-GP instrument among patients with chronic conditions","volume":"39","author":"Bjertn\u00e6s","year":"2022","journal-title":"Fam Pract"},{"key":"2026060304034025700_cmag017-B15","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1093\/intqhc\/mzy212","article-title":"Validation of the person-centred coordinated care experience questionnaire (P3CEQ)","volume":"31","author":"Lloyd","year":"2019","journal-title":"Int J Qual Health Care"},{"key":"2026060304034025700_cmag017-B16","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1377\/hlthaff.2016.1088","article-title":"In new survey of eleven countries, US adults still struggle with access to and affordability of health care","volume":"35","author":"Osborn","year":"2016","journal-title":"Health Aff (Millwood)"},{"key":"2026060304034025700_cmag017-B17","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s41687-017-0003-8","article-title":"Two-item PROMIS\u00ae global physical and mental health scales","volume":"1","author":"Hays","year":"2017","journal-title":"J Patient Rep Outcomes"},{"key":"2026060304034025700_cmag017-B18","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000376585","article-title":"The WHO-5 well-being Index: a systematic review of the literature","volume":"84","author":"Topp","year":"2015","journal-title":"Psychother Psychosom"},{"key":"2026060304034025700_cmag017-B19","volume-title":"The Norwegian General Practitioner Service 2023\u20132024: A Research-Based Baseline Measurement of Patient Experiences at the Municipal Level. Report","author":"Norman","year":"2025"},{"key":"2026060304034025700_cmag017-B20","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1080\/10810730600934633","article-title":"Understanding consumers\u2019 health information preferences: development and validation of a brief screening instrument","volume":"11","author":"Maibach","year":"2006","journal-title":"J Health Commun"},{"key":"2026060304034025700_cmag017-B21","doi-asserted-by":"publisher","first-page":"b3851","DOI":"10.1136\/bmj.b3851","article-title":"Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England","volume":"339","author":"Roland","year":"2009","journal-title":"BMJ"},{"key":"2026060304034025700_cmag017-B22","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1177\/1062860608326418","article-title":"Measuring patients\u2019 experiences with individual specialist physicians and their practices","volume":"24","author":"Rodriguez","year":"2009","journal-title":"Am J Med Qual"},{"key":"2026060304034025700_cmag017-B23","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: an updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann Intern Med"},{"key":"2026060304034025700_cmag017-B24","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s13690-021-00648-7","article-title":"Association between health literacy and mortality: a systematic review and meta-analysis","volume":"79","author":"Fan","year":"2021","journal-title":"Arch Public Health"},{"key":"2026060304034025700_cmag017-B25","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/heapro\/day062","article-title":"Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review","volume":"34","author":"Stormacq","year":"2019","journal-title":"Health Promot Int"},{"key":"2026060304034025700_cmag017-B26","doi-asserted-by":"publisher","first-page":"e600","DOI":"10.3399\/bjgp20X712289","article-title":"Primary medical care continuity and patient mortality: a systematic review","volume":"70","author":"Baker","year":"2020","journal-title":"Br J Gen Pract"},{"key":"2026060304034025700_cmag017-B27","doi-asserted-by":"publisher","first-page":"e84","DOI":"10.3399\/BJGP.2021.0340","article-title":"Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway","volume":"72","author":"Sandvik","year":"2022","journal-title":"Br J Gen Pract"},{"key":"2026060304034025700_cmag017-B28","doi-asserted-by":"publisher","first-page":"e347","DOI":"10.3399\/BJGP.2023.0211","article-title":"Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data","volume":"74","author":"Pahlavanyali","year":"2024","journal-title":"Br J Gen Pract"},{"key":"2026060304034025700_cmag017-B29","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1186\/s12913-024-11460-8","article-title":"Factors associated with patients\u2019 experience of accessibility to general practice: results from a national survey in Norway","volume":"24","author":"Jelin","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026060304034025700_cmag017-B30","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/joim.12881","article-title":"Quality of care assessment for people with multimorbidity","volume":"285","author":"Valderas","year":"2019","journal-title":"J Intern Med"},{"key":"2026060304034025700_cmag017-B31","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1186\/s12916-022-02427-9","article-title":"Costs of multimorbidity: a systematic review and meta-analyses","volume":"20","author":"Tran","year":"2022","journal-title":"BMC Med"},{"key":"2026060304034025700_cmag017-B32","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.healthpol.2017.09.006","article-title":"Joint Action on Chronic Diseases and Life Cycle (JA-CHRODIS). multimorbidity care modelPromoting Healthy Ageing Across the : recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS)","volume":"122","author":"Palmer","year":"2018","journal-title":"Health Policy"},{"key":"2026060304034025700_cmag017-B33","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.healthpol.2017.06.002","article-title":"SELFIE consortium. The SELFIE framework for integrated care for multi-morbidity: development and description","volume":"122","author":"Leijten","year":"2018","journal-title":"Health Policy"},{"key":"2026060304034025700_cmag017-B34","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1016\/S0140-6736(24)01495-8","article-title":"Ten Americas: a systematic analysis of life expectancy disparities in the USA","volume":"404","author":"Dwyer-Lindgren","year":"2024","journal-title":"Lancet"},{"key":"2026060304034025700_cmag017-B35","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1007\/s11606-015-3227-4","article-title":"Building equity improvement into quality improvement: reducing socioeconomic disparities in colorectal cancer screening as part of population health management","volume":"30","author":"Berkowitz","year":"2015","journal-title":"J Gen Intern Med"},{"key":"2026060304034025700_cmag017-B36","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1136\/bmjqs-2023-017027","article-title":"Taking action on inequities: a structural paradigm for quality and safety","volume":"33","author":"Burra","year":"2024","journal-title":"BMJ Qual Saf"}],"container-title":["Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/43\/3\/cmag017\/67993821\/cmag017.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/43\/3\/cmag017\/67993821\/cmag017.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:03:47Z","timestamp":1780473827000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/fampra\/article\/doi\/10.1093\/fampra\/cmag017\/8644438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,4,3]]}},"URL":"https:\/\/doi.org\/10.1093\/fampra\/cmag017","relation":{},"ISSN":["0263-2136","1460-2229"],"issn-type":[{"value":"0263-2136","type":"print"},{"value":"1460-2229","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,4,3]]},"article-number":"cmag017"}}