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Advisor: Vittorio Maio, PharmD, MS, MSPH-Thomas Jefferson University


Background: Primary care in the Emilia-Romagna Region of Italy is delivered through 11 Local Health Authorities (LHAs) by General Practitioners (GPs) organized into Primary Care Groups (PCGs), the result of a law enacted in 2004. The purpose of PCGs is to facilitate collaboration between GPs and improve quality of care; however, researchers found that performance variability exists between the PCGs. The purpose of this study was to reveal perceptions of practice culture to inform strategies and promote interaction between PCGs through surveying GPs in the LHA of Parma. Methods: Through an extensive literature review on outpatient practice culture, a validated survey tool, developed and tested in the United States, was found. The validated instrument served as a framework to develop a survey containing 18 items covering 7 cultural dimensions including information emphasis, quality emphasis, management style, organizational trust, collegiality, cohesiveness, and autonomy. The survey was administered to all 301 GPs in 21 PCGs in Parma, Italy. Data on PCG characteristics was retrieved from the LHA demographic file. Descriptive analyses were conducted on all variables of interest. A linear regression with PCG characteristics as the independent variables and cultural dimensions as the dependent variables was performed to identify associations. Results: 224 GPs from 19 PCGs completed the survey (response rate = 75%). The results of the linear regression revealed size of PCGs (number of GPs) has a strong impact on culture. Organizational trust was greater in groups where >20% of the GPs were over 60 y/o. Being located in the mountains was associated with practicing autonomously and a decreased emphasis was placed on quality in groups where some GPs practiced alone. Conclusions: Our study findings demonstrate that characteristics of PCGs are likely to have an impact on practice culture. Knowledge of group characteristics and practice culture will inform LHA decisions about PCG structure and practice.