Does workforce explain the relationship between funding and patient experience? A mediation analysis of primary care data in England.

OBJECTIVES: To determine whether general practitioner (GP) workforce contributes to the link between practice funding and patient experience. Specifically, to determine whether increased practice funding is associated with better patient experience, and to what degree an increase in workforce accounts for this relationship. SETTING: Primary care practice level analysis of workforce, funding and patient experience of all NHS practices in England. PRIMARY AND SECONDARY OUTCOME MEASURES: The link between NHS-provided funding to general practice (payments per patient) and patient experience, as per the General Practice Patient Survey, was evaluated. Subsequently, mediation analysis, adjusted for covariates, was used to scrutinise the extent to which GP workforce accounts for this relationship (measured as the number of GPs per 10 000 patients). PARTICIPANTS: We included all general practices in England for which there was relevant data for each primary variable. Atypical practices were excluded, such as those with a patient list size of 0 or where the workforce variable was recorded as being more than 3 SD from the mean. After exclusion, 6139 practices were included in the final analysis. RESULTS: We found that workforce (GPs per 10 000 population) significantly (p<0.001) acts as a mediator in the effect of practice funding on overall patient experience even after adjusting for rurality, sex and age, and deprivation. On average, the mediated effect constitutes 30% of the total effect of practice funding on patient experience. CONCLUSIONS: The increase in the number of doctors in primary care in England appears to be a mechanism through which augmented practice funding could positively impact patient experience. Policy initiatives targeting improved patient experience should prioritise considerations related to workforce and practice funding.

Predictors of physical violence against children in Rwanda: findings from a National Cross-Sectional Survey.

BACKGROUND: To address the challenges of limited national data on the prevalence and nature of violence experienced by children, Rwanda conducted, in 2015-2016, the first National Survey on Violence among female and male children and youth aged 13-24 years. To further contribute to these efforts to fill existing data gaps, we used the Rwanda survey data to assess the prevalence and predictors of physical violence (PV) in children aged 13-17. METHODS: A nationally representative sample of 618 male and 492 female children were analysed. Nationally representative weighted descriptive statistics were used to analyse the prevalence of PV self-reported by children, and logistic regression models were applied to investigate its predictors. RESULTS: Sixty percent of all children, including 36.53% of male and 23.38% of female children, reported having experienced any form of PV in their lifetime. Additionally, 21.81% of male children and 12.73% of female children reported experiences of PV within twelve months before the survey date. Older children (OR: 0.53 [0.40-0.72]), female children (OR: 0.43 [0.31-0.58]), and children not attending school (OR: 0.48 [0.31-0.73]) were less likely to be physically abused. However, sexually active children (OR: 1.66 [1.05-2.63]), children in households from the middle wealth quintile (OR: 1.63 [1.08-2.47]), children living in a larger family (OR: 1.55 [1.07-2.26]), and children who reported not feel close to both biological parents (OR: 2.14 [1.31-3.49]) had increased odds of reporting physical violence. CONCLUSION: Higher rates of PV in children attending school were the key finding. There is an urgent need to design and implement particular national interventions to prevent and reduce the incidence of PV in schools in Rwanda. PV was also associated with poor parent-child relations. Parents and other adult caregivers should be sensitised to the consequences of PV on children and be urged to adopt positive parenting practices.