Better together? A mediation analysis of general practitioners' performance in multi-professional group practice

Ob jectives: To analyse how general practitioners (GPs) respond to insucient GP supply in their practice area in terms of quantity and quality of care, and how this response can be mediated by enrolment in integrated primary care teams (multi-professional group practices (MGP)).Methods: We used three representative cross-sectional surveys (2019-2020) of 1,209 French GPs. Using structural equations, we assumed that low GP density inuences GPs' work-related stress (mediator 1) as well as their use of e-health tools (mediator 2) and ultimately quantity and quality of care. Quantity (respectively quality) of care were approximated by demand absorption capacities (respectively frequencies of vaccine recommendations). We estimated an additional specication where enrolment in an MGP was a mediator between GP density and the two mediators dened above.Results: GP density was signicantly and positively associated with work-related stress, which was consecutively associated with deteriorated demand absorption capacity. Higher use of e-health tools was associated with greater involvement in vaccine recommendations. Lastly, GPs in MGP tend to use more e-health tools than those practicing outside MGP, with a favourable eect on quality of care.Discussion: This study demonstrates that a lower level of work-related stress is the key mediator in handling patients' requests. Correcting for the self-selection into MGP, we amend some unstable results contained in the literature: there is no signicant mediation eect of enrolment in integrated primary care teams on the quantity of care, but rather an eect on the quality of care. Although probably disappointing for the quantity of care provided, our results pinpoint a novel added value of enrolment in an integrated practice as a response to decreasing GP density.