scholarly journals Comparing quality of primary healthcare between public and private providers in China: study protocol of a cross-sectional study using unannounced standardised patients in seven provinces of China

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040792
Author(s):  
Dong Xu ◽  
Jay Pan ◽  
Xiaochen Dai ◽  
Mengyao Hu ◽  
Yiyuan Cai ◽  
...  
Keyword(s):  
Private Sector ◽  
Primary Healthcare ◽  
Chinese Government ◽  
Health Coverage ◽  
Primary Analysis ◽  
Clinical Trial Registry ◽  
Cross Sectional ◽  
Private And Public ◽  
Standardised Patients

IntroductionThe Chinese government has encouraged the development of private sector in delivering healthcare, including primary healthcare (PHC) in the new round of national health reform since 2009. However, the debate about the role of the private sector in achieving universal health coverage continues with poor support from theories and empirical evidence. This study intends to compare the quality of PHC services between the private and public providers in seven provinces in China, using unannounced standardised patients (USPs).MethodsWe are developing and validating 13 USP cases most commonly observed in the PHC setting. Six domains of quality will be assessed by the USP: effectiveness, safety, patient centredness, efficiency, timeliness and equity. The USP will make 2200 visits to 705 public and 521 private PHC institutions across seven provinces, following a multistage clustered sample design. Using each USP-provider encounter as the analytical unit, we will first descriptively compare the raw differences in quality between the private and public providers and then analyse the association of ownership types and quality, using propensity score weighting.Ethics and disseminationThe study was primarily funded by the National Natural Science Foundation of China (#71974211, #71874116 and # 72074163) and was also supported by the China Medical Board (#16-260, #18-300 and #18-301), and have received ethical approval from Sun Yat-sen University (#2019–024). The validated USP tool and the data collected in this study will be freely available for the public after the primary analysis of the study.Trial registration numberChinese Clinical Trial Registry: #ChiCTR2000032773.

scholarly journals Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023997 ◽  
Author(s):  
Dong Roman Xu ◽  
Mengyao Hu ◽  
Wenjun He ◽  
Jing Liao ◽  
Yiyuan Cai ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Rating Scale ◽  
Physical Symptoms ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Real Patient ◽  
Cross Sectional ◽  
Patient Rating ◽  
Standardised Patients ◽  
Real Practice

IntroductionPrimary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.Methods and analysis1981 SP–clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test–retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.Ethics and disseminationThis study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.

scholarly journals A qualitative inquiry of access to and quality of primary healthcare in seven communities in East and West Africa (SevenCEWA): perspectives of stakeholders, healthcare providers and users

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Soter Ameh ◽  
Bolarinwa Oladimeji Akeem ◽  
Caleb Ochimana ◽  
Abayomi Olabayo Oluwasanu ◽  
Shukri F. Mohamed ◽  
...  
Keyword(s):  
Health Insurance ◽  
West Africa ◽  
Primary Healthcare ◽  
A Priori ◽  
Healthcare Providers ◽  
Health Coverage ◽  
Health Seeking ◽  
East And West ◽  
Universal Health

Abstract Background Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in East and West Africa. The aim of this study was to describe the viewpoints of healthcare users, healthcare providers and other stakeholders on health-seeking behaviour, access to and quality of healthcare in seven communities in East and West Africa. Methods A qualitative study was conducted in four communities in Nigeria and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit: 155 respondents (mostly healthcare users) for 24 focus group discussions, 25 healthcare users, healthcare providers and stakeholders for in-depth interviews and 11 healthcare providers and stakeholders for key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand the a priori themes on access to and quality of primary healthcare as well as health-seeking behaviours of the study respondents. A content analysis of the data was done using MAXQDA 2018 qualitative software to identify these a priori themes and emerging themes. Results Access to primary healthcare in the seven communities was limited, especially use of health insurance. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Health providers and users as well as stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in the Nigerian sites. Conclusions There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery that address social and health inequities, through affordable health insurance, can be used to fill this gap and facilitate achieving universal health coverage.

scholarly journals Evaluation of rational prescribing and dispensing of medicines in Mali

2017 ◽  
Author(s):  
Yaya Coulibaly ◽  
Fanta Sangho ◽  
Aboubacar Alassane Oumar
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Treatment Guidelines ◽  
Generic Drugs ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical Practitioners ◽  
The Public ◽  
Quality Of Prescribing

Objective: The drug policy of Mali is based on the concept of essential generic drugs. The adoption of generic drugs in a program is often accompanied by irrational use of these drugs precisely because of the availability of these drugs. Thus, this study was initiated to assess the quality of prescribing and dispensing drugs in Mali. Methods: This is a descriptive cross-sectional study was conducted from 2004 to 2013, the survey was conducted in 20 primary health centers and 20 private pharmacies in three regions of the country. In each of these structures, 30 prescriptions filled at the time of the survey were collected. Results: The average number of drugs per prescription was 3.0 ± 1.3 and 2.4 ± 1.2, respectively, in the public and private sectors. Prescription of drugs under international name was 91.6% in the public sector and 37.2% in the private sector. The public sector prescribed 33.7% of injectable drug against 16.2% in the private sector (p <0.001). The average cost of a prescription was lower in the public sector (3415.3 FCFA or 5.21euros) than in the private sector (7111 FCFA or 10.85 euros).Conclusion: Generic drugs are commonly used in the public, but much less in the private sector. The treatment guidelines are already available, should be introduced interactively to medical practitioners, through visits and intensive supervision by more experienced managers in the hierarchy, it would be likely to improve the quality of prescribing practitioners.

scholarly journals Risk selection in primary care: a cross-sectional fixed effect analysis of Swedish individual data

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020402
Author(s):  
David Isaksson ◽  
Paula Blomqvist ◽  
Ronnie Pingel ◽  
Ulrika Winblad
Keyword(s):  
Healthcare Provider ◽  
Primary Healthcare ◽  
Population Based ◽  
Skewed Distribution ◽  
Risk Selection ◽  
Swedish Population ◽  
Cross Sectional ◽  
Percentage Points ◽  
Primary Healthcare Provider ◽  
Private And Public

ObjectiveTo assess socioeconomic differences between patients registered with private and public primary healthcare centres.DesignPopulation-based cross-sectional study controlling for municipality and household.SettingSwedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions.ParticipantsAll individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study.Primary outcome measuresRegistration with private versus public primary healthcare centres.ResultsAfter controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1–3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education.ConclusionsThe results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.

scholarly journals The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027296 ◽  
Author(s):  
Nóra Kovács ◽  
Orsolya Varga ◽  
Attila Nagy ◽  
Anita Pálinkás ◽  
Valéria Sipos ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Cross Sectional Study ◽  
Gender Effect ◽  
Sectional Study ◽  
Cross Sectional ◽  
Process Indicators ◽  
Wide Cross ◽  
The Impact

ObjectivesThe objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.Study designA nation-wide cross-sectional study was performed in 2016.Setting and participantsThe study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.Main outcome measuresMultilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.Results48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.ConclusionFemale GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.

scholarly journals The relationship between psychosocial risk factors, burnout and quality of life among primary healthcare workers in rural Guangdong province: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joseph Obiri Asante ◽  
Meng Jie Li ◽  
Jing Liao ◽  
Yi Xiang Huang ◽  
Yuan Tao Hao
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Guangdong Province ◽  
Cross Sectional Study ◽  
Poor Quality ◽  
Cross Sectional ◽  
Developing Cities

Abstract Background Healthcare workers are often exposed to stressful working conditions at work which affect their quality of life. The study investigated the relationship between psychosocial risk factors, stress, burnout, and quality of life among primary healthcare workers in general medical practice in Qingyuan and Chaozhou cities in Guangdong province. Method The cross-sectional study was conducted in 108 primary health facilities including 36 community health centers (CHCs) across two developing cities in Guangdong province. A total of 873 healthcare workers completed the questionnaires. Quality of life was evaluated using The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and psychological risk factors were evaluated by the Copenhagen Psychosocial Questionnaire (COPSOQ). General quality of life and the quality of life domains were transformed into a score range from minimum 0 to 100 maximum. Higher scores indicated better quality of life and vice versa. Significant associations were verified using multiple regression analysis. Results Poor quality of life was observed in 74.6% of healthcare workers surveyed. General poor quality of life was significantly higher among workers who reported higher burnout (Beta = − 0.331, p < 0.001). In addition, workers with high levels of burnout, unmarried workers and female workers had a higher possibility of physical health. A greater risk of poor psychological health was observed among workers with high burnout, poor sense of community and those with lower educational levels. Workers who lacked social support, those with fewer possibilities for development had increased probability of poor quality of life in the social domain. Poor quality of life in the environmental domain was observed among workers who were dissatisfied with their jobs and workers with low salaries. Conclusions Primary healthcare workers in developing cities in China have a highly demanding and strained working environment and poor quality of life. Reducing job stress and improving work conditions may ultimately improve the well-being of primary healthcare workers.

scholarly journals Cancer patients with oral mucositis: challenges for nursing care

2015 ◽  
Vol 23 (2) ◽  
pp. 267-274 ◽  
Author(s):  
Sarah Nilkece Mesquita Araújo ◽  
Maria Helena Barros Araújo Luz ◽  
Grazielle Roberta Freitas da Silva ◽  
Elaine Maria Leite Rangel Andrade ◽  
Lívio César Cunha Nunes ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Nursing Care ◽  
Oral Mucositis ◽  
Oral Care ◽  
Care Plan ◽  
Cross Sectional ◽  
Human Needs ◽  
Public Facilities ◽  
Private And Public

OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan.

scholarly journals Tuberculosis practices among private medical practitioners in Kaski district, Nepal

2013 ◽  
Vol 1 (2) ◽  
pp. 68-75
Author(s):  
AK Nepal ◽  
A Shrestha ◽  
SC Baral ◽  
R Bhattarai ◽  
Y Aryal
Keyword(s):  
Quality Of Care ◽  
Private Sector ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Public And Private ◽  
Medical Practitioners ◽  
Sputum Microscopy ◽  
Public And Private Sector

INTRODUCTION: Although the evidences suggest that more than one third tuberculosis (TB) cases are being managed in private sector, the quality of care in private sector is major concern. However, the information regarding the private practices were lacking. Therefore the study was conducted to gain insights on current practices of TB management at private sectors. MATERIALS AND METHODS: A descriptive cross sectional study, applying quantitative method, was conducted at two cities of Kaski among all private practitioners, private pharmacies and private laboratories through self administered questionnaire and structured interview schedule. RESULTS: Nearly one fourth of the TB suspects in the district were found to have consulted private providers with about 20.0% of the total smear positive cases diagnosed in private laboratories. Beside sputum microscopy, Private Medical Practitioners (PMPs) were also found to prefer other tests like X-ray, culture for TB diagnosis. Similarly, PMPs’ varying prescription of anti TB drugs beyond National TB Programme (NTP) recommendation along with their weak recording and case holding were noteworthy, and the cost of TB treatment seemed higher in private sector. Only one third of private institution had their staff trained in TB. Except some informal linkage, no collaboration between public and private sector was noted. CONCLUSIONS: Private sector was managing many TB cases in the district. However, their practice of TB management was not much satisfactory. Therefore NTP should take effective measures for Public Private Mix and to make them aware of the standards through training and orientation in order to improve the quality of care. DOI: http://dx.doi.org/10.3126/ijim.v1i2.7085 Int J Infect Microbiol 2012;1(1):68-75

scholarly journals Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

BMJ Open ◽  
2016 ◽  
Vol 6 (3) ◽  
pp. e010632 ◽  
Author(s):  
Anthony K Mbonye ◽  
Esther Buregyeya ◽  
Elizeus Rutebemberwa ◽  
Siân E Clarke ◽  
Sham Lal ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Private Sector ◽  
Improve Quality ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Drug Shops
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