scholarly journals Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catherine Arsenault ◽  
Bereket Yakob ◽  
Tizta Tilahun ◽  
Tsinuel Girma Nigatu ◽  
Girmaye Dinsa ◽  
...  
Keyword(s):  
Primary Care ◽  
Information System ◽  
Quality Of Care ◽  
Antenatal Care ◽  
Service Provision ◽  
Patient Volume ◽  
Quality Of Primary Care ◽  
Assessment Survey ◽  
Facility Level

Abstract Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts.

scholarly journals Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephan Brenner ◽  
Caterina Favaretti ◽  
Julia Lohmann ◽  
Jobiba Chinkhumba ◽  
Adamson S. Muula ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Services ◽  
Antenatal Care ◽  
Service Provision ◽  
Child Health Services ◽  
Negative Externalities ◽  
Positive Externalities ◽  
Performance Based Financing ◽  
A Performance

Abstract Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care. Methods We explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations. Results Our study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi. Conclusions Prior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

scholarly journals Primary care management for isolated limb injury: Referral to orthopedic surgery in a trauma center

2010 ◽  
Vol 33 (2) ◽  
pp. 99
Author(s):  
Dominique M Rouleau ◽  
Stefan Parent ◽  
Debbie Ehrmann Feldman
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Care Center ◽  
Related Factors ◽  
Lower Limb Injury ◽  
Health Care Center ◽  
Factors Associated ◽  
Limb Injury ◽  
Quality Of Primary Care

Introduction: Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to identify related factors. Methods: A cross sectional study was undertaken prospectively on 166 consecutive ambulatory adult patients with isolated limb injury who presented to orthopedics service in a Level one Trauma Centre. Quality of care was assessed by evaluating analgesia, walking aids, immobilization, and quality of referral diagnosis according to actual expert recommendations. Results: This study revealed low quality of primary care for 82 (53.2%) of injured patients. Seventy-three patients (50.3%) had pain level over 5/10 and 45 cases (28.5%) had insufficient/absent analgesia prescriptions. Fifty-one (32.3%) had unacceptable immobilization and 21/59 (35.6%) patients with a lower limb injury did not receive a walking aid prescription. A total of 61 patients (36.7%) had an absent or inadequate referral diagnosis. Factors associated with lower quality depended on the specific quality indicator and included: living further away from the hospital, younger age, initially consulting at another health care center, having a fracture, and being a smoker. Conclusion: The high frequency of low quality of care underlines the necessity for orthopedic surgeons to be involved in primary care education. Identifying factors associated with lower quality of care will orient efforts to improve medical care of patients with isolated traumatic injury.

Lean maturity and quality in primary care

2019 ◽  
Vol 33 (2) ◽  
pp. 141-154 ◽  
Author(s):  
Monica Kaltenbrunner ◽  
Svend Erik Mathiassen ◽  
Lars Bengtsson ◽  
Maria Engström
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Satisfaction With Care ◽  
National Guidelines ◽  
Content Type ◽  
Lean Principles ◽  
Quality Of Primary Care ◽  
Further Development ◽  
Practical Implications

Purpose The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff. Design/methodology/approach Data were collected using a survey based on Liker’s four principles, divided into 16 items (n=298 staff in 45 units). Complementary observations (n=28 staff) were carried out at four units. Findings Lean maturity varied both between and within units. The highest Lean maturity was found for “adhering to routines” and the lowest for “having a change agent at the unit.” Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality. Practical implications Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development. Originality/value This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

scholarly journals The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire

2020 ◽  
Vol 5 (9) ◽  
pp. e002934
Author(s):  
Denizhan Duran ◽  
Sebastian Bauhoff ◽  
Peter Berman ◽  
Tania Gaudet ◽  
Clovis Konan ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Health System ◽  
Cote D'ivoire ◽  
Côte D’Ivoire ◽  
Cote D’Ivoire ◽  
Design And Implementation ◽  
Côte D'ivoire ◽  
Quality Of Primary Care

Low quality of care is a significant problem for health systems in low-income and middle-income countries (LMICs). Policymakers are increasingly interested in using performance-based financing (PBF), a system-wide provider payment reform, conditioned on both quantity and quality of performance, to improve quality of care. The health system context influences both the design and the implementation of these programmes and thus their effectiveness. This study analyses how context has influenced the design and implementation of PBF in improving the quality of primary care in one particular setting, Cote d’Ivoire, a lower-middle income country with some of the poorest health outcomes in the world. Based on literature, an analytical framework was developed identifying five pathways through which financial incentives can influence the quality of primary care: earmarking, conditioning, provider behaviour, community involvement and management. Guided by this framework, semistructured interviews were conducted with policymakers and providers to diagnose the context and to assess the links between financing and quality of care at the primary care level. PBF in Cote d’Ivoire was found to have increased data availability and quality, facility-wide and disease-specific inputs, provider motivation and management practices in contracted facilities, but had limited success in improving process and outcome measures of quality, as well as community involvement and the provision of non-incentivised services. These limitations were attributable to a centralised health system structure constraining the decision space of health providers; financing and governance challenges across the health sector; and shortcomings with regard to the design of the PBF quality checklist and incentive structures in Cote d’Ivoire. In order to improve the quality of primary care, health sector reforms such as PBF should incorporate the organisational and service delivery context more broadly into their design and implementation, as is the case in other countries.

scholarly journals Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Cathy Kande ◽  
Robert Mash
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Blood Pressure Control ◽  
Catchment Area ◽  
Pressure Control ◽  
Prevalence Studies ◽  
Quality Of Primary Care

Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05) was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90) in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

scholarly journals Reviewing Inequities in Primary Care Received by Indigenous Peoples in Ontario

2020 ◽  
pp. 21-28
Author(s):  
Heba Shahaed ◽  
Guneet Sandhu ◽  
Eric Seidlitz
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Indigenous Peoples ◽  
Health Care Providers ◽  
Indigenous Population ◽  
Indigenous Communities ◽  
Indigenous Populations ◽  
Care Providers ◽  
Quality Of Primary Care

Research has shown that Indigenous peoples in Canada experience health inequities when compared to the non-Indigenous population. High quality primary care has been described in literature; however, this has not been explored through the lens of Indigenous health. A scoping review was performed in order to investigate the quality of primary care received by indigenous peoples in Ontario. To conduct this review, a search of current literature on primary care in Indigenous communities in Ontario was performed. The studies examined in this review were derived from four different databases and many evaluated specific communities using a qualitative and quantitative approach. Several themes were identified including inadequate preparation and training of health care providers, physician and nursing shortages, strategies associated with improved quality of care, management of mental health, disparities in health service delivery station types and ineffective primary care impacts on hospitalizations. This literature search demonstrated a clear gap in the literature on the quality of primary care received by the Indigenous population in Ontario. Thus, further research is necessary in order to outline the current state of primary care being delivered to Indigenous populations in Ontario, and develop strategies to enhance the quality of care for this population.  

scholarly journals Antenatal care processes in rural Southern Nepal: gaps in and quality of service provision—a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e056392
Author(s):  
Emily Bryce ◽  
Joanne Katz ◽  
Tsering Pema Lama ◽  
Subarna K Khatry ◽  
Steven C LeClerq ◽  
...  
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Antenatal Care ◽  
Service Provision ◽  
Quality Care ◽  
First Trimester ◽  
Adjusted Risk ◽  
Provision Of Services ◽  
Standard Quality

ObjectivesThis study aimed to compare a standard quality of care definition to one that reflected focused antenatal care (FANC) guidelines and examine associations with receipt of good quality of care.DesignThis study was a longitudinal cohort study.SettingsFive government health posts in the Sarlahi district of Southern NepalParticipantsPregnant women between the ages of 15 and 49 who presented for their first antenatal care (ANC) visit at the study health posts.Main outcomesThere were two quality of care definitions: (1) provision of seven services at least once during pregnancy (QOC1) and (2) provision of services to reflect the FANC guidelines by incorporating a frequency of care dimension for certain services (QOC4+).ResultsThere was variation in service provision both in terms of frequency of provision and by gestational age at the visit. There were 213 women (49.1%) that received good quality care by the first definition, but when the frequency of service provision was included for the second definition the percentage dropped to 6.2%. There were significant differences in provision of quality care by health post for both definitions. The number of visits (QOC1 adjusted risk ratio (aRR) 1.18, 95% CI 1.13 to 1.23; QOC4+ aRR 1.46, 95% CI 1.11 to 2.80) and care during the first trimester (QOC1 aRR 1.22, 95% CI 1.01 to 1.49) and maternal age (QOC1 aRR 1.27, 95% CI 1.03 to 1.58) were associated with greater likelihood of good quality ANC.ConclusionThis analysis demonstrated that measuring quality of care by receipt of services at least once during pregnancy may overestimate the true coverage of quality of ANC. Future efforts should improve feasibility of including frequency of care in quality of care definitions.

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