The Quality of Primary Care Performance in Private Sector Facilities in Nairobi, Kenya: A Cross-Sectional Descriptive Survey

Mapping Intimacies ◽

10.21203/rs.3.rs-899530/v1 ◽

2021 ◽

Author(s):

Gulnaz Mohamoud ◽

Robert Mash

Keyword(s):

Primary Care ◽

Poor Performance ◽

Cross Sectional ◽

Community Orientation ◽

Quality Of Primary Care ◽

Overall Performance ◽

Ongoing Care ◽

First Contact ◽

Care Performance

Abstract BackgroundIntegrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is little information on these key elements and such information is needed to improve service delivery. This study aimed to evaluate the quality of primary care performance in a group of private sector clinics in Nairobi, Kenya.Methods A cross-sectional descriptive study adapted the Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data was analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying poor overall performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact (access), coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.Conclusion These primary care clinics in Nairobi had a poor overall performance. There was a report of acceptable-to-good performance in first-contact utilisation, the information systems, family centredness and cultural competence. However, patients rated first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team, as poor. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, improving access after-hours and marketing the use of the clinics to the practice population.

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Comparison of Patients’ Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China

10.21203/rs.2.20339/v1 ◽

2020 ◽

Author(s):

aiyun chen ◽

Shanshan Feng ◽

liang Zhang ◽

leiyu Shi

Keyword(s):

Primary Care ◽

Community Health Centers ◽

Health Centers ◽

Care Experience ◽

Community Orientation ◽

Quality Of Primary Care ◽

Family Centeredness ◽

Ongoing Care ◽

First Contact

Abstract Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients' perceived quality of primary health care between rural and urban community health centers in Guangdong.Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either CHCs/CHSs in urban areas or THCs/RHSs in rural areas via face-to-face interviews. A validated Chinese version of Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing 10 primary care domains, was used to collect information on patients’ primary care experiences. T-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. Analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background, and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experience.Conclusion: Continued efforts are needed to strengthen primary care performance, particularly in community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains including first contact, accessibility, ongoing care, and community orientation.

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Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE

BMJ Open ◽

10.1136/bmjopen-2017-021317 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021317 ◽

Cited By ~ 8

Author(s):

Lina Li ◽

Chenwen Zhong ◽

Jie Mei ◽

Yuan Liang ◽

Li Li ◽

...

Keyword(s):

Primary Care ◽

Family Practice ◽

Assessment Tool ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Quality Of Primary Care ◽

Care Assessment ◽

First Contact

ObjectiveCurrent healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care.DesignA cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP.SettingThree community health centres in Guangzhou, China.Participants698 patients aged 18–89 years.Main outcome measuresThe quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient’s perceptions).ResultsA total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not.ConclusionOur findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.

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Effect of family doctor contract services on patient perceived quality of primary care in southern China

BMC Family Practice ◽

10.1186/s12875-020-01287-7 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shanshan Feng ◽

Aiyun Cheng ◽

Zhenni Luo ◽

Yao Xiao ◽

Luwen Zhang

Keyword(s):

Primary Care ◽

Linear Regression ◽

Service Utilization ◽

Family Doctor ◽

Perceived Quality ◽

Community Orientation ◽

Quality Of Primary Care ◽

Family Centeredness ◽

First Contact

Abstract Background Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. Methods This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. Results A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = − 8.98, P < 0.000), first contact-utilization(β = − 0.71,P < 0.001), first contact-accessibility(β = − 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = − 1.42, P < 0.001), comprehensiveness (utilization) (β = − 1.70, P < 0.001), comprehensiveness (provision) (β = − 0.99, P < 0.001),family-centeredness(β = − 0.52, P < 0.01), community orientation(β = − 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = − 0.25, P = 0.137) and culture orientation (β = − 0.264, P = 0.056) between the two both groups. Conclusions This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.

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Comparison of Patients’ Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134898 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4898

Author(s):

Aiyun Chen ◽

Shanshan Feng ◽

Liang Zhang ◽

Leiyu Shi

Keyword(s):

Primary Care ◽

Community Health ◽

Community Health Centers ◽

Health Centers ◽

Care Experience ◽

Community Orientation ◽

Quality Of Primary Care ◽

Family Centeredness ◽

First Contact

Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients’ perceived quality of primary healthcare between rural and urban community health centers in Guangdong. Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients’ primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. Conclusion: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.

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Performance of primary care in different healthcare facilities: a cross-sectional study of patients’ experiences in Southern Malawi

BMJ Open ◽

10.1136/bmjopen-2019-029579 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029579

Author(s):

Luckson Dullie ◽

Eivind Meland ◽

Øystein Hetlevik ◽

Thomas Mildestvedt ◽

Stephen Kasenda ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Health Facilities ◽

Cross Sectional ◽

Public Health Facilities ◽

Quality Of Primary Care ◽

Care Assessment ◽

Health Centres ◽

Care Performance

ObjectiveIn most African countries, primary care is delivered through a district health system. Many factors, including staffing levels, staff experience, availability of equipment and facility management, affect the quality of primary care between and within countries. The purpose of this study was to assess the quality of primary care in different types of public health facilities in Southern Malawi.Study designThis was a cross-sectional quantitative study.SettingThe study was conducted in 12 public primary care facilities in Neno, Blantyre and Thyolo districts in July 2018.ParticipantsPatients aged ≥18 years, excluding the severely ill, were selected to participate in the study.Primary outcomesWe used the Malawian primary care assessment tool to conduct face-to-face interviews. Analysis of variance at 0.05 significance level was performed to compare primary care dimension means and total primary care scores. Linear regression models at 95% CI were used to assess associations between primary care dimension scores, patients’ characteristics and healthcare setting.ResultsThe final number of respondents was 962 representing 96.1% response rate. Patients in Neno hospitals scored 3.77 points higher than those in Thyolo health centres, and 2.87 higher than those in Blantyre health centres in total primary care performance. Primary care performance in health centres and in hospital clinics was similar in Neno (20.9 vs 19.0, p=0.608) while in Thyolo, it was higher at the hospital than at the health centres (19.9 vs 15.2, p<0.001). Urban and rural facilities showed a similar pattern of performance.ConclusionThese results showed considerable variation in experiences among primary care users in the public health facilities in Malawi. Factors such as funding, policy and clinic-level interventions influence patients’ reports of primary care performance. These factors should be further examined in longitudinal and experimental settings.

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Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China

Frontiers in Public Health ◽

10.3389/fpubh.2021.606188 ◽

2021 ◽

Vol 9 ◽

Author(s):

Hua Jin ◽

Zhaoxin Wang ◽

Leiyu Shi ◽

Chen Chen ◽

Yongyan Huo ◽

...

Keyword(s):

Primary Care ◽

Community Health ◽

Community Health Centers ◽

Patient Experiences ◽

Health Centers ◽

Quality Of Primary Care ◽

Family Centeredness ◽

Ongoing Care ◽

First Contact

Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences.Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics.Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores.Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.

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Municipal Management, Infrastructure And Perception Of Users: A Description Of National Program For Improving Access And Quality Of Primary Care In The Brazilian Semiarid

International Archives of Medicine ◽

10.3823/2515 ◽

2017 ◽

Vol 10 ◽

Author(s):

Marília Gomes De Sousa Bezerra ◽

Roseanne De Sousa Nobre ◽

Artemizia Francisca De Sousa ◽

Maísa De Lima Claro

Keyword(s):

Primary Care ◽

Cross Sectional ◽

Unified Health System ◽

Quality Of Primary Care ◽

Brazilian Semiarid ◽

Municipal Management ◽

Access And Quality ◽

Objective Description

Introduction: The Ministry of Health with the aim of improving the service provided by the Unified Health System has been creating work tools to identify which points need to receive more attention to be optimized. Objective: Description of the role of municipal management, infrastructure assessment and perception of users of primary care. Method: Cross-sectional and descriptive study, conducted with Basic Units of Piauí municipality in 2015. The data were represented by tables. Results: 90% of the units reported receiving support for the planning and organization of the work process. Only 14, 81% of the units have equipment and supplies for proper operation. Users recommend the service in 92,62% of the cases. Conclusion: despite the precarious structure of the basic units of the county, the population still recognizes them as the best care.

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