Client/patient perceptions of achieving equity in primary health care: a mixed methods study.

Sharareh Akhavan,Per Tillgren

doi:10.1186/s12939-015-0196-5

Sharareh Akhavan, Per Tillgren

Open Access

https://doi.org/10.1186/s12939-015-0196-5

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Abstract

IntroductionTo provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden’s national Care on Equal Terms project.MethodsMixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used.ResultsThe interview data were divided into two main categories and three subcategories. The first category “Perception of equitable health care” had two subcategories, namely “Health care providers’ perceptions” and “Fairness and participation”. The second category “To achieve more equitable health care” had four subcategories: “Encounter”, “Access”, “Interpreters and bilingual/diverse health care providers” and “Time pressure and continuity”. Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful.ConclusionsClients/patients perceived health care providers’ perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter if needed. Employing bilingual/diverse kinds of health providers is a way of providing more equitable primary health care.

Highlights

To provide health care on equal terms has become a challenge for the health system
Results from the National Patient Survey (NPS) showed that two of the primary health care units (PHCUs) improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful
The current study describes and assesses client/patient experiences and perceptions of primary health care when the Care on Equal Terms project was at its concluding phase

Summary

Introduction

To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. During the past decade, several reports from different governmental agencies, and the Swedish Association of Local Authorities and Regions (SALAR), have revealed that health care is uneven in quality, lacking in accessibility, and not offered on equal terms to all people [3,4,5]. Primary health care teams provide continuous care for all patient groups, irrespective of social class, gender, ethnicity, etc., and have an important role to play in the provision of equitable care [9]. In Sweden, people are encouraged to visit primary care facilities to meet their medical requirements in the first

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