Availability Of Primary Health Care Research Articles

The impact of multimorbidity among adults with cardiovascular diseases on healthcare costs in Indonesia: a multilevel analysis

BackgroundCardiovascular diseases (CVDs) are the leading cause of death in Indonesia, accounting for 38% of the total mortality in 2019. Moreover, healthcare spending on CVDs has been at the top of the spending under the National Health Insurance (NHI) implementation. This study analyzed the association between the presence of CVDs with or without other chronic disease comorbidities and healthcare costs among adults (> 30 years old) and if the association differed between NHI members in the subsidized group (poorer) and non-subsidized households group (better-off) in Indonesia.MethodsThis retrospective cohort study analyzed the NHI database from 2016–2018 for individuals with chronic diseases (n = 271,065) ascertained based on ICD-10 codes. The outcome was measured as healthcare costs in USD value for 2018. We employed a three-level multilevel linear regression, with individuals at the first level, households at the second level, and districts at the third level. The outcome of healthcare costs was transformed with an inverse hyperbolic sine to account for observations with zero costs and skewed data. We conducted a cross-level interaction analysis to analyze if the association between individuals with different diagnosis groups and healthcare costs differed between those who lived in subsidized and non-subsidized households.ResultsThe mean healthcare out- and inpatient costs were higher among patients diagnosed with CVDs and multimorbidity than patients with other diagnosis groups. The predicted mean outpatient costs for patients with CVDs and multimorbidity were more than double compared to those with CVDs but no comorbidity (USD 119.5 vs USD 49.1, respectively for non-subsidized households and USD 79.9 vs USD 36.7, respectively for subsidized households). The NHI household subsidy status modified relationship between group of diagnosis and healthcare costs which indicated a weaker effect in the subsidized household group (β = -0.24, 95% CI -0.29, -0.19 for outpatient costs in patients with CVDs and multimorbidity). At the household level, higher out- and inpatient costs were associated with the number of household members with multimorbidity. At the district level, higher healthcare costs was associated with the availability of primary healthcare centres.ConclusionsCVDs and multimorbidity are associated with higher healthcare costs, and the association is stronger in non-subsidized NHI households. Households' subsidy status can be construed as indirect socioeconomic inequality that hampers access to healthcare facilities. Efforts to combat cardiovascular diseases (CVDs) and multimorbidity should consider their distinct impacts on subsidized households. The effort includes affirmative action on non-communicable disease (NCD) management programs that target subsidized households from the early stage of the disease.

Trend, Pattern and Presentation of Visual Impairment and Blindness among Students of Schools for the Blind in South-East Nigeria

Introduction: The prevalence and distribution of major causes of blindness in children vary based on the availability of primary health care and eye care services, and under-5 mortality rates amongst others. Irrespective of the aetiology, blind children have a lifetime to live with the disability and this places enormous pressure on the family unit and the society.
 Data on the magnitude of blindness is usually gotten from schools for the blind.
 This study aimed to identify the recent trend, and presentation of visual impairment and blindness among students in schools for the blind located in southeast Nigeria.
 Methods: This was a cross sectional descriptive study conducted among visually impaired students in schools for the blind in southeast, Nigeria. A total of 92 students were examined from three randomly selected schools out of the six schools in this region.
 Results: There was a male to female ratio of 1.3:1, an age range of 8-32 years with a mean age of 18.4 6.4 years. Majority of the students (85.9%) were blind with visual acuity <3/60, and 14.1% had visual impairment.
 Glaucoma was the leading cause of blindness followed by cataract and most known causes of blindness occurred in childhood.
 Conclusion: Most of the causes of blindness were from preventable and treatable causes. Increasing the availability of specialized eye care services for children, and improving primary health services will reduce the prevalence of blindness due to avoidable causes.

ОЦЕНКА ДОСТУПНОСТИ МЕДИЦИНСКОЙ ПОМОЩИ В ПЕРИОД ПАНДЕМИИ ИНФЕКЦИИ COVID-19 НА ТЕРРИТОРИИ КРАСНОЯРСКОГО КРАЯ

Significance. The introduction of various restrictive measures at the beginning of 2020 to prevent the spread of COVID-19 infection contributed to a decrease in the planned volumes and availability of medical care for the population. The purpose of the study is to assess availability of primary health care and specialized medical care during the COVID-19 pandemic for the assigned population of the Krasnoyarsk Territory. Material and methods. The study covered the period from 2012 to 2021 and was conducted in the Krasnoyarsk Territory within the catchment area of the Federal Siberian Research and Clinical Center of the FMBA of Russia, including catchment areas in the city of Krasnoyarsk and in the closed territorial-administrative unit Zelenogorsk (Clinical Hospital No. 42). The study material was the information from the federal statistical observation forms (No. 12, No. 30). Changes in primary care availability at outpatient settings and specialized medical care in inpatient settings in the pre-COVID period (from 2017 to 2019) and the period of the COVID-19 pandemic (2020-2021) were analyzed. Results. In 2020, the overall disease incidence decreased by 8.0% compared to the long-term average in the pre-COVID period from 2012 to 2019 equaling to 2148.3 cases per 1000 population. The primary incidence added up to 792.9 cases per 1000 population, which is 7.9% lower than the pre-pandemic level. There was a decrease in the doctor-to-population ratio from 24.3 per 10 thousand population in the pre-pandemic period to 21.8 per 10 thousand population in 2021, and from 26.8 per 10 thousand population down to 25.2 per 10 thousand population (Clinical Hospital #42). During the pandemic, there was a decrease in the rate of visits per resident per year within the catchment area of the Federal Siberian Research and Clinical Center from 10.2 visits in 2017-2019. to 7.8 per resident in 2020-2021, and from 9.6 to 8.15 visits per resident per year within the closed administrative territory. During the pandemic, the structure of visits changed, the number of visits for illnesses within the catchment area of the Federal Siberian Research and Clinical Center decreased by 22.7%, the number of preventive visits decreased by 16.4%, and by 25.4%, and 17.4 % respectively within the closed administrative territory. During the pandemic, 39.5% of the total number of beds were repurposed as an infectious disease hospital to provide care for patients with the new coronavirus infection, primarily beds allocated to pulmonary care (55.9%), beds for rehabilitation (29.0%), beds allocated to cardiac care (36.4%), beds allocated to therapeutic care (28.6%). As a result of a set of organizational measures and a number of management decisions, in 2021, there was a positive trend in resuming availability of primary health care and specialized care for the population. Conclusion. The COVID-19 pandemic has significantly affected availability of primary health care and specialized medical care, highly contributed to the change in the structure of care seeking at the outpatient level and planned hospital admission rate. The complex of implemented organizational measures contributed to better performance of medical organizations, higher availability of medical care, and more effective management of the hospital bed fund.

Care accessibility and availability for hypertensive patients in primary health care in a remote rural municipality in the state of Amazonas, Brazil, 2019

This single-case study aimed to evaluate access the geographic accessibility and availability of primary health care (PHC) in a remote rural municipality in Amazonas Stater, Brazil, to control systemic arterial hypertension. A thematic analysis was conducted to interpret the content of 11 semi-structured interviews with municipal managers, PHC professionals, and hypertensive healthcare users. Geographical accessibility is associated with river mobility, transportation availability, users' financial travelling condition, and the presence of services near riverine communities, whereas availability to diagnose and monitor hypertensive patients depend on the presence of healthcare providers, medications, and equipment and the integration of PHC with the local health care network. Although access to health is more complex than our research goals, the evaluated dimensions show weaknesses which are exacerbated by a context marked by socio-spatial disparities and absent public policies, compromising the guarantee of individuals' right to health.

Gastrointestinal infections after earthquake

Natural disasters such as earthquakes resulting in infrastructural damage in affected areas can also result in outbreaks of infectious diseases, with infections usually beginning within 4 days of the initial impact. Gastrointestinal diseases are prevalent due to the lack of food and water supplies. The rates of diarrheal illnesses following natural disasters are mainly influenced by the (i) endemicity of intestinal pathogens before the disaster, (ii) the availability of safe water and sanitation facilities, (iii) the severity of the disaster, (iv) the degree of crowding and (v) the availability of healthcare resources. Among the causative agents of gastroenteritis, viral infections are the most common ones, followed by bacterial and parasitic infections. Maintenance of sanitation and availability of primary healthcare are critical for early diagnosis, treatment and prevention of infectious disease outbreaks following natural disasters.

Equality and social determinants of spatial accessibility, availability, and affordability to primary health care in Hong Kong, a descriptive study from the perspective of spatial analysis

ObjectivePrimary health care (PHC) is widely perceived to be the backbone of health care systems. Since the outbreak of COVID-19, PHC has not only provided primary medical services, but also served as a grassroots network for public health. Our research explored the accessibility, availability, and affordability of primary health care from a spatial perspective, to understand the social determinants affecting access to it in Hong Kong.MethodThis constitutes a descriptive study from the perspective of spatial analysis. The nearest neighbor method was used to measure the geographic accessibility of PHC based on the road network. The 2SFCA method was used to measure spatial availability and affordability to primary health care, while the SARAR model, Spatial Error model, and Spatial Lag model were then constructed to explain potential factors influencing accessibility and availability of PHC.ResultsIn terms of accessibility, 95% of residents in Hong Kong can reach a PHC institution within 15 minutes; in terms of availability, 83% of residents can receive PHC service within a month; while in terms of affordability, only 32% of residents can afford PHC services with the support of medical insurance and medical voucher. In Hong Kong, education status and household income show a significant impact on accessibility and availability of PHC. Regions with higher concentrations of residents with post-secondary education receive more PHC resources, while regions with higher concentrations of high-income households show poorer accessibility and poorer availability to PHC.ConclusionThe good accessibility and availability of primary health care reflects that the network layout of existing PHC systems in Hong Kong is reasonable and can meet the needs of most residents. No serious gap between social groups further shows equality in resource allocation of PHC in Hong Kong. However, affordability of PHC is not ideal. Indeed, narrowing the gap between availability and affordability is key to fully utilizing the capacity of the PHC system in Hong Kong. The private sector plays an important role in this, but the low coverage of medical insurance in outpatient services exacerbates the crowding of public PHC and underutilization of private PHC. We suggest diverting patients from public to private institutions through medical insurance, medical vouchers, or other ways, to relieve the pressure on the public health system and make full use of existing primary health care in Hong Kong.

Death Inequality During the First Year of Life in Morocco: A Macro Level Analysis

Disparities in child mortality are a reality in Morocco. These disparities coexist with inequalities in: (i) the availability of primary health care (PHCs); (ii) the socioeconomic status of the population as reflected by the prevalence of various forms of poverty; as well as (iii) fertility levels (TFRs) and the status of women in literacy and employment rates. Despite its limitations, this research provides a macro-level understanding of the link between infant mortality and a range of aggregates (political, economic, social and demographic).The metadata collected in the 2014 census (RGPH-2014) RGPH-2014 was used to construct a provincial proxy indicator of infant mortality by area of residence.This is considered as a dependent variable that we have tried to explain by the above-mentioned indicators. This is considered as a dependent variable that we have tried to explain by the above-mentioned indicators. The latter indicators reflect the socio-economic conditions prevailing in each of the provinces by area of residence. In addition, they give information on the availability of basic health services and on the woman's status. A key finding is that the level of current fertility as measured by the TFR negatively affects child survival. With a statistically significant regression coefficient of 2.912 (Pvalue =0.000), it can be argued that high fertility increases the risk of infant mortality. In turn, the prevalence of overall poverty also has a statistically significant effect on infant survival (β= -0.213 with a pvalue =0.029).

Assessment of primary healthcare accessibility and inequality in north-eastern Kazakhstan.

Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.

АНАЛИЗ ЗАБОЛЕВАЕМОСТИ ВЗРОСЛОГО НАСЕЛЕНИЯ, ПРОЖИВАЮЩЕГО В ЗОНЕ ДЕЙСТВИЯ ПРЕДПРИЯТИЯ АТОМНОЙ ИНДУСТРИИ

Significance. Implementation of the federal projects “Fight against cardiovascular diseases” and “Fight against cancer” requires assessment of incidence of socially significant diseases in population (malignant neoplasms, diabetes mellitus, mental and behavioral disorders, diseases characterized by elevated blood pressure). One of the categories of citizens requiring such assessment is population of single-industry towns accounting for about 12.5 % of the Russian population. Purpose. To analyze incidence of socially significant diseases in the adult population of a single-industry town located in the area of operation of a nuclear industry enterprise in 1990-2020. The material of the study was information on disease incidence among adult population of the closed administrative-territorial entity – the city of Seversk, residing in the operation area of the Siberian Chemical Plant in 1990-2020. Results. During the study period there was an increase in the incidence of malignant neoplasms, diseases of the endocrine system (including diabetes mellitus), as well as diseases of the circulatory system (in particular, diseases characterized by elevated blood pressure). At the same time, in 2018-2020, there was a decrease in the incidence of diseases under study, as well as a decrease in the incidence rates with temporary disability. The incidence of mental and behavioral disorders associated with the use of psychoactive substances has been steadily decreasing throughout the study period. Conclusion. Increase in incidence of socially significant diseases is most likely due to population aging and increase in the share of people aged 60 and older in population. However, the 2018-2020, decline in incidence rates requires a further analysis of availability of primary health care, volumes of emergency care, hospital mortality and mortality of population of the area under study. Decreased incidence of mental and behavioral disorders associated with the use of psychoactive substances suggests that the socio-economic situation in the Russian Federation has significantly improved during the study period.

The value of an integrated approach to assessing the availability of primary health care, taking into account public opinion and EMIAS data

Introduction. The study of public opinion as the basis for strategic planning of the activities of medical institutions is more relevant than ever, as it allows finding ways to solve the problems of ensuring the availability and satisfaction of citizens with medical care. Purpose. Comparative assessment of the availability of primary health care based on the results of a sociological study of public opinion and data from the Unified Medical Information and Analytical System of the City of Moscow (UMIAS). Material and methods. To study public opinion, the practice of population survey was used, which was conducted through direct interviewing with filling out questionnaires of visitors to Moscow polyclinics and the method of questioning doctors based on a questionnaire developed by researchers. To analyze the data, the authors used general scientific methods of cognition, including the dialectical method, a systematic approach, logical correspondence and harmonization, detailing and generalization. As part of the study, the index value of the patient loyalty to the medical institution (MI) was calculated according to Net Promoter Score (NPS) method as the difference between the share of the “Promoters” group and the share of the “Critics” group in the total number of responses. Results and discussion. The established correlations indicate the opinions of doctors and citizens to coincide and the UMIAS data on the issue of assessing the accessibility of admission of level 1 doctors for citizens. Based on the results of a sociological survey, the number of dissatisfied patients is mainly affected by managing medical care and its availability. The study confirmed that the higher the availability of an appointment with a level 1 doctor, the lower the number of visits the doctor on duty. Conclusion. The conducted research has shown the practicality of an integrated approach to evaluating the activities of medical organizations based on the results of public opinion research and UMIAS data.

The experience, results, and possible perspectives of organizing the optimally accessible primary medical care for the rural population of Zaporizhzhia region

Nowadays, the assessment of the activity of the domestic healthcare system is an important and actual issue, especially against the background the active reformation of this industry. One of the important elements of the assessment is studying the availability of primary healthcare to the rural population. The aim of this work is to study the territorial accessibility of primary healthcare, the adequacy and effectiveness of the principles of forming a network of primary care facilities in the rural areas of Zaporizhzhia region that enables to address issues and optimize the location of primary care facilities in the rural areas. Materials and methods. The materials of the research were the data of the official statistical reports for the past 20 years, which characterize the state of health and the degree of medical care accessibility to the rural population. During the research, the technique of complex social and hygienic research was applied, with the use of historical, sociological, sanitary and statistical methods, organizational experiment and others. Results. The article presents the main results of studying the current state of primary healthcare organization for the rural population of Zaporіzhzhia region against the background of active reforming processes. According to the research results, the main elements forming the system of accessibility are territorial, medical, social and economic. The main factors of impact on territorial accessibility are identified. These are: the nature of the settlement of rural residents (density, compactness, service-area radius, the proportion of the rural population, the distance between villages, the distance from a household to a healthcare facility); quality of roads; transport connections between settlements and healthcare facilities; availability of communication means. Conclusions. As a result of the research, the following conclusions were drawn. Such factors as population density, compactness of its location, service-area radius, distance between villages, distance from a household to a healthcare facility, condition and quality of roads, transport connections between settlements and healthcare facilities are important during forming or improving the network of healthcare facilities in rural areas. These factors must be considered for the rational placement of primary care facilities in rural areas.

Measurements of quality of village-level care and patients\u2019 healthcare-seeking behaviors in rural China

BackgroundAlthough the progress in global health initiatives has improved the availability of primary health care (PHC), unqualified healthcare remains a serious challenge in low- and middle-income countries, where PHC is often underutilized. This study examines factors associated with patients’ healthcare-seeking behaviors in rural Chin—seeking healthcare at village-level PHC providers, at higher-level health facilities, self-medicating, and refraining from seeking medical help. We focus on provider-side factors, including (1) the unobservable quality indicator, (2) the observable quality indicator, and (3) the observable signal indicator.MethodsWe analyzed 1578 episodes of healthcare-seeking behaviors of patients with diarrhea or cough/runny nose symptom from surveys conducted in July 2017 and January 2018 in 114 villages of the Yunnan province. We investigated the correlation between quality-related factors with patients’ healthcare-seeking behaviors by multinomial logit regression.ResultsWe found that rural patients were insensitive to the unobservable quality of healthcare providers, as measured by standardized clinical vignettes, which might be attributable to the credence nature of PHC. The observable quality indicator, whether the clinician has received full-time junior college formal medical education, was associated with patients’ healthcare choices. Patients, however, were more likely to select healthcare based on the observable signal indicator, which was measured by the availability of medicines. Additionally, the observable signal indicator had no significant association with two quality indicators. Notably, socioeconomically-disadvantaged patients relied more on the village-level PHC, which emphasized the role of PHC in promoting the welfare of rural populations.ConclusionsOur study found an inconsistency between objective quality of healthcare provided by providers and subjective quality perceived by patients. Patients could not identify the actual quality of PHC precisely, while they were more likely to make decisions based on the observable signal indicator. Therefore, the quality of PHC should be more observable to patients. This study not only supplements the literature on healthcare-seeking choices by examining four types of behaviors simultaneously but also clarifies rural patients’ perceptions of the quality of PHC for policy decision-making on increasing the utilization of PHC and improving the medical welfare of the vulnerable.

Analysis of the primary health care state for the rural population at the regional level

Introduction. The main goal of the state policy in the field of healthcare is to form a system that ensures the availability of medical care and increases the efficiency of medical services. The volume, type and quality of medical care must correspond to the level of morbidity, the needs of the population and the advanced achievements of medical science. Primary health care is the backbone of the health care delivery system. The problem of it improvement, including in rural areas, is a priority and has national significance. The development of measures to increase the availability of primary health care according to the territorial principle is an urgent scientific and practical problem.The purpose of the study — based on the analysis, methodologically substantiate and develop measures to increase the availability and improve the system of organizing the provision of primary health re to the rural population on a territorial basis.Materials and methods. Mathematical-statistical and analytical (quantitative, structural, comparative) research methods were used.Results and Discussion. In the Chelyabinsk Region, there are disproportions in the provision of the population with medical personnel: the provision of the urban population with doctors and l personnel is significantly higher than that of the rural population. The indicator of staffing with paramedical personnel in full-time positions of feldsher-obstetric stations is 20.1% lower than in the Russian Federation. The index of "combination rate" among doctors working in outpatient departments is 1.2 times higher than the target indicator of the National Health Project, and in rural areas it is 1.1 times. In order to unify the organizational and methodological approaches, the authors proposed a classification of medical stations and their organizational and functional structure.Conclusions. The organization of the provision of primary health care to the rural population according to the territorial-district principle with the formation of an organizational model of the rural medical district will increase the availability of primary medical health care to the rural population.

Barriers and facilitators of providing primary health care to Afghan refugees: A qualitative study from the perspective of health care providers.

Background: One of the important aspects in the field of refugee health is the availability of primary health care, and the quality improvement of health care requires identifying barriers and facilitators. The present study aimed to identify obstacles and facilitators of providing primary health care to Afghan refugees from the perspective of health care providers. Methods: In this qualitative study, a semi-structured interview was conducted based on purposeful sampling with the involvement of 21 managers and experts in primary health care centers. Data were analyzed using the content analysis method and MaxQDA. Results: Data analysis led to the production of 4 main themes: (1) challenges while providing primary health care, with 10 subthemes; (2) challenges after providing care, with 4 subthemes; (3) opportunities, with 3 subthemes; and (4) solutions, with 6 subthemes. Conclusion: According to the results of this study, identifying the challenges and providing opportunities and solutions to existing problems seem to be effective steps in the quality improvement of providing primary health care to refugees.

НАУЧНОЕ ОБОСНОВАНИЕ ФОРМИРОВАНИЯ СТРУКТУРЫ ПОЛИКЛИНИКИ ЦРБ

Significance. The existing personnel imbalance in health care, including the number of medical staff and occupied positions in the central district hospitals (CDH) of the constituent entities of the Russian Federation and structural units of these hospitals, makes it difficult to improve availability and quality of primary health care (PHC). Development and implementation of the standard CDH models with the standard staffing table, on the basis of which it is possible to form the optimal structure of the central district hospital with the optimal staffing table based on the justified need for human resources, will contribute to improving quality and availability of primary health care at the municipal level. Purpose of the study: to significantly substantiate the regular number of medical personnel of the central district hospital with differently sized catchment areas. Material and methods: Forms of the federal statistical observation (FSN) No. 30 in the pilot territories in three constituent entities of the Russian Federation in the three different federal districts, procedures for care delivery by specialty. Analytical and statistical methods. Results. Actually, a doctor position should be included in the CRH staffing table if the standards allow for the full-time position. Certain health specialties allow for part-time positions if the outpatient and inpatient positions of the specialists can be combined into one full-time position, or part-time positions in the related specialties in the polyclinic with due regard to the population demand. Results. The structure of the CDH polyclinic and the list of full-time medical positions considerably differ depending on the size of the attached population. The adequate number of specialty doctors is ensured by the CDH work organization, distribution of specialists across separate subdivisions that are part of the CDH structure, and the use of telehealth technologies.

РЕЗУЛЬТАТЫ РЕАЛИЗАЦИИ ПИЛОТНОГО ПРОЕКТА ПО ПОВЫШЕНИЮ ДОСТУПНОСТИ ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ ЛИЦАМ СТАРШЕ 65 ЛЕТ, ПРОЖИВАЮЩИМ В СЕЛЬСКОЙ МЕСТНОСТИ

Significance. Today, the issue of preserving health, especially in older ages, is considered both in the context of care delivery and development of enabling conditions for remaining socially active. In order to increase the period of active longevity and healthy life expectancy, the national project “Demography”, federal and regional projects "Development and implementation of the program of systemic support and improvement of quality of life of older citizens “Older Generation”, which are of an interdepartmental nature, include measures for rural dwellers aged over 65, to ensure transportation of this contingent to health care facilities for additional screenings by vehicles of the social service. For the first time ever, this organizational technology was implemented in the Chelyabinsk Region in 2019 as a pilot. The purpose of the study is to analyze results of the project on improving availability of primary health care to rural dwellers aged over 65. Material and methods Material: materials of the pilot project “Transportation of people aged over 65 to health care facilities”. Methods include mathematical-statistical, analytical, and organizational experiment. Results. During the implementation of the pilot project, 1,892 people were transported to health care facilities, 75.6% of them completed their clinical examination. 80.97% of people of older working age with detected diseases and pathological conditions were taken under medical follow-up, this indicator is 24.4% higher than the regional one. Conclusion. Results evaluation of the project implementation proves effectiveness of the developed measures aimed at improving availability of primary health care to rural dwellers aged over 65. Scope of application. The presented results of the analysis can be used by heads of health care facilities and regional public health authorities for developing measures aimed at improving availability of primary health care for rural dwellers in the region and effectiveness of preventive measures.

SUBSTANTIATION OF COMPONENTS OF AVAILABILITY AND INTEGRATION OF PRIMARY HEALTH CARE ASSOCIATED WITH AMBULATORY CARE SENSITIVE CONDITIONS IN UKRAINE

The aim: Identifying the components of availability of Primary Health Care (PHC) and integration between PHC and secondary Health care (SHC) which need strengthening to reduce the rate of Ambulatory Care Sensitive Hospitalizations (ACSH) in Ukraine. Materials and methods: The study was conducted in two stages: the focus of interviewing experts on the list of components of the availability of PHC and its integration with SHC; survey of our questionnaire is based on the results of the first stage of the study. The responses of 93 respondents - 20 experts and 73 general practitioners/family doctors - were analyzed using descriptive and analytical statistics. Results: There were identified 14 components of PHC availability and 8 integration components of PHC with SHC, their quantitative value (in points) of impact on ACSH. The informativeness of components is confirmed by the agreement of opinions of experts on their list (concordance coefficient W = 0.75 -0.87; p <0.01) and the reliable correlations of scores of impact assessments of the identified components with overall values of the impact availability PHC and the integration between PHC and SHC on the ACSH. Conclusions: The results of the study can be used to develop an action plan for reform of PHC, the implementation of which will reduce rates hospitalizations of Ambulatory care sensitive conditions and increase the efficiency use of limited resources of health care system of Ukraine.

The comparison of patients' satisfaction with primary health care received in the context of the process of reforming health care sector in Ukraine: a cross-sectional research (based on the example of the primary health care center in the city of Kyiv)

The purpose of the research is to compare the satisfaction of patients of the PHC center in the city of Kyiv who made declarations with doctors and received primary health care in 2019 with the satisfaction of patients of former therapeutic sites who received PHC in 2017. A cross-sectional research was conducted in the primary health care center in the city of Kyiv in two stages. The first phase was held during the 6 months of 2017. In total, 397 people at the age of 18 and older were selected, who contacted with primary health care physicians at the time of the research not less than one year. The EUROPEP questionnaire that was used consists of 23 questions with possible rating them according to five-point Likert scale and covering the following aspects: relationship between a doctor and a patient, evaluation of direct medical care, information and support of the patient by doctor, organizational aspects of health care delivery, availability of primary health care. The second phase of the research, using the same EUROPEP questionnaire was held during the 6 months of 2019. In total, there were 402 respondents who took part in research. We offered to determine the average value of the proportion of patients with the evaluation criteria «good» and «excellent» from received by them PHC for each of the 23 questions of a questionnaire as an integral indicator of satisfaction with the received PHC. The research found that the integral indicator of satisfaction with the received PHC in the city of Kyiv during the last two years in the context of the process of reforming the health care sector in Ukraine has increased from 75,5 ± 0,5 in 2017 to 85,9 ± 0,4 in 2019. The comparison of the average values obtained as a result of the research before and after the reforming of the primary care link in the city of Kyiv has revealed a statistically significant (p˂0,01) increase in patients’ satisfaction with the PHC in all the investigated aspects, except the answers to Q1 (making you feel you had enough time for consultation?) and Q23 questions (urgent care delivery).

Scientific substantiation of the assessment of the territorial availability of primary medical health care to the rural population

Aim. To assess the territorial accessibility of primary health care (PHC) to the rural population in the Orenburg region.&#x0D; Methods. Statistical, monographic, organizational experiment research methods were applied. Statistical processing was carried out by using the Statistica 10.0 software. Basic statistics were calculated (arithmetic mean, weighted arithmetic mean). All parameters were checked by using ShapiroWilk, KolmogorovSmirnov and Lilliefors tests for normal distribution. The parametric method of statistics (Student's t-test) was used.&#x0D; Results. The assessment of the territorial accessibility of primary medical health care to the population of the Orenburg region was carried out using the methodology developed by us for calculating the criteria for the accessibility of primary medical health care to the rural population Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population. The use the methodology allows making management decisions regarding the territorial planning of primary health care for the rural population in the selection of problem areas with low accessibility of primary medical care. In the Orenburg region, there are the following problems: different levels of accessibility of primary health care with a variety of distance up to 30 km and different population sizes in settlements create difficulties in organizing the provision of primary health care; remoteness from the regional center up to 300 km forms a personnel deficit.&#x0D; Conclusion. Application of the methodology Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population in the Orenburg region has allowed the development of the following recommendations for making management decisions at the regional level: (1) prioritization of territories for priority measures to ensure the availability help; (2) selection of the form of primary health care organization for the timely medical care provision to the population; (3) the formation of competition among medical organizations in the ranking of the availability of primary health care.

The relationship between doctors' points of view and indicators that characterize citizens' access to primary health care in Moscow

This article presents the results of a study on the relationship between indicators of accessibility of citizens to primary health care (PHC), based on the data of the Unified medical informational analytical system of Moscow (EMIAS) and the results of the survey of physicians of medical institutions of the state healthcare system, providing primary care to adults. The analysis of scientific publications has shown that when assessing the availability and quality of medical care, taking into account public opinion, the main attention is paid to sociological surveys of citizens and less often the opinion of medical personnel who provide medical care to citizens is studied. The analysis of the information from foreign sources has shown that the availability of primary health care is a hot topic in many countries all over the world, including the countries with a high level of GDP per capita. The survey of medical men, which was attended by more than 500 doctors, was conducted in six medical organizations in Moscow that provide primary health care to adults. The questionnaire contained 26 questions, the answers to which reflect the personal opinion of doctors about their attitude to the improvement of their professional skills, satisfaction with working conditions, the organization of PHC and its accessibility to the population, etc. EMIAS The data were used to calculate individual indicators that characterize the population's access to PHC. The results of this scientific study confirmed the existence of a high correlation between the responses of doctors and indicators calculated on the basis of EMIAS data, which indicates the feasibility of using the opinion of medical personnel to make timely and effective management decisions aimed at optimizing organizational processes to ensure public access to medical care.