Efficiency Of Primary Health Care Research Articles

Modelling efficiency in primary healthcare using the DEA methodology: an empirical analysis in a healthcare district

BackgroundPrimary healthcare management efficiency conditions the functioning of specialized care and has a direct impact on the outcomes of the health system and its sustainability. The objective of this research is to develop models to evaluate the efficiency, including health outcomes, of the primary healthcare centres (PHC) of the Clínico – La Malvarrosa Health District in Valencia.MethodsTo evaluate efficiency, Data Envelopment Analysis (DEA) was used with output orientation and variable returns to scale, with panel data from the years 2015 to 2019. In rates per 10,000 inhabitants, the inputs are: medical and nursing staff and pharmacy cost. The outputs are: number of consultations, hospital emergencies, referrals, avoidable hospitalisations, avoidable mortality and pharmaceutical prescription efficiency. As exogenous variables: the percentage of population over 65 years old, over 80 and case-mix. Three models were developed, all of them with the same inputs and different combinations of outputs related to: healthcare activity, outcomes, and both, in order to study the influence of the different approaches on efficiency. Each model is analysed both without exogenous variables and with each of them.ResultsThe efficiency results vary depending on the model used, although certain PHCs are always on, or very close to, the efficient frontier, while others are always inefficient. When healthcare activity outputs are considered, efficiency scores improve and the number of efficient PHCs increases. However, in general, the PHC score decreases throughout the evaluated period. This decrease is more pronounced when only activity outputs are included.ConclusionsDEA allows the inefficiencies of PHCs to be analysed and the efficient ones are clearly distinguished from the inefficient, although different efficiency scores are obtained depending on the model used. Evaluation can be according to healthcare activity, health outcomes or both, making it necessary to identify the expected objectives of the PHCs, as the perspective of the analysis influences the results.

The comparison of the selected key performance indicators between the primary health care centers in Belgrade

Introduction/Objective. The purpose of the article is to analyze the efficiency of primary health care centers (PHCCs) in the city of Belgrade, using key performance indicators (KPIs). The main objective is to present the potentiality of the application of KPIs for improving primary health care services, in order to increase efficiency. Methods. As a tool for measuring the efficiency of PHCCs in Belgrade, this article defines a set of KPIs. Based on defined KPIs, a comparative analysis of PHCCs? efficiency is conducted. Results. According to the values of the overall average efficiency rating according to all observed KPIs, the best-rated, i.e., the most efficient PHCC in Belgrade is Rakovica, and the lowest, i.e., the least efficient is the PHCC Zvezdara. It was noticed that the PHCCs Novi Beograd and Vracar are among the least efficient. Conclusion. The efficiency of primary health care can be measured by applying KPIs, and the observed results can be used as a basis for increasing the efficiency of health care services in the PHCCs in Belgrade. Based on the results, recommendations to PHCCs to improve the efficiency of health care services are: appropriate distribution of patients to selected physicians, measuring patient satisfaction, improving internal processes by engaging professional managers, increasing the ability and opportunities to apply new technologies and new knowledge, increasing the accuracy of the data used for detailed analyzes, motivate physicians to raise the level of awareness of their patients about the importance of preventive examinations.

Factors influencing the technical efficiency of diabetes care at primary care level in Mexico.

Diabetes prevalence is rising globally, especially in low- and middle-income countries like Mexico, posing challenges for healthcare systems that require efficient primary care to manage the disease. However, healthcare efficiency is influenced by factors beyond decision-makers, including socioeconomic and political conditions. This study aims to evaluate the technical efficiency of primary healthcare for diabetes patients in Mexico over a 12-year period and explore the impact of contextual variables on efficiency. A longitudinal analysis was conducted using administrative and socio-demographic data from 242 health jurisdictions between 2009 and 2020. Data envelopment analysis with bootstrapping and output orientation was used to measure the technical efficiency; health resources in infrastructure and human resources were used as inputs. As outcome, the number of patients receiving treatment for diabetes and the number of patients with controlled diabetes were considered. Machine learning algorithms were employed to analyse multiple factors affecting the provision of diabetes health services and assess heterogeneity and trends in efficiency across different health jurisdictions. The average technical efficiency in primary healthcare for diabetes patients was 0.44 (CI: 0.41-0.46) in 2009, reaching a peak of 0.71 (CI: 0.69-0.72) in 2016, and moderately declining to 0.60 (CI: 0.57-0.62) in 2020; these differences were statistically significant. The random forest analysis identified the marginalization index, primary healthcare coverage, proportion of indigenous population and demand for health services as the most influential variables in predicting efficiency levels. This research underscores the crucial need for the formulation of targeted public policies aimed at extending the scope of primary healthcare services, with a particular focus on addressing the unique challenges faced by marginalized and indigenous populations. According to our results, it is necessary that medical care management adjust to the specific demands and needs of these populations to guarantee equitable care in Mexico.

Challenges of Health Informatics Systems in Primary Health Care

Health informatics systems are indispensable implements for cultivating the eminence and effectiveness of primary health care. Health informatics systems are formed of databases and figures regarding all clinical facilities. The utilization of health informatics systems helps both healthcare providers and patients in the management of disorders and disease risks and in developing well-being. However, there are a number of challenges to the application and practice of health informatics systems in the settings of primary health care. These challenges embrace; the absence of capital and money, the absence of technical skill, the absence of user recognition and approval, information quality problems, safety and confidentiality concerns, incorporation with other systems, and interoperability deficiency. Human, cultural, and financial barriers with deficiency of technical proficiency, deficiency of a relation between clinicians and patients, worries about information privacy, absence of administration guidelines, bureaucracy, lack of training, English language barrier, the degree of workload due to the time shortness during clinical settings, infrastructure concerns e.g. availability of the electricity, computers, and internet, also high turnover in IT among healthcare are also some challenges that should be addressed. These challenges can hold back the capacity of health informatics systems to comprehend their complete perspective in primary health care. To address these challenges, it is essential to provide sufficient capital and funds, offer practice and maintenance for users, overcome information quality concerns, apply safety and confidentiality procedures, incorporate health informatics systems with other systems, and endorse interoperability. By overcoming these challenges, health informatics systems can play a major role in developing the quality and efficiency of primary health care.

The review of the book "The general practitioner (the family doctor)" in three volumes by R. S. Gadzhiev

The review analyzes formulated and proposed by prof. R. S. Gadzhiev genuine original comprehension of ways of enhancement and perspectives of development of primary health care by leading role of general practitioner in its development. The author fundamental postulate about priority of complex implementation of all aspects of activity of general practitioner to enhance quality and efficiency of primary health care in Russia is discussed.

A transformer fine-tuning strategy for text dialect identification.

Online medical consultation can significantly improve the efficiency of primary health care. Recently, many online medical question-answer services have been developed that connect the patients with relevant medical consultants based on their questions. Considering the linguistic variety in their question, social background identification of patients can improve the referral system by selecting a medical consultant with a similar social origin for efficient communication. This paper has proposed a novel fine-tuning strategy for the pre-trained transformers to identify the social origin of text authors. When fused with the existing adapter model, the proposed methods achieve an overall accuracy of 53.96% for the Arabic dialect identification task on the Nuanced Arabic Dialect Identification (NADI) dataset. The overall accuracy is 0.54% higher than the previous best for the same dataset, which establishes the utility of custom fine-tuning strategies for pre-trained transformer models.

OPTIMIZATION OF HEALTHCARE WORKERS AVAILABILITY : INCREASING PRIMARY HEALTH CARE EFFICIENCY IN INDONESIA

Policy has focused on the unequal distribution of health workers, while the potential for improvements in efficiency to address this problem has been neglected. This study aims to measure and compare the level of efficiency in the use of the available health workforce for the delivery of selected primary healthcare services among districts/cities in Indonesia, and to identify factors influencing that efficiency. The Data Envelopment Analysis method with output orientation to measure efficiency and Tobit regression analysis was performed to determine the effect of contextual factors. The average score for the technical efficiency of primary health care service delivery throughout Indonesia was 1.29, indicating the potential to achieve on average 29% higher coverage of the selected primary health services if all were as efficient as the most efficient. The average efficiency score in the Eastern Indonesia region was 1.62 and the average in the Java-Bali region was 1.05, indicating higher potential efficiency gains in the Eastern Indonesia region. Access to health care facilities was a consistently significant factor influencing the efficiency of primary health care in almost all regions. This study has demonstrated the potential for significant gains in coverage of key primary care services through improvements in the efficiency of use of the existing health workforce.

The criterion mode of evaluating functioning of stomatologic polyclinic

To improve quality and efficiency of primary health care and to strengthen its preventive directivity is possible through health care modernization including implementation of management technologies, development of database for evaluation and control. The purpose of the study is to develop method of evaluating activity of stomatologic clinic. The methodology was based on concepts of "functional systems" and "decision making". The listing of informative criteria was based on data analysis of functioning of stomatologic service of the Chechen Republic in 2002-2016 and results of sociological survey of stomatologists (n=181), health care administrators in stomatology (n=45), paramedics (n=220) and patients (n=359). The experts (n=13) developed required number of criteria and their gradation. The algorithm of evaluating activity of stomatologic clinic was developed using systematic approach. The listing of 52 criteria and their 10 blocks were established. The experts established coefficients of significance of criteria (0.0084-0.0781; ≥0.0224 - more significant, <0.0224 - less significant). Three levels were determined for each criterion (according principle of minimization) that became a basis for calculation of integrated indicator of efficiency of functioning of stomatologic polyclinic. The expanded methodological approaches ensure comparartivity of estimates of stomatologic polyclinic in various time periods. The health care authorities have opportunity to objectify analysis of functioning of a number of polyclinics in different periods.

The results and perspectives of primary health care reforming in Moscow

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high. The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists. The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis. The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation. In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow. The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%. The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision. The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar. The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Evaluating the impact of results-based motivating system on noncommunicable diseases risk factors in Iran: Study protocol for a field trial.

Background: Risk factors of noncommunicable diseases (NCD) are increasingly contributing to morbidity and mortality in Iran. Health care providers’ competencies and motivation are essential factors for the success and efficiency of primary health care. This field trial aims to evaluate the impact of a results-based motivating system on population level of the NCD risk factors field trial (IRPONT) in Iran. Methods: Population groups of 24 rural or urban catchment areas from 3 provinces were randomized to 1 of the 4 types of study groups. The groups were defined based on a set of 4 intervention packages. Extra 8 rural or urban catchment areas in a separate city were considered as independent nonintervention (control) group. Population levels of major NCD risk factors in all 32 population groups were measured at the beginning of the trial, at the end of the first year, and will be measured in the second year through standardized population surveys. As the outcome measure, the difference in population levels of the risk factors will be compared among the study groups. Study group IV will be compared with combined control groups (study groups I, II, and III). Also, we will conduct subgroup analysis to determine the effects of interventions 2, 3, and 4. Ethics: This trial has received ethical approval from National Institute for Medical Research Development in Iran (IR.NIMAD.REC.1396.084) in 2017. Trial Registration Number: This trial has been registered on the Iranian Registry of Clinical Trials (identifier: IRCT20081205001488N2). Registered on 3 June 2018 and updated on 12 April 2020.

Data Envelopment Analysis and Malmquist Index Application: Efficiency of Primary Health Care in Morocco and Covid-19

The Primary Health Care in Morocco plays a very strategic role in the prevention against various diseases, in particular the current pandemic COVID 19. The efficiency of these centers has a direct impact on the reduction of this pandemic. First, this is why will try to research the literature review about the technical efficiency of primary health care. In the second step, the non-parametric: Data Envelopment Analysis method will be used to apply the empiric phase during the period 2012-2015, to estimate the relative technical efficiency, this method will be calculated by using two models: the theory of the return to scale constant with a middle equal to 0.437 and the theory of the variable return to scale with an average of 0.537. It’s necessary to combine the DEA approach with the Malmquist index to evaluate the factors of production. Finally, to compare the results of the proposed method which are generally very poor, and discuss his policy implications for health care.

An assessment of job satisfaction among primary health care workers in Rivers State, Nigeria

Background: Primary Health Care (PHC) is considered to be a more appropriate approach to health, and the health system, improving access to health services, as well as disease prevention. The availability and efficiency of PHC is a key determinant of the overall health and wellbeing of a people, and a useful yardstick for assessment of a nation's health system. Hence, PHC workforce are at the vanguard of essential health service delivery through direct contact with grassroots community members, within and without the health facilities, for provision of preventive, treatment, referral and follow-up health services. Poor motivation and non-retention of PHC workers weakens the health systems' ability to meet the above goals.Aim: To assessed the job satisfaction of primary health care workers in Rivers State, Nigeria.Methodology: The study utilized the descriptive cross-sectional design and the mixed methods of data collection. The quantitative method used semi-structured, pretested, self- administered questionnaires to obtain information on socio-demographic and occupational characteristics, job satisfaction, motivation, frustration, retention potentials and awareness of existing policies and incentives of respondents. The respondents which included Community Health Extension Workers (CHEW), Community Health Officers (CHO), nurses and doctors in Primary health facilities in the State, were selected using the multistage sampling method. Quantitative data was analyzed using SPSS version 20.0 software and results presented using tables and charts.Results: A total of 378 respondents participated in the study. Nurses constituted 47.6% of the respondents, with equal proportions of CHEWs and CHOs [23.8% and 23.8% respectively] and 4.8% were doctors. The mean age of the respondents was39.8±8.1 years; with 89.7% females and 10.3% males. Of all the respondents, 79.6% were married,82% were senior cadre staff and 78.8% were Pentecostal Christians. Ikwerre, Ogoni and Kalabari had the highest distribution in ethnicity (19.3%, 14.8% and14.0% respectively). Among the respondents, 75.7% had worked for less than 7 years in their current facility while 82.9% had worked for same duration in their previous facility. Almost two third 240 (63.5%) reported that their workplace was far from their residence while 12 (3.2%) stated that it was very close. A high proportion of the respondents (78.3%) were satisfied with the general working condition in their Primary Health Care facility while 21.7% of the respondents were satisfied with the pay and promotion potentials of their work place. Notably, while 97.9% of the respondents were satisfied with their work relationships, 57.7% were satisfied with the use of their skills and abilities at their workplace and 88.1% of the respondents were satisfied with their work activities. These gave a good job satisfaction score for 88.9% of the respondents. Profession, community, distance from work and duration of work were significant factors (p < 0.05).Conclusion: This study concluded that age, marital status, profession, and location of health facility, duration of work played vital roles in level of satisfaction of PHC workers. Hence, offering opportunities for professional advancement through training of the healthcare workers though already included in the Nigerian National Healthcare policy, should be efficiently implemented and monitored by the government and other relevant stakeholders to improve job satisfaction and in turn quality health service delivery.Keywords: Job Satisfaction, Healthcare Workers

Análise da Eficiência na Atenção Primária à Saúde sob a Ótica dos Profissionais da Área

This study aimed to analyze the efficiency of primary health care, evaluating the experiences in cities in the state of Minas Gerais as regards their effectiveness in health promotion. The cities were selected among the ten benchmark and anti-benchmark ones obtained by a first calculation of efficiency by data envelopment analysis. In-depth interviewing was the technique used to capture the perception of professionals of the municipalities analyzed. In each municipality, three professionals of Primary Health Care were interviewed. The answers were analyzed by content analysis approach and divided into categories defined by the literature in the field of public administration and health management. Among the main results, it was observed that the difficulties highlighted in common in the analyzed cities refer to lack of resources or its limitation as well as the educational status of the population and their low participation and knowledge of Health Strategy. We conclude that there is great need for cross-section work to support promotional activities of existing health and new strategies that can raise people's knowledge level of professionals and managers as a way to improve the performance of health promotion in cities and new strategies that can increase people's knowledge level of professionals as well as managers to improve the performance of health promotion in cities.

Experiences of general practitioners, practice nurses, psychologists and patients with stepped collaborative care for depression: a focus group study in a large primary healthcare organization

Rationale, aims and objectives: Depression is a major and complex problem in primary care. Stepped Collaborative Care (SCC) models for depression have been developed to support primary care in diagnostic and therapeutic procedures. This study aimed to compare barriers and facilitators experienced by general practitioners (GPs), practice nurses for psychosocial care, primary care psychologists and patients working with SCC for depression and to discuss possible solutions for barriers in daily practice.Method: Conventional content analysis of focus group data. Nine mono-disciplinary focus groups including 16 general practitioners (GPs), 4 practice nurses, 6 psychologists and 23 patients.Results: All 4 participant groups appeared to perceive a need for more skills, support and time for GPs to adequately assess symptoms and initiate psychosocial management accordingly. Psychologists often ignore a GP’s diagnosis. The GPs’ diagnostic uncertainty and their unfamiliarity with psychological therapies can result in inappropriate treatments, incorrect referrals and long waiting lists. To improve stepped collaborative care programs for psychosocial symptoms, improving initial symptom assessment by the GP, seems the most important aspect. All participants agreed that diagnostic tools/questionnaires should be used in primary care, but such activities should not be complicated and should not add to the GPs’ workload. Patients need more information to share decisions with their care providers.Conclusion: There is a need for a diagnostic-therapeutic tool to support GPs in regulating the influx of patients in SCC models and enhancing the effect of SCC in daily practice in order to improve the person-centeredness and efficiency of primary healthcare.

Seeking interactions between patient satisfaction and efficiency in primary healthcare: cluster and DEA analysis

This study investigates efficiency and quality of care in primary healthcare centres. At first, we performed cluster analysis to group health centres by their level of quality based on user’s experiences that were collected from a satisfaction survey over a representative sample of patients. Secondly, a DEA analysis was conducted by generating bootstrapped efficiency scores for each health centre, and then we regressed these scores on variables that represent clusters from certain dimensions of patient satisfaction. The results of this study indicate statistically significant relations of health centres’ efficiency with several dimensions of patient satisfaction. More specifically we identified direct relations of efficiency with accessibility, lab services and facilities. On the other hand there exist inverse relationships of the health centres efficiency with patients’ opinions regarding scheduling appointment and doctor services.

The effect of quality and socio-demographic variables on efficiency measures in primary health care

This paper aims to extend the literature on measuring efficiency in primary health care by considering the influence of quality indicators and environmental variables conjointly in a case study. In particular, environmental variables are represented by patients' characteristics and quality indicators are based on technical aspects. In order to deal with both aspects, different extensions of data envelopment analysis (DEA) methodology are applied. Specifically, we use weight restrictions to ensure that the efficiency scores assigned to the evaluated units take quality data into account, and a four-stage model to identify which exogenous variables have impact on performance as well as to compute efficiency scores that incorporate this information explicitly. The results provide evidence in support of the importance of including information about both aspects in the analysis so that the efficiency measures obtained can be interpreted as an accurate reflection of performance.

Erratum to: Measuring Technical Efficiency in Primary Health Care: The Effect of Exogenous Variables on Results

Erratum to: Measuring Technical Efficiency in Primary Health Care: The Effect of Exogenous Variables on Results

Technical efficiency in primary health care: does quality matter?

The accuracy required in the measurement of output is an issue that has as yet still not been satisfactorily addressed in empirical research on efficiency in primary health care. We exploit information retrieved from a newly constructed database (APEX06) for the Spanish region of Extremadura. The richness of our dataset allows us to consider original synthetic measures of output that take into account both the quantity and the quality of services provided by 85 primary care centers (PCCs) in 2006. We provide evidence that neglecting the issue of properly accounting for the quality of health services can lead to misleading results. Our main finding is that adjusting output for quality has a three-fold effect on efficiency analysis. Firstly, inefficiency explains relatively more of the deviation from potential output. Secondly, the average technical efficiency in the sector is lower, while its dispersion among PCCs is significantly higher. Thirdly, the efficiency ranking of the PCCs is affected.

Measuring Technical Efficiency in Primary Health Care: The Effect of Exogenous Variables on Results

The aim of this paper is to extend the existing literature about efficiency measurement in primary health care with the application of a recently developed method to deal with exogenous variables. In this context, these variables are represented by the main characteristics of the covered population. The use of this technique allows calculating more accurate efficiency scores that can reflect the performance of units more properly. Our results show that the inclusion of these variables in the evaluation has a great impact on both the values of efficiency scores and the rank of units. This analysis has been carried out using a great amount of data available about primary health care centers in the Spanish region of Extremadura.