Utilization Of Primary Health Care Services Research Articles

Associated Factors in Patient Satisfaction among Older Persons Attending Primary Health Facilities in Sepang, Malaysia.

With Malaysia's ageing population, the utilisation of primary healthcare services by older individuals with comorbidities is expected to increase. Patient satisfaction serves as a key indicator for assessing the quality of healthcare services. Thus, the aim of this study is to evaluate patient satisfaction among older persons attending public primary healthcare facilities and to identify associated factors. A cross-sectional survey was conducted from October 2017 to January 2018, involving face-to-face interviews with older outpatients in primary health clinics. Minimum 300 participants were required and systematic random sampling were used. The measurement included sociodemographic variables, patient comorbidity and patient satisfaction using the Short-Form Patient Satisfaction Questionnaire (PSQ-18). A total of 317 participants enrolled in this study, resulting in a response rate of 95.6%. The findings indicated that 35.7% of participants reported high satisfaction, while 64.3% reported moderate satisfaction. Participants with at least secondary education (OR = 3.12) were more likely to experience satisfaction compared to those without formal education. Participants with monthly incomes above RM2,000 (OR = 0.40) and RM1,000-RM1,999 (OR = 0.53) were less likely to be satisfied compared to those earning less than RM999. Moreover, participants with two or more comorbidities were less likely to be satisfied compared to those with one comorbidity. Gender, marital status, employment status and living arrangements were not significant factors. This study highlights the need for healthcare authorities to examine factors such as patients' education level, income level and comorbidity status that are associated with healthcare satisfaction to enhance overall patient satisfaction.

Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid).

Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.

Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis.

Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.

Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review.

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

A five year descriptive analysis of potentially preventable hospitalisations for Ear, Nose, and Throat conditions in regional Victoria, Australia, from 2015 to 2020

BackgroundPotentially preventable hospitalisations of ear, nose, and throat conditions in the Murray Primary Health Network region have been found to be higher than the state average of Victoria, Australia. This study aimed to examine the association between selected patient-level characteristics and the likelihood of residing in a Murray PHN postcode with higher than expected numbers of potentially preventable ENT hospitalisations.MethodsUnit record hospital separation data were obtained from the Victorian Admitted Episodes Dataset. Postcodes were classified as having higher than expected numbers of potentially preventable hospitalisations across three subgroups of ENT using indirect standardisation techniques. Differences between patients from ‘higher than expected’ postcodes and ‘other’ postcodes with respect to the distribution of demographic and other patient characteristics were determined using chi-squared tests for each ENT subgroup. The results were confirmed by logistic regression analyses using resident of a postcode with higher than expected hospitalisations as the outcome variable.ResultsOf the 169 postcodes located in the catchment area, 15 were identified as having higher than expected numbers of upper respiratory tract infection hospitalisations, 14 were identified for acute tonsillitis, and 12 were identified for otitis media. Patients from postcodes with ‘higher than expected’ hospitalisations for these conditions were more likely than others to be aged between 0 and 9 years, Indigenous, or from a culturally and linguistically diverse background.ConclusionFurther investigation of the identified postcodes is warranted to determine access to and utilisation of primary healthcare services in the management of PPH ENT conditions in the region.

Barriers and facilitators influencing access to and utilization of primary healthcare services in Kurdistan-region, Iraq: a cross-sectional study.

This was a cross-sectional study. A questionnaire-based survey was used for data collection. Totally, 2400 individuals have been selected in 6 different districts and the centre of Erbil through the multi-cluster random sampling method. The χ2 test was used for categorical variables, and a one-way ANOVA was used for numerical variables. A P value less than 0.05 was considered statistically significant. The main reason for utilizing PHC centres was preventive purpose (68.1%), then poverty was the second reason (11.33%), and the participants reported that during the presence of urgent cases when they cannot use other health facilities, they use PHC centres (9%). In terms of barriers for utilizing and visiting PHC centres, the participated people stated that most of them, due to inadequate services, did not use and visit PHC centres (83.21%); the second reason was the presence of chronic diseases such as hypertension, which makes them visit private clinics (7.79%) and generally, (31.4%) of the participants were satisfied with the health services nearby. In conclusion, it appears that many people visit PHC facilities, but most of them only do so as a preventative measure, and very few go there to obtain basic medical treatment. Most patients go to private clinics and/or hospitals since those facilities have better access to specialists, better quality and quantity of medications, and laboratory testing. Additionally, combining and strengthening service quality aspects that prioritize a patient-centred environment and an effective service delivery system is a key strategy for the health sector to increase patient satisfaction.

Utilisation of primary healthcare services by Sjögren's syndrome patients in the Community of Madrid and associated factors: a population-based cross-sectional study.

To describe the utilisation of primary health care (PHC) services and factors associated with its use by patients diagnosed with Sjögren's syndrome (SS). Population-based cross-sectional cohort of SS patients in Madrid, Spain (SIERMA). Sociodemographic, diagnostic, clinical and PHC service utilisation variables were studied by bivariate analyses and regression models. A total of 4,778 SS patients were included, 65.2% classified as primary SS (pSS), while 34.8% associated with another autoimmune disease (associated SS). Mean age was 64.3 years, and 92.8% of the patients were women. A total of 87.5% used PHC services, with a mean of 19.8 consultations/year. The general practitioner was the most visited health professional, with a mean of 10.9 consultations/year, followed by the nurse, with a mean of 5.7. Characteristics associated with a greater use of PHC services in SS patients were associated SS, higher adjusted morbidity groups (AMG) risk level and older age. Additional factors included symptoms such as dry mouth, fatigue, dry vagina and joint and muscle pain; comorbidities such as atrial fibrillation, diabetes, hypertension, solid malignant neoplasms, coronary heart disease and chronic obstructive pulmonary disease; and treatments such as sterile saline solution, corticosteroids, opioids and biologic disease-modifying anti-rheumatic drugs. Most SS patients used PHC services during the study period, and the mean number of consultations was remarkably high. Utilisation was mainly associated with AMG risk level, ageing, glandular and extra-glandular symptoms, substantial comorbidities and various treatments. An optimised design of PHC policies will facilitate early diagnosis, improved management and better quality of life for SS patients.

Scale Measurement of Health Primary Service Utilization among the Migrant International Population.

In this article, we analyze the internal structure of the scale for experience in exercising the right to health care (EERHC), based on the focus from the World Health Organization (WHO) on the right to health care, from the perspective of international migrants, in Chile. The methodology was an instrumental study (n = 563) conducted to analyze the psychometric properties of the EERHC scale. Its reliability and internal consistency were evaluated, while the exploratory structural equation modeling (ESEM) model and confirmatory factor analysis (CFA) were used to identify the structure of relationships between the variables measured. The item-dimension correlations obtained present levels of r ≥ 0.3, and the Cronbach's α and McDonald's ω presented ranges >0.9, considered to be acceptable on all models. Results: the model was selected for presenting a good fit index χ2 = 24,850, df = 300, p = 0.000; RMSEA = 0.07; CFI = 0.97; TLI = 0.95; and SRMR = 0.03. The evidence obtained lets us conclude that the scale has forty-five items and four dimensions. The findings demonstrate a good internal structure and are useful to measure primary health care service utilization based on the framework.

Utilization of Primary Healthcare Centers by Residents of Ido-Ekiti, Nigeria.

Primary health care (PHC) centers help in providing a complete, universal, unbiased, and reasonable healthcare service to all. One major aim of PHC is to reduce health inequality. Most PHC centers in Nigeria cannot deliver fundamental healthcare services due to staffing, equipment distribution, quality infrastructure, and drug supply problems. The objective of this study was to assess the awareness and utilization of PHC services in a rural community in Nigeria. The study was carried out in a pastoral area in Ekiti State, Nigeria. A multistage sampling procedure was used to recruit adults aged 18 years and over residing in 361 households. A semi-structured questionnaire was utilized for data compilation. Study data were evaluated using IBM SPSS version 28.0 and reported using descriptive and inferential statistics. Chi-square test and binary logistic regression were used to assess the associated factors and predictors of PHC utilization. The proportion of those who had ever utilized PHC services was 45.7%. Significant predictors of the utilization of PHC centers include knowledge of the location of a PHC center, awareness that PHC centers operate 24 hours every day, and awareness that community members are part of the PHC staff. Non-availability of medical personnel and ease of access to secondary and tertiary health institutions are potential threats to the use of PHC facilities.

Use of primary health care services among older patients with and without diabetes

BackgroundThe aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes.MethodsElectronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person with diagnosis of diabetes. A health questionnaire was sent by mail to 527 people with diabetes and 890 controls. Of the persons who answered the questionnaire, 518 persons were randomly selected to participate in a health examination. The study group in this analysis consisted of 187 persons with diabetes and 176 persons without diabetes who attended the health examination. The data on primary health care utilization were extracted from electronic patient records one year before and one after the health examination.ResultsBefore the onset of the study, the patients with diabetes had more doctor’s appointments (p < 0.001), nurse’s appointments (< 0.001) and laboratory tests taken (p < 0.001) than those without diabetes After 1-year follow-up period the patients with diabetes had more doctor’s appointments (p = 0.002), nurse’s appointments (p = 0.006), laboratory tests taken (p = 0.006) and inpatient care at the community hospital (p = 0.004) than patients without a diagnosis of type 2 diabetes. The use of the community hospital increased significantly among patients with diabetes (ratio 2.50; 95% Cl 1.16–5.36) but not by patients without diabetes (ratio 0.91; 95% Cl 0.40.2.06). The number of nurse’s appointments increased for patients without diabetes (ratio 1.31; 95% Cl 1.07–1.60) but not for those with diabetes (ratio 1.04; 95% Cl 0.88–1.24).ConclusionsPatients with diabetes visit more often physicians and nurses compared with those without diabetes. During a 1-year follow-up, the use of community hospital care increased significantly among patients with diabetes. In addition to focusing on prevention and care of diabetes, these results suggest the importance of diabetes in planning community-based health care services.

The utilization of primary healthcare services among frail older adults \u2013 findings from the Helsinki Birth Cohort Study

BackgroundThe impact of frailty on primary healthcare service use, especially general practice office visits and remote contacts, is currently unknown. Further, little is known about the association of frailty with physiotherapy contacts.Methods We examined the utilization of primary healthcare services among 1064 participants from the Helsinki Birth Cohort Study between the years 2013 and 2017. Frailty was assessed based on Fried’s frailty criteria at mean age of 71.0 (2.7 SD) years in clinical examinations between the years 2011 and 2013. General practice office visits and remote contacts, the total number of general practice contacts, physiotherapy contacts, and the total number of primary healthcare contacts were extracted from a national Finnish register. We analyzed the data with negative binomial regression models.ResultsOf the 1064 participants, 37 were frail (3.5%) and 427 pre-frail (40.1%); 600 non-frail (56.4%) served as a reference group. Frailty was associated with general practice office visits (IRR 1.31, 95% CI=1.01-1.69), physiotherapy contacts (IRR 2.97, 95% CI=1.49-5.91) and the total number of primary healthcare contacts (IRR 1.41, 95% CI=1.07-1.85). Pre-frailty predicted the use of general practice remote contacts (IRR 1.39, 95% CI=1.22-1.57) and the total number of general practice contacts (IRR 1.25, 95% CI=1.12-1.40).ConclusionsFrailty increases the overall primary healthcare service use whereas pre-frailty is associated with the use of general practice services, especially remote contacts. Primary healthcare needs measures to adapt healthcare services based on the needs of rapidly increasing number of pre-frail and frail older adults and should consider preventative interventions against frailty.

Determinants of primary healthcare services utilisation in an under-resourced rural community in Enugu State, Nigeria: a cross-sectional study.

Introductionprimary health care (PHC) is essential towards achieving universal health coverage. Improving PHC services require understanding context-specific factors influencing utilisation. We assessed the factors influencing utilisation of PHC services in a rural community in Enugu, Nigeria.Methodswe conducted a cross-sectional community-based survey between May and June, 2017. Information on socio-demographic characteristics, utilisation of PHC services, community- and PHC facility-related factors associated with utilisation of PHC services was obtained from 335 adult residents aged ≥ 18 years using a pre-tested semi-structured interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at 5% level of significance.Resultsof the 335 respondents, 155 (46.2%) reported utilisation of PHC services the last time they were sick. Of 178 respondents who did not utilise PHC services, 51 (28.7%) reported poor quality health services, 41 (23.0%) unavailability of medical doctors, 31 (17.4%) long patient waiting time and 25 (14.0%) unavailability of drugs as reasons for non-utilisation. Being a female (AOR = 2.3 (95% CI 1.3 - 4.0)), affordability of health services (AOR = 2.4 (95% CI 1.3 - 4.6)), inadequacy of healthcare staff (AOR = 0.3 (95% CI 0.1 - 0.5)), shorter hospital waiting time (AOR = 2.2 (95% CI 1.2 - 4.3)) and satisfaction with PHC services during previous visit (AOR = 2.6 (95% CI 1.1 - 6.3)) influenced utilisation of PHC services.ConclusionPHC services utilisation was low. Improving utilisation would require addressing cost of health services, adequacy of healthcare staff, patient waiting time and ensuring patient satisfaction with PHC services.

Community residents\u2019 preferences for chronic disease management in Primary Care Facilities in China: a stated preference survey

BackgroundAlthough Chinese government has dedicated the past decades to treating chronic diseases by primary healthcare system, many more residents are apt to choose higher-tier facilities to treat minor chronic diseases. Understanding residents’ preferences for chronic disease management in primary care facilities can bridge the gap between residents’ choices and policy implementation. This study aims to elicit residents’ preferences for chronic disease management in primary care facilities in the hypothetical minor chronic disease scenario.MethodsSix hundred eighty residents were administered a discrete choice experiment that elicited preferences for chronic disease management in primary care facilities. Services attributes were service mode, treatment measure, out-of-pocket expenditure (OOP), traveling time to healthcare facility and title of physician. Mixed logit models were used to estimate stated preferences and willingness to pay for attributes. WTP confidence intervals were estimated by the delta method.ResultsA total of 94.44% of the completed questionnaires were valid (680 of 720 respondents). The participants preferred chronic disease management service with modern medicine, traveling time ≤ 30mins, and less OOP expenditure. Compared with Traditional Chinese Medicine (TCM), residents prefer modern medicine, willing to pay 155.53 CNY ($21.97) to change from TCM to modern medicine. Compensation about 86.02 CNY ($12.15) was needed to enable residents to change the choice of the nearer primary care facility to a further one. Integrated medicine in community clinics by experts was residents’ most preferred scenario while TCM in the tertiary hospital was their least preferred one.ConclusionIn order to increase the utilization of primary healthcare services in chronic diseases management, policy makers need to concern more about the services of medical treatment type, price and convenience. Therefore, we advise policy makers to provide nearer primary healthcare services for residents especially for residents in surrounding areas. Furthermore, balancing the resource allocation between Traditional Chinese Medicine and modern medicine is worthy of consideration.

Impact of the COVID-19 Pandemic on Outpatient Service in Primary Healthcare Institutions: An Inspiration From Yinchuan of China.

The coronavirus disease 2019 (COVID-19) pandemic has posed a great challenge to the healthcare system. This study evaluated the impact of the pandemic on the utilization of primary healthcare (PHC). The outpatient data from 158 PHC institutions in Yinchuan from May 1, 2017 to April 30, 2020 were used. The difference in difference (DID) model was used to analyze the difference in the number of outpatient visits per day, total outpatient expenditure per day, and outpatient expenditure per visit between December 2019 and February 2020 compared with the same periods in two previous years. The autoregressive integrated moving average (ARIMA) modelling was used to investigate the association between the outpatient volume and the number of the last week's new COVID-19 cases in Yinchuan, Ningxia, and China. From December 2019 to February 2020, the decline in the number of outpatient visits per day (DID: -367.21 times, P=.004) was larger than that in two previous years, and a similar trend can be seen in the outpatient expenditure per day. However, the rise in the outpatient expenditure per visit (DID: 19.06 thousand yuan, P=.003) was larger than that in two previous years. In 2020, the outpatient visits for most types of diseases decreased from week 3 and rebounded after week 5. The decline and rebound of outpatient visits in the population aged 45 years and older were steeper than in those younger. The outpatient volume was negatively associated with the number of the last week's new COVID-19 cases. This study indicated a significant impact of the pandemic on PHC service utilization. Since PHC service is the foundation of the healthcare system in most developing countries, measures should be taken to make PHC help cope with the crisis and relieve the burden of hospital care.

I Know Some People: The Association of Social Capital With Primary Health Care Utilization of Residents in China.

Background: Primary health care (PHC) services are underused due to the unbalanced distribution of medical resources. This is especially true in developing countries where the construction of PHC systems has begun to take effect. Social capital is one of the important factors affecting primary health care utilization.Method: This study investigated the utilization of PHC services by Chinese community residents in the past year. Social capital, PHC utilization, age, health care insurance, etc., were measured. A multilevel negative binomial model was adopted to analyze the association of social capital with PHC utilization.Results: Data of 5,471 residents from 283 communities in China were collected through a questionnaire survey in 2018. The results showed that community social capital (CSC) is significantly associated with PHC utilization in China, but individual social capital (ISC) had no significant association with PHC utilization. A one-standard deviation increase in the CSC leads to a 1.9% increase in PHC utilization. Other factors like gender, education, income, health insurance, health status, etc., are significantly associated with PHC utilization in China.Conclusions: Community social capital plays a more important role in promoting PHC utilization, while ISC plays an unclear role in PHC utilization by the residents of China.

Refugee and Immigrant Community Health Champions: a Qualitative Study of Perceived Barriers to Service Access and Utilisation of the National Health Service (NHS) in the West Midlands, UK

There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study higlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals’ healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands.

Utilization of Primary Healthcare Services among Women of Child Bearing Age in Epe Local Government Area of Lagos State

Utilization of Primary Healthcare Services among Women of Child Bearing Age in Epe Local Government Area of Lagos State

Trends in the utilization of youth primary healthcare services and psychological distress

BackgroundPsychological distress among young people is increasing in Northern Europe. According to established healthcare utilization theory, this will create a greater need for youth primary healthcare and subsequently lead to more help-seeking behavior by distressed young people. The aim of this study was to investigate the association between the use of youth primary healthcare services and psychological distress in times of increasing mental health problems and increased service need.MethodsThis study consisted of five waves of repeated annual cross-sectional data collected from young people (aged 13–19) living in Norway between 2014 and 2018 (n = 368,579). Population-weighted and design-adjusted generalized linear regression with a log-link was used to examine the use of youth primary healthcare services over time.ResultsWe found that a large proportion of young people use primary healthcare services and that young people with high levels of psychological distress use primary healthcare services twice as much as their peers with low levels of psychological distress. In addition, between 2014 and 2018 both psychological distress and primary healthcare service utilization increased: psychological distress increased by 5% and total primary healthcare service use increased by 500 consultations per 1000 young people. Overall, psychological distress had a conditional association with youth primary healthcare service use and could account for between 16 and 66% of the change in the use of services between 2014 and 2018, depending on the service type. However, the absolute increase seen in the use of primary healthcare services was mainly driven by young people with low levels of psychological distress as opposed to young people with high psychological distress. This suggest a converging trend.ConclusionsOur findings suggest that there might be serious barriers between need and help-seeking behavior for young people with high levels of psychological distress and that the pattern of utilization among young people with lower distress may indicate overuse, possibly as an inadvertent consequence of a newly introduced school absence policy. While further research is needed to confirm these findings, our work may inform healthcare providers and policy makers about primary healthcare utilization trends among young people.

The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province.

The re-engineering of primary health care (PHC) called for the establishment of ward-based outreach teams as a reform strategy to bridge the gap between health facilities and communities. The Nkangala district established ward-based outreach teams in 2012. We used process evaluation to assess the acceptability of the outreach teams from the perspectives of those involved in the implementation as well as the clients who are the recipients of the outreach services in order to describe how the programme benefits the recipients, the staff, and the health system. Data were collected through interviews with multiple data sources. A thematic analysis was done using NVivo 11. The outreach programme is acceptable to the recipients and staff. The acceptability translated into measurable benefits for the recipients and the health system. Health benefits included increased access to services, support for treatment adherence, and linkages to various sector departments for social support. Since the inception of outreach teams, the district has recorded low utilisation of PHC services and improved priority indicators such as immunisation coverage, early antenatal bookings, treatment adherence, TB cure rates, and decreased default rates. The positive effects of the outreach teams on indicators underscore the need to roll the programme out to all sub-districts.

Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh

BackgroundThe government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh.MethodsThis study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention.ResultsPost CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs.ConclusionCSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.