Quality Of Primary Health Care Services Research Articles

Strengthening the quality of primary healthcare services and interdisciplinary collaboration

Abstract Background Political organisations stress the need for preventive strategies to reduce the amount of avoidable hospital admissions, i.e. admissions that could have been avoided given timely and adequate care in the primary healthcare setting. Interdisciplinary collaboration has been suggested as a means to prevent hospitalizations, but effective implementation remains a challenge. Thus, there is a need for evidence-based strategies to prevent avoidable admissions and support interdisciplinary collaboration. The aim was to develop an evidence-based framework for preventive and coordinated interventions strengthening the quality of primary healthcare services and supporting interdisciplinary collaboration. Methods The project consists of three sub-studies: 1) a mixed methods systematic review following the JBI methodology; 2) a focus group study with primary healthcare providers in the Central Denmark Region, including general practitioners, physiotherapists, occupational therapists, home care providers, registered nurses and nurse specialists; and 3) a study using participatory design, where a framework for coordinated interventions were developed based on the results from study 1 and 2, supported by all stakeholders. Results Findings suggest that some hospitalizations can be prevented by intervening on mental factors, e.g., through trustful relations, and social factors, e.g., living situation. Also, a strong collaboration between healthcare providers from different disciplines and healthcare services is needed to improve the care pathway and prevent hospitalization. The collaboration may be strengthened if the health providers share a common language regarding the citizens’ health status. Conclusions Stakeholders at all levels should be informed about the relevance of considering mental, social and physical factors to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration. Key messages • By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some admissions. • Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration.

Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach.

Reducing under-five mortality is a crucial indicator of overall development in a country. However, in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in sub-Saharan Africa, Angola faces significant challenges such as malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, which are the leading causes of death among children. This study aimed to identify factors associated with hospital deaths among children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Using a hospital-based case-control design, the study included 1020 children, among whom 340 experienced hospital deaths. Distal and intermediate determinants emerged as primary predictors of hospital mortality, showing significant associations with: mother without schooling (OR [95%CI] 4.3 [1.2-15.7], p < 0.027); frequent alcohol consumption during pregnancy (OR [95%CI] 3.8 [2.5-5.9], p < 0.001); hospital stay ≤24 h (OR [95%CI] 13.8 [6.2-30.8], p < 0.001); poor nutritional status (OR [95%CI] 2.1 [1.4-3.2], p < 0.001); short interbirth interval (OR [95%CI] 1.7 [1.1-2.5], p < 0.014); maternal age ≤19 years (OR [95%CI] 5.6 [3.0-10.8], p < 0.001); and maternal age ≥35 years (OR [95%CI] 2.1 [1.2-3.7], p < 0.006). These findings highlight the preventable nature of most under-five hospital deaths and underscore the urgent need to address social inequities and improve the quality of primary healthcare services to effectively reduce child mortality in Angola.

Analysis of Risk Factors for the Quality of Health Services in Primary Health Facilities: An Observational Study in North Bengkulu Regency, Indonesia

Primary health care (PHC) is crucial for overall health system performance, particularly in developing nations. However, variations in the quality of PHC services in Indonesia, particularly in North Bengkulu Regency, raise concerns. This study aimed to identify and analyze risk factors associated with suboptimal quality of health services in these facilities. This observational, cross-sectional study was conducted in 20 primary health centers (PHCs) in North Bengkulu Regency. A multi-stage random sampling technique was used to select 400 patients and 80 healthcare providers. Data were collected using validated questionnaires assessing various dimensions of service quality (tangibles, reliability, responsiveness, assurance, and empathy), patient satisfaction, and potential risk factors (socio-demographic, facility-related, and provider-related). Descriptive statistics, bivariate analysis, and multivariate logistic regression were used for data analysis. The study found a significant association between perceived service quality and patient satisfaction. Socio-demographic factors (lower education and income), facility-related factors (inadequate staffing and lack of essential medicines), and provider-related factors (insufficient communication and perceived lack of empathy) were identified as risk factors for lower service quality. The quality of health services in North Bengkulu PHCs is influenced by a complex interplay of patient, facility, and provider factors. Interventions targeting these risk factors, such as community education, capacity building for providers, and improvements in resource allocation, may improve PHC service quality and patient satisfaction in this region.

Qualidade da atenção primária à saúde da pessoa idosa durante a pandemia da covid-19: uma revisão sistemática

Abstract Objective To evaluate the quality of primary healthcare services for older adults during the COVID-19 pandemic through studies evaluating health services. Method A systematic literature review was conducted. The search for articles covered the databases Web of Science, Embase, Scopus, and Medline/Pubmed. Original scientific articles with a case-control or cross-sectional design, involving populations that included older adults, focusing on primary healthcare, and assessing the quality of health services were included. Exclusion criteria were studies without specific analysis for older adults, studies evaluating health access or economic evaluation of health. The risk of bias analysis was conducted according to JBI protocols, and data synthesis was performed using SWiM guidelines. Results Seven studies were included in the review. The primary care services evaluated were mostly outpatient, with diverse quality assessment parameters related to individual care. The evaluation of quality identified a decrease in in-person consultations and visits, and an increase in the use of telehealth, with good satisfaction ratings among older adults. Conclusion The studies highlighted the difficulties maintaining and accessing in-person services during the COVID-19 pandemic, which directly contributed to a reduction in consultations and exams, usage of and access to health services, and the quality of primary healthcare.

Family caregivers' perceptions of the quality of primary healthcare services for people with disabilities: a cross-sectional study.

How do caregivers of people with disabilities perceive the quality of health services in primary healthcare? The objective of this study was to show the quality of health services for people with disabilities in primary healthcare, based on the perceptions of family caregivers. This is a cross-sectional study. During data collection, 49 family caregivers who use the center were interviewed. The assessment instruments used were the Socio-Economic and Demographic Questionnaire and the PCATool-Brasil (Primary Care Assessment Tool), in the reduced adult and child versions, to assess the level of essential and derived characteristics of primary healthcare. Women were the main caregivers (40; 82%), and the main disability was mental (28; 58%). The highest scores were observed in affiliation (100%), utilization (73.4%), and information system (83.7%). The lowest scores were found in longitudinal (26.5%), integration of care, available services, services provided (28.6%), and derived scores (28.6-22.4%) related to family guidance and community guidance. The population showed a low orientation toward primary healthcare, with a high total score (22.4%). The economic situation showed a positive association (p=0.017). According to the characteristics of primary healthcare, care is fragmented and disjointed and does not meet the needs of people with disabilities and their caregivers.

CHD-related/specific mortality of 3.17 million people in a transitioning region: trends, risk factors, and prevention.

Demographic shifts cause uncertain changes in the burden of coronary heart disease (CHD) in transitioning regions. We aimed to analyze the trends of CHD burden and its risk factors in Pudong, Shanghai, and explore prevention strategies for transitioning regions. We analyzed CHD-related and CHD-specific deaths in Pudong from 2005 to 2020, including the crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), years of life lost (YLL), and age-specific proportions. We also examined the impact of population aging on the burden of CHD. The Joinpoint Regression Program was used to analyze trends, and the decomposition method was used to evaluate the impact of demographics on the mortality rate. Of the 86,171 CHD-related deaths, 52,152 (60.52%) were CHD-specific deaths. For both CHD-related and CHD-specific deaths, there was a significant increase in the CMR, ASMRW, and YLL rate, except in the 70-79-year age group, which exhibited a distinctive and statistically significant decline in these rates (all P < 0.05). There were steadily increasing trends in the rates caused by aging from 2005 to 2020, with average annual percent changes (AAPCs) of 42.59% and 41.43%, respectively (all P < 0.05). Our results indicate that the CHD burden in Pudong has been persistently increasing, but in the age group of 70-79years, substantial declines were observed. The quality of primary healthcare services may be a critical point in addressing the overwhelming CHD burden.

Tokens Shuffling Approach for Privacy, Security, and Reliability in IoHT under a Pandemic

Privacy and security are unavoidable challenges in the future of smart health services and systems. Several approaches for preserving privacy have been provided in the Internet of Health Things (IoHT) applications. However, with the emergence of COVID-19, the healthcare centers needed to track, collect, and share more critical data such as the location of those infected and monitor social distancing. Unfortunately, the traditional privacy-preserving approaches failed to deal effectively with emergency circumstances. In the proposed research, we introduce a Tokens Shuffling Approach (TSA) to preserve collected data’s privacy, security, and reliability during the pandemic without the need to trust a third party or service providers. TSA depends on a smartphone application and the proposed protocol to collect and share data reliably and safely. TSA depends on a proposed algorithm for swapping the identities temporarily between cooperated users and then hiding the identities by employing fog nodes. The fog node manages the cooperation process between users in a specific area to improve the system’s performance. Finally, TSA uses blockchain to save data reliability, ensure data integrity, and facilitate access. The results prove that TSA performed better than traditional approaches regarding data privacy and the performance level. Further, we noticed that it adapted better during emergency circumstances. Moreover, TSA did not affect the accuracy of the collected data or its related statistics. On the contrary, TSA will not affect the quality of primary healthcare services.

Primary Health Institutions and Service Quality in China: Implications for Health Policy.

Background: To protect and improve the health of populations, the important role of primary health institutions has been strengthened through a series of health policies, especially the implementation of a national hierarchical diagnosis and treatment system. In this light, we aim to evaluate the development of primary health institutions between 2013, before the implementation of the hierarchical diagnosis and treatment system, and 2020 as well as people’s perception of the quality of primary healthcare services. Method: The national-level data (e.g., the numbers of primary health institutions, personnel, beds, visits, and hospitalizations) regarding primary health institutions were collected from the Health Statistics Yearbook, and the perceptions of the quality of primary healthcare services were collected by a web-based questionnaire survey using an internationally recognized assessment tool (i.e., PCAT-AE). In total, 10,850 persons were surveyed, and 10,419 participants were incorporated into the final analysis after removing invalid questionnaires. A descriptive statistical analysis (i.e., frequency and percentage) was used to analyze the national-level characteristics of primary health institutions and people’s perceptions of the quality of primary healthcare services. Moreover, a logistic regression model was used to analyze the factors influencing the perceptions of the quality of primary healthcare services. Results: From the macro perspective, the number of primary health institutions, beds, and personnel per 10 thousand residents slightly increased from 2013 to 2020, especially in the eastern and central areas. However, the average number of visits and the hospitalization rate in primary health institutions showed a decrease, especially in central and eastern areas. Among participants, 92.2% (9606/10,419) of them had previously sought healthcare services in primary health institutions, and most were seeking general outpatient services (57.06–63.45%), followed by medicine purchasing (16.49–21.51%), physical examinations (9.91–11.49%), preventive health services (5.11–6.48%), and hospitalization services (3.17–5.67%). The total perception scores on the quality of primary healthcare services reported by the participants were 26.19 and 27.00 for rural and urban areas, respectively, which accounted for 65.5% and 67.5% of the total score, respectively, and 26.62, 26.86, and 25.89 for the eastern, central, and western areas, respectively, with percentages of 66.6%, 67.2%, and 64.7%. The perception score on the quality among people contracted with a family doctor (29.83, 74.58%) was much higher than those who were not (25.25, 63.13%), and the difference was statistically significant (p < 0.001). Moreover, people who were female, married, had higher incomes, and were diagnosed with various diseases had better perceptions of the primary healthcare services compared to their counterparts (p < 0.05). Conclusion: Improvements were seen for primary health institutions, especially in terms of hardware resources such as beds and personnel. However, the service utilization in primary health institutions did not improve between 2013 and 2020. The perception score on the quality of primary healthcare was moderate to low in rural and urban as well as eastern, central, and western areas, but it was significantly higher among people contracted with a family doctor than those who were not. Therefore, it is important for policy makers to take or adjust measures focusing on quality improvement and increasing the service utilization in primary health institutions with good first contact, accessibility, continuity, comprehensiveness, and coordination, such as raising the enrollment rate of family doctors and promoting the provision of high-quality services.

Perceived quality of primary healthcare services among the National Health Insurance members and fee for service patients in the West Denpasar II Public Health Center Bali, Indonesia

Background and purpose: The Government of Indonesia established the National Health Insurance or in Indonesia called Jaminan Kesehatan Nasional (JKN) in 2014 with the target of achieving universal health coverage (UHC) by 2019. However, many have not become JKN participants and still use the fee for service financing system. The purpose of this study was to determine patient’s perceptions of the quality of health services under the JKN and fee for service payment methods. Methods: A cross-sectional study was conducted at West Denpasar II Public Health Centre (PHC) with 133 outpatient respondents who were selected sequentially. Data collection was carried out in June 2019 through interviews. Patients’ perceptions of service quality were measured according to the six domains of health service quality established by the Institute of Medicine (IOM) which include effectiveness, efficiency, timeliness, patient-centered approach, safety and equity. Bivariate analysis was conducted with Mann Whitney test and multivariate analysis with Ancova. Results: Patients’ perceptions of the quality of services in the JKN and fee for service payment methods were found to be quite good with an average of 3.08 and 3.17 of the maximum value of 4.0. Bivariate analysis showed a significant difference with a mean rank of 54.28 for JKN and 79.16 for fee for service (p&lt;0.01). Patients’ perceptions of service quality also differed significantly based on the dimensions of efficiency (p=0.001), effectiveness (p=0.005), timeliness (p=0.007) and patient-centered approach (p=0.032). Multivariate analysis showed that the variable that was significantly related to patient perceptions of service quality was the payment methods (p&lt;0.001). Conclusion: Patients with a fee for service payment methods have a better perception of service quality than patients who use JKN. Advocacy to policy makers and service providers should be conducted in order to ensure the equal quality of service for all patients.

Primary Healthcare Quality in Conflict and Fragility: a subnational analysis of disparities using Population Health surveys

BackgroundRecent global reports highlighted the importance of addressing the quality of care in all settings including fragile and conflict-affected situations (FCS), as a central strategy for the attainment of sustainable development goals and universal health coverage. Increased mortality burden in FCS reflects the inability to provide routine services of good quality. There is also paucity of research documenting the impact of conflict on the quality of care within fragile states including disparities in service delivery. This study addresses this measurement gap by examining disparities in the quality of primary healthcare services in four conflict-affected fragile states using proxy indicators.MethodsA secondary analysis of publicly available data sources was performed in four conflict-affected fragile states: Cameroon, the Democratic Republic of Congo, Mali, and Nigeria. Two main databases were utilized: the Demographic Health Survey and the Uppsala Conflict Data Program for information on components of care and conflict events, respectively. Three equity measures were computed for each country: absolute difference, concentration index, and coefficients of mixed-effects logistic regression. Each computed measure was then compared according to the intensity of organized violence events at the neighborhood level.ResultsOverall, the four studied countries had poor quality of PHC services, with considerable subnational variation in the quality index. Poor quality of PHC services was not only limited to neighborhoods where medium or high intensity conflict was recorded but was also likely to be observed in neighborhoods with no or low intensity conflict. Both economic and educational disparities were observed in individual quality components in both categories of conflict intensity.ConclusionEach of the four conflict-affected countries had an overall poor quality of PHC services with both economic and educational disparities in the individual components of the quality index, regardless of conflict intensity. Multi-sectoral efforts are needed to improve the quality of care and disparities in these settings, without a limited focus on sub-national areas where medium or high intensity conflict is recorded.

Perception and Aspiration on Primary Healthcare Service Quality in Puskesmas in Pati Regency Government, Central Java Province, Indonesia

The research of the quality of primary public health services in the Government of Kabupaten Pati is measured using the quality of medical services that are being held by all of its local public health centers, Puskesmas. The number of respondents in this research is 640 respondents. The research is being done in 64 different places that are distributed equally so that it can gather good quality data. The result of this research shows that the quality of primary public health services in the Government of Kabupaten Pati is perceived as good by its citizens. The improvement on the quality of medical services of Puskesmas can be done by improving its facility, human resource, and its medicine quality.

Stakeholders' perspectives on facilitative supervision implementation in north-western Ghana: an exploration of adherence and quality of primary healthcare.

Following growing concern about healthcare quality in many developing countries, this article analyses the relationship between facilitative supervision (FS) and the quality of primary healthcare (PHC) services in north-western Ghana. While adherence to the tenets of FS aims to trigger improvement in the quality of PHC services, research has seldom explored this relationship to facilitate effective planning and implementation of PHC services, particularly in deprived areas. Based on the implementation of FS in primary health facilities in a district and a municipality in north-western Ghana, a multi-case study approach was employed to collect and analyse the data. Specifically, 52 semi-structured interviews were conducted in the two study settings and the data were analysed using a thematic framework. Observation and secondary analysis were also employed to generate data to triangulate and supplement the interview data. The results reveal that health facilities in the Wa West district are relatively under-resourced, and this impedes the regularity of supervisory visits compared to the Wa Municipality. This notwithstanding, adherence to the prescriptions of FS is rated by the study participants as moderately satisfactory in both districts, culminating in improvement in the quality of PHC. This finding has implications for innovation in the mobilisation of health resources to increase the regularity of facilitation supervision in deprived settings. We advocate further research to establish whether the marginal improvement in the quality of PHC achieved in the two districts has resulted in an increase in uptake of PHC services to improve the health of the population or not.

The institutional primary healthcare service quality and patients\u2019 experiences in Chinese community health centres: results from the Greater Bay Area study, China

BackgroundThe goal of this paper was to assess the quality of primary healthcare services at community health centres (CHCs) from the demand (patient) and supplier (healthcare service institution) angles.MethodsThis study was conducted at six CHCs in the Greater Bay Area of China. Between August and October 2019, 1,568 patients were recruited (55.8% women and 44.2% men). We evaluated the service quality of CHCs using the National Committee for Quality Assurance Patient-Centred Medical Home (NCQA-PCMH) recognition questionnaire. We assessed patients’ experiences with medical and health services using the Primary Care Assessment Tools (PCAT).ResultsPCAT total and sub-domains scores were significantly difference at the six CHCs (P < 0.001). Among the six CHCs, Shayuan CHC had the highest PCAT total and sub-domain scores and the highest NCQA-PCMH total and sub-domain scores, as well. Older (> 60 years), female, lower education, and employee medical-insured individuals had better patient experiences.ConclusionsOur results indicate that CHCs could improve their service quality by improving both institutional health service quality based on NCQA-PCMH assessment and patient experiences based on PCAT scales. These findings can help inform patient-centred primary healthcare policy and management.

Factors Influencing the Quality of Primary Healthcare Services in Southern Senatorial District of Cross River State, Nigeria

Background: The aim of this study is to determine the factors influencing the quality of primary healthcareservices in southern senatorial district of Cross River State, Nigeria.Materials and Method: A cross sectional descriptive study design with both qualitative and quantitativemethod of data collection was used. Donabedian’s structure, process and outcome model guided the researchprotocol. Ethical clearance for the study was obtained from Cross River State Ministry of Health EthicsCommittee. Two semi-structured questionnaires and a Focus Group Discussion Guide were used for datacollection. Four hundred and eighty clients and 144 healthcare providers from 12 primary healthcare centresin the study area were selected by simple random sampling method. Statistical package for social sciencesversion 20.0 was used to analyze the quantitative data while thematic coding was used to analyse thequalitative data.Results: The major structure factors mitigating the quality of care as observed by the healthcare providersinclude insufficient manpower 58(40.28%), lack of basic amenities (light, water supply and good road)58(40.28%), insufficient equipment 26(18.06%), insecurity and communal crises 22(15.28%). Theperceptions of the clients were similar to that of the healthcare providers. In terms of process factors; poorattitude of some healthcare providers and clients was the main response of healthcare professionals. Thequalitative results were similar to that of quantitative. All the basic primary health care services (includinghealth education, health promotion, environmental sanitation, immunization, reproductive health, nutrition,HIV/AIDS and oral care) were provided in the selected health centres except mental health.Conclusions: The quality of healthcare services in the southern senatorial district,Cross River State, Nigeria,is affected by structure and process factors of the Donabedian’s model.

Impact of Quality of Healthcare Services on Consumer’s Satisfaction at Primary Healthcare Centers

Background: Current trend in quality healthcare services is to work toward providing ‘people-centered’,healthcare that puts the consumers at the center in the health delivery system. This study aims to determinethe level of quality of healthcare services in primary healthcare centers.Method: The study included a simple random sample of (180) health and medical care providers in primaryhealthcare centers in Baghdad City by (5-8) healthcare providers for each center.The study results showed that the general evaluation of the quality of primary healthcare services is highlyefficient and that the result has a significant impact on the beneficiaries’ satisfaction.Conclusion: The researchers concluded that the primary healthcare centers are not commensurate withthe increasing population density, and the lack of an ambulance in most of the primary healthcare centers.Furthermore, the level of confidence in our health institutions regarding service efficiency indicates a highlevel.

Evaluation of the Participation of Community Pharmacists in Primary Healthcare Services in Nigeria: A Mixed-Method Survey.

Background: Achieving universal health coverage in poorly-resourced settings like Nigeria demands optimal mobilization of all healthcare resources including community pharmacists. Such efforts are hampered by insufficient data on primary healthcare (PHC) contributions by community pharmacists. The study aimed to identify PHC services offered by community pharmacists; assess impact of technologies on PHC service quality; and evaluate factors influencing management of PHC services in Nigeria.Methods: A descriptive cross-sectional survey of 321 community pharmacies and 642 clients was undertaken between April and August, 2019. Semi-structured pre-tested questionnaires were administered on randomly-selected community pharmacists and clients. Interviews were conducted with key informants. Data were summarized using frequency and percentages while weighted averages on 5-point ordinal scales and chi-square tests were used to identify weights and associations between variables respectively at P<.050.Results: Response rates of pharmacists and clients were 74.7% (N=321) and 100% (N=642); while their median ages were 39.41 and 51.20 years respectively. Community pharmacists offered services in all eight domains of PHC, especially supply of medicines for treating of endemic diseases (mean weighted average [MWA]=4.59), and disease prevention (4.54) but least of vaccine administration (2.39). Blood glucose screening devices were the most adopted technology with significant impact on service quality (χ2 6.86, P=.030). Major challenges to management of PHC services were poor awareness of pharmacists’ roles (4.31) and lack of integration with the PHC infrastructure (4.31). Capacity constraints in finances (4.11), technologies (4.09), and human resources (3.99) were significant. However, major facilitators were pharmacists’ managerial skills (4.35), and strong client relationships (4.27). Conclusion: In Nigeria, community pharmacists offered important PHC services. Deploying technologies were associated with improved service quality. If community pharmacists are integrated in the national PHC architecture and financial incentives are provided, their competences and goodwill would enhance the achievement of universal health coverage.

Perceived quality of primary healthcare services and its association with institutional trust among caregivers of persons diagnosed with a severe mental illness in China.

Low utilization of the family-oriented community rehabilitation services is a threatening challenge facing low- and middle- income countries. Family caregiver's trust in community healthcare providers is the precondition of service utilization and is shaped by their perceived quality of primary healthcare services from previous experience. Most of the studies concerning the relationship between perceived quality and institutional trust were conducted in western countries, resulting in limited attention paid to conditions in non-western countries. Which aspect of quality predicts institutional trust in China has not been studied yet. In China's context, institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Significant rural-urban disparity was observed: among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief; institutional trust was only associated with worry relief in urban respondents. Mental health nurses training or working with community healthcare workers may improve their technical and communicative competence. Priorities may differ between rural and urban areas. Mental health nurses or community healthcare workers may provide more family-oriented psycho-education to rural families, and more emotional support to urban families. Wider public anti-stigma initiatives are needed to reduce the affiliated stigma of families of persons diagnosed with a severe mental illness. Introduction Prior studies suggested that caregiver's trust in community healthcare providers is the precondition of the utilization of community-based rehabilitation services and is shaped by their perceived quality of primary healthcare services. Nevertheless, the research conducted in non-western countries is scarce, and which aspect of quality is associated with institutional trust in China has not been studied. Aim To explore the association between perceived quality of primary healthcare services and institutional trust in China's context. Methods This cross-sectional study was conducted with 796 family caregivers from Eastern, Central and Western China between August 2018 and October 2019. Perceived quality of primary healthcare services was measured by technical competence, communication, worry relief and risk of privacy leak. Results Institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief. Contrary finding was observed in urban respondents. Discussion and implications for practice With rural-urban disparity considered, strategies such as improving the technical and communicative competence of community healthcare workers, providing family-oriented psycho-education and emotional support, and promoting public anti-stigma initiatives may be worth consideration.

Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area

Abstract Background The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs. Methods This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform. Results The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years. Conclusions Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges. Key messages Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.

Evaluation of the Quality of Primary Health Care Services for Adolescents With Chronic Illness in Kirkuk City

Background: Providing interventions, and implementing of best-practice care for patients with chronic diseases is of greatest challenges currently facing primary care providers. This study aimed to evaluate the quality of primary health care(PHC)services for adolescents with chronic diseases in Kirkuk city. Methodology: A descriptive (quantitative design) was conducted through (18) primary health care centers (PHCCs) in Kirkuk city. A questionnaires was designed for the purpose of the study. A simple random sample of organization structure PHC services (18) health professional were selected through the use of probability sampling approach. Data were analyzed is performed through the use of descriptive statistical data analysis approach. Results: The overall evaluation of quality of PHC services in Kirkuk city is adequate on (77.7 % : N=14), fair on (16.7 % :N=3) and Inadequate on (5.6%: N=1 ) .Domains such as quality of health service represent high mean of scores on its items, Except on 2 items of Tangibles and on items of Responsiveness 2 on from the quality of PHC are low. Conclusion: The study indicates that the quality of PHC services does not execute impact upon adolescents’ health status. This study depict that the evaluate of the quality of PHC services is adequate relative to all of its dimensions of general health status, tangibles, accreditation, responsiveness, assurance and empathy.

Perceived quality of primary healthcare services among the National Health Insurance members and fee for service patients in the West Denpasar II Public Health Center Bali, Indonesia

Background and purpose: The Government of Indonesia established the National Health Insurance or in Indonesia called Jaminan Kesehatan Nasional (JKN) in 2014 with the target of achieving universal health coverage (UHC) by 2019. However, many have not become JKN participants and still use the fee for service financing system. The purpose of this study was to determine patient’s perceptions of the quality of health services under the JKN and fee for service payment methods.Methods: A cross-sectional study was conducted at West Denpasar II Public Health Centre (PHC) with 133 outpatient respondents who were selected sequentially. Data collection was carried out in June 2019 through interviews. Patients' perceptions of service quality were measured according to the six domains of health service quality established by the Institute of Medicine (IOM) which include effectiveness, efficiency, timeliness, patient-centered approach, safety and equity. Bivariate analysis was conducted with Mann Whitney test and multivariate analysis with Ancova.Results: Patients' perceptions of the quality of services in the JKN and fee for service payment methods were found to be quite good with an average of 3.08 and 3.17 of the maximum value of 4.0. Bivariate analysis showed a significant difference with a mean rank of 54.28 for JKN and 79.16 for fee for service (p&lt;0.01). Patients' perceptions of service quality also differed significantly based on the dimensions of efficiency (p=0.001), effectiveness (p=0.005), timeliness (p=0.007) and patient-centered approach (p=0.032). Multivariate analysis showed that the variable that was significantly related to patient perceptions of service quality was the payment methods (p&lt;0.001).Conclusion: Patients with a fee for service payment methods have a better perception of service quality than patients who use JKN. Advocacy to policy makers and service providers should be conducted in order to ensure the equal quality of service for all patients.