Private Primary Health Care Research Articles

Resilience among Malaysian Community Pharmacists and General Medical Practitioners Using the 10-Item Connor-Davidson Resilience Scale (CD-RISC): The First National Survey.

With the growing importance of the healthcare sector, resilience has become a fundamental personal quality that healthcare professionals need to cultivate to cope with adverse events in daily work. Distress in the workplace cannot only impact the well-being of healthcare professionals but also negatively affect the capability to care effectively for others. This study was conducted to determine the score and level of resilience among private primary healthcare professionals and their relationships with independent variables. Sets of questionnaires on resilience based on the Connor–Davidson resilience scale-10 (CD-RISC-10) were completed by 164 general practitioners (GPs) and 87 community pharmacists (CPs). Inferential analysis was used to assess the difference, correlation, association, and predictor among dependent and independent variables. The validity and reliability of the study instrument were assessed using Modern Test Theory (MTT) and Classical Test Theory (CTT). The majority of GPs and CPs possessed the lowest resilience level. There were significant differences between CD-RISC-10 with gender, age, and years of experience in GPs as well as overall. Significant associations were found between CD-RISC-10 with all independent variables, except for the highest education level in GPs and overall. This study revealed significant correlations between independent variables with CD-RISC-10 in GPs and overall. However, there were nonsignificant differences, associations, and correlations among CPs between all independent variables and CD-RISC-10. Gender was the predictor of CD-RISC-10 in GPs, while age and years of experience were the predictors of CD-RISC-10 in GPs and overall. There was no predictor of independent variables for CPs. In multinomial logistics regression, years of experience and gender were the significant predictors of CD-RISC-10 among GPs. The CD-RISC-10 instrument had good validity and reliability. Overall, healthcare professionals showed a low level of resilience. This emphasized the need to cultivate and build resilience, as it is a desirable, important element when working in harsh and unprecedented healthcare settings.

Compliance of Private Primary Health Care Facilities Towards Requirements of Labelling of Dispensed Medicine in Sarawak.

Compliance towards the requirements of labelling of dispensed medicine (LDM) among private primary health care facilities ensures appropriate use of medicines. This study aimed to examine the rate of compliance towards the requirements of LDM among retail pharmacies (RPs) and private medical clinics (PMCs). A cross-sectional study was conducted from April 2019 to January 2020 across all inspected premises in Sarawak. Publics who attended RPs and PMCs and have medicines dispensed have their medicine labels examined for compliance with the requirements of LDM upon exiting the premises. Their verbal consents were obtained and the compliance score was recorded into self- -developed data collection forms. The compliance rate was the percentage of requirements on the examined medicine labels that fulfill the requirements under Regulation 12 of Poisons Regulations 1952. A total of 414 LDM were examined, with 135 from RPs and 279 from PMCs. The full compliance towards the requirements of LDM among RPs and PMCs were 23.7% and 41.6%, respectively. The median compliance score of PMCs (0.83) was significantly higher (P<0.001) than RPs (0.67). The requirements of LDM with the lowest compliance were name of medicine (53.1%), followed by name of patient (31.9%) and date of dispensing (25.6%). The full compliance rate on the requirements of LDM among RPs and PMCs were low. More stringent enforcement and public education on their rights for fully compliant medicine labels could improve the compliance.

Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?

Background:In 2007, a reform of Swedish primary healthcare began when some regions implemented enhanced patient choice in combination with free establishment for private providers. Although heavily debated, in 2010 it became mandatory for all regions to implement this choice system.Aim:The aim of this article was to review all published research articles related to the primary healthcare choice reform in Sweden, to investigate what has been published about the reform and summarise its first 15 years.Methods:A scoping review was performed to cover the breadth of research on the reform. Searches were made in Scopus, Web of Science and PubMed for articles published between 2007 and 2021, resulting in 217 unique articles. In total, 52 articles were included.Results:The articles were summarised and presented in relation to six overarching themes: arguments about the primary healthcare choice reform; governance and financial reimbursements; choice of provider and use of information; effects on equity and access; effects on quality; and differences between private and public primary healthcare centres.Conclusions: The articles show that the reform has led to an increase in access to primary healthcare, but most studies indicate that the increase is inequitably distributed in terms of socioeconomy and geographical location. The effects on quality are unclear but several studies show that the mechanisms supposed to lead to quality improvements do not work as intended. Furthermore, from a population health perspective, it is time to discuss how such a responsibility can be reintegrated into primary healthcare and function with the choice system.

OPPORTUNITIES FOR COMPETITIVE ADVANTAGE IN THE VALUE, CREATED BY PRIMARY HEALTH CARE INSTITUTIONS IN LITHUANIA: DOES COMPETITIVENESS POSSIBLY DEPENDENT ON THE FORM OF OWNERSHIP?

Background. In the face of competition between primary health care institutions (PHCIs), attempts are made to gain a competitive advantage in the market by creating greater value for patients. Little research has been conducted on whether the form of a PHCI’s ownership is a factor of its competitive advantage. The aim of the study. To determine opportunities for competitive advantage in the management of value creation in public and private primary health care institutions by using the method of focus group discussion with managers. Methods. Focus group discussions were held in 10 Lithuanian counties, and 10 focus group sessions were carried out overall. A total of 48 primary health care managers were interviewed. Results. The competitive advantage of a PHCI depends on its form of ownership, which makes for unfair competitive conditions. A competitive advantage is created by factors such as: the variety of services available; the health care policy in action; the function of the manager; the professionalism of the staff; and the location of the institution. Medical staff have the same opportunities to express and develop their professional skills in public and private PHCIs, but private institutions attract the most skilled staff because they have the resources to increase their motivation. Conclusions. The managers of PHCIs indicated that the competitive advantage depends on the form of ownership. In management science this study and the results can be a basis for the health care reform development and the foundation for new theories.

Assessment of medication discrepancies with point prevalence measurement: how accurate are the medication lists for Swedish patients?

BackgroundMedication discrepancies are common, potentially harmful and may result from poor medication information across medical records. Our aim was to describe current medication discrepancy rates, types and severity in hospital, primary and specialized outpatient care in Sweden, as well as comparing these with previous measurements.MethodsParticipants visiting health care in Skåne in November 2020 were randomly selected to include 100 adult patients each in public and private primary health care centers, hospitals and outpatient care. Within 2 weeks after a health care visit or hospital admission, a pharmacist medication reconciliation was performed to identify any discrepancies. Two general practitioners assessed their potential to cause harm. Descriptive and comparative statistics were used.ResultsIn total, 405 patients (mean age 61.6 years, median 6.5 medications) were included in the analysis. The majority (72%) of the included patients had ≥1 medication list discrepancy. Total number of discrepancies was 1038 (average 2.6 per patient), with a significantly higher discrepancy rate (4.5) noted in specialized outpatient care (p < 0.001). Overall, unintentional addition (44%) or omission (39%) of drug were most frequent. Out of all discrepancies, 20.7% were rated to have moderate (18.2%) or high (2.5%) potential risk of harm. Cardiovascular, nervous system and antidiabetic medications were more often involved in potentially harmful discrepancies. When compared with previous measurements, the proportion of accurate medication lists significantly improved in primary care compared to 2018 (34% vs 20%, p = 0.0011), as well as a decrease in overall discrepancy rate (p = 0.0029).ConclusionMedication discrepancies were in general abundant despite a recent health care visit, both in hospital care and primary care, with the highest number in specialized outpatient care. A considerable share was classified as potentially harmful thus implying a major threat to medication safety.

Initiating a district-based public\u2013private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage

BackgroundDistrict-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy.MethodsThe research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression.ResultsDistrict TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05).ConclusionsEngaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.

Patients’ Satisfaction in Public and Private Primary Health Care: A Study in Karawang Regency, West Java, Indonesia

Background : Primary health care is the foundation of the Sustainable Development Goals (SDGs) to achieve Universal Health Coverage (UHC). Patient satisfaction with the health services acquired is one of the factors to achieve the UHC target. This study aimed to determine patients’ satisfaction in public and private primary health care centers. Methods : This quantitative analytic study with a cross-sectional method was conducted in five sub-districts of Karawang Regency based on community satisfaction surveys. The instrument used was a standard questionnaire with nine dimensions and filled with a survey approach by the respondents. Data was transformed from ordinal to numeric using Rach modelling. Then, numerical data were analysed with Chi Square Test in IBM SPSS Statistic 23 Version to determine differential between public and private groups. Results : In total, 193 respondents were included of whom 123 patients were from public health centers (Pusat Kesehatan Masyarakat, Puskesmas) and 70 from private primary care (clinic). Three dimensions had differences in satisfaction, including the requirements (p=0.001); systems, mechanisms, and procedures (p=0.001); and service time (p=0.001). The other six dimensions such as cost (p=0.534); product specification type of service (p=0.213); implementer competence (p=0.163); implementer behavior (p=0.000); handling of complaints, suggestions, and advances (p=0.448); and facilities infrastructure (p=0.063) were not proven to have differences in satisfaction. Overall, patients’ satisfaction level at Puskesmas (67.5%) was lower than at clinics (88.6%) (p=0.001). Conclusion : Patients’ satisfaction with the Puskesmas is lower than the clinic. Further study with a larger sample size and more complete dimension is needed.

The caring perspective during a COVID pandemic

Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt.

Development, validation and reliability of a questionnaire for assessment of physician's knowledge, attitude and practices (KAPs) regarding foodborne diseases in the Kingdom of Saudi Arabia

Background: The burden of foodborne illness is considered to be high across the world. Based on the Knowledge-Attitude-Practice (KAP) model, physician’s awareness is essential for conducting individualized treatments, thus reducing the burden of foodborne illness. However, there have been no validated questionnaires specific to the awareness of physicians with foodborne diseases. This study aims to develop and validate a KAP questionnaire for physicians to assess their awareness about the diagnosis and management of foodborne illness. Methods The questionnaire was developed in three phases: a comprehensive literature review, face and content validity, followed by a reliability test by internal consistency. A cross-sectional study was designed in Abha, Saudi Arabia. Physicians (n=125) were opportunistically recruited from both public and private primary healthcare centers. The questionnaire’s content and validity were confirmed by experts in their corresponding fields. After signing the informed consent, the study participants received the questionnaire to evaluate their KAPs on foodborne diseases. Results: A total of 160 physicians from both public and private primary health care centers were approached to enrol 125 study participants into the survey (response rate 78.13%). Of the 31 items designed for assessing the KAP of physicians on foodborne illnesses, three items were excluded after Cronbach’s α analysis. In total, 29 items were included in the final set of the questionnaire. Results of different validity and reliability analyses suggest the questionnaire has a high face and content validity as well as good reliability in internal consistency and stability. Conclusions: This study introduces a newly developed questionnaire with good reliability and validity values that can assess physician’s awareness of foodborne disease. The awareness questionnaire, as a study instrument, had a favourable acceptance among physicians. It is a sound method for evaluating and measuring levels of foodborne disease-related awareness among physicians in Abha, Saudi Arabia.

Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa

BackgroundThe proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice.MethodsWe conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities).ResultsThe majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice.ConclusionsIt is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

Evaluation of the Cold Chain Expanded Program on Immunization at Governmental and Private Health Care Centers in Riyadh City, Saudi Arabia

Objective: Vaccine storage is essential to ensure optimal vaccine effectiveness. Cold chain is a series of storage and transport links, designed to keep the vaccine at the correct temperature till it reaches the user. To evaluate the Cold Chain Expanded Program on Immunization at Governmental and Private Health Care Centers in Riyadh city, Saudi Arabia.&#x0D; Methods: A cross-sectional study was conducted from March to May 2021 in government and private primary health care centers of Riyadh, Saudi Arabia were included. Data collection was carried out using standardized check list developed by Saudi Ministry of Health (MOH) and World Health Organization (WHO). Data were analysed using IBM SPSS Statistics 26 (C) and IBM SPSS 26 (IBM Inc.)&#x0D; Results: The results showed that the mean score of Room and Refrigerator Elements for governmental PHCs was 8.8(±0.82), while it was 8.3(±1.86) for private PHCs. The mean temperature monitoring device score for government PHCs was 4.0 (0.0), and the 3.65 (±0.92) for PHCs centers. The mean temperature chart (record keeping) score for governmental PHCs was 2.55(±0.5) and 1.8(±1.2) for private PHCs. The mean maintenance and operations score for governmental PHCs was 4.6 (±0.49), while it was 4.1 (±0.84) for private PHCs. The mean scores of all cold chain components differed significantly between government and private facilities (p=0.000).&#x0D; Conclusion: Our study highlights the cold chain management programs Saudi Arabia. More importantly governmental PHC centers in the current settings comply with the standards to the guidelines, provided by Saudi Ministry of Health and WHO, was observed, in comparison to private PHC centers.

Development, validation and reliability of a questionnaire for assessment of physician's knowledge, attitude and practices (KAPs) regarding foodborne diseases in the Kingdom of Saudi Arabia

Background: The burden of foodborne illness is considered to be high across the world. Based on the Knowledge-Attitude-Practice (KAP) model, physician’s awareness is essential for conducting individualized treatments, thus reducing the burden of foodborne illness. However, there have been no validated questionnaires specific to the awareness of physicians with foodborne diseases. This study aims to develop and validate a KAP questionnaire for physicians to assess their awareness about the diagnosis and management of foodborne illness. Methods The questionnaire was developed in three phases: a comprehensive literature review, face and content validity, followed by a reliability test by internal consistency. A cross-sectional study was designed in Abha, Saudi Arabia. Physicians (n=125) were opportunistically recruited from both public and private primary healthcare centers. The questionnaire’s content and validity were confirmed by experts in their corresponding fields. After signing the informed consent, the study participants received the questionnaire to evaluate their KAPs on foodborne diseases. Results: A total of 160 physicians from both public and private primary health care centers were approached to enrol 125 study participants into the survey (response rate 78.13%). Of the 31 items designed for assessing the KAP of physicians on foodborne illnesses, three items were excluded after Cronbach’s α analysis. In total, 29 items were included in the final set of the questionnaire. Results of different validity and reliability analyses suggest the questionnaire has a high face and content validity as well as good reliability in internal consistency and stability. Conclusions: This study introduces a newly developed questionnaire with good reliability and validity values that can assess physician’s awareness of foodborne disease. The awareness questionnaire, as a study instrument, had a favourable acceptance among physicians. It is a sound method for evaluating and measuring levels of foodborne disease-related awareness among physicians in Abha, Saudi Arabia.

Interoperability of Health Digitalization

: Introduction : Maternal and child health (MCH) is a global priority as health care innovation continues to evolve, including the use of information and communication technology. Studies showed that interoperable information systems can improve the quality of health services and at the same time facilitate the integration of data for the purpose of monitoring and evaluating the performance of health services, especially MCH. Aims : This study aims to identify various maternal and child health information systems used in Indonesia and opportunity of interoperability between systems to support continuum of care services. Methodology: Qualitative descriptive research was conducted in Yogyakarta Province from November to December 2020. This study assessed MCH applications that have been used in public and private primary health care, hospitals, health offices and in the community by identifying their functions and mapped data elements used by each application to assess potential interoperability between systems. The online focus group discussions with various application providers was conducted to explore the challenges of interoperability between digital systems. Results and Discussion : There were 18 maternal and child health information systems have been developed by the government (central and local), health facilities and private sector. The initiation of interoperability between systems has not yet occurred, except to support regular reporting at the health office and Ministry of Health level. Interoperability between information systems required efforts to improve information technology facilities and infrastructure, development of health data standards, strengthening governance and regulation and utilization of data as an effort to monitor, evaluation and continuity of interoperability between systems to support the digitalization of services and routine reporting. Conclusions and Recommendations : Digitalization of MCH services in Indonesia has the opportunity to support the continuum of care through an interoperable system. However, several enabler factors need to be prepared to support interoperability between information systems.

Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

BackgroundThe elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme.MethodsBased on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources.ResultsThe simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period.ConclusionsOur findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

Development, validation and reliability of a questionnaire for assessment of physician's knowledge, attitude and practices (KAPs) regarding foodborne diseases in the Kingdom of Saudi Arabia.

Background:The burden of foodborne illnessisconsidered to behigh across the world.Basedonthe Knowledge-Attitude-Practice(KAP) model, physician's awareness is essentialforconductingindividualized treatments, thus reducingtheburdenof foodborne illness. However, there have been no validated questionnaires specific to the awareness of physicians with foodborne diseases.This study aims to develop and validateaKAPquestionnaire for physiciansto assess their awarenessaboutthediagnosis and managementof foodborneillness. MethodsThe questionnaire was developed in three phases: a comprehensive literature review, face and content validity, followed by a reliability test by internal consistency. A cross-sectional study was designed in Abha,Saudi Arabia. Physicians (n=125) wereopportunisticallyrecruited from both public and private primary healthcarecenters.The questionnaire'scontent and validity were confirmed by experts in their corresponding fields. After signing the informed consent, the study participants received the questionnaire to evaluate theirKAPson foodborne diseases. Results:A totalof160 physicians from both public and private primary health carecenterswere approached to enrol125study participantsintothe survey(response rate78.13%). Of the 31itemsdesigned for assessing theKAPof physicians on foodborne illnesses, threeitems were excluded afterCronbach'sα analysis. In total, 29 items wereincluded inthe final set of the questionnaire.Results of different validity and reliability analyses suggestthe questionnaire hasahigh faceandcontent validity as well as good reliability in internal consistencyand stability. Conclusions:This study introduces a newly developed questionnaire with good reliability and validity values that can assess physician's awarenessof foodborne disease.The awareness questionnaire,as a study instrument,hadafavourable acceptanceamong physicians. It is a sound method for evaluating and measuring levels of foodborne disease-related awareness among physicians in Abha, Saudi Arabia.

A survey of the involvement of primary care doctors in HIV prevention and care in a low-prevalence, high-income setting

BackgroundIn high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong’s population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care.MethodsA cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants’ level of involvement in HIV prevention and care and their demographics and medical practice characteristics.ResultsThe response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50–59 age group (OR: 2.48, 95% CI: 1.12–5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4–7.12).ConclusionsOverall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.

Patients’ Shift from Public to Private Primary Health Care Providers in Lithuania: Analysis of the Main Reasons

AimsLithuania is one of the countries where public and private primary health care (PHC) providers compete for patients. Patients continuously shift from public to PHC providers, but an analysis of the main reasons was never performed. This study aimed to analyze the reasons why patients shift from public to private PHC providers and identify the associations between the reasons and demographic characteristics of the patients.MethodsA cross-sectional study based on a phone questionnaire was conducted among patients who shifted from public to private primary health care (PHC) providers. A total of 810 phone calls were made, and 572 telephone surveys were completed. The response rate was 70.49%. The difference between the proportions was assessed using the Z-test. The association between categorical variables was assessed using the chi-square test.ResultsThe study identified the following main reasons: long queues to obtain family physician appointments (23.6%), inconvenient location of public’s institution department (20.1%), patients relocating (19.2%), enrolment at a former family physician who transitioned from a public to private PHC institution (10.5%), and long waiting time at the family physician’s office for the appointment (9.4%). Some statistically significant correlations were found between the specific reasons for shifting from public to private PHC organizations and patients' demographic characteristics.ConclusionsPersonal reasons are the most common reasons for shifting from public to private PHC providers (43.36% of the respondents), following the reasons related exclusively to the family physician (25.17%) and related PHC institutions only (24.9%).

Comparing quality of primary healthcare between public and private providers in China: study protocol of a cross-sectional study using unannounced standardised patients in seven provinces of China

IntroductionThe Chinese government has encouraged the development of private sector in delivering healthcare, including primary healthcare (PHC) in the new round of national health reform since 2009. However, the debate...

Drug Utilization and Drug Pricing in the Private Primary Healthcare System in Malaysia: An Employer Price Control Mechanism.

Uncontrolled drug pricing in the private healthcare system in Malaysia leads to high drug prices; however, its impact on employee drug utilization and employer reimbursement coverage is unclear. This study examined patterns of drug pricing and drug utilization among employees covered by employer medical insurance. A drug price control mechanism was also devised for the employer to ensure fair benefits to all parties without compromising the quality of patient care. This retrospective study was conducted among International Islamic University Malaysia (IIUM) community members who sought outpatient treatment at the IIUM panel of health clinics serviced by general practitioners from January 2016 to September 2019. Prescription data (drug type, dose, quantity, duration, price, and manufacturer), patient characteristics (age, sex, and diagnosis) and total charges were extracted from the claims database of PMCare, the insurance company managing IIUM medical claims. Patterns of commonly prescribed drugs, drug pricing, profit margins, and total charges per clinic visit were evaluated. Descriptive statistics were used, and all analyses were performed using Stata v15.1. There were a total of 161,146 prescriptions for 10,150 patients in the IIUM community during the study period (48.85% women, mean ± standard deviation; age: 26.33 ± 17.63 years). The most commonly prescribed drug was paracetamol (25.3%), followed by chlorpheniramine (9.46%), cetirizine (7.3%), diphenhydramine (6.13%), loratadine (4.57%), and diclofenac (4.36%). Generic paracetamol (500 mg), which serves as a prime example for details on drug pricing, is commonly charged between Ringgit Malaysia (RM) 5 and 10 for 10 tablets with a profit between 2,400 and 4,900% according to the average cost price of RM 0.20 per 10 tablets. Most patients were charged within the approved coverage limit of RM 45 per clinic visit, with only 2.41% of patients being charged with costs that exceeded this limit. Uncontrolled drug pricing in the private healthcare system in Malaysia indicates that drug prices differ greatly across private healthcare providers most of the prices were charged with high profit margins. Employers may consider a multilayer capping system to prevent inappropriate drug pricing, which will inevitably benefit patients clinically and economically and provide greater patient access to better drug treatment.

Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

ObjectivesTo identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.DesignA cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance...