Quality Of Primary Health Care Research Articles

Assessing primary healthcare quality through avoidable hospitalizations: a systematic review

Abstract Background Avoidable hospitalization (AH) for ambulatory care sensitive conditions (ACSC) has been widely used as a measure of the performance of primary health care. However, the lack of a standardized definition of these conditions and the absence of conclusive evidence regarding their efficacy across diverse healthcare settings remain significant challenges. This review aims to systematically identify and synthesize the utilization of AH for ACSCs as a metric for evaluating the quality of primary healthcare (PHC) and factors influencing such quality. Methods We conducted a systematic search for peer-reviewed studies on 3 electronic databases. Studies that used AH for ACSCs to investigate the quality of PHC were included. The following characteristics were extracted: study design, ACSCs definition, AH rates, intervention if applicable, PHC and or patients’ characteristics associated to AH rates, such as accessibility, continuity of care, demographics, socio-economic status, and comorbidities. Results 73 relevant articles were identified, published between 1994 and 2023 and mostly in USA. Preliminary findings based on 56 articles indicate that the majority (48.2%) employed the list of ACSCs from the AHRQ (i.e. the prevention quality indicators) (48.2%). Meanwhile, 12 studies (17.9%) used lists developed or modified by the authors, and another 7 (12.5%) adopted lists previously utilized in other research. Studies conducted in Brazil, Canada and USA employed lists issued by relevant national institutions. Conclusions Although preliminary, these findings highlight two main trends. Firstly, in countries where health authorities have established a standardized set of ACSCs, a notable uniformity is observed. Conversely, in the absence of such standards, variability in defining these conditions is likely to increase. This variation could hinder the comparability across different Primary Health Care (PHC) service organizations and affect the analysis of care quality. Key messages • Most studies used established indicators for the measuring of primary healthcare quality. • Diverse ACSC definitions across countries impair the generalizability of healthcare quality analysis.

Improving access and quality of primary healthcare through women and adolescents' user committees: A mixed-methods case study in Kinshasa, Democratic Republic of the Congo.

Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents. Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n=55; WC2: Adolescents user committee (AUC) n=63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative. Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49years old (increase of 283% for Makala and 23% for Maluku II)). Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.

Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria

Achieving universal health coverage (UHC) and the Sustainable Development Goals (SDG) by 2030 relies on the delivery of quality healthcare services through effective primary healthcare (PHC) systems. This necessitates robust infrastructure, adequately skilled health workers and the availability of essential medicines and commodities. Despite the critical role of minimum standards in benchmarking PHC quality, no global consensus on these standards exists. Nigeria has established minimum standards to enhance healthcare accessibility and quality, including the Revised Ward Health System Strategy (RWHSS) by the National Primary Health Care Development Agency (NPHCDA). This paper outlines the evolution of PHC minimum standards in Nigeria, evaluates compliance with RWHSS standards across all public PHC facilities, and examines the implications for ongoing PHC revitalization efforts. The study used a cross-sectional descriptive design to assess compliance across 25 736 public PHC facilities in Nigeria. Data collection involved a national survey using a standardized assessment tool focussing on infrastructure, staffing, essential medicines and service delivery. Compliance with RWHSS minimum standards was found to be below 50% across all facilities, with median compliance scores of 40.7%. Outreach posts had a median compliance of 32.6%, level 1 facilities 31.5% and level 2+ facilities 50.9%. Key findings revealed major gaps in health infrastructure, human resources and availability of essential medicines and equipment. Compliance varied regionally, with the North-west showing the highest number of facilities but varied performance across standards. The lessons learned underscore the urgent need for targeted interventions and resource allocation to address the identified deficiencies. This study highlights the critical need for regular, comprehensive compliance assessments to guide policy-makers in identifying gaps and strengthening PHC systems in Nigeria. Recommendations include enhancing monitoring mechanisms, improving resource distribution and focussing on infrastructure and human resource development to meet UHC and SDG targets. Addressing these gaps is essential for advancing Nigeria’s healthcare system and ensuring equitable, quality care for all.

International students' perceived quality of university health centre services: an exploratory sequential mixed methods study.

This study aims to investigate international students' perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students' requirements, including healthcare services, is essential. A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students' perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students' perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. The qualitative strand revealed five major themes representing the study participants' thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students' socio-demographic characteristics.

Does contracting family doctor promote primary healthcare utilization among older adults? - evidence from a difference-in-differences analysis

IntroductionIn 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients’ health seeking behavior from tertiary hospitals to primary health facilities.MethodsThis study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study.ResultsParticipants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities (P = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not.ConclusionsThe study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

Impact of Family Doctor Contract Services on Preventable Hospitalizations Amongst Patients with Hypertension in Rural China: Mediating Role of Primary Healthcare Quality.

The objective of this study was to explore the connection between family doctor contract services and preventable hospitalizations. Additionally, we sought to examine the role of primary health care quality as a mediating factor in the link between family doctor contract services and preventable hospitalizations among patients with hypertension. This cross-sectional study was performed in Dangyang (Hubei Province, Central China) and Xishui (Guizhou Province, Western China) counties in July-August 2023. Participants comprised 625 patients selected via a multi-stage sampling method. Causal mediation analysis was conducted to explore the effect of family doctor contract services on preventable hospitalizations and the mediating effect of primary healthcare quality on this relationship. Utilization rate of family doctor contract services of hypertensive patients was 58.6%, score of primary health service quality was 70.75 and incidence of preventable hospitalizations was 28.2%. Amongst hypertensive patients, utilization of family doctor contract services decreased the occurrence of preventable hospitalizations, with a total effect of -0.22 (p < 0.001). Primary healthcare quality mediates the association, with a mediate effect of -0.05 (p < 0.001), explaining 22.73% of the total effect. Improving the utilization of family doctor contract services and primary healthcare quality may result in lower rates of preventable hospitalizations amongst hypertensive patients.

Assessment of multi-professional primary healthcare center quality by patients with multimorbidity

BackgroundThe main aim of this study was to build an item bank for assessing the care quality of multi-professional healthcare centers (MPHCC) from the perspective of patients with multimorbidity. This study was part of the QUALSOPRIM (QUALité des SOins PRIMaires; primary healthcare quality) research project to create a psychometrically robust self-administered questionnaire to assess healthcare quality.MethodsFirst, twelve experts built an item bank using data from a previous qualitative work and a systematic literature review. Second, the validity of each item was assessed in a sample of patients. Adult patients with multimorbidity were recruited from six French MPHCC. Items were assessed based on ceiling effects, the level of missing or neutral responses and patient feedback. Patient feedback was recorded after the item bank completion. Based on results, items were validated, improved, or removed during expert meetings. In case of disagreement the Delphi method was used to reach consensus.ResultsThe study sample included 209 outpatients. The most frequent medical conditions were cardiovascular risk factors, cardiovascular diseases and rheumatological conditions. In total, a bank of 109 items classified in nine domains was built. The validity assessment led to the removal of 34 items. Retained items explored a variety of topics related to care quality: availability, accessibility, premises’ layout and building, technical care, expertise, organization, relationships with caregivers and communication, involvement and personal relationships.ConclusionsThis study allowed cross-validation of a bank of 75 items, leading to a complete picture of the patient perception of care quality items. Overall, patients were generally satisfied with their care at the MPHCC. Nonetheless, there were still numerous items on subjects for which patients’ satisfaction could be improved.

Assessing patient satisfaction and healthcare delivery amidst the COVID-19 pandemic: insights from Jammu and Kashmir, India

IntroductionAmidst the challenges posed by Covid-19, assessing healthcare quality in India is crucial, particularly through patient satisfaction levels.MethodologyA cross-sectional survey of 277 participants in Jammu and Kashmir was conducted, utilizing a semi-structured questionnaire and PSQ-18. Data analysis was performed using SPSS (v25) including Chi-Square tests and Descriptive analysis.ResultsOut of 277 participants, 70.8% expressed high satisfaction with medical care. Majority (70%) agreed that doctors explained medical tests well. Additionally, 70% strongly agreed that their doctor’s office was well-equipped. Dissatisfaction factors were notably low. Significant associations were found between age and alcohol use (p = 0.041), gender and alcohol use (p = 0.007), gender and tobacco use (p = 0.032), and education level and vaccination (p = 0.001).ConclusionThe study highlights high patient satisfaction during the pandemic. Improving accessibility and quality of primary healthcare and community centres is essential to meet patient needs effectively.

Intention of Retention and Its Predictors among PHC Workers in Buraidah, Saudi Arabia

Introduction: The turnover of healthcare professionals is seen to be a significant contributor to the shortage of healthcare personnel. This study aimed to evaluate the level and predictors of retention intention among primary health workers (PHWs) in Buraidah, KSA. Methods: This cross-sectional study was conducted among primary healthcare workers in Buraidah, Qassim between the period from October 2023 to March 2024. Data were collected using an online self-administered questionnaire. The used scales in the study were the Job Autonomy Scale (JAS) and the Anticipated Turnover Scale (ATS). Data were analyzed using SPSS version 21.0. Results: A total of 194 healthcare workers were enrolled in this study; there were 50.5% males and 35.1% physicians. The mean ± SD of turnover intention was 37.2 ± 7.92 out of a maximum possible score of 75. The mean score of turnover intention was significantly affected by job title (p < 0.001), education level (p = 0.005), marital status (p = 0.004), attending certificate programs (p = 0.002), work method autonomy (p < 0.001), and total autonomy score (p = 0.008). Multivariate analysis revealed that the predictors of turnover intention were other job titles B 8.53 (95% CI: 6.17–10.89), ever married B –3.87 (95% CI: −5.80 to 1.94), and not attending certificate programs B –5.55 (95% CI: −8.46 to −2.63). Job autonomy did not show any association with turnover intention. Conclusion: Turnover intention was a significant problem among PHW in Buraidah, Saudi Arabia. The predictors of turnover intention included job title, marital status, and attending or having certificate programs. There is a need to address the issue of turnover intention among PHWs to ensure the provision of quality primary healthcare services to the population.

Good Management Practice Is Correlated With Good Performance of Community-Engaged Primary Health Care Facilities in Peru.

Increasing prioritization of quality primary health care (PHC) includes community engagement as a key element to improve PHC performance. We assessed the correlation of good regional management practices with PHC performance in Peru in community-comanaged PHC that is designed with multiple accountability mechanisms. We conducted a secondary analysis of a survey of Dirección Regional de Salud (regional health directorates, DIRESAs) regarding their management of public PHC services with collaborative community involvement by a Comunidad Local de Administración de Salud (Local Community for Health Administration, CLAS). CLAS-run facilities have previously shown evidence of superior performance over standard PHC services. We classified survey questions on 5 management functions of the Primary Health Care Performance Initiative: leadership, information system, financial control, transfer of management and leadership skills to health facilities, and supervision. An expert panel designated management practices as "good" or "less effective." The outcome, PHC service performance, was the percentage of CLAS comanaged facilities in each DIRESA achieving coverage and utilization goals. We correlated frequency of good management practices with PHC service performance. DIRESAs were divided into Group 1, "higher performance," and Group 2, "lower performance," to identify specific practices linked to better performance. We identified 32 good management practices among 52 response options to 17 questions. Correlation between good management practice and good service performance was significant (r=.7266; 12 df; P<.01). An average of 91.1% and 37.6% of CLAS facilities achieved service goals in Groups 1 and 2, respectively. Of all good management practices identified, an average of 40.6% and 24.0% were used by Groups 1 and 2, respectively. Group 1 used 11 specific good practices more frequently than Group 2. Regional management and community-comanaged PHC services designed with accountability mechanisms should be intentionally aligned, incorporating these into policies, budgets, processes, and capacities to strengthen PHC services.

Family Health Clinical Officers: Key professionals to strengthen primary healthcare in Kenya.

Primary healthcare (PHC) is recognised as the means to achieve universal health coverage, a national priority for Kenya. With only approximately 200 family physicians for a population of over 54 million, innovative solutions for providing quality PHC are needed. Clinical Officers, as mid-level health workers, already provide much of the primary care across Kenya, but without specialised training. To provide highly trained Family Health practitioners, a Higher Diploma in Family Health for Clinical Officers (FHCO) was launched by the government in 2018. With experience in delivering innovative and strategic higher diplomas, AIC Kijabe Hospital has been involved in curriculum development of this new diploma since its inception, and in October 2021 the first cohort of FHCO trainees was admitted to Kijabe College of Health Science, graduating in 2023. The second cohort is underway with plans for an annual intake. The FHCO graduates are running Family Medicine clinics at AIC Kijabe Hospital and its satellite clinics and are heavily involved in teaching. They are well-trained to deliver comprehensive, evidence-based, cost-effective and holistic care. As the programme expands, we expect graduates to be working across the country and leading efforts in enhancing the health and well-being of individuals, families and communities within primary healthcare networks (PCNs). By training FHCOs, this higher diploma is an efficient and cost-effective way to improve PHC, particularly for underserved Kenyans, and thus is a key part of enabling the Kenyan Government to achieve universal health coverage. This model of training could easily be replicated in other countries.

Telemedicine in primary care of older adults: a qualitative study

BackgroundThe COVID-19 pandemic changed the healthcare system, leading to the rapid evolution and implementation of telemedicine (TM). TM has the potential to improve the quality of primary health care and increase accessibility for the population. However, its use may represent challenges for older people, as they may have distinct needs from the general population due to age-related changes in perceptual, motor, and cognitive capacities. We, thus, aimed to identify potential facilitators and barriers to TM use in primary care for older adults and develop recommendations accordingly.MethodsWe conducted a qualitative study to explore the challenges associated with TM use among older adults and healthcare professionals (HCPs) in primary care practice. Interviews were conducted with 29 older adults, and three focus groups involving HCPs from four McGill family medicine sites were organized. Employing a hybrid codebook thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), we identified facilitators and barriers affecting the optimal use of TM by older adults and HCPs. We synthesized the results from semi-structured interviews and focus groups. These findings were then presented during a deliberative dialogue with eight participants, including family physicians, nurses, a social worker, and a government-level TM expert, to validate our results. The purpose was to gather feedback, identify and refine actionable recommendations. Subsequently, we utilized a thematic analysis using the same codebook to synthesize findings from the deliberative dialogue.ResultsParticipants agreed that TM contributed to maintaining the continuity of care and was particularly convenient when there was an existing or established patient-physician relationship or for addressing minor health issues. TM was found to be beneficial for people with limited mobility, reducing their exposure to potentially high-risk environments. However, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Additionally, issues related to miscommunication due to language or hearing barriers were identified. HCPs perceived that most older adults did not consider phone consultations a medical act. Participants were open to a hybrid approach, combining in-person consultations and TM, based on their specific health conditions. Building upon these results, we formulated seven key recommendations.ConclusionsBoth older adults and HCPs consider TM a good alternative for accessing healthcare services. To improve the effective use of TM, it’s crucial to advocate for a hybrid approach that integrates both in-person and virtual methods. This approach should actively encourage and support individuals in becoming familiar with technological tools.

Barriers and enablers to improving integrated primary healthcare for non-communicable diseases and mental health conditions in Ethiopia: a mixed methods study

BackgroundThe Ethiopian Primary Healthcare Clinical Guidelines (EPHCG) seek to improve quality of primary health care, while also expanding access to care for people with Non-Communicable Diseases and Mental Health Conditions (NCDs/MHCs). The aim of this study was to identify barriers and enablers to implementation of the EPHCG with a particular focus on NCDs/MHCs.MethodsA mixed-methods convergent-parallel design was employed after EPHCG implementation in 18 health facilities in southern Ethiopia. Semi-structured interviews were conducted with 10 primary healthcare clinicians and one healthcare administrator. Organisational Readiness for Implementing Change (ORIC) questionnaire was self-completed by 124 health workers and analysed using Kruskal Wallis ranked test to investigate median score differences. Qualitative data were mapped to the Consolidated Framework for Implementation Science (CFIR) and the Theoretical Domains Framework (TDF). Expert Recommendations for Implementing Change (ERIC) were employed to select implementation strategies to address barriers.ResultsFour domains were identified: EPHCG training and implementation, awareness and meeting patient needs (demand side), resource constraints/barriers (supply side) and care pathway bottlenecks. The innovative facility-based training to implement EPHCG had a mixed response, especially in busy facilities where teams reported struggling to find protected time to meet. Key barriers to implementation of EPHCG were non-availability of resources (CFIR inner setting), such as laboratory reagents and medications that undermined efforts to follow guideline-based care, the way care was structured and lack of familiarity with providing care for people with NCDs-MHCs. Substantial barriers arose because of socio-economic problems that were interlinked with health but not addressable within the health system (CFIR outer setting). Other factors influencing effective implementation of EPHCG (TDF) included low population awareness about NCDs/MHCs and unaffordable diagnostic and treatment services (TDF). Implementation strategies were identified. ORIC findings indicated high scores of organisational readiness to implement the desired change with likely social desirability bias.ConclusionAlthough perceived as necessary, practical implementation of EPHCG was constrained by challenges across domains of internal/external determinants. This was especially marked in relation to expansion of care responsibilities to include NCDs/MHCs. Attention to social determinants of health outcomes, community engagement and awareness-raising are needed to maximize population impact.

Predictors of time to recovery from uncomplicated severe acute malnutrition among children in eastern Ethiopia.

Managing severe acute malnutrition (SAM) involves an outpatient therapeutic program (OTP), targeting more than 80% of SAM children where the quality of primary healthcare remains poor. Treatment success and recovery from SAM remain poor and could be affected by many factors, where such evidence is limited in East Hararghe. This study assessed the predictors of time to recovery from SAM in eastern Ethiopia. A retrospective cohort study was conducted on 402 records of SAM children under 5 years of age enrolled on OTP at 12 health posts retrieved from 2020 to 2021. We used the Kaplan-Meir estimate along with the p-value of the log-rank test and the survival curve to compare the time to recovery across categories. A multivariable Cox proportional hazard model was fitted to identify predictors of time to recovery from SAM. A p-value below 0.05 was used to declare statistical significance. A total of 402 records were reviewed, and the cure rate from SAM was 89.6% [95% confidence interval (CI), 87-93]. Moreover, a death rate of 0.7%, a default rate of 9.5%, and a non-responder rate of 0.2% were obtained with a median length of stay of 7 weeks. The median time to recovery was significantly shorter for children from shorter distances from OTP sites with edema, amoxicillin, (p < 0.05). Edema at admission [adjusted hazard ratio (AHR) = 1.74; 95% CI: 1.33-2.29], without diarrhea (AHR = 1.51; 95% CI: 1.18-1.94), taking amoxicillin (AHR = 1.55; 95% CI: 1.19-2.02), shorter travel time to the OTP site (AHR = 1.44; 95% CI: 1.13-1.85), breastfeeding (AHR = 1.60; 95% CI: 1.27-2.02), adequacy of ready-to-use therapeutic food (RUTF) (AHR = 1.22; 95% CI: 0.90-1.65), and new admission (AHR = 1.62; 95% CI: 0.84-3.10) were important predictors of recovery from SAM. Recovery from SAM was found to be acceptable in comparison with the Sphere Standards and is predicted by edema, diarrhea, distance from the OTP site, amoxicillin, and RUTF adequacy. These allow for focused interventions that address the identified factors for better recovery from SAM.

Community-led monitoring and the role of Ritshidze in improving the quality of primary healthcare in South Africa.

Community-led monitoring (CLM) of health services is a mechanism of community participation and accountability that is increasingly advocated across the globe. In South Africa (SA), a large-scale community-led monitoring initiative called Ritshidze ('saving our lives') was established in 2019. Steered by a coalition of civil society organisations representing people living with HIV, Ritshidze monitors just over 400 primary healthcare (PHC) facilities in 8 provinces on a quarterly basis. In this piece we describe the purposes and design features and the five-step approach to CLM of the Ritshidze model. We also highlight some of the positive changes achieved, and reflect on possible reasons for successes. In doing so, we aim to draw attention to this significant national initiative and its potential as a mechanism of social accountability in SA.

Exploring the path to optimal diabetes care by unravelling the contextual factors affecting access, utilisation, and quality of primary health care in West Africa: A scoping review protocol.

The prevalence of diabetes in West Africa is increasing, posing a major public health threat. An estimated 24 million Africans have diabetes, with rates in West Africa around 2-6% and projected to rise 129% by 2045 according to the WHO. Over 90% of cases are Type 2 diabetes (IDF, World Bank). As diabetes is ambulatory care sensitive, good primary care is crucial to reduce complications and mortality. However, research on factors influencing diabetes primary care access, utilisation and quality in West Africa remains limited despite growing disease burden. While research has emphasised diabetes prevalence and risk factors in West Africa, there remains limited evidence on contextual influences on primary care. This scoping review aims to address these evidence gaps. Using the established methodology by Arksey and O'Malley, this scoping review will undergo six stages. The review will adopt the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines to ensure methodological rigour. We will search four electronic databases and search through grey literature sources to thoroughly explore the topic. The identified articles will undergo thorough screening. We will collect data using a standardised data extraction form that covers study characteristics, population demographics, and study methods. The study will identify key themes and sub-themes related to primary healthcare access, utilisation, and quality. We will then analyse and summarise the data using a narrative synthesis approach. The findings and conclusive report will be finished and sent to a peer-reviewed publication within six months. This review protocol aims to systematically examine and assess the factors that impact the access, utilisation, and standard of primary healthcare services for diabetes in West Africa.

Managing the quality of primary health care in urban China: the impact of organizational and physician features.

Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Evaluation of an online "Train the Trainers" course for family physicians in Pakistan: Expectations vs reality.

Pakistan is in dire need of trained family physicians to enhance the quality of primary health care. To build capacity, there is a need to train the trainers on a large scale through a feasible and accessible program. Therefore, for the first time, a three-month online course was designed and piloted, in collaboration with national and international family medicine faculty. The aim of this study was to determine the gap between the pre-course expectations and the post-program perceptions of the participants for* a unique family medicine "Train the Trainers" course. A longitudinal-observational study was conducted at a private college of Karachi after approval from the Institutional Review Board. The expectations and perceptions of all (31) participants were recorded through a pre- and post-course questionnaire. Data were analyzed through descriptive and analytical statistics on SPSS-26. The responses to the open-ended questions were analyzed by content analytical approach. Out of 20 quantitative items on the questionnaire, four were associated with a positive gap between the expectations and perceptions. One item showed a negative gap, while the rest did not show any significant difference. The majority of the participants expressed that they expected to see an improvement in their teaching skills because of the online course. The online course was successful in meeting the participants' expectations. The course delivery can be revisited to further improve its quality according to the participant's feedback, including an opportunity to ask questions and incorporating some face-to-face sessions.

Primary Health Care: the Relational Aspects of Social Interaction between Family Doctors and People with Disabilities

Strategic documents of the United Nations and the European Union express the belief that primary health care is a fundamental part of health care services and it must be accessible to all people and funded according to the means. Many research studies prove that enhancement of the primary health care system helps to effectively eliminate causes and risk factors for poor health and to prevent likely impairment of health in the future. However, the data of recent investigations demonstrate that the quality of health care services in Lithuania is much poorer than the average of the EU, and the institution of family doctors providing services of this type suffers from problems related to the efficiency of functioning. Therefore, it is worth investigating possible causes for this problem, to identify them and search for solutions. The paper presents the research that is aimed at examining one part of the aspects of the problem, specifically the relational aspects of social interaction between family doctors and people with disabilities from the point of view of people with disabilities and their relatives. 555 people with disabilities (PWD) and 540 respondents who had relatives with disabilities and took care of them (PWDcare) participated in the survey carried out in 2019–2020 and reported about their experience of social interaction with family doctors. The research indicated many positive tendencies, of which the most prominent was the satisfaction of the relationship, trust and understandment with family doctors. But at the same time the research revealed some more problematic areas, such as the lack of family doctors’ compassion and warmth to many patients. These results are important for improving the primary health care service and quality as well for strengthening the family doctors’ education.