Quality Of Primary Health Care Research Articles

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.

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.

Change in avoidable hospitalizations for low-income elders following quasi-market reform in primary care – Evidence from a natural experiment in Sweden

Quasi-market reforms have been increasingly implemented in tax-funded health care, but their effects in terms of equity, quality and socioeconomic differentials in quality remain sparsely studied.We create a natural experiment setup exploiting the differential timing of a set of quasi-market reforms – including patient choice, free establishment of providers and changes in provider remuneration –, implemented in primary care in the two largest Swedish regions (Stockholm and Västra Götaland) in 2008–2009. Using a database with individual level data from 2005 to 2009, we construct a difference-in-difference-in-differences model that compares pre to post reform changes in avoidable hospitalizations (AHs) for low-income elders and a matched comparison group, in the region exposed to, versus unexposed to, reform (total N ∼ 200 000).The results show that for low-income elders – a group dominated by older women – reform led to higher AH rates, i.e., worse primary health care quality, than what would have been the case in absence of reform. Specifically, low-income elders exposed to reform missed out on improvements in AHs seen simultaneously in the unexposed region. At the same time, the reform had on average no effect for comparable, non-low-income, peers. The fact that this pattern was specific for avoidable hospitalizations – judged as amenable to interventions in primary care –, but not present for total hospitalizations, supports that it was driven by reform implementation rather than other factors.The study contributes with high-quality empirical evidence to a policy relevant but sparsely researched area and highlights the necessity to consider differential effects of organizational changes across socioeconomic groups.

Impact of primary care coverage on hospital admissions for conditions sensitive to primary care in the municipality of Rio Verde – GO

The indicator Hospitalizations for Causes Sensitive to Primary Care (ICSAP) has been used as an indicator of access and quality of primary health care, and its high rates have been correlated with deficiencies in service coverage or an inadequate resolution capacity of primary care for certain basic health problems, The study was carried out with the objective of characterizing the rates of hospital admissions for causes sensitive to primary care in the city of Rio Verde – GO, as well as describing its historical series and verifying the impact of Primary Care coverage, in period from 2008 to 2018. Ecological time series study, whose data were collected from the Hospital Admissions System of the Unified Health System, based on the Brazilian List of Admissions for Conditions Sensitive to Primary Care. For data analysis, the research was divided into two axes: clinical-epidemiological and demographic aspects. The causes of hospitalizations for conditions sensitive to primary care were based on the list from the Ministry of Health. It was concluded that hospitalizations for conditions sensitive to primary care showed a reduction, while the coverage of primary care and the health strategy teams of the family, an increase was observed throughout the period analyzed. The three main groups with the highest percentage of hospitalizations for conditions sensitive to primary care were infectious gastroenteritis, followed by heart failure and lung diseases.

The association of family doctor contract service and patient trust in doctor: evidence from twenty-five village clinics of three counties in rural China

BackgroundChina is implementing the family doctor (FD) system to reform the primary healthcare (PHC). The family doctor contract service (FDCS) policy plays a crucial role in this system implementation, aiming to transform the doctor-patient relationship and enhance PHC quality. This study aims to investigate the impact of FDCS on the doctor-patient relationship in PHCs using field research methodology.MethodThe field research methodology was employed to address the research questions. Quantitative methods were utilized for data collection and analysis. A structure questionnaire was used to collect data based on the research questions. Our investigation encompassed twenty-five village clinics across three counties in China. A total of 574 subjects helped us to finish this investigation in the study. The collected data was analyzed using statistical analysis including ordinary least squares (OLS) model and propensity scores matching model (PSM) to estimate the relationship.ResultThe findings from ordinary least squares (OLS) regression revealed that FDCS had a positive influence on patient trust in doctors within PHCs, with patients who participated the FDCS exhibiting higher levels of trust compared to those who did not participate. Propensity score matching (PSM) analysis further confirmed these results by accounting for selection bias.ConclusionsThe implementation of family doctor contract service has brought about significant transformation in the doctor-patient relationship within rural Chinese PHCs. In essence, it has revolutionized the service model of doctor in PHC, playing a pivotal role in improving primary health quality and enhance the service capability of doctors in PHC. This transformative process has been crucial for carrying out hierarchical diagnosis and treatment policy, which aims to adjust the medical service structure and optimizing the health service system. Therefore, it is imperative for government authorities and health administration departments to ensure continuous support for this essential service through appropriate formulation.

An Explainable and Personalized Cognitive Reasoning Model Based on Knowledge Graph: Toward Decision Making for General Practice.

General practice plays a prominent role in primary health care (PHC). However, evidence has shown that the quality of PHC is still unsatisfactory, and the accuracy of clinical diagnosis and treatment must be improved in China. Decision making tools based on artificial intelligence can help general practitioners diagnose diseases, but most existing research is not sufficiently scalable and explainable. An explainable and personalized cognitive reasoning model based on knowledge graph (CRKG) proposed in this article can provide personalized diagnosis, perform decision making in general practice, and simulate the mode of thinking of human beings utilizing patients' electronic health records (EHRs) and knowledge graph. Taking abdominal diseases as the application point, an abdominal disease knowledge graph is first constructed in a semiautomated manner. Then, the CRKG designed referring to dual process theory in cognitive science involves the update strategy of global graph representations and reasoning on a personal cognitive graph by adopting the idea of graph neural networks and attention mechanisms. For the diagnosis of diseases in general practice, the CRKG outperforms all the baselines with a precision@1 of 0.7873, recall@10 of 0.9020 and hits@10 of 0.9340. Additionally, the visualization of the reasoning process for each visit of a patient based on the knowledge graph enhances clinicians' comprehension and contributes to explainability. This study is of great importance for the exploration and application of decision making based on EHRs and knowledge graph.

Myriad untold stories unfolding daily: South Africa's pursuit of quality primary health care.

No abstract available.

Availability and quality of primary health care in the compulsory health insurance system in Kazakhstan

Availability and quality of primary health care in the compulsory health insurance system in Kazakhstan

The quality of primary health care: assessment of the state and ways of improvement (results of a sociological study)

The quality of primary health care: assessment of the state and ways of improvement (results of a sociological study)

Unmet need for healthcare in the Russian Federation: subnational retrospective modelling analysis (2014–2018)

IntroductionUnmet need for healthcare is a proxy indicator used to assess the performance of healthcare systems throughout the world. While the Russian Federation is committed to improving healthcare for its...

Evaluating Primary Healthcare Quality from Migrants and Refugees' Viewpoint.

The likelihood of poor health outcomes for refugees is increased due to a variety of complicated causes. Lack of access to high-quality care during resettlement is frequently cited by migrants. Therefore, this study was carried out to assess the quality of primary care services from the perspective of refugees and migrants. This cross-sectional study was conducted in three health networks affiliated with Iran University of Medical Sciences in 2021. Data were collected by using a self-administrative questionnaire, the validity and reliability of which were checked and confirmed. The questionnaires were randomly completed by 280 migrants and refugees. Data were analyzed by using Kruskal-Wallis, Mann-Whitney U, Spearman correlation, exploratory factor analysis, and Cronbach's α with SPSS 22. According to the results, the overall service quality was 3.86 out of 5. The highest and lowest mean scores were related to efficiency (4.12 ±0.64) and tangibility (3.28 ±0.39). Furthermore, there was a significant relationship between the perception of service quality and gender, education, residence area, and the rate of center visits (P < 0.05). The quality of services was generally rated favorably by the refugees. Managers and decision-makers are recommended to allocate enough funds to equip and upgrade the amenities at health centers to increase the quality of services.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states. We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state. We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano. Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

The Comprehensive Primary Care Plus Model and Health Care Spending, Service Use, and Quality

Implemented in 18 regions, Comprehensive Primary Care Plus (CPC+) was the largest US primary care delivery model ever tested. Understanding its association with health outcomes is critical in designing future transformation models. To test whether CPC+ was associated with lower health care spending and utilization and improved quality of care. Difference-in-differences regression models compared changes in outcomes between the year before CPC+ and 5 intervention years for Medicare fee-for-service beneficiaries attributed to CPC+ and comparison practices. Participants included 1373 track 1 (1 549 585 beneficiaries) and 1515 track 2 (5 347 499 beneficiaries) primary care practices that applied to start CPC+ in 2017 and met minimum care delivery and other eligibility requirements. Comparison groups included 5243 track 1 (5 347 499 beneficiaries) and 3783 track 2 (4 507 499 beneficiaries) practices, matched, and weighted to have similar beneficiary-, practice-, and market-level characteristics as CPC+ practices. Two-track design involving enhanced (higher for track 2) and alternative payments (track 2 only), care delivery requirements (greater for track 2), data feedback, learning, and health information technology support. The prespecified primary outcome was annualized Medicare Part A and B expenditures per beneficiary per month (PBPM). Secondary outcomes included expenditure categories, utilization (eg, hospitalizations), and claims-based quality-of-care process and outcome measures (eg, recommended tests for patients with diabetes and unplanned readmissions). Among the CPC+ patients, 5% were Black, 3% were Hispanic, 87% were White, and 5% were of other races (including Asian/Other Pacific Islander and American Indian); 85% of CPC+ patients were older than 65 years and 58% were female. CPC+ was associated with no discernible changes in the total expenditures (track 1: $1.1 PBPM [90% CI, -$4.3 to $6.6], P = .74; track 2: $1.3 [90% CI, -$5 to $7.7], P = .73), and with increases in expenditures including enhanced payments (track 1: $13 [90% CI, $7 to $18], P < .001; track 2: $24 [90% CI, $18 to $31], P < .001). Among secondary outcomes, CPC+ was associated with decreases in emergency department visits starting in year 1, and in acute hospitalizations and acute inpatient expenditures in later years. Associations were more favorable for practices also participating in the Medicare Shared Savings Program and independent practices. CPC+ was not associated with meaningful changes in claims-based quality-of-care measures. Although the timing of the associations of CPC+ with reduced utilization and acute inpatient expenditures was consistent with the theory of change and early focus on episodic care management of CPC+, CPC+ was not associated with a reduction in total expenditures over 5 years. Positive interaction between CPC+ and the Shared Savings Program suggests transformation models might be more successful when provider cost-reduction incentives are aligned across specialties. Further adaptations and testing of primary care transformation models, as well as consideration of the larger context in which they operate, are needed.

Quality of antenatal care in primary health care in Brazil: a latent class analysis

Abstract Background Adequate antenatal care (ANC) is fundamental in preventing maternal and neonatal mortality. Developing indicators for assessing the ANC quality in Primary Health Care (PHC) is essential. Objective To characterize subgroups of quality of care with respect to ANC at the PHC level in Brazil. Methods We conducted a cross-sectional study with data from the first Brazil’s National Program for Improving Primary Care Access and Quality (PMAQ-AB) Cycle (2011–2012). A total of 16 566 PHC teams participated in the first cycle of the PMAQ-AB, corresponding to 49.6% of the teams active across Brazil, distributed across 69.3% of Brazilian municipalities. To assess the quality of ANC, six indicators were defined: ‘Group of medicines,’ ‘Protocols and patient flows,’ ‘Record-keeping practices,’ ‘ANC routine tests,’ ‘Protocols for early detection of pregnant women and ANC provision,’ and ‘Identification and ANC of low/high-risk pregnancies.’ Latent Class Analysis (LCA) was carried out to characterize the quality of care provided by PHC teams according to these six indicators. Results ‘Identification and ANC of low/high-risk pregnancies’ indicator had the highest percentage of teams providing adequate care (39.5%), while ‘ANC routine tests’ had the lowest percentage (16.8%). The LCA identified three classes, and 20.5% of PHC teams had the probability of belonging to the class denominated ‘High adequacy.’ Conclusion Using a national PHC-level dataset, we evaluated PHC teams’ ANC adequacy through six indicators. Brazilian PHC teams consistently show weaknesses across these indicators, particularly in essential care. This approach can guide global initiatives to evaluate the quality of ANC.

Quality Control in Primary Healthcare in Saudi Arabia: A Systematic Review

Introduction: The quality of primary healthcare is crucial for ensuring efficient and effective patient care, particularly in rapidly evolving healthcare systems like that of Saudi Arabia. With ongoing reforms aimed at improving healthcare delivery, there is a pressing need to assess the state of quality control within primary healthcare settings. This systematic review aimed to evaluate the effectiveness of various quality control interventions implemented in primary healthcare centers in Saudi Arabia, focusing on their impact on patient care and system efficiency. Methods: The review strictly included interventional studies and clinical trials published in the last years up to 2022, employing a comprehensive search across multiple databases including PubMed, Scopus, Web of Science, and the Cochrane Library. Inclusion criteria were set to consider only studies that directly addressed quality control measures within primary healthcare settings in Saudi Arabia, with clear intervention and outcome measures. The analysis synthesized data on the types of interventions, sample sizes, and effectiveness, including risk ratios and percentage improvements with their confidence intervals. Results: Seven studies were included, revealing a range of interventions from EHR implementations to provider training programs and patient feedback systems. Key findings include a 55% reduction in medication errors following EHR system implementation, a 35% increase in compliance with national quality standards post-provider training, a 20% increase in patient satisfaction with the introduction of patient feedback systems, and a 30% improvement in patient outcomes from clinical guideline updates for chronic disease management. Conclusions: The review demonstrates that targeted interventions can significantly enhance quality control in primary healthcare settings in Saudi Arabia, with notable improvements in medication accuracy, compliance with quality standards, patient satisfaction, and clinical outcomes. These findings highlight the potential of comprehensive, integrated quality control measures to advance patient care and healthcare system efficiency.

Association between hospitalizations for sensitive conditions and quality of primary care.

To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019. Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman's test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years. A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations. The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators.

Programa Médicos pelo Brasil: primeiros resultados

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Doctors for Brazil Program: first results.

Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Development and validation of primary health care quality assessment tool

BackgroundAssessing the quality of health services gives insights to managers about the status of services delivered by them, especially from the client’s perspective. Although various tools have been developed to measure the quality of primary health care (PHC), no specific tool was found in this field in Iran. Therefore, the present study was conducted to develop and validate the quality assessment tool of PHC in Iran.MethodsThis methodological study was conducted in 2021. In the first step, based on a literature review, an initial questionnaire was designed, and its face validity, content validity, construct validity, and reliability were evaluated. Descriptive tests, Kolmogorov-Smirnov, exploratory factor analysis, Kaiser-Myer-Olkin (KMO), and Cronbach’s alpha were performed by using SPSS 22.ResultsThe initial questionnaire included 33 items, of which three items were removed due to inconsistency with factorization. The final questionnaire consisted of 30 items and nine dimensions: interaction, efficiency, timeliness, accuracy, consultation, tangibility, safety, accessibility, and environment. The KMO and Cronbach’s alpha index values were 0.734 and 0.82, respectively, indicating acceptable reliability and validity. The developed dimensions represented about 73% of the total variance.ConclusionThe designed questionnaire has relatively good validity and reliability and can be used to measure the quality of PHC and to identify weaknesses in service delivery. However, researchers should carefully examine it to enhance its applicability as a standard tool for measuring PHC quality.