Quality Of Primary Health Care Research Articles

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.

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

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;To evaluate patient satisfaction with primary healthcare services and determine effectiveness indicators within Kazakhstan&amp;#039;s compulsory health insurance system.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;An analytical observational study with cross-examination was conducted in Kazakhstan&amp;#039;s primary healthcare (PHC) organizations. Patient satisfaction was assessed through a 35-item closed-question questionnaire. An analysis of stimulating component result indicators for per capital standard financing in PHC organizations based on their achieved outcomes was performed.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Among surveyed patients, 54.0% (1.80&amp;amp;plusmn;1.108) expressed complete satisfaction with medical care, while 59.4%&amp;lt;br /&amp;gt;(1.82&amp;amp;plusmn;1.269) perceived laboratory tests as readily accessible. Notably, males exhibited higher satisfaction levels with medical care and the availability of laboratory tests compared to females. The city polyclinics № 3 and № 14 in Almaty, Kazakhstan, achieved significant performance indicators, resulting in a 1.1-fold increase in the incentive component of per capital funding.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Within the framework of compulsory health insurance, primary healthcare organizations in Kazakhstan offer affordable and effective medical care, as attested by surveyed patients and the final result indicators of the polyclinics.&amp;lt;/p&amp;gt;

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.

Challenges of Health Informatics Systems in Primary Health Care

Health informatics systems are indispensable implements for cultivating the eminence and effectiveness of primary health care. Health informatics systems are formed of databases and figures regarding all clinical facilities. The utilization of health informatics systems helps both healthcare providers and patients in the management of disorders and disease risks and in developing well-being. However, there are a number of challenges to the application and practice of health informatics systems in the settings of primary health care. These challenges embrace; the absence of capital and money, the absence of technical skill, the absence of user recognition and approval, information quality problems, safety and confidentiality concerns, incorporation with other systems, and interoperability deficiency. Human, cultural, and financial barriers with deficiency of technical proficiency, deficiency of a relation between clinicians and patients, worries about information privacy, absence of administration guidelines, bureaucracy, lack of training, English language barrier, the degree of workload due to the time shortness during clinical settings, infrastructure concerns e.g. availability of the electricity, computers, and internet, also high turnover in IT among healthcare are also some challenges that should be addressed. These challenges can hold back the capacity of health informatics systems to comprehend their complete perspective in primary health care. To address these challenges, it is essential to provide sufficient capital and funds, offer practice and maintenance for users, overcome information quality concerns, apply safety and confidentiality procedures, incorporate health informatics systems with other systems, and endorse interoperability. By overcoming these challenges, health informatics systems can play a major role in developing the quality and efficiency of primary health care.

Strategies of Improvement of Access to Quality Primary Healthcare in the United Arab Emirates: Lessons to Learn

Strategies of Improvement of Access to Quality Primary Healthcare in the United Arab Emirates: Lessons to Learn

Healthcare Stakeholders' Perspectives on Challenges in the Provision of Quality Primary Healthcare for People with Disabilities in Three Regions of Guatemala: A Qualitative Study.

It is estimated that 3.75 billion people worldwide lack access to healthcare services. Marginalized populations, such as people with disabilities, are at greater risk of exclusion. People with disabilities not only face the same barriers as people without disabilities, but also experience a range of additional barriers in accessing healthcare due to a variety of discriminatory and inaccessible environments. These extra barriers exist despite their greater need for general healthcare, as well as specialized healthcare related to their impairment. Few studies have focused on healthcare providers and the challenges they face in caring for this group. This paper describes the perspectives of healthcare stakeholders and reported challenges to the provision of quality primary healthcare for people with disabilities. In-depth interviews with 11 healthcare stakeholders were conducted in three regions of Guatemala. Data were analyzed using thematic analysis. Five sub-themes emerged from the above theme: infrastructure and availability of resources, impairment-based challenges, need for special attention and empathy, opportunity to provide services to people with disabilities, and gaps in training. The results could contribute to the development and implementation of strategies that can improve primary care provision and ultimately access to services for people with disabilities in low- and middle-income countries.

Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review.

Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem-featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments-is pivotal for eHealth interventions' success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth's potential is often restricted by existing socio-cultural norms, geographical inequities in technology access, and digital literacy disparities. Our review underscores the importance of considering the digital ecosystem's readiness, user behavior, broader health system requirements, and PHC capacity for adopting digital solutions while assessing digital health interventions' impact.

The review of the book "The general practitioner (the family doctor)" in three volumes by R. S. Gadzhiev

The review analyzes formulated and proposed by prof. R. S. Gadzhiev genuine original comprehension of ways of enhancement and perspectives of development of primary health care by leading role of general practitioner in its development. The author fundamental postulate about priority of complex implementation of all aspects of activity of general practitioner to enhance quality and efficiency of primary health care in Russia is discussed.

The perceptions of nurse managers working in the mining industry on workplace relationships.

Positive workplace relationships improve the quality of healthcare provided by promoting teamwork and ensuring that challenges are addressed amicably. Nurse managers, unit managers, nurses, doctors and union leaders are obligated to establish positive working relationships to deliver quality primary healthcare service to mine workers at the clinics of the mine. However, there are negative workplace relationships at the clinics of a specific mining company that affect the quality of service delivered. The purpose of this study was to explore and describe the perceptions of primary healthcare nurse managers working in the mining industry on workplace relationships. This study was conducted in mining primary healthcare clinics located in Gauteng province, in the West Rand. A qualitative, exploratory, descriptive and contextual research design was adopted in this study. Individual interviews were conducted to collect data from the primary healthcare nurse managers, and data were analysed using thematic analysis. Trustworthiness measures and ethical principles were upheld in this study. Three themes surfaced in this study: (1) negative perceptions of primary healthcare nurse managers on workplace relationships, (2) positive perceptions of primary healthcare nurse managers on workplace relationships and (3) building workplace relationships between primary healthcare nurse managers and union leaders. Nurse managers had positive and negative perceptions on working relationships in this study. Negative workplace relationships should be prevented at all costs by resolving conflicts amicably. Resolving of conflicts amicably to build positive workplace relationships.

Healthcare provider’s performance monitoring for undercovered population during the Covid-19 epidemic, 2021, Tehran: a cross-sectional study

BackgroundConsidering the necessity and importance of providing health care to children during the Covid-19 epidemic, this study aims to investigate primary health workers performance for infants under 6 months during the Covid-19 epidemic and parent’s satisfaction level with these services.MethodsThis was a cross-sectional study conducted among the defined population of Tehran University of Medical Sciences. The descriptive analysis focused on frequencies and percentages. A chi-square test was used to compare the categorical data between the studied groups.ResultsThree-hundred seventy-two participants from two District Health Networks of Islamshahr 90 (24%) and Shahr-e-rey 107 (29%) and South Tehran Health Center 175 (47%) were included in the study. About 45% of 2 months old, 54% of 4 months old, and 42% of 6 months old received full basic healthcare package. Coverage of services such as vaccination and height, weight, and head circumference in all three age groups and health networks was 100%. Training in handwashing, touch the face, and hygiene while breastfeeding (64.4%, p = 0.043) and not to use a pacifier (64%, p = 0.038) in Islamshahr Health Network was significantly less than other health networks. The level of parental satisfaction with the provided services was 90.1%. There is a significant association between the dissatisfaction of the participants and not receiving the services completely (p = 0.000).ConclusionDuring the Covid-19 pandemic, the quality and quantity of primary health care to children have been declined. The focus of health workers was on essential physical health services for infants, and education was almost neglected during this period.

Successes and challenges towards improving quality of primary health care services: a scoping review

BackgroundQuality health services build communities’ and patients’ trust in health care. It enhances the acceptability of services and increases health service coverage. Quality primary health care is imperative for universal health coverage through expanding health institutions and increasing skilled health professionals to deliver services near to people. Evidence on the quality of health system inputs, interactions between health personnel and clients, and outcomes of health care interventions is necessary. This review summarised indicators, successes, and challenges of the quality of primary health care services.MethodsWe used the preferred reporting items for systematic reviews and meta-analysis extensions for scoping reviews to guide the article selection process. A systematic search of literature from PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), Scopus, and Google Scholar was conducted on August 23, 2022, but the preliminary search was begun on July 5, 2022. The Donabedian’s quality of care framework, consisting of structure, process and outcomes, was used to operationalise and synthesise the findings on the quality of primary health care.ResultsHuman resources for health, law and policy, infrastructure and facilities, and resources were the common structure indicators. Diagnosis (health assessment and/or laboratory tests) and management (health information, education, and treatment) procedures were the process indicators. Clinical outcomes (cure, mortality, treatment completion), behaviour change, and satisfaction were the common indicators of outcome. Lower cause-specific mortality and a lower rate of hospitalisation in high-income countries were successes, while high mortality due to tuberculosis and the geographical disparity in quality care were challenges in developing countries. There also exist challenges in developed countries (e.g., poor quality mental health care due to a high admission rate). Shortage of health workers was a challenge both in developed and developing countries.ConclusionsQuality of care indicators varied according to the health care problems, which resulted in a disparity in the successes and challenges across countries around the world. Initiatives to improve the quality of primary health care services should ensure the availability of adequate health care providers, equipped health care facilities, appropriate financing mechanisms, enhance compliance with health policy and laws, as well as community and client participation. Additionally, each country should be proactive in monitoring and evaluation of performance indicators in each dimension (structure, process, and outcome) of quality of primary health care services.

Do Primary Healthcare Facilities in More Remote Areas Provide More Medical Services? Spatial Evidence from Rural Western China

Primary healthcare institutions (PHIs) in China have experienced a sizable decline in medical services in recent years. Despite the large regional disparities in China, there is a lack of evidence on the differential patterns of medical services offered by PHIs, especially from a spatial perspective. This study examines whether residents in more remote areas use more medical services offered by township healthcare centers (THCs), a main type of PHIs. Linking medical visits to 923 THCs in a western Chinese province in 2020 with the driving time and geographic coordinates from the Gaode map, a leading map navigation provider in China, we applied a multilevel linear model and a geographically weighted regression to examine spatial heterogeneity in medical service utilization. We showed that a one-hour increase in the shortest driving time between THCs and the local county hospitals was associated with an average 6% increase in THCs outpatient visits and a 0.6% increase in THCs inpatient visits. Our findings suggest that THCs located in more remote areas provided more medical services, especially outpatient services. This study may improve our understanding of the spatial disparity in medical services provision for THCs in western China. We suggest that more attention should be paid to enhance the quality of THCs in remote areas, which deserve a higher priority in the process of improving the quality of primary healthcare. Health policymaking in developing regions such as western China should take geographic factors into account.

Birinci basamak sağlık hizmetlerinin kalitesinin değerlendirilmesine yönelik küresel çabaların genel değerlendirmesi

The quality of health care has been the subject of research for many years. However, the studies have mostly focused on the problems of clinical medicine, and relatively little work has been done on the quality of primary health care. As the health systems around the world are faced with social, economic, and demographical challenges, countries started to lean towards primary health care which can adapt and respond to an ever-changing world. Quality primary health care is shown to provide accessible, affordable, comprehensive, continuous, coordinated and people-centered care in the community. It plays an important role in ensuring equity in health, reducing morbidity and mortality, optimizing efficient use of resources, achieving better health outcomes, and improving the health of populations. Over the past decades, quality improvement has received increasing attention as a systematic approach guided by scientific evidence-based data; and is regarded the crucial component of health systems strengthening. The global health community has made concrete efforts to improve the quality of health care across primary, secondary and tertiary levels of health systems. Several organizations have developed frameworks and quality indicators to be used as quality assessment tools, and countries have defined their own national frameworks, quality indicators and standards to assess the quality of primary health care. The current study aims to provide a chronological review of the global efforts towards quality assessment in primary health care.

The effect of statins on mortality and cardiovascular disease in primary care hypertensive patients without other cardiovascular disease or diabetes.

Studies in primary healthcare (PHC) assessing the effect of primary prevention with statins on mortality and cardiovascular disease (CVD) are scarce. This study aimed to estimate the effect of statins on all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke in individuals in PHC with hypertension without CVD or diabetes. Using the Swedish PHC quality assurance register QregPV, the study included 13 193 individuals with hypertension without CVD or diabetes, who had filled a first statin prescription between 2010 and 2016, and 13 193 matched controls without a filled statin prescription at the index date. Controls were matched on sex and propensity score using clinical data and data from national registers on comorbidities, prescriptions, and socioeconomic status. The effect of statins was estimated in Cox regression models. During a median of 4.2 years of follow-up, 395 individuals in the statin group vs. 475 in the control group died, 197 vs. 232 died of cardiovascular disease, 171 vs. 191 had an MI, and 161 vs. 181 had a stroke. The treatment effect of statins was significant for all-cause mortality [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74-0.93] and cardiovascular mortality (HR 0.85, 95% CI 0.72-0.998). Overall, no significant treatment effect of statins was seen for MI (HR 0.89, 95% CI 0.74-1.07), but there was a significant interaction with sex (P = 0.008) with decreased risk of MI for women but not for men (HR 0.66, 95% CI 0.49-0.88 vs. HR 1.09, 95% CI 0.86-1.38). Primary prevention with statins in PHC was associated with reduced risk of all-cause mortality, cardiovascular mortality, and in women, lower risk of MI.

Cистема оплаты труда как инструмент влияния на качество первичной медико-санитарной помощи

Qualified and motivated employees of a medical organization are a necessary component that ensures the provision of medical care of appropriate quality One of the motivating factors of medical workers for high-quality and efficient work is wages. The purpose of the study. To analyze and evaluate the impact of the remuneration system of medical workers based on labor rationing on the quality of primary health care (PHC) on the example of the state district polyclinics of St. Petersburg. Materials and methods. Based on the reporting data of polyclinics selected by the research bases, the following were studied: the dynamics of the number and staffing of medical workers from 2018 to 2021; the percentage and structure of reasons for refusal to pay for cases of medical care in 2010–2018 and 2020–2021; the dynamics of the detection of malignant neoplasms in the early stages. The results of the patient survey were analyzed in order to assess changes in the quality of primary health care for the adult population after the introduction of a system of remuneration for medical workers based on labor rationing. Results. After the introduction of a new wage system based on its rationing, a number of general positive trends were identified for the studied polyclinics, such as: an increase in staffing of medical personnel in general by 3.5%–8.7%, district internists by 4.6%–42.7%, specialist doctors by 2.8%–12.4%, average medical personnel by 4.5%–17.7%; increase in the proportion of oncological pathology detected at early stages by 13.5%–20.1%; decrease in the share of refusals to pay for medical care cases by 9.3%–32.9%; a decrease in the total number of citizens’ complaints in the form of complaints by 6.0–58.0%, including justified ones. Findings. The introduction of a wage system based on labor rationing has increased the economic and medico-social efficiency of the polyclinics under study, as well as the motivation of medical workers to provide medical care of appropriate quality.