The influence of patient characteristics on healthcare-seeking behavior : a multilevel analysis of 70 primary care practices in urban-suburban regions in Malta

This work was co-financed by the European Commission in the 7th Framework Programme under the Grant Agreement Number 242141.Background: Social homogeneity and an almost indiscernible rural-urban difference are generally assumed to be strong factors that reduce any tendency for health inequities in a small island community. A strong primary health care system is one of the components that protect populations against inequities. Aim: The aim of this study was to examine healthcare- seeking behaviour in urban and suburban regions in Malta. Methods: The dataset of the Maltese arm of the QUALICOPC Project was analysed. A descriptive, cross- sectional study was designed. Seventy practicing general practitioners were selected randomly from the Malta Medical Council Family Medicine register after systematically removing the inactive practices. Ten patients presenting quasi-randomly in each primary care clinic completed a self- administered questionnaire. The chi-square test was used to test for differences in demographic and health care characteristics between the urban and suburban primary health care service. Generalized Linear and Latent Mixed Models (GLLAMM) were used to perform the multilevel analysis using Stata/SE version 12. Results: None of the 4 predictors (patients’ primary or secondary educational level, age and gender) emerged to be significant for coping better with illness after GP visit. 82% of the total variance in this response (Yes/No) was between patients, 13% was between clinics and 5% between regions. General practitioners offered more health promotion services and asked more about polypharmacy when their patients were older. Conclusion: Such findings provide information for policy makers to improve equity and resource allocations within the setting of urban Malta to help improve patients’ outcomes, particularly for the at-risk or vulnerable population.peer-reviewe

Comparison of patients’ experiences in public and private primary care clinics in Malta

Demographic changes, technological developments and rising expectations require the analysis of public–private primary care (PC) service provision to inform policy makers. We conducted a descriptive, cross-sectional study using the dataset of the Maltese arm of the QUALICOPC Project to compare the PC patients’ experiences provided by public-funded and private (independent) general practitioners in Malta. Seven hundred patients from 70 clinics completed a self-administered questionnaire. Direct logistic regression showed that patients visiting the private sector experienced better continuity of care with more difficulty in accessing out-of-hours care. Such findings help to improve (primary) healthcare service provision and resource allocation.peer-reviewe

Primary care in a post-communist country 10 years later:Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004

Objectives: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. Methods: A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians’ involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. Results: In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. Conclusions: Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition

Quality of primary health care in Poland from the perspective of the physicians providing it

Background: Primary care (PC) allows patients to address most of their health needs and is essential for high quality healthcare systems. The aim of the study was to analyze the insight of nine core dimensions of Polish PC system: “Economic conditions”, “Workforce”, “Accessibility”, “Comprehensiveness”, “Continuity”, “Coordination”, “Quality of care”, “Efficiency” and “Equity” and to identify the characteristics of the providing physicians that influence their perception of the quality of care.Methods: A cross-sectional study was conducted as part of an international QUALICOPC project. In Poland a nationally representative sample of 220 PC physicians was selected from the database of Polish National Health Fund by a stratified random sampling procedure. The research tool was a standardized 64-item questionnaire. Each of the respondents’ answers were assigned a numerical value ranging from−1 (extremely negative) to +1 (extremely positive). The quality indicators were calculated as an arithmetic mean of variables representing particular PC dimensions.Results: The mean scores for the majority of the dimensions had negative values. Accessibility of care was perceived as the best dimension, while the economic conditions were evaluated most negatively. Only a small part of variation in quality evaluation could be explained by physicians’ characteristics.Conclusions: The negative evaluation of primary care reflects the growing crisis in the health care system in Poland. There is an urgent need to apply complex recovery measures to improve the quality of primary care

What is important in evaluating health care quality? An international comparison of user views

BACKGROUND: Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care. METHODS: Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis. RESULTS: Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest. CONCLUSION: Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system