| Abstract |
Introduction: The search for factors related to the quality of health services can be a means of targeted reform of the health system with regard to Primary Health Care (PHC). Aim: Μapping the current situation of quality of service in the PHC, identifying malfunctioning outbreaks, and linking the individual characteristics of the PHC system to the quality of health services (QHS). Data and methods: Data were collected from a questionnaire used in a cross-sectional European study called QUALICOPC (QUALIty and COst of Primary Care in Europe) completed in 2012 by 220 GPs from all over Greece. Four indicators were selected for the evaluation of the QHS that related to the Working Group (human resources, interdisciplinary cooperation, referrals), Infrastructures, (benefits, equipment, facilities, etc.), Degree of Educational (implementation of guidelines, etc.) and Working Conditions (workload, remuneration, etc.). These indicators consisted of 20 questionnaire questions, the response of which was coded separately (yes = 1, no = 0), and their aggregation produced composite scores for each of the 4 indicators as well and overall (Total QHS rating). The score was transformed on a scale of 0-100 for the sake of simplicity and comprehensibility, while high values indicate better or higher levels of QHS. A correlation of the 4 indices was followed to check their cohesive structure and degree of validity and to apply multiple linear regression to evaluate the relationship of the overall QHS score with the characteristics of the GPs. Result: The 54.1% of the participants GPs were male while the mean age of all was 43.5 years (±7.9). The 25.0% practiced medicine in purely urban areas, 8.6% declarated self-employment, 48.2% worked co-located with others GPs, and 58.2% reported that they request the assistance of another colleague for ≥1 times a month. The 77.3% said they had easy access to lab facilities, 16.4% kept records in every patient visit, 81.4% applied guidelines for chronic heart disease while 73.2% participated in patient education for physical exercise. The mean score of overall QHS was evaluated as moderate (58.8 ± 14.1) and a significantly higher score was found in the GP’s degree training than in their working conditions (76.7 vs. 40.0, p <0.001). The mean score of QHS in the working group was valuated 60.4 (± 20.5) and 48.5 (± 25.6) in the infrastructure, respectively. There was a significant positive correlation between the GP’s training level with the working group (r = 0.733, p = 0.001) and with the working conditions (r = 0.194, p = 0.004), also a high correlation of the four indicators with the overall score of QHS was assessed (p <0.001). Only 16.8% of participants GPs were founded to have an overall QHS score of ≥75%, while the overall QHS score was not found to differ in the descriptive characteristics of the GPs. The exception was the form of work, which shows that 36.8% of freelancers had a high QHS score (≥75%) compared to only 14.9% of those with a remunerated employment relationship (p = 0.041). Multivariate linear regression confirmed that from GP’s characteristics, the form of work (working as a freelance professional) was positively correlated with QHS scores (stand. beta = 0.174, p = 0.012).
Conclusions: The QHS studies, which emerge from the view of the GPs, can be valuable tools for the design of the PHC system, as they can identify system factors that remain to varying degrees. The information that can be gathered through these studies can be used to restructure the PHC system so that future planning is directed in a way that ensures savings and optimal utilization of resources and ensures the universal and continuous provision of quality health services through the PHC
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Αξιολόγηση της ποιότητας των υπηρεσιών υγείας της πρωτοβάθμιας φροντίδας υγείας μέσω των Γενικών Ιατρών – δεδομένα από την μελέτη QUALICOPC
