Health care in Armenia

Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study

Background

Armenia has trained physicians to practice family medicine (FM) for over 20 years. The pediatric population comprises a significant proportion of patients seen by FM practices, yet to date, there have been no studies assessing the knowledge and self-efficacy of FM physicians regarding pediatric care. As the first step is needs assessment to improve the quality of care, this study aims to assess the self-efficacy and knowledge of FM physicians regarding the care of pediatric patients.

Materials and Methods

We distributed a survey to attendees at an FM conference in Lori Province, Armenia. The survey instrument assessed demographics and experience, self-efficacy in providing pediatric care, and pediatric knowledge via questions adapted from the American Board of Family Medicine (ABFM).

Results

Eighty-seven percent of participants were female. Roughly half (45%) had trained through an FM residency program, while the remainder had retrained to become FM physicians following a residency in another field. Almost all (97%) practiced outside of the capital city, Yerevan. About half believed that their didactic (51%) and clinical education (48%) prepared them either "extremely" or "very" well. Overall, there was no clear relationship between participants' reported self-efficacy in a given area of pediatrics and their score in that area on the knowledge portion of the survey.

Conclusions

Our findings reveal opportunities for improvement in knowledge related to pediatric care in FM physicians in Armenia, as well as a lack of relationship between reported self-efficacy and knowledge. Thus, future programs should not rely solely on self-reported gaps to identify or prioritize areas of focus. Further study is recommended in other specialties in Armenia and internationally to improve future programs.

Incidence patterns and review of Hodgkin lymphoma in the Republic of Armenia

Hodgkin lymphoma (HL) accounts for roughly 10% of all lymphomas and 0.6% of all malignant tumours analysed worldwide yearly. Data regarding HL in developing world are exceptionally constrained. The main objective of this research is to investigate the incidence patterns of HL within the Republic of Armenia and to portray disease distribution according to age and sex. There is a very strict evidence on the frequency of HL in Armenia. The results of our research find out that the frequency of HL in Armenia has not changed altogether over the past 15 years and is comparable to that detailed from the USA and Europe.

Giving birth: the voices of Armenian women

PURPOSE AND STUDY DESIGN: The purposes of this qualitative descriptive study were to describe the perceptions of Armenian childbearing women about the meaning of giving birth and to conduct an outcomes evaluation of the Erebuni Women's Wellness Center.

METHOD

Fifteen women who had given birth to healthy term infants during the past 8 months and who received health-care services at the Erebuni Medical Center, Yerevan, Armenia participated in audiotaped interviews. Questions were asked about the meaning of their childbirth experience and their satisfaction with their health care.

RESULTS

Themes included the meaning of giving birth within the Armenian sociocultural context, enriching the family perspective across generations of Armenian families and receiving supportive quality health care.

DISCUSSION AND CLINICAL IMPLICATIONS

This research is an example of an international collaborative work conducted with the American International Health Alliance (AIHA) who established women's wellness centres in Eastern Europe in conjunction with United States Agency for International Development. Outcomes data is very important in order to ensure the quality of health care provided. Clinical personnel found evaluative data were helpful in improving services to women and newborns. Because of dramatic socioeconomic situation in Armenia and many changes that have happened in their health care over the past 18 years, it is important to document the outcomes of AIHA partnership programmes in improving the health of childbearing women and their families. Listening to the voices of Armenian childbearing women is essential to guide health-care initiatives.

Primary health care facility performance assessment in Armenia

Purpose

The purpose of this study is to focus on the performance of select facilities in Lori and Shirak provinces in Armenia in Spring 2008. This is in response to the deterioration of the primary healthcare sector in Armenia.

Design/methodology/approach

The performance assessment focused on the status of several performance indicators, both current and as recalled for 2006. The interviewer‐administered questionnaire addressed access to care, provider relations with community and clients, environment, management, and primary and secondary prevention at the facilities. For each domain, a summative score that ranged from 0 to 3 was computed and a mean score for each facility derived.

Findings

The project has had significant positive impact on facilities' performance. Access to care scores increased from 2.0 in 2006 to 2.5 in 2008; provider relations with community improved from 1.1 to 1.4; environment scores improved from 1.3 to 1.9, facility management improved from 1.4 to 1.7; and prevention efforts increased from 1.3 to 1.9. The overall mean facility score increased from 1.4 to 1.8. Although the scores for small rural clinics increased, their scores were lower than the scores for other facility types.

Originality/value

In the chronic absence of administrative surveillance data, this paper provides valuable information on the status of primary healthcare services in Armenian provinces. It demonstrates the value of interviewer‐administered performance assessments in obtaining data across project sites when internal monitoring of progress is unavailable.

Patient satisfaction with primary care in Armenia: good rating of bad services?

The study assessed the level of patient satisfaction at selected primary health-care facilities in Lori and Shirak provinces of Armenia. Self-administered questionnaires were distributed to 684 recent clients at primary health-care facilities. The majority of patients were satisfied with their provider (mean satisfaction score of 1.75 out of maximum 2). Most patients (89.0%) would visit the same provider again, and would recommend the provider to friends (85.6%). Satisfaction with other aspects of care, including waiting time, accessibility of services, confidentiality and cleanliness of the facility, was also high (mean score of 1.70 out of 2). Seventy-eight percent of respondents considered the care they received to be ‘excellent’ or ‘good’. The less educated and those in rural areas were more likely to be satisfied with the provider's quality. Despite the fundamental problems now challenging the Armenian primary health-care sector, patient satisfaction remains high. Given the high level of reported satisfaction, more focused satisfaction research tools and alternative approaches to patient assessments of care are needed to inform quality improvement in the Armenian setting.