Attributes and circumstances that induce inappropriate health services demand: a study of the health sector in Brazil

Basic Health Units services quality assessment through Kano and SERVQUAL models

Purpose

The present research aims to evaluate the quality of services provided by the Basic Health Units (UBS) of the Unified Health System (SUS) located in the city of Recife, in the state of Pernambuco, Brazil, using the Kano model integrated with the dimensions of quality proposed by the service quality (SERVQUAL) model.

Design/methodology/approach

The research was classified as bibliographic, descriptive, quantitative and surveyable. A structured questionnaire based on the Kano Model integrated with the dimensions of quality proposed by the SERVQUAL model, applied online through Google Forms. The questionnaires were distributed on social networks, obtaining a non-probabilistic sample of 120 individuals, collected for convenience.

Findings

Through the analysis of the Kano Model, it was possible to observe that all the investigated attributes are classified as one-dimensional. Among the attributes that deserve to be highlighted are attributes “Clean and pleasant environment”, “Reliability and security of information”, “Knowledge of employees to perform services”, “Service performed in the promised time”, “Polite and kind staff in dealing with users” and “Effectiveness of the service provided” due to having the longest intervals when considering the satisfaction and dissatisfaction coefficients, above 1.575. These attributes must be considered as critical priorities when implementing improvements, since their presence considerably increases users' satisfaction, as well as their absence generates great dissatisfaction.

Originality/value

The research is original and justified by the potential use of a quality assessment tool in the public health service, especially primary care. It is noteworthy that there are few works that integrate the Kano and SERVQUAL models applied in the public health service and that this integration can contribute to the national and international literature, mainly in the identification and prioritization of areas for improvement.

Factors associated to inappropriate use of emergency services

The increase in the demand for Emergency Services is a worldwide phenomenon, and its inappropriate use is one of the main problems. Factors related to the inappropriate use must be investigated to guide improvement in the quality of services. This article aims at analyzing factors associated with the inappropriate use of emergency services. This is a cross-sectional study with secondary data from 384 medical records from two emergency services in a city in central-southern region of the state of Paraná, Brazil, in 2013. A descriptive, bivariate using Pearson's chi-squared test was performed to verify associations between inappropriate use and independent variables. Multiple Logistic Regression was also performed. The proportion of inappropriate use of Emergency Services was 73.4% and was associated with people with some primary health care sensitive conditions, residents in areas without primary care coverage, people between 0 and 11 years old, and 12 to 17 years old, care in the first trimester of the year, respiratory diseases, lesions and poisonings and diseases of the musculoskeletal system. Primary care must be strengthened to reduce the inappropriate use of care, especially in the attention to primary health care sensitive conditions and to increase the socio-organizational accessibility.

Association between the Use of Health Services, Cardiovascular Risk Factors and Metabolic Syndrome in Mexican Adults

Background: The use of health services is a complex behavioral phenomenon affected by multiple factors (availability, distance, cost, quality, attitudes, cultural beliefs, socioeconomic characteristics, and individuals' self-perception of health). Mexico has a segmented health system, and the access to it depends on the labor insertion and the population's ability to pay. Objective: To assess association between use of health services and cardiovascular and metabolic syndrome risk factors among Mexican adults. Methods: Analytical cross-sectional nationally representative study carried out on Mexican adults (≥20-year-old adults of both sexes; n = 4595). Socioeconomic factors, geographic area, health care coverage, information about the use of health services, previous medical diagnoses of diabetes and hypertension, and smoking were assessed. Anthropometrics, triglyceride, total cholesterol, HDL-cholesterol, and glucose plasma levels were measured. Metabolic syndrome (MetS) and cardiovascular risk factors were assessed. Prevalences were expressed in terms of percentages, and significant differences were calculated using χ2 test. Univariate and multivariate analysis was performed to evaluate the association between the use of health services and cardiovascular risk factors and sociodemographic variables. Results: The probability of using health services is higher and more significant in subjects with obesity, diabetes (OR (95% CI): 1.73 (1.49-2.00; p < 0.001), hypertension (OR (95% CI): 1.29 (1.14-1.45; p < 0.001), hypertriglyceridemia (OR (95% CI): 1.30 (1.15-1.46; p < 0.001), and in those with hypercholesterolemia (OR (95% CI): 1.23 (1.03-1.39; p = 0.001). Conclusions: Among health service users, there is a positive significant association between the use of health services and the presence of metabolic syndrome, obesity, diabetes, hypertension, hypertriglyceridemia, and hypercholesterolemia.

Factors that influence the quality of services provided by the bus rapid transit system

Purpose

This study analyses the factors that can influence the quality of service provided by the bus rapid transit (BRT) system in the state of Pernambuco. It is incipient, considering that the system was implemented in this state in 2014 to the World cup. In this context, the purpose of this paper is to identify the factors considered important for the services provided by this system and their impact on perceived quality.

Design/methodology/approach

The authors analyzed the data using exploratory factorial analysis, and linear and quantile regression techniques. Regarding the classification, this research is applied, exploratory, descriptive and in the form of a case study describing the situation experienced by the users of BRT in Pernambuco.

Findings

The results showed that it was possible to identify five factors that impact the level of satisfaction of the offered services: fluency in the provision of the service; staff training; physical conditions in the provision of the service; convenience/accessibility; and integration between transport lines.

Originality/value

With initial identification, factors 1, 3, 4 and 5 have been found to have an impact on overall service quality in a positive and statistically significant way. Factors 3 and 4 have a different impact with high- and low-quality standard perceived by users, and these should be the guiding elements by companies in establishing actions to improve the services offered.