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Kruk ME, Kapoor NR, Lewis TP, Arsenault C, Boutsikari EC, Breda J, Carai S, Croke K, Dayalu R, Fink G, Garcia PJ, Kassa M, Mohan S, Moshabela M, Nzinga J, Oh J, Okiro EA, Prabhakaran D, SteelFisher GK, Tarricone R, Garcia-Elorrio E. Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey. Lancet Glob Health 2024; 12:e100-e111. [PMID: 38096882 PMCID: PMC10716625 DOI: 10.1016/s2214-109x(23)00499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey-a novel population survey conducted in 15 low-income, middle-income, and high-income countries-we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece-countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eleni C Boutsikari
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - João Breda
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Susanne Carai
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Kevin Croke
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rashmi Dayalu
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Patricia J Garcia
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Munir Kassa
- Minister's Office, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Emelda A Okiro
- Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Ezequiel Garcia-Elorrio
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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2
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Mora-García CA, Pesec M, Prado AM. The effect of primary healthcare on mortality: Evidence from Costa Rica. JOURNAL OF HEALTH ECONOMICS 2024; 93:102833. [PMID: 38041894 DOI: 10.1016/j.jhealeco.2023.102833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/04/2023]
Abstract
This paper uses the gradual implementation of a primary healthcare (PHC) intervention in Costa Rica to examine the long-term effect of PHC on mortality. Nine years after opening a primary care center, known as a Health Area, there was an associated 13% reduction in age-adjusted mortality rate in the assigned patient population. The effect was highest among adults over 65 years of age and for those with noncommunicable diseases, such as cardiovascular-related causes of death. We also show that as Health Areas opened, more individuals sought care at primary care clinics, while fewer sought care at emergency rooms; these changes may have partially mediated the effect of the intervention on mortality.
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Affiliation(s)
| | - Madeline Pesec
- Ariadne Labs, Brigham and Women's Hospital and Boston Children's Hospital, Boston, MA.
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Medina-Ranilla J, Espinoza-Pajuelo L, Mazzoni A, Roberti J, García-Elorrio E, Leslie HH, García PJ. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys. Health Policy Plan 2023; 38:1225-1241. [PMID: 37803966 DOI: 10.1093/heapol/czad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.
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Affiliation(s)
- Jesús Medina-Ranilla
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Laura Espinoza-Pajuelo
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Agustina Mazzoni
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Javier Roberti
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Ezequiel García-Elorrio
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Hannah Hogan Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th St., Floor 4, San Francisco, CA 94143, United States
| | - Patricia Jannet García
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
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Contreras Sánchez SE, Doubova SV, Grajales Álvarez R, Dip Borunda AK, Martínez Pineda WJ, Nuñez Cerrillo JG, Silva Bravo F, Zalapa Velázquez R, Gutiérrez De la Barrera M, Leslie HH. Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial. BMJ Open 2023; 13:e077322. [PMID: 37931967 PMCID: PMC10632859 DOI: 10.1136/bmjopen-2023-077322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses. METHODS AND ANALYSIS We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico's largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months. ETHICS AND DISSEMINATION The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT05925257.
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Affiliation(s)
- Saúl Eduardo Contreras Sánchez
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | | | | | | | | | - Fernando Silva Bravo
- Oncology Department, Speciality Hospital CMN Manuel Ávila Camacho, IMSS, Puebla, Puebla, Mexico
| | - Rita Zalapa Velázquez
- Oncology Department, Speciality Hospital CMN Manuel Ávila Camacho, IMSS, Puebla, Puebla, Mexico
| | | | - Hannah H Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
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Klimesch A, Martinez-Pereira A, Topf C, Härter M, Scholl I, Bravo P. Conceptualization of patient-centered care in Latin America: A scoping review. Health Expect 2023; 26:1820-1831. [PMID: 37491799 PMCID: PMC10485332 DOI: 10.1111/hex.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION Patient-centered care (PCC) has been declared as a desirable goal for health care in Latin American countries, but a coherent definition of what exactly PCC entails for clinical practice is missing. This article's aim was to identify how PCC is conceptualized in Latin American countries. METHODS Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scielo, Scopus, Web of Science) and webpages of the ministries of health were searched, and experts were contacted for suggestions of literature. References were included if they contained one of a range of a priori defined keywords related to PCC in the title, were published between 2006 and 2021, and were carried out in or concerned Latin America. Definitions of PCC were extracted from the included articles and analyzed using deductive and inductive coding. Deductive coding was based on the integrative model of patient-centeredness, which unites the definitions of PCC in the international literature (mainly North America and Europe) and proposes 16 dimensions describing PCC. RESULTS Thirty-two articles were included in the analysis and about half of them were from Brazil. Numerous similarities were found between the integrative model of patient-centeredness and the definitions of PCC given in the selected literature. The dimensions of the integrative model of patient-centeredness that were least and most prominent in the literature were physical support and patient information, respectively. A differentiation between PCC and family-centered care (FCC) was observed. Definitions of PCC and FCC as well as their cited references were diverse. CONCLUSION A considerable overlap between the conceptualization of PCC in Latin America and the integrative model of patient-centeredness has been identified. However, there are substantial differences between countries in Latin America regarding the emphasis of research on PCC versus FCC and diverse conceptualizations of PCC and FCC exist. PATIENT CONTRIBUTION This scoping review takes the patient's perspective based on the integrative model of patient-centeredness. Due to the study being a review, no patients, neither caregivers, nor members of the public, were involved.
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Affiliation(s)
- Anne Klimesch
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cheyenne Topf
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
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Rasheed MA, Hussain A, Hashwani A, Kedzierski JT, Hasan BS. Implementation evaluation of a leadership development intervention for improved family experience in a private paediatric care hospital, Pakistan. BMC Health Serv Res 2022; 22:944. [PMID: 35870912 PMCID: PMC9308933 DOI: 10.1186/s12913-022-08342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.
Methods
A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.
Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.
The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.
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Yudkin JS. Advancing patient-centered care: moving from outcome-based to risk factor-based models using the big four risk factors. Rev Panam Salud Publica 2022; 46:e162. [DOI: 10.26633/rpsp.2022.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
This article reimagines the health care system to focus on risk factors rather than outcomes in order to improve patient-centered care and reduce health care expenditure. Patient-centered care has been a global priority since 2001 when the Institute of Medicine declared it an essential aim for health care systems. As part of this discussion and to help facilitate this change, the concept of the big four risk factors – diet and nutrition; physical activity; smoking and tobacco use; and excessive alcohol consumption – is introduced in the context of the Americas from which it originates. Using peer-reviewed literature, health policy guidelines, theories, frameworks, and transdisciplinary implementation science strategies, this article explains how public health research and medical centers are set up in terms of disease, or outcome, rather than risk factor, or exposure. It suggests how moving from outcome-based health care models to focus on prevention using the big four risk factors will lead to better patient-centered care and health outcomes. Transdisciplinary research and complexity science, a framework largely developed and tested in Latin America, are recommended to facilitate this change and develop multicomponent, multistakeholder action and cooperation. Future research should pilot the proposed changes at various health-system levels and in different settings and report on the outcomes of implementation to assess effectiveness and improve translation of research, perhaps using the standardized RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework.
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Affiliation(s)
- Joshua S. Yudkin
- University of Texas Health Science Center at Houston, Houston, United States of America
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Espinel-Flores V, Tiburcio-Lara G, Vargas I, Eguiguren P, Mogollón-Pérez AS, Ferreira-de-Medeiros-Mendes M, López-Vázquez J, Bertolotto F, Amarilla D, Vázquez ML. Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13008. [PMID: 36293587 PMCID: PMC9602030 DOI: 10.3390/ijerph192013008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.
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Affiliation(s)
- Verónica Espinel-Flores
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Gabriela Tiburcio-Lara
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Universidad de Chile, Independencia 939, Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, Bogotá 11001, Colombia
| | - Marina Ferreira-de-Medeiros-Mendes
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, Recife 50070-550, Brazil
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n Col. Industrial Ánimas, Xalapa 91190, Mexico
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, Montevideo 11200, Uruguay
| | - Delia Amarilla
- Maestría en Salud Pública, Centro de Estudios Interdisciplinarios, Universidad Nacional de Rosario, Maipú 1065, Rosario 2000, Argentina
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
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Sacks E, Mendez Alvarez M, Bancalari P, Alegre JC. Traditions and trust: a qualitative study of barriers to facility-based obstetric and immediate neonatal care in Chiapas, Mexico. Women Health 2022; 62:522-531. [DOI: 10.1080/03630242.2022.2089442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | | | - Pilar Bancalari
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Juan-Carlos Alegre
- Monitoring, Evaluation, and Research, Management Sciences for Health, Washington, DC, USA
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Persai D, Balu RK, Singh K, Prabhu RR, Lahoti S, Rout S, Panda R. Patient Satisfaction with Quality of Primary Care Health services‐findings from India. Int J Health Plann Manage 2022; 37:2256-2265. [DOI: 10.1002/hpm.3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Divya Persai
- Department of Behavioral Health and Recovery Services County of San Mateo San Mateo California USA
| | - Ravi Kumar Balu
- Department of Epidemiology and Biostatistics, School of Public Health University at Albany Albany New York USA
| | | | | | | | - Sarit Rout
- Indian Institute of Public Health Bhubaneshwar Odisha India
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Kim JH, Bell GA, Ratcliffe HL, Moncada L, Lipsitz S, Hirschhorn LR, Bitton A, Schwarz D. Predictors of patient-reported quality of care in low- and middle-income countries: a four-country survey of person-centered care. Int J Qual Health Care 2021; 33:6329399. [PMID: 34318883 PMCID: PMC8519224 DOI: 10.1093/intqhc/mzab110] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 06/20/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023] Open
Abstract
Background Person-centeredness is a foundation of high-quality health systems but is poorly measured in low- and middle-income countries (LMICs). We piloted an online survey of four LMICs to identify the prevalence and correlates of excellent patient-reported quality of care (QOC). Objective The aims of this study were to investigate the examine people’s overall ratings of care quality in relation to their experiences seeking care in their respective health systems as well as individual-, provider- and facility-level predictors. Methods We administered a cross-sectional online survey using Random Domain Intercept Technology to collect a sample of random internet users across India, Kenya, Mexico and Nigeria in November 2016. The primary outcome was patient-reported QOC. Covariates included age, gender, level of education, urban/rural residence, person for whom care was sought, type of provider seen, public or private sector status of the health facility and type of facility. The exposure was an index of health system responsiveness based on a framework from the World Health Organization. We used descriptive statistics to determine the prevalence of excellent patient-reported QOC and multivariable Poisson regression to calculate adjusted prevalence ratios (aPRs) for predictors of excellent patient-reported quality. Results Fourteen thousand and eight people completed the survey (22.6% completion rate). Survey respondents tended to be young, male, well-educated and urban-dwelling, reflective of the demographic of the internet-using population. Four thousand one and ninety-one (29.9%) respondents sought care in the prior 6 months. Of those, 21.8% rated their QOC as excellent. The highest proportion of respondents gave the top rating for wait time (44.6%), while the lowest proportion gave the top rating for facility cleanliness (21.7%). In an adjusted analysis, people who experienced the highest level of health system responsiveness were significantly more likely to report excellent QOC compared to those who did not (aPR 8.61, 95% confidence interval [95% CI]: 7.50, 9.89). In the adjusted model, urban-dwelling individuals were less likely to report excellent quality compared to rural-dwelling individuals (aPR 0.88, 95% CI: 0.78, 0.99). People who saw community health workers (aPR 1.37, 95% CI: 1.12, 1.67) and specialists (aPR 1.30, 95% CI: 1.12, 1.50) were more likely to report excellent quality than those who saw primary care providers. High perceived respect from the provider or staff was most highly associated with excellent ratings of quality, while ratings of wait time corresponded the least. Conclusion Patient-reported QOC is low in four LMICs, even among a well-educated, young population of internet users. Better health system responsiveness may be associated with better ratings of care quality. Improving person-centered care will be an important component of building high-quality health systems in these LMICs.
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Affiliation(s)
- June-Ho Kim
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Griffith A Bell
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA
| | - Hannah L Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA
| | - Leah Moncada
- RIWI Corp, 180 Bloor Street West, Suite 1000, Toronto, ON M5S 2V6, Canada
| | - Stuart Lipsitz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Lisa R Hirschhorn
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA 02215, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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12
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Ratcliffe HL, Bell G, Awoonor-Williams K, Bitton A, Kim JH, Lipstiz S, Macarayan E, Ofosu A, Otupiri E, Schwarz D, Hirschhorn LR. Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey. BMJ Open Qual 2021; 9:bmjoq-2019-000886. [PMID: 32404309 PMCID: PMC7228562 DOI: 10.1136/bmjoq-2019-000886] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/07/2020] [Accepted: 04/18/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Person-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries. Methods A multistage cluster sample design was used to obtain a nationally representative sample of women of reproductive age in Ghana. Women were interviewed in their homes regarding their demographic characteristics, recent care-seeking characteristics, satisfaction with care, patient-reported outcomes, and—using questions from the World Health Survey Responsiveness Module—the seven domains of responsiveness of outpatient care to assess patient experience. Using Poisson regression with log link, we assessed the relationship between responsiveness and satisfaction, as well as patient-reported outcomes. Results Women who reported more responsive care were more likely to be more educated, have good access to care and have received care at a private facility. Controlling for respondent and visit characteristics, women who reported the highest responsiveness levels were significantly more likely to report that care was excellent at meeting their needs (prevalence ratio (PR)=13.0), excellent quality of care (PR=20.8), being very likely to recommend the facility to others (PR=1.4), excellent self-rated health (PR=4.0) and excellent self-rated mental health (PR=5.1) as women who reported the lowest responsiveness levels. Discussion These findings support the emerging global consensus that responsiveness and patient experience of care are not luxuries but essential components of high-performing health systems, and highlight the need for more nuanced and systematic measurement of these areas to inform priority setting and improvement efforts.
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Affiliation(s)
- Hannah L Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Griffith Bell
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Koku Awoonor-Williams
- Division of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - June-Ho Kim
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart Lipstiz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Erlyn Macarayan
- Harvard Global Health Institute, Harvard University T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | | | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.,Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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13
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Leslie HH, Laos D, Cárcamo C, Pérez-Cuevas R, García PJ. Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study. BMC Health Serv Res 2021; 21:123. [PMID: 33549079 PMCID: PMC7865111 DOI: 10.1186/s12913-021-06117-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care. METHODS This cross-sectional continuous observation time motion study took place from July - September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection. RESULTS Two hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors. CONCLUSIONS The time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery.
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Affiliation(s)
- Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Denisse Laos
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Inter-American Development Bank, Lima, Peru
| | - Cesar Cárcamo
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Inter-American Development Bank, 6 Montrose Road, Kingston, Jamaica
| | - Patricia J García
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
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14
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Yamson P, Tetteh J, DeGraft-Amoah D, Quansah H, Mensah G, Biritwum R, Yawson AE. Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211028172. [PMID: 34180280 PMCID: PMC8243108 DOI: 10.1177/00469580211028172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana's Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.
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Affiliation(s)
- Phaedra Yamson
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - John Tetteh
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Daniel DeGraft-Amoah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Henry Quansah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - George Mensah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Richard Biritwum
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
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Doubova SV, Terreros-Muñoz E, Delgado-Lòpez N, Montaño-Figueroa EH, Infante-Castañeda C, Pérez-Cuevas R. Experiences with health care and health-related quality of life of patients with hematologic malignancies in Mexico. BMC Health Serv Res 2020; 20:644. [PMID: 32650770 PMCID: PMC7353677 DOI: 10.1186/s12913-020-05498-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Mexico, patients with hematologic malignancies (HMs) are characterized by being at high risk and advanced stages at diagnosis and by having a low cure rate; yet information on their experiences with health care and health-related quality of life (HRQL) is scarce. We aimed to evaluate experiences with health care and HRQL of patients with HMs and the association between these patient-reported measures. METHODS We conducted a cross-sectional survey in two public oncology hospitals in Mexico City. The study included outpatient cancer patients aged ≥18 years with a diagnosis of leukemia, lymphoma, or multiple myeloma. We used a patient-centered quality of cancer care questionnaire to assess patient experiences with receiving 1) timely care; 2) clear information; 3) information for treatment decision-making; 4) care to address biopsychosocial needs; and 5) respectful and coordinated care. We applied the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) to measure HRQL. We performed a multiple linear regression to evaluate the association between patient-reported experiences (independent variables) and the QLQ-C30 summary score (dependent variable). RESULTS Of the 515 participating HM patients, 46.6% had lymphoma, 34% leukemia, and 19.4% multiple myeloma; 70.9% were at advanced stages or at high risk. Additionally, 15.1% had anxiety and 12.8% had depression. Over one third (35.9%) reported receiving clear information, 28.5% timely care, 20.6% information for treatment decision-making, 23.7% care that addressed their biopsychosocial needs, and 31% respectful and coordinated care. The mean QLQ-C30 summary score was 71.9 points. Timely care, clear information, and care that addresses biopsychosocial needs were associated with higher HRQL. CONCLUSIONS Health care services for HM patients at public oncology hospitals in Mexico need improvement. Notably, providing timely care, clear information, and care that addresses patients' biopsychosocial needs can increase the likelihood of better HRQL. Health care providers should measure and improve the experiences of HM patients with health care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, CP 06720, Mexico City, Mexico.
| | - Eduardo Terreros-Muñoz
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Nancy Delgado-Lòpez
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Efreen Horacio Montaño-Figueroa
- Departamento de Hematología, Hospital General de México "Dr. Eduardo Liceaga". Secretaría de Salud, Ciudad de México, Mexico
| | - Claudia Infante-Castañeda
- Instituto de Investigaciones Sociales, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica
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Holt K, Doubova SV, Lee D, Perez-Cuevas R, Leslie HH. Factors associated with positive user experience with primary healthcare providers in Mexico: a multilevel modelling approach using national cross-sectional data. BMJ Open 2020; 10:e029818. [PMID: 31941761 PMCID: PMC7045193 DOI: 10.1136/bmjopen-2019-029818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to investigate factors associated with patient experience with primary care in a large public health system in Mexico and determine the amount of variability in experience attributable to facility-level and state-level factors. METHODS We analysed cross-sectional 2016 national satisfaction survey data from the Mexican Social Security Institute (IMSS). Patient-level data were merged with facility-level data and information on poverty by state. We assessed general contextual effects and examined the relationship of patient, facility and state factors with four patient experience measures using random effects logistic regression. RESULTS 25 745 patients' responses from 319 facilities were analysed. The majority experienced good communication (78%), the opportunity to share health concerns (91%) and resolution of doubts (85%). 29% of visits were rated as excellent. Differences between facilities and states accounted for up to 12% and 6% of the variation in patient experience, respectively. Inclusion of facility-level contextual effects improved model predictions by 8%-12%; models with facility random effects and individual covariates correctly predicted 64%-71% of individual outcomes. In adjusted models, larger patient population was correlated with worse reported communication, less opportunity to share concerns and less resolution of doubts. Men reported more positive communication; older individuals reported more positive communication and experiences overall, but less opportunity to share concerns; and more educated individuals were less likely to report positive communication but more likely to report resolution of doubts and overall positive experiences. Preventive care visits were rated higher than curative visits for resolution of doubts, but lower for opportunity to share concerns, and specific conditions were associated with better or worse reported experiences in some cases. CONCLUSION Quality improvement efforts at IMSS facilities might bolster individual experiences with primary care, given that up to 12% of the variation in experience was attributable to facility-level differences. The relationship between individual characteristics and experience ratings reinforces the importance of patients' expectations of care and the potential for differential treatment by providers to impact experience.
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Affiliation(s)
- Kelsey Holt
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Dennis Lee
- Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Ricardo Perez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Kingston, Jamaica
| | - Hannah H Leslie
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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