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Primary health care quality in Iran: a systematic review and meta-analysis

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Abolghasem Gorji H., Royani S., Mohseni M., Azami-Aghdash S., Moosavi A., Gareh Sheyklo S.
Family Medicine & Primary Care Review
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2019
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issue 1
71-77
XX
Quality measurement is the first step in improving overall quality. Servqual has been identified as one of the most important methods frequently used in assessing the quality of healthcare services. This study aims to systematically review and conduct meta- analysis of conducted studies in this regard in which Servqual tools were used to assess and measure the quality of services. In this systematic review and meta-analysis, the required data were collected using several keywords (and their Persian equivalents): services quality, Servqual, quality, gap, primary health cares, health services, Iran. The databases searched were as follows: PubMed, Scopus, Google Scholar, SID, Magiran, and Iranmedex. The comprehensive meta-analysis (CMA) software, Version 2 was used for data analysis. Based on the random effect model, the total mean score of Service Consumers’ perception, Service Consumers’ expectation and the gap between them were estimated as being 3.81 (95% CI: 3.56–4.06), 4.49 (95% CI: 4.31–4.67) and -0.83 (95% CI: -065 – -1.01), respectively. The lowest score of consumers’ perception of services quality, was related to the empathy dimension (3.57) and the highest score of consumers’ expectation of services quality was related to the reliability dimension (4.60). Furthermore, there was a quality gap in all dimensions. In order to achieve desired quality and meet service receivers’ needs, attention should be always given to their views, so that proper planning can be done to address existing problems through assessing views. Should such be undertaken, we would be able to witness services quality improvement.
2
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Central Portuguese Doctors’ agreement with the “Ten Commandments for patient-centred treatment”

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Santiago L. M., Marques P. P., Simões J. A.
Family Medicine & Primary Care Review
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2019
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issue 1
47-52
EN
To ascertain the level of agreement with the “Ten Commandments for patient-centred treatment” by physicians in Central Portugal, exploring differences by age group, sex and medical speciality. Material and methods. An online questionnaire in September of 2016, sent to doctors registered in the Central Regional Section of the Portuguese Medical Association, with weekly reminders to non-respondents. The English wording was translated to Portuguese, a questionnaire with a four-grade answer was created and its reliability determined. Variables such as sex, age group and medical specialty were considered. Descriptive and inferential statistics were performed. Results. A representative yet convenient sample of 811 doctors participated. Their description is as follows: ≤ 35 years n = 203, ≥ 36 and ≤ 55 years n = 217 and ≥ 56 years n = 373, women n = 391 (49.2%), General Practice/Family Medicine (GP/FM) n = 301, medical specialty n = 303 and medico-surgical specialty n = 173. By medical specialty, for commandment 1, there is higher prevalence of “Disagree/Completely Disagree” in the GP/FM specialty (p < 0.001). By gender, for commandment 1, women vs men doctors “Disagree/Completely Disagree” proportion of 11.7% vs 6,4% (p = 0.003). For the younger age groups, there is a greater proportion of “Disagree/Completely Disagree” for Commandment 1 (p = 0.016), for Commandment 4 (p = 0.007), for Commandment 6 (p = 0.001), for Commandment 7 (p = 0.001) and for Commandment 8 (p = 0.020). Conclusions. There is vast agreement with the “Ten Commandments for patient-centred treatment” in central Portugal. For Commandments 1, 3 and 6, the proportion of “Disagree/Completely Disagree” is higher than for the remaining. There is a need for future investigations to explain the present results.
3
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Assessment of the health care system functioning in Poland in light of the analysis of the indicators of the hospital emergency department (ED) and primary health care (PHC) – proposals for systemic solutions

88%
Szwamel K., Kurpas D.
Family Medicine & Primary Care Review
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2019
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issue 2
164-173
EN
has dramatically increased. The number of visits to EDs can be an important indicator of the quality of primary health care. Objectives. To analyse: 1) the frequency of admissions to EDs, 2) the type and number of medical procedures performed in EDs, and 3) the type and number of services provided by PHC in the Kedzierzyn-Kozle district. Material and methods. A retrospective analysis of the statistical data regarding services provided by PHC in the Kedzierzyn-Kozle district within the National Health Fund (NHF) and data from the hospital emergency department in Kedzierzyn-Kozle (Opole Province, Poland). Results. The results showed an annual increase in the number of hospitalisations (13,815 – 2012, 14,192 – 2013, 15,123 – 2014) and the number of medical procedures performed in the ED (mainly those from I–III categories), as well as the low rate of admission from the ED to ICU (Department of Anaesthesiology and Intensive Care). There was an increase in the overall number of consultations given by a primary health care doctor and the total number of healthcare services provided at night and during holidays. Conclusions. Reducing the number of non-urgent visits to EDs can be achieved by making efforts to meet the needs of patients at the level of primary health care, in particular through better coordination of services provided by EDs and PHC and better motivation of primary care doctors to perform the role of gatekeeper to the health care system
4
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The capacity to implement Lean Management in the healthcare system in Poland – results of a public consultation

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Chmielewska M., Lotek-Waćkowska R., Brzozowski S., Tytko Z., Dziok-Dmowska K., Hermanowski T.
Medycyna Pracy
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2023
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vol. 74
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issue 1
1-8
EN
Background Lean healthcare management is an innovative approach to process management in healthcare organizations. Despite that the Lean principles have been increasingly recognized worldwide as a tool to boost organizational performance, improve the quality of care and curb waste, the Lean methodology can be difficult to implement in some countries. This study seeks to identify the facilitators of and barriers to the implementation of Lean in the healthcare system in Poland. Material and Methods A public consultation was held among 318 representatives of stakeholder groups in the healthcare system in Poland. Data was collected using validated self-administered questionnaires. Statistical analysis was performed using the IBM SPSS Statistics 25 software. Results The study revealed that a large share of respondents believed that the awareness of the existing organizational deficiencies in work practices among stakeholders can greatly facilitate the implementation of Lean in the healthcare system in Poland (50.9%, p < 0.05). The main barriers to the deployment of Lean include lack of awareness of the Lean methodology and its benefits (76.1%, p < 0.001); insufficient institutional support (43.7%), and lack of funding for Lean solutions (32.4%). Conclusions Gaps in the medical curricula and education programs for healthcare professionals concerning the latest process management solutions in healthcare should be addressed in order to raise awareness of the benefits of cooperation with and the active involvement of Lean experts in applying “lean” ideas to improve the organizational performance in healthcare. It is also necessary for policy makers to be aware of the benefits of contemporary process management in healthcare and to support its implementation. Med Pr. 2023;74(1):1–8
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Developing a model of information transfer practice between institutions targeted at primary health care patients who are asymptomatic carriers of carbapenemase producing Enterobacteriacae

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Timler M., Timler W., Kozłowski R., Zdęba-Mozoła A., Marczak M., Timler D.
Medycyna Pracy
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2023
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vol. 74
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issue 4
263-270
EN
Background Drug-resistant bacteria are one of the main reasons of deaths worldwide. A significant group of these bacteria are carbapenemase producing Enterobacteriaceae (CPE). The goal of this study was to develop a diagnostic and therapeutic model targeted at asymptomatic carriers of CPE. Material and Methods A team of experts from different branches connected to health care, discussing the topic based on the data collected from previous research. Working sessions were dispersed between June and December 2022. The consensus has been reached via repeated discussion and literature search. Results The facility where CPE are detected is required to create an alert pathogen note and to notify sanitary-epidemiological station and National Reference Centre for Antimicrobial Susceptibility of Microorganisms – neither these institutions, nor the patient are required to notify the primary care physician. In primary care clinics, it is possible to work towards breaking the transmission of CPE by educating patients with CPE and persons who were in contact with them, and to undertake actions in order to look for patients with risk factors for CPE colonisation. In order to improve communication between individual levels of the health care system, standardised information could be introduced to the discharge note about a case of CPE, which will be electronically transmitted to the primary care facility. It might contribute to effective combating of the spread of CPE, by serving as a source of knowledge and education for patients and by checking the patient’s risk factors, which will improve the performance of tests for CPE colonisation. Conclusions The established model of good practice requires a change of legal regulations and its implementation, which will reduce the spread of CPE in health care facilities and will enable its future improvement.
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An Overview of the Canadian Health Care System

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Bielska I. A., Hampel E. M., Johnson A. P.
Zdrowie Publiczne i Zarządzanie
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2012
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vol. 10
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issue 1
51–56
EN
The Canadian health care system is a publicly financed system administered by ten provincial and three territorial governments. The purpose of this article is to provide an overview of the universal health care system in Canada, including its history, the health status of Canadians, health care funding and spending, and health research and data collection. Health care spending in Canada amounts to 11.6% of the country’s gross domestic product and is estimated to have been $200.5 billion Canadian dollars in 2011. Hospitals account for the largest source of health care spending (29%), followed by drugs (16%) and physician spending (14%). Of the total health care spending, 70% is paid for by the public system. Due to the Canadian population being covered by the universal health care system, health data are being collected and can be used to monitor the health care system and inform evidence-based medicine.
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