ObjectiveTo establish the reliability and validity of the translated version of the Safety Attitudes Questionnaire (SAQ) by evaluating its psychometric properties and to determine possible differences among nurses and physicians regarding safety attitudes.DesignA cross-sectional study utilising the Albanian version of the SAQ and a demographic questionnaire.SettingFour regional hospitals in Albania.Participants341 healthcare providers, including 132 nurses and 209 doctors.Main outcome measure(s)The translation, construct validity and internal validity of the SAQ. The SAQ includes six scales and 30 items.ResultsA total of 341 valid questionnaires were returned, for a response rate of 70%. The confirmatory factor analysis and its goodness-of-fit indices (standardised root mean square residual 0.075, root mean square error of approximation 0.044 and comparative fit index 0.97) showed good model fit. The Cronbach's α values for each of the scales of the SAQ ranged from 0.64 to 0.82. The percentage of hospital healthcare workers who had a positive attitude was 60.3% for the teamwork climate, 57.2% for the safety climate, 58.4% for job satisfaction, 37.4% for stress recognition, 59.3% for the perception of management and 49.5% for working conditions. Intercorrelations showed that the subscales had moderate-to-high correlations with one another. Nurses were more hesitant to admit and report errors; only 55% of physicians and 44% of nurses endorsed this statement (χ2=4.9, p=0.02). Moreover, nurses received lower scores on team work compared with doctors (N 45.7 vs D 52.3, p=0.01). Doctors denied the effects of stress and fatigue on their performance (N 46.7 vs D 39.5, p<0.01), neglecting the workload.ConclusionsThe SAQ is a useful tool for evaluating safety attitudes in Albanian hospitals. In light of the health workforce's poor recognition of stress, establishing patient safety programmes should be a priority among policymakers in Albania.

Aim: Assess the use of different health care service providers by adults (aged 18–59) and elderly (aged &gt; =60) who suffer from non-communicable disease (NCD) and explore relationships between sociodemographic variables and care-seeking behaviors.Methods: A cross-sectional survey was conducted in the districts of Diber and Fier in December 2018, using random cluster sampling. Descriptive statistics were used to compare the care-seeking behaviors of adults and elderly people. We employed binary and multinomial logistic regression to assess factors associated with the type of health service provider used. Analyses were adjusted for clustering within districts of residence.Results: Out of 3,799 respondents, 1,116 (29.4%) suffered from an NCD. Of these, 95% sought to obtain care for their chronic condition through public healthcare providers. The elderly were more likely to use primary healthcare services (PHC) to initiate care when facing health problems (56%), compared to those aged 18–59 years (49%, p &lt; 0,001). Over the last 8 weeks, 82% (914/1,116) of participants sought care. Binary and multinomial logistic regression analyses, adjusted for socio-demographic variables, showed that the elderly were more likely to choose PHC services (OR 1.56; 95% CI: 1.04; 2.35). Moreover, individuals who suffered from hypertension used PHC services more frequently than hospitals (OR 1.94; 95% CI: 1.32; 2.85). A positive association was found between living in an urban area and seeking care for NCDs at polyclinics (OR 10.1; 95% CI: 2.1; 50.1). There was no significant gender difference observed with regard to the type of provider consulted.Conclusion: Public facilities were reported as the main providers for initiating care and the main providers used in the 8 weeks prior to the interview. While a majority of elderly people visited a PHC to initiate treatment (and follow up) on their chronic conditions, a substantial proportion of adults (aged 18–59) initiated and sought regular NCD care at a hospital. Educating patients and caregivers on active participation in NCD prevention, management, and control through the PHC level should be a long-term effort, along with the establishment of well-structured referral mechanisms and integrated care systems.

Staff at primary healthcare centers are used to adverse events and errors. Despite the demand for safety improvement and the existing evidence on the epidemiology of outpatient medical errors, most research has only been conducted in hospital settings. Many patients are put at risk and some are harmed as a result of adverse events in primary care. Adequate communication and technical skills should be utilized by primary care providers (PCPs) for improvement of patient safety. The patient safety measures should include assessment of the safety attitudes of PCPs.

ObjectivesTo identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.DesignA cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.SettingExit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July–August 2018.ParticipantsRepresentative sample of 629 adults ≥18 years of age.Main outcomes measures(1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients’ decision to attend a given provider. Data were analysed using mixed logistic regression models.ResultsNearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were ‘quality of care’ and ‘healthcare professionals’ attitudes. Solely looking at patients using a public provider, ‘geographical proximity’ was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider’s patients, the ‘availability of diagnostic devices’ was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).ConclusionThe use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.