Can patients make heads or tails of enhanced primary health care (EnPHC)? Experience through their own journey

Abstract

Background: Implementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients' experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients. Methods: This phenomenological qualitative study focussed on patients' experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach. Results: A total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient's health through their lens. Conclusion: Even though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.

Integrating eye care in low-income and middle-income settings: a scoping review

“…Twelve papers developed or provided integrated eye care guidelines, protocols, pathways, manuals and training modules for non-eye care specific workers. Intervention strategies included Integrated Management of Neonatal and Childhood Illness protocol and procedures,18 hypertension and diabetes guidelines and care pathways for primary care workers,28 29 37–39 screening protocols for community and hospital health workers to detect vision impairment, cataracts or retinopathy of prematurity,25 30 40 guidelines and training manuals on the management or referral of eye conditions for primary health staff21 22 27 34 and clinical protocols provided in the primary care nursing education curriculum 24…”

“…Eleven papers described strategies for sharing infrastructure and structural integration with other services including co-locating ophthalmic services with NCD or infectious disease services,36 38–41 integrating eye care indicators within health management information systems,20 project teams sharing space with subregional health offices,19 health supervisors incorporating eye care supervision with other health areas,26 creating a dedicated retinopathy of prematurity screening space and providing more blenders and oxygen saturation monitors in neonatal units,25 counselling services with diabetes care28 and incorporating NCD care in primary health services 29. However, few studies reported any factors impacting integration success.…”

“…In primary healthcare settings, integrating medical records improved hypertension and diabetes management, contributing to diabetic retinopathy prevention 39. Delivering other services, such as counselling and eye care services present in the same facilities, were all well-received by patients 28 38…”

Patients’ Perception Towards Health Education Services Received at the Enhanced Primary Healthcare Facilities: A Qualitative Exploration

“…The EnPHC initiatives consisted of redesigning work processes in the clinic, community intervention through community enrolment and profiling, and improving the referral system between the clinic and hospital. 6 One of the intervention components of the EnPHC is the provision of health education to attending patients. One of the aims of EnPHC is to ensure improvements in patient care experience toward a patient-centered approach using active, population-level strategies for health and wellness.…”