Patient experiences of primary care quality amongst different types of health care facilities in central Vietnam

Abstract

Background Patient experience with primary health care services can vary markedly between different types of health care facilities, even within the same country setting. Given known benefits of high quality primary health care, the performance of these facilities may significantly impact population health. The aim of this study was to compare the quality of primary care in different types of health facilities as experienced by Vietnamese consumers. Methods 1662 people who utilized primary health care services at least once over the past two years in various types of facilities in central Vietnam were surveyed in a cross-sectional study using the Vietnamese version of the Primary Care Assessment Tool (VN PCAT-AE) to assess overall primary care quality as well as several different domains of high quality primary care services. Results Commune health centers were associated with the highest overall primary care quality (PCAT expanded score 21.07, p < 0.001) as well as high scores in nearly all individual domains of primary care quality experienced by consumers compared with other types of facilities. Conversely, private facilities such as private clinics and pharmacies were rated lowest overall (PCAT expanded score 18.45, p < 0.05 and 16.90, p < 0.001 respectively). District hospitals and other government hospitals (PCAT expanded score 20.10 and 19.72 respectively) were reported as the best quality in comprehensiveness of available services (p < 0.001). Polyclinics performed quite well in comprehensiveness of services available (3.11) and first contact-access (2.79) but less so in other domains, especially in cultural competency (1.87). Conclusions The high quality of primary care services experienced by consumers in commune health centers compared with other facilities gives Vietnam ample reason to promote greater use of these community-based primary care facilities. Populations may benefit most from building and strengthening grassroots networks of such community-based health centers as an effective solution for overcrowding at hospitals while simultaneously providing better overall health outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-019-4089-y) contains supplementary material, which is available to authorized users.

Primary care quality in Vietnam: Perceptions and opinions of primary care physicians in commune health centers – a mixed-methods study

“…On the other hand, our previous PCAT study of consumer experiences showed that CHCs were the most common choice of respondents as a usual source of primary care. In that study, consumers gave CHCs the highest scores for Ongoing Care and First-Contact utilization and the next highest score for First-Contact access in comparison with other types of health care facilities [ 9 ]. The consistency of this assessment from both the supply- and demand-sides implies that CHCs are a reliable first-contact point for patients at the primary care level.…”

“…PCPs and consumers also share similar assessments of Coordination as the worst performing primary care core domain [ 9 ]. Some explanations for this may be that the two—way referral and counter-referral system between the CHCs and upper level facilities still does not exist in Vietnam, and the connection between the private and public sectors is also still weak [ 29 ].…”

“…The first major obstacle was patients bypassing primary care and choosing to be treated in a more fully equipped hospital at a higher level, or relying solely on pharmacists’ advice, or even merely self-treatment. In an earlier consumer survey among 1662 adults living in Central Vietnam, 15.3% and 11.8% of residents utilized high–level hospitals such as provincial or central hospitals and pharmacies (in that order) as sources of primary care [ 9 ]. Together with policy changes restricting medication sales without a prescription at pharmacies, primary care doctors suggested that media campaigns on health promotion and CHC services should be launched more frequently.…”

“…To obtain an objective and comprehensive view of this service delivery, evaluation should come from both sides of the system: users (patients) on the demand-side, and providers (health care professionals) and health care managers on the supply-side. A recent study in Vietnam used a validated version of the adult consumer version of the PCAT to survey residents on their experiences of different primary health care facilities [ 9 ]. In contrast, relatively little energy has been invested in learning how primary care physicians perceive the status of the services they are providing and the environment they are working in.…”

Developing monitoring and evaluation tools for event-based surveillance: experience from Vietnam

“…Districts are divided into communes, and each commune has a commune health station (CHS). The CHS is the primary healthcare unit in Vietnam [18] and is usually staffed by a physician, a nurse, and a midwife. Within each commune, village health workers (VHWs; rural areas) and health collaborators (HCs; urban areas) constitute community networks and support the CHSs in different health-promotion activities.…”