Quality in primary care

Guthrie, Bruce; Dreischulte, Tobias

doi:10.1136/bmj.g6485

Cited by 8 publications

(4 citation statements)

References 15 publications

(12 reference statements)

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“…Less‐prescriptive approaches simply built around incentives may produce equal or better results . When general practitioners in the United Kingdom were given incentive payments for reducing hospital admissions for ambulatory care sensitive conditions (ACSCs), admissions over 1 year fell 8% more for doctors who received the incentive than for those who did not, the difference also persisted for non‐ACSC conditions …”

Section: Studies Of Coordinated Carementioning

confidence: 99%

The Enthusiasm: Evidence Ratio for Comprehensive Chronic Disease Care?

Kane

2015

J American Geriatrics Society

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Section: Studies Of Coordinated Carementioning

confidence: 99%

The Enthusiasm: Evidence Ratio for Comprehensive Chronic Disease Care?

Kane

2015

J American Geriatrics Society

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“…The WHO has identified three levers to improve PHC: multi-sectoral policy and action, empowered people and communities, and integrated health care services with emphasis on primary care and essential functions of public health [ 3 ]. Primary care (PC) is defined as a “key process in the health system that supports first-contact, accessible, continued, comprehensive and coordinated patient-focused care” and acts as a gatekeeper to other levels of care [ 3 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey

Mohamoud

Mash

2022

BMC Prim. Care

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Background Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya. Methods A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences. Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good. Conclusion These primary care clinics in Nairobi showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.

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“…1,6,7 Primary care is the first-contact with patients and a gatekeeper to other levels of health care. [8][9][10] However, quality PC requires accessible, coordinated and ongoing comprehensive care. 11 Primary care may be delivered by family physicians, general practitioners, or non-physician practitioners, such as nurses.…”

Section: Introductionmentioning

confidence: 99%

Clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study

Mohamoud

Mash

2022

BJGP Open

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BackgroundQuality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, general practitioners (GP), with no post-graduate training in family medicine, offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya.AimTo evaluate GPs’ training and experience in the skills required for comprehensive primary care.Design and settingA cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, KenyaMethodA questionnaire, originally designed for a national survey of primary care doctors in South Africa, was adapted. The study collected self-reported data on performance of clinical skills by 25 GPs. Data were analysed in the Statistical Package for Social Sciences.ResultsGPs were mostly under 40 years, with less than 10 years of experience and an equal gender distribution. GPs reported moderate performance with adult health, communication and consultation, and clinical administration; and weak performance with emergencies, child health, surgery, ear-nose-and-throat, eyes, women’s health and orthopaedics. The GPs lacked training in specific skills such as proctoscopy, contraceptive devices, skin procedures, intra-articular injections, red reflex test and use of a genogram.ConclusionGeneral practitioners lacked training and performed poorly in some of the essential skills required in primary care. Continuing professional development, training in Family Medicine and deployment of family physicians to the clinics could improve the comprehensiveness of care.

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Quality in primary care

Abstract: Individual doctors matter, and pay for performance may reduce hospital admissions

Cited by 8 publications

References 15 publications

The Enthusiasm: Evidence Ratio for Comprehensive Chronic Disease Care?

The Enthusiasm: Evidence Ratio for Comprehensive Chronic Disease Care?

The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey

Clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study

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