Factors affecting the use of primary health care clinics for children.

Factors affecting the attendance at primary health care clinics in Lagos were studied at Oguntolu Clinic and Randle Road Health Centre among 120 Nigerian children. The level of immunisation was a measure of the frequency (regularity) of attendance at the clinics. Certain socioeconomic, psychological, and demographic factors were the major factors affecting attendance. Among those fully immunised, the family sizes were low, the mothers and fathers were educated, the mothers were younger, and a higher proportion of the children were boys. The family health workers were responsible for earlier and regular attendance at the clinic. The perception of the severity of symptoms of disease was a major psychological factor affecting attendance. A predictive model for the identification of high need but low users and low need but high users is presented to facilitate the formulation of more realistic primary health care programme priorities and policies.     

Factors affecting quality of care in family planning clinics: a study from Iran.

BACKGROUND: Despite good contraceptive coverage rates, recent studies in Iran have shown an alarmingly high incidence of unplanned pregnancy. OBJECTIVE: To determine factors affecting quality of family planning services, a cross-sectional study was performed from June to August 2006 on women visiting urban Primary Health Care clinics in a provincial capital in western Iran. The primary focus of the study was on provider-client interaction. METHOD: We used a slightly edited version of a UNICEF checklist and a convenient sampling method to assess quality of care in 396 visits to the family planning sections at 25 delivery points. RESULTS: Poor performance was observed notably in Counselling and Choice of method sections. In logistic regression analysis, the following factors were found to be associated with higher quality of care: provider experience [OR (odds ratio)=1.9, CI(0.95) (confidence interval)=1.2-3.0], low provider education (OR=6.7, CI(0.95)=4.0-10.8), smaller workload at the clinic (OR=3.7, CI(0.95)=2.0-6.7), and 'new client' status (OR=4.2, CI(0.95)=2.6-6.7). CONCLUSION: This study identified the issues of counselling and information exchange as the quality domains in serious need of improvement; these areas are expected to be the focus of future training programmes for care providers. Also, priority should be given to devising effective supervision mechanisms and on-the-job training of senior nursing and midwifery graduates to make them more competent in delivering basic family planning services.     

Quality of care in decentralized primary care clinics: a conceptual framework

In an attempt to provide high quality medical care, despite limited resources, health care providers in various countries have introduced decentralization into their health care services. It has been assumed that the delegation of authority to the local levels of the organization will enhance their ability to respond to local needs, and improve cost containment without compromising the quality of care. However, to date, few empirical studies have explored the relationship between decentralization and such projected outcomes. In this article we present a conceptual framework for analyzing possible consequences of decentralization on dimensions of quality of primary health care. We also suggest a framework for defining decentralization programs by their key components, and employ these frameworks to analyze a specific decentralization program being implemented in Israel's largest health maintenance organization (HMO). While we identify the dimensions most likely to be affected, we also conclude that data presently available do not permit a definitive prediction of whether the overall effect of decentralization on quality of care will be positive or negative. The potential reaction of a unit to the elements of change introduced by a decentralization program is influenced by the structural, cultural and management characteristics of that unit. Therefore, future attempts to decentralize health care organizations should be accompanied by close monitoring.     

Factors affecting newborn care practices in Bangladesh

Newborn care is of immense importance for the proper development and healthy life of a baby. Although child and infant mortality in South Asia has reduced substantially, the rate of neonatal mortality is still high, although these deaths can be prevented by adopting simple interventions at the community level. The aim of the study was to identify the associated factors which affect newborn care practices. Data for the study were drawn from the Bangladesh Demographic and Health Survey 2007, in which 6150 mothers were considered. The mean age of the mothers was 18 (±3.2) years. A little over 62% of the pregnant women received at least one antenatal check-up during the entire period of their pregnancy. About 70% of deliveries were conducted at home either by unskilled family members or by relatives. A clean instrument was used for cutting the cord of 87% of the newborn babies, while about 34% of them were reported to have had their first bath immediately after delivery. Initiation of breast feeding immediately after birth was practised in only about 19% of the cases. Compared with mothers with no education, those with secondary or higher levels were associated with clean cord care [odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.0, 1.9] and early breast feeding [OR = 1.6, 95% CI 1.2, 2.2]. The study revealed an urgent need to educate mothers, and train traditional birth attendants and health workers on clean delivery practices and early neonatal care. Increasing the number of skilled birth attendants can be an effective strategy to increase safe delivery practices, and to reduce delivery complications.     

Challenges in implementing a budget-holding programme for primary care clinics

In 1990, Kupat Holim Clalit (KHC), Israel's largest sick fund, initiated a demonstration programme for transforming a number of primary care clinics in the Negev district of southern Israel into autonomous budget-holding units. Four programme components were implemented in the nine participating clinics: allocation of a fixed budget; expansion of day-to-day decision-making authority; establishment of a computerized information system to produce monthly reports on expenditure; and provision of incentives for budgetary control. The research findings are based on a four-year evaluation of the programme, which involved a longitudinal case study conducted with multiple research tools: in-depth interviews, a staff survey, and analysis of relevant documents. This article analyzes the challenges involved in implementing the demonstration programme. It examines clinic staff evaluation of the implementation process (e.g. overall staff had a positive attitude toward it); assesses staff satisfaction with clinic participation in the programme (while only 33% were satisfied, only 21% said they would like the clinic to revert to the pre-programme model) and factors influencing this satisfaction (among them intrinsic benefits, perception of the programme as fair and age); and discusses the lessons to be learnt from the programme regarding effective implementation of organizational change. The main lessons indicate the importance of certain factors in implementing such programmes: (a) long-term management commitment to the programme; (b) appointment of agents of change/programme administrators; (c) establishment of a formal agreement between the parties involved; (d) establishment of communication channels between the parties involved; (e) intrinsic benefits for staff, perceived as incentives to economize; (f) reliable data, perceived to be reliable by the parties involved; (g) staff participation in the process of change; and (h) involvement of the participating unit as a single entity.     

Physician productivity in ambulatory care: for-profit and military primary care health clinics

In summary, by being aware of the characteristics of their physicians and patients, ambulatory care managers might be able to influence their physician productivity. Specifically, managers may wish to hire physicians who are board certified or foreign medical school graduates. Similarly, managers may seek to attract patients with acute, nonsevere, nonurgent conditions. Managers seeking to enhance physician productivity should consider these characteristics regardless of the reimbursement or proprietary nature of their ambulatory care organizations.     

Managing access to primary care clinics using scheduling templates

Health Care Management Science - An important challenge confronting healthcare is the effective management of access to primary care. Appointment scheduling policies/templates can help strike an...     

Retail health clinics drive innovation into primary care practices

A myriad of patient dissatisfaction issues stemming from antiquated approaches to primary care access are resulting in the establishment of retail health clinics (RHCs) throughout the country. RHCs are usually located within retail stores or stand-alone pharmacies and are staffed by nurse practitioners (NPs). They offer treatment for colds, coughs, skin rashes, and ear infections along with offering preventive care and physicals. As disruptive innovations, or innovations that offer services to ignored markets, these clinics are siphoning patient care visits away from primary care physicians because of their attention to quick access, affordable prices, and consumer-friendly approaches. In response, family and internal medicine physicians must follow three strategies to secure their patient population as well as attract new patients: build relationships with RHCs through referral networks and NP supervisory agreements, transform the provision of patient access through the development of physician-owned RHCs, and support the concept of the advanced medical home.     

Quality assessment program in primary care clinics: a tool for quality improvement.

BACKGROUND: Assessment of quality of health care is a major ongoing project of the Israeli Defense Forces (IDF) medical corps. OBJECTIVE: (i) To describe mechanisms of quality assessment (QA) in IDF primary care clinics; (ii) to compare quality of care in different types of primary care clinics; and (iii) to test the hypothesis that implementation of the QA program results in improved quality of care. RESEARCH DESIGN: A prospective, single-blinded, uncontrolled, non-randomized study. MEASURES: Teams of two physicians carry out the QA process once or twice a year according to clinic size. Five areas were evaluated: (i) physician-patient interaction; (ii) medical chart evaluation; (iii) high-risk patients management; (iv) medical care provided by specialists; and (v) medical staff guidance. Clinics were classified in two groups: single-physician clinics (battalion troop clinics) and multi-physician clinics (home-front base clinics). General Linear Models were used for analysis. A P-value <0.05 was considered significant. RESULTS: In 2000 and 2001, 99 primary clinics and 162 primary care physicians were assessed. Seventy-four (45%) physicians were evaluated twice. Single-physician clinics scored higher than multi-physician clinics on most QA parameters. Physicians had significantly better QA results at the second encounter, regardless of the type of clinic. CONCLUSIONS: A primary care medicine QA system is feasible in the IDF. It allows for standardized, reliable, and comprehensive assessment of primary care across the military clinics. We postulate that the increase in QA assessment scores from one examination to the next one indicates an improvement in quality due to the QA program.