The quality of primary health care: assessment of the state and ways of improvement (results of a sociological study)

Abstract

Purpose is the study of the opinion of employees of various categories employed in the primary care system (managers, doctors, nurses), regarding the state and main incentives for improving the quality of primary health care (PHC). Materials and methods. A cross-sectional sociological study of the opinions of primary care workers was conducted using a specially designed structured questionnaire posted in the Ukrainian Association of Family Medicine group on the Facebook social network. A total of 360 people were interviewed. The materials were processed using the methods of descriptive and analytical statistics. Results. It was found that the majority of respondents believe that the quality of PHC affects the health of the population (63.1%) and their needs for specialized and emergency care (82.8%). Two-thirds of all respondents (66.9%), including 81.3% of the management staff of PHC facilities, spoke in favor of the introduction of special incentives for improvement quality PHC, which include: the formation of a team approach in teams, the rational distribution of responsibility for health between the doctor and the patient, monitoring the results of the professional activity of the PHC personnel, increasing the remuneration of medical workers. Significant differences in the views of different groups of respondents regarding the stimulating effect on the quality of PHC of the existing monitoring system of the institution's activity and payment mechanisms were revealed. An extensively larger share of managers compared to doctors and nurses (by 57.1% and 75.2%; p<0.05); believes that the approved indicators do not fully characterize the quality of PHC. The majority of managers (64.1%) noted that it is possible to stimulate employees to better and more efficient work only with the help of differentiated wage calculation, taking into account the volume and quality of the work performed. Conclusions. According to the results of a sociological survey, the expediency of using motivational mechanisms to improve the quality of PHC was established. Quantitative characteristics indicate the need to justify and develop on a scientifically sound basis a system of indicators for assessing the quality of the work of PHC facilities and the development of a methodology for the payment of medical personnel of primary health care facilities, taking into account the volume and quality of the work performed.