Correction: Factors affecting patient satisfaction in refugee health centers in Turkey.

[This corrects the article DOI: 10.1371/journal.pone.0274316.].

Factors affecting patient satisfaction in refugee health centers in Turkey.

BACKGROUND: Turkey hosts an estimated 3.7 million Syrian refugees. Syrian refugees have access to free primary care provided through Refugee Health Centers(RHC). We aimed to determine factors that influence patient satisfaction in refugee health centers. METHODS: The study was a cross-sectional quantitative study. A patient survey was administered among 4548 patients attending services in selected 16 provinces in Turkey. A quantitative questionnaire was used to collect information on patient satisfaction and experience in the healthcare facility. Information on "overall satisfaction with health services" was collected on a 5-point Likert scale and dichotomized for analysis. Logistic regression was conducted to identify factors that influenced patient satisfaction. RESULTS: We found that 78.2% of the participants were satisfied with the health services they received. Factors related to service quality and communication were significant determinants of patient satisfaction. The strongest predictors of satisfaction were having a sufficient consultation time (AOR: 2.37; 95% CI: 1.76-3.21; p< 0.0001), receiving a comprehensive examination (AOR: 2.01; 95% CI: 1.49-2.70; p < 0.0001) and being treated with respect by the nurse (AOR: 2.08; 95% CI: 1.52-2.85; p< 0.0001). CONCLUSION: Providing integrated, culturally and linguistically sensitive health services is important in refugee settings. The quality of service and communication with patients influence patient satisfaction in refugee health centers. As such, improvements in aspects such as consultation time and the quality of physician-patient interaction are recommended for patient satisfaction.

Responding to mental health needs of Syrian refugees in Turkey: mhGAP training impact assessment.

BACKGROUND: About 1468 Syrian and Turkish doctors, serving in primary health care, have received the mhGAP training during 2016-2019. As additional training needs were identified, MoH and WHO wanted to understand the usefulness of the training and its impact in responding to the mental health needs of Syrian refugees in Turkey. METHODS: A five component assessment was done in 2019, consisting of feedback of trainees, assessment of increase in knowledge; utilization of service; compliance to treatment guidelines and service user satisfaction. The purpose was to understand the perception of participants on the training; estimate the knowledge gained-attributable to the training; estimate the increase in mental health cases identified and treated; compliance with treatment guidelines; as well as perception of the services received by end-beneficiaries. RESULTS: Results indicate that most of the respondents were happy with the training, but preferred additional mhGAP training as a refresher course in the future. There was knowledge gained due to the training, 9% for the Syrian and 5% for Turkish doctors. The knowledge gained has helped the practicing doctors to be more attentive and increase the numbers of cases diagnosed after the training for almost all groups of diagnoses. Most doctors, observed during practice, comply with the guidelines shared during the training, but improvement is still needed when it comes to prescription and treatment of certain conditions. The average number of mental health cases identified increased by 38 (%27) cases in the year following the training. We observed over 70% compliance with guidelines for 9 out of 12 criteria in question. The results of the patient exit interviews indicate a high level of satisfaction with the MHPSS services provided. About 95% of beneficiaries were happy with the quality of the service, and 92% having their needs met. CONCLUSIONS: The mhGAP training was found useful. More training should be conducted to fill in the gap in service provision and meet the mental needs of Syrian refugees in Turkey.

Satisfaction with mental health and psycho-social support services provided to Syrians under temporary protection in Turkey, evidence from refugee health training centers.

AIM: The objectives of the study were to determine the level of satisfaction with Mental Health and Psycho-social Support Services (MHPSS) provided to Syrians under temporary protection (SuTP) in Turkey and identify predictors that significantly determine the satisfaction with the MHPSS. This study is part of an effort by Ministry of Health (MoH) and World Health Organization (WHO) to evaluate the improvement in the MHPSS following capacity strengthening of social and health providers. METHODS: 357 Syrians under temporary protection were interviewed as they exited the Refugee Health Training Centers in 7 provinces in Turkey (Adana, Gaziantep, Hatay, Istanbul, Izmir and Sanliurfa), using patient exit interviews during mid-Oct - mid-Nov 2019. Uni and bivariate analysis for association was done using Chi square test for categorical variables, looking for significance at p < 0.05. Multivariate analysis (logistic regression) was used to determine the profile of service users and the predictors of satisfaction with MHPSS. RESULTS: Overall satisfaction with services was 93%. The profile of the MHPSS user suggests that the odds of using the service are twice as much for people aged 40+ years (OR 2.016, CI95% [1.129-3.601]), and five times less for married women (OR 0.180, CI95% [0.083-0.391]). The service characteristics that can predict service satisfaction are "having the needs met" (OR 138.73, CI95% [27.99-687.54]) and "satisfaction with the length of the appointments" (OR 54.50, CI95% [6.07-489.57]). There was no multicollinearity detected between the predictors. CONCLUSIONS: MHPSS services provided by professionals trained by MoH and WHO, have a high satisfaction rate and are serving the SuTP population in need. The high satisfaction rate is predicted by having MHPSS needs met, which is a key indication of the usefulness of these services.

CT/MRI accuracy in detecting and determining preoperative stage of gastric adenocarcinoma in Albania.

AIM OF THE STUDY: Gastric adenocarcinoma is among most frequent among cancers in Albania. Early detection and staging is helped by imaging methods, including CT and MRI. This study provides evidence on the CT and MRI accuracy in detecting and pre-operative staging of gastric adenocarcinoma in 62 patients in a diagnostic clinic in Albania. The correct staging of the gastric adenocarcinoma helps decide on the next treatment options. MATERIAL AND METHODS: Sixty-two patients with gastric adenocarcinoma, confirmed with biopsy, underwent both CT and MRI examination at a clinic in Tirana during same week. Images were reviewed to determine the TNM classifications and staging using the current AJCC guidelines. Data on age, sex, cancer location and differentiation were also collected and analyzed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value was estimated for both CT and MRI. RESULTS AND CONCLUSIONS: CT has a higher accuracy than MRI (83% vs. 67%) for T1. Accuracy for T2 was the same (74%). Starting with T3 and upwards, MRI has a slightly more accurate ability to detect and stage the gastric adenocarcinoma (T3: 81 vs. 75; T4: 83 vs. 64). Both the CT and MRI abilities to accurately detect the N classification were the same. Regarding the M classification, the MRI has a slightly more accurate ability to detect metastases (M: 83 vs. 64). Clinicians might benefit from using CT whenever suspect gastric adenocarcinoma patients present first. Decision on surgery requires a MRI to rule out metastases.

Synergy in combining findings from mammography and ultrasonography in detecting malignancy in women with higher density breasts and lesions over 2 cm in Albania.

AIM OF THE STUDY: To provide evidence of the synergy of combining findings from mammography (MM) and ultrasonography (US) in detecting malignancy in women with high-density breasts. MATERIAL AND METHODS: A total of 245 women were screened for breast cancer using both mammography and ultrasonography at the American Hospital in Tirana during 2013-2014. The data was used to identify possible benefits in detecting malignancy, by combining the findings of MM and US and confirming them with those of the biopsy. Data on age, breast density, BI-RADS classification, and biopsy confirmations were collected and analysed. RESULTS: Out of the 245 women, 36 biopsies were taken (17 for women classified BI-RADS 4 and 5; 19 for women with BI-RADS 3 that had grown in size from the previous examination). The accuracy in detecting malignancy for low-density-breast women was 90% for MM, 70% for US, and 90% for combined. For high-density breasts, the accuracy was 65% for MM, 79% for US, and 82% for combined findings. Multivariate analysis indicates that high-density-breast women who have a malignant finding in at least one of the examinations (MM or US) are 24 times more likely (p = 0.039) to have a positive finding in biopsy for malignancy. The odds increased 32 times for lesions over 2 cm (p = 0.056). CONCLUSIONS: Our study results indicate additional benefits of combining findings from MM and US for high-density-breast women. Further study is warranted in a larger population and for different kinds of cancer.

Addressing the phenomenon of bypassing in Albania: the impact of a primary health care strengthening intervention.

The purpose of this study is to assess the impact of a primary health care strengthening intervention on bypassing behavior in Albania, a middle-income country that has experienced substantial structural changes that affect PHC and where bypassing among health care clients is common. The intervention aimed to improve the quality of health care in low-level facilities through improved availability and use of health information, the adoption of clinical practice guidelines, and provider training. The study employs a quasi-experimental research design to evaluate the impact of the intervention on health care utilization. The survey findings suggest that the pilot areas outperformed the control areas with respect to a number of key population-based indicators of health care utilization. For example, in the 2-year period between December 2002 and December 2004, bypassing for treatment of simple acute health problems during the month prior to the survey decreased by 47%, and the percentage of chronically ill health care clients who utilized PHC facilities for treatment in the month prior to the survey increased by 29%. These differences, which are statistically significant at the 10% level or better, suggest that the improved performance in the pilot areas is attributable to the intervention.

Out-of-pocket payments and utilization of health care services in Albania: evidence from three districts.

Like most countries in Central and Southeastern Europe, Albania is currently considering a number of alternative health sector reform strategies to improve the availability, quality and use of primary health care services. However, in order to assess the likely success of such reforms, more needs to be known about the current levels, distribution and determinants of household out-of-pocket spending on health. The purpose of this paper is to use the 2002 Albania Baseline Health Survey, a survey of 2,000 households in Berat, Kucova, and Fier, to understand the magnitude and distribution of out-of-pocket payments for health care services and to identify the factors that operate at the household- and provider-levels that determine whether individuals pay for health care and how much is paid within the month prior to the survey. Of particular interest in the study is examining the extent to which households incur out-of-pocket payments across a number of dimensions-including health insurance status, socio-economic status (SES), type of service, and type of facility. The findings suggest that out-of-pocket payments for care provided in government facilities are widespread, with marked differences in payment practices between inpatient and outpatient care. For outpatients using Primary Health Centers (PHCs), the type of facility that is the focus of the government's primary health care program, average payments appear to be nominal (0.6% of estimated total monthly household expenditure per capita). The multivariate findings indicate that insurance coverage significantly reduces the likelihood of paying for medicines to treat acute and chronic health problems, but not of paying for consultations. The policy implications of the findings on alternative health care financing reforms are briefly discussed.