Population and primary health-care team characteristics explain the quality of the service.

OBJECTIVES: To identify the characteristics of the primary health-care (PHC) team's structure and of the assigned population affecting service quality dimensions, and to check whether the PHC team's performance varies when assessing the service quality using crude values or those adjusted by the structural factors that affect it. RESEARCH DESIGN: Cross-sectional descriptive study. SUBJECTS: 213 Catalan PHC teams. MEASUREMENTS: Service quality indicators measured in three dimensions: (1) access and physician-patient relationship; (2) team coordination and (3) evidence-based practice. The PHC team structural factors studied are: experience, setting (urban or rural), geographical dispersion, teaching activities and managerial structure. The catchment population characteristics analysed are: age, socio-economic level, mortality, and the proportion of the population that are immigrants. RESULTS: Access and physician-patient relationship dimension were not affected by the studied structural factors. Team coordination improved in rural teams and in those providing care for older populations. Evidence-based practice was found to be higher in teaching teams, in more experienced teams and in those attending populations with a lower socio-economic level. Adjusted service quality indicator values substantially modify the PHC team quality ranking carried out on the basis of its crude values, especially in the team coordination and evidence-based practice dimensions. CONCLUSIONS: A fair evaluation of PHC team performance must be based on its health-care service quality indicators adjusted for setting, age and socio-economic level of the catchment population and for the team's experience and teaching activities.

Personalised care, access, quality and team coordination are the main dimensions of family medicine output

BACKGROUND: Health organisations continually seek good output indicators of family medicine health care provision because they are accountable to society, they need to compare services, and need to evaluate the impact of organisational reforms. OBJECTIVES: Using the sources of information routinely available in health-service management, we sought to assess the groups of components of primary health care output that best serve to define the outcome of family medicine services. DESIGN: Cross-sectional descriptive study. SITE: Primary health care in Catalunya. PARTICIPANTS: 213 primary health care teams. MEASUREMENTS: Information was collected on team structure, user satisfaction, quality-of-professional-life of the health care professionals, and physicians' drug prescription. Confirmatory Factor Analysis was used to assess the number of dimensions that best explained the family medicine outcome. RESULTS: The model that best fits the structure of the data (AGFI=0.778) is that which consists of three dimensions i.e. (1) the individual accessibility to the services and professional-patient relationship; (2) the coordination within the health care team; (3) the scientific-technical quality of the service. The first two of these dimensions were correlated between themselves, but the third was totally independent of the other two. CONCLUSIONS: Using sources of information that are routinely employed in primary health care services management, the model enables the measurement of the output of family medicine by considering the dimensions such as inter-personnel relationships, internal coordination of the team and the scientific-technical quality of the service. Despite its simplicity, this measure of the output incorporates the views not only of the users but of the health care professionals, as well. (AU)

Personalised care, access, quality and team coordination are the main dimensions of family medicine output.

BACKGROUND: Health organisations continually seek good output indicators of family medicine health care provision because they are accountable to society, they need to compare services, and need to evaluate the impact of organisational reforms. OBJECTIVES: Using the sources of information routinely available in health-service management, we sought to assess the groups of components of primary health care output that best serve to define the outcome of family medicine services. DESIGN: Cross-sectional descriptive study. SITE: Primary health care in Catalunya. PARTICIPANTS: 213 primary health care teams. MEASUREMENTS: Information was collected on team structure, user satisfaction, quality-of-professional-life of the health care professionals, and physicians' drug prescription. Confirmatory Factor Analysis was used to assess the number of dimensions that best explained the family medicine outcome. RESULTS: The model that best fits the structure of the data (AGFI=0.778) is that which consists of three dimensions i.e. (1) the individual accessibility to the services and professional-patient relationship; (2) the coordination within the health care team; (3) the scientific-technical quality of the service. The first two of these dimensions were correlated between themselves, but the third was totally independent of the other two. CONCLUSIONS: Using sources of information that are routinely employed in primary health care services management, the model enables the measurement of the output of family medicine by considering the dimensions such as inter-personnel relationships, internal coordination of the team and the scientific-technical quality of the service. Despite its simplicity, this measure of the output incorporates the views not only of the users but of the health care professionals, as well.

Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care.

BACKGROUND: A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams. OBJECTIVE: To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction. METHODS: Before-after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002-2003. QPL and end-user satisfaction were used as outcome measures. RESULTS: QPL was improved in terms of the dimension "perception of support from the management structure" among physicians (4.897 versus 5.220; p<0.001) as well as nurses (5.272 versus 5.638; p<0.001). Further, physicians perceived an increase in the dimension "demands made upon them" (6.124 versus 6.364; p<0.001), differently from the nurses group (5.8191 versus 5.929; p=0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses (beta=0.078, p=0.007), and a negative relationship between "demands made upon them" and user satisfaction in the case of physicians (beta=-0.057, p=0.011). CONCLUSIONS: Incentives related to quality of care annual targets may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase in professionals' perception of support from the management structure. Among nurses, this increase is related to an improvement of user satisfaction.

[Primary health care product defined by health professionals and users]. / El producto de la atención primaria definido por profesionales y usuarios.

OBJECTIVE: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. METHODS: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. RESULTS: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. CONCLUSION: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.

El producto de la atención primaria definido por profesionales y usuarios / Primary health care product defined by health professionals and users

Objetivo: Definir los componentes del producto de la atención primaria de salud (APS) a partir de las opiniones de profesionales y usuarios, para establecer indicadores de evaluación. Métodos: Estudio con metodología cualitativa, con técnicas grupales: grupo nominal (profesionales) y grupos focales (usuarios). Ámbito de realización: APS de Catalunya. Se realizaron 7 grupos: a) médicos de familia y pediatras; b) enfermeras y trabajadoras sociales; c) personal de la unidad de admisión y atención al usuario; d) otros médicos especialistas; e) usuarios, y f) gestores, farmacéuticos y farmacólogos y técnicos de salud. Los participantes respondieron a la pregunta: «Respecto a los servicios que debería ofrecer la APS, ¿cuáles son los aspectos que se deberían valorar?». Se realizó un análisis de contenido. Los datos textuales se descompusieron en unidades, posteriormente agrupadas en categorías, siguiendo el criterio de analogía. Se tuvo en cuenta el contexto de interpretación del equipo investigador. Resultados: Profesionales y usuarios identifican 4 dimensiones del producto de la APS, coincidentes con sus atributos básicos: a) accesibilidad a los servicios; b) coordinación y continuidad del equipo de APS con otros niveles asistenciales; c) relación entre profesionales y usuarios, y d) calidad científico-técnica de los equipos de atención primaria y cartera de servicios. Equidad, satisfacción y eficiencia aparecen en los discursos como ejes transversales de todos los componentes del producto identificados. Conclusión: Hay una gran coincidencia en la definición del producto entre profesionales y usuarios. La relación profesional-paciente aparece como un elemento clave en todos los grupos. Estas 4 dimensiones deberían formar parte de la evaluación de los equipos de APS

Objective: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Methods: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: «Which features should be evaluated in the services that should be provided by PHC?». A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Results: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. Conclusion: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams