Factors affecting bypass of local health care facilities in a tertiary hospital: A key to utilization of primary health care services

Background@#Bypass, is a pattern of seeking health care outside the local community where primary health care facilities are not efficiently utilized. It is common practice for patients to go directly to secondary or tertiary health facilities for primary health concerns, causing heavy traffic at the higher level facilities and corresponding over-utilization of resources.@*Objective@#This study aimed to determine factors associated in the bypass of health care facilities among outpatient department patients and to identify health care facility factors perceived important among patients.@*Method@#The study employed self-administered questionnaire with the assistance of trained research assistants among patients who sought consult at the Baguio General Hospital and Medical Center Outpatient Department during the study period of August 2018 – October 2018. Respondents were asked about demographic characteristics, health insurance status, referral status, health care facility factors and answer the Personal Satisfaction Questionnaire 18 (PSQ 18) survey.@*Results@#The questionnaire survey included 251 patients. The total rate bypassing of local health care facilities was 37.8%. Pearson chi square test revealed that educational attainment was associated with increased bypass of health care facilities (p=0.013). Factors such as age, sex, civil status, employment status, monthly income and health insurance status were significantly associated with bypass. Availability of medical doctors was the most prevelant factor in choosing a health care facility in both bypassers (36%) and non bypassers (46%). PSQ 18 survey revealed that patients are generally satisfied on the availment of health services in both bypassers (mean 3.78) and non bypassers (mean 3.89). The subscales in communication, time spent with doctor and accessibility and convenience were scored highest while technical quality was scored lowest on both groups.@*Conclusion@#Bypass of local health care facilities is a major health concern. Travelling longer distances for health care imposes unnecessary shift of direct health care costs into indirect costs such as transport. Increasing awareness of available local health care facilities and services together with its improvement might help decrease bypass especially on patients with lower educational attainment. The referral system and network of health care providers should be reinforced for better health care service delivery, patient satisfaction and lower health care cost.

Study of satisfaction of diabetic patients attending the diabetic clinic at primary health centers in Abha city, Saudi Arabia.

Background: With the ageing of the population and the advances in the treatment of chronic diseases, the teamwork in the context of chronic diseases needs to be re-examined. Patients with chronic diseases have to pay repeated visits to PHC clinics, usually for the rest of their lives. These patients are usually more difficult to satisfy. Patient satisfaction is the extent to which the patients feel that their needs and expectations are being met by the service provided. It has been a widely recognized indicator of quality of care in medical practice. Aims & Objective: This study aims to assess patients’ satisfaction with the main aspects of primary health care provided at the Chronic Diseases Clinic, identify areas of health care that show low satisfaction and Identify determinants of patients’ satisfaction. Materials and Methods: A cross sectional study was carried out among a representative random sample of registered patients, at randomly selected two PHCCs in Abha, KSA. The tool used for data collection consisted of two parts; the first part was about the personal information of the participants, while the second part was the Arabic version of Modified patient satisfaction questionnaire (PSQ-18). Results: The study include 600 patients, almost one fourth of participants aged above 60 years, while 37% of them aged 50-60 years and 38.7% of them aged below 50 years. Of the respondents, 13% were dissatisfied, while 87% were satisfied (i.e., 44% were moderately satisfied and 43% were highly satisfied).This study revealed significantly lower levels of satisfaction among diabetic patients who attended at Al-Qabel PHCC than those who attended at Al-Manhal PHCC, i.e. pre-clinic items (67.7% vs. 76%, respectively); clinic items (81% vs. 92.3%, p<0.001); post-clinic items (86.3% vs. 92.3%, p<0.001) and overall satisfaction (81.3% vs. 92.7%, p<0.001. Regarding diabetic patients’ grades of overall satisfaction, the highest proportion of dissatisfaction was observed among patients aged <50 years, males, lower levels of education and higher monthly income. Unemployed patients expressed significantly higher grades of satisfaction than employed patients (p=0.005). Conclusion: This study concluded that diabetic patients’ satisfaction grade was least toward pre-clinic (i.e., PHCC accessibility, availability of parking areas, comfortable waiting area, short waiting times and measurement of patient’s vital signs before meeting the physician) followed by post-clinic items (i.e., performing the necessary routine investigations, availability and accessibility of labs within the PHCC, availability of medications within the PHCC’s pharmacy).Patients’ characteristics associated with less satisfaction include younger age, male gender, higher education, employment and higher monthly income.