Quality assessment of medical care in chest dispensaries in Alexandria

ABSTRACT

Eight million new cases of tuberculosis are merging annually, worldwide, of which an estimated three million are dying. The quality of medical care rendered by chest clinics [dispensaries] to tuberculous patients is crucial. The present study was conducted in order to assess quality of medical care rendered to tuberculous patients in all chest clinics in Alexandria [n=7]. To achieve this aim, three checklists were developed in relation to the three dimensions of medical care, namely, structure, process of care and outcome. They were validated and rated by ten medical experts working in the field of tuberculosis and chest diseases. Accordingly for the process of care, each item was scored using weighted scores for physicians performance. Unit weighted scoring was also used for physicians, nurses, as well as social workers. Direct observation was conducted for assessment of structure and process of care rendered by physicians, nurses and social workers. On the other hand outcome was measured by cure or treatment completion rate, treatment failure rate, defaulter rate, as well as death rate. The results revealed that percentage of recommended structure items ranged between 77.8% and 94.4%. Regarding process of care, it was found that the overall weighted physicians performance index [PPI] expressed in percentage was 36.97 +/- 13.65% while the mean unit weighted PPI was 35.26 +/- 13.5%. For the different areas of care, the mean weighted and unit weighted PPI, respectively, were 27.86 +/- 20.83% and 28.61 +/- 21.7% in history taking, 54.65 +/- 11.92% and 42.83 +/- 13.83% for examination, 31.64 +/- 19.61% and 37.10 +/- 19.40% for educating patients, while it was 36.36 +/- 16.0% and 37.90 +/- 16.20% for measures applied to contacts. Moreover, assessment of nurses and social workers performance revealed that they had carried out 91.86% and 86.60% of their recommended activities, respectively. Outcome indices among the different clinics showed that cure or treatment completion rate ranged from 47.48% to 81.51%, while treatment failure rate ranged between 1.71% and 11.54%. On the other hand, the defaulter rate showed a minimum of 13.70% and a maximum of 44.86%. From the present study it could be recommended that quality of medical care in chest clinics should be emphasized specially as regards process of care given by physicians