Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden.
BMC Health Serv Res. 2013 Aug 15;13:315. doi: 10.1186/1472-6963-13-315.
The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city.
The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users.
The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation--rated as critical by users; the distribution of financial resources--rated as critical by health managers; and, accessibility--rated as intermediate by users.
The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required.
服务的高度分割和碎片化是哥伦比亚卫生系统的主要问题之一。2004 年，波哥大地区政府决定通过家庭保健计划实施初级卫生保健（PHC）战略。PHC 被构想为在第一级公共卫生保健设施网络内转变医疗服务提供方式的模式。本研究旨在评估在波哥大市六个地理位置分布的地区，PHC 战略的基本维度的绩效。
应用了在巴西经过验证的快速评估工具来衡量 PHC 绩效。比较了在实施家庭保健计划的公共卫生设施中参与人员（用户、专业人员、卫生管理人员）的看法，以及在未实施该计划的私人卫生设施中参与人员的看法。计算了全球绩效指数和每个初级保健维度的特定指数。进行了多变量逻辑回归分析，以确定 PHC 维度的绩效与用户自我感知的健康状况之间可能存在的关联。
接受采访的所有参与者都对全球绩效指数给予了良好的评价。总的来说，除了专业人员外，家庭保健计划实施的公共卫生保健设施在大多数基本维度上的差异似乎更有利于该计划。最薄弱的维度是家庭为中心和社区导向——用户认为是关键；财务资源分配——卫生管理人员认为是关键；以及可及性——用户认为是中等。
总体结果表明，家庭保健计划可能正在提高第一级公共卫生保健设施网络在一些 PHC 基本维度上的绩效，但需要做出重大努力来实现其目标并提高其在社区中的知名度。
