Kitreerawutiwong Nithra, Jordan Sue, Hughes David
Faculty of Public Health, Naresuan University, Phitsanulok, Thailand.
College of Human & Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
PLoS One. 2017 Mar 24;12(3):e0174055. doi: 10.1371/journal.pone.0174055. eCollection 2017.
Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2).
A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses.
THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22).
Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.
泰国的低收入和中等收入人群严重依赖基层医疗保健服务。这些服务由一系列专业人员提供。然而，基层医疗的绩效是否因当地服务提供单位的人员配备和组织情况而有所不同尚不清楚。2009年引入了区（县）健康促进医院（THPH），以提升此前健康中心提供的服务，但仍面临医生和护士持续短缺的问题。泰国公共卫生部（MoPH）将THPH分为三类，根据其是否有执业医生、合格护士或非临床公共卫生官员定期任职来界定。本研究旨在比较泰国北部一个公共卫生区域（公共卫生区域2）内三种不同类型基层医疗设施提供的基层医疗服务绩效。
2013年进行了一项横断面调查。收集了来自23个基层医疗设施的825名患者在医疗可及性、连续性、全面性、协调性和社区导向性方面的数据。这些设施包括由医疗、护理或公共卫生人员领导的三种官方指定类型的区（县）健康促进医院（THPH）。在未调整和调整分析中比较了调查得分。
仅由公共卫生官员配备人员的THPH获得了最高绩效得分（均值 = 85.14，标准差 = 7.30），其次是由合格护士配备人员的THPH（均值 = 82.86，标准差 = 7.06）。由轮流坐诊医生配备人员的THPH得分最低（均值 = 81.63，标准差 = 7.22）。
总体得分的差异主要源于所报告的医疗可及性、连续性和全面性方面的差异，而非人员技能组合本身。因此，质量改进政策应侧重于改善这些方面的绩效。
