Hoa Nguyen Thi, Tam Nguyen Minh, Derese Anselme, Markuns Jeffrey F, Peersman Wim
Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen street, Hue, Vietnam.
Department of Public Health and Primary Care, Campus UZ 6K3, C.Heymanslaan 10, B-9000, Ghent, Belgium.
BMC Health Serv Res. 2019 May 2;19(1):275. doi: 10.1186/s12913-019-4089-y.
Patient experience with primary health care services can vary markedly between different types of health care facilities, even within the same country setting. Given known benefits of high quality primary health care, the performance of these facilities may significantly impact population health. The aim of this study was to compare the quality of primary care in different types of health facilities as experienced by Vietnamese consumers.
1662 people who utilized primary health care services at least once over the past two years in various types of facilities in central Vietnam were surveyed in a cross-sectional study using the Vietnamese version of the Primary Care Assessment Tool (VN PCAT-AE) to assess overall primary care quality as well as several different domains of high quality primary care services.
Commune health centers were associated with the highest overall primary care quality (PCAT expanded score 21.07, p < 0.001) as well as high scores in nearly all individual domains of primary care quality experienced by consumers compared with other types of facilities. Conversely, private facilities such as private clinics and pharmacies were rated lowest overall (PCAT expanded score 18.45, p < 0.05 and 16.90, p < 0.001 respectively). District hospitals and other government hospitals (PCAT expanded score 20.10 and 19.72 respectively) were reported as the best quality in comprehensiveness of available services (p < 0.001). Polyclinics performed quite well in comprehensiveness of services available (3.11) and first contact-access (2.79) but less so in other domains, especially in cultural competency (1.87).
The high quality of primary care services experienced by consumers in commune health centers compared with other facilities gives Vietnam ample reason to promote greater use of these community-based primary care facilities. Populations may benefit most from building and strengthening grassroots networks of such community-based health centers as an effective solution for overcrowding at hospitals while simultaneously providing better overall health outcomes.
即使在同一个国家，不同类型的医疗保健机构为患者提供的初级卫生保健服务体验也可能存在显著差异。鉴于高质量初级卫生保健的已知益处，这些机构的表现可能会对人群健康产生重大影响。本研究的目的是比较越南消费者在不同类型卫生机构中所体验到的初级保健质量。
在一项横断面研究中，对越南中部各类机构中过去两年至少使用过一次初级卫生保健服务的1662人进行了调查，使用越南版的初级保健评估工具（VN PCAT-AE）来评估整体初级保健质量以及高质量初级保健服务的几个不同领域。
与其他类型的机构相比，社区卫生中心的整体初级保健质量最高（PCAT扩展得分21.07，p < 0.001），并且在消费者体验到的几乎所有初级保健质量的各个领域中得分也很高。相反，私人诊所和药店等私人机构的总体评分最低（PCAT扩展得分分别为18.45，p < 0.05和16.90，p < 0.001）。地区医院和其他政府医院（PCAT扩展得分分别为20.10和19.72）在可提供服务的全面性方面被报告为质量最佳（p < 0.001）。多科门诊在可提供服务的全面性（3.11）和首次接触可及性（2.79）方面表现相当不错，但在其他领域表现较差，尤其是在文化能力方面（1.87）。
与其他机构相比，消费者在社区卫生中心体验到的高质量初级保健服务，使越南有充分理由促进更多地使用这些基于社区的初级保健机构。通过建立和加强此类基于社区的卫生中心的基层网络，人群可能会受益最大，这是解决医院过度拥挤问题的有效办法，同时还能提供更好的整体健康结果。
