Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
Faculty of Medicine, University of Basel, Basel, Switzerland.
BMJ Open. 2020 Dec 1;10(12):e040398. doi: 10.1136/bmjopen-2020-040398.
To identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.
A cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.
Exit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July-August 2018.
Representative sample of 629 adults ≥18 years of age.
(1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients' decision to attend a given provider. Data were analysed using mixed logistic regression models.
Nearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were 'quality of care' and 'healthcare professionals' attitudes. Solely looking at patients using a public provider, 'geographical proximity' was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider's patients, the 'availability of diagnostic devices' was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).
The use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.
确定影响阿尔巴尼亚政府和私人初级保健服务利用的关键因素。
使用 4 分李克特量表问卷对影响服务利用的因素进行排名，进行横断面卫生机构调查。
2018 年 7 月至 8 月期间，对来自阿尔巴尼亚菲尔地区 23 家初级保健提供者（18 家公立和 5 家私立）之一就诊的患者进行出院访谈。
≥18 岁的代表性 629 名成年人样本。
（1）影响选择政府或私人初级保健提供者的决策的因素，以及（2）社会人口特征和患者选择特定提供者的决策之间的关联。使用混合逻辑回归模型分析数据。
在这项研究中，近一半的参与者年龄在 60 岁以上（45%）。大多数（63%）报告患有慢性病。选择提供者的主要决定因素是“护理质量”和“医疗保健专业人员的态度”。仅考虑使用公共提供者的患者，“地理位置接近”是指导决策的最重要因素（85%比 11%，p<0.001）。对于私人提供者的患者，“诊断设备的可用性”是最重要的因素（69%比 9%，p<0.001）。那些认为自己健康状况较差（OR 5.59；95%CI 2.62 至 11.92）、患有慢性病（OR 3.13；95%CI 1.36 至 7.24）或受益于社会经济援助计划（OR 3.52；95%CI 1.64 至 7.56）的患者使用公共设施的可能性明显更高。
公共设施使用者的地理和财务获取以及私人使用者设备的可用性强烈影响初级保健的利用。本研究发现，服务的可接受性和充分性方面同样受到重视。需要通过当地决策者和专业协会的参与，进一步承诺发展初级保健。
