Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia.
Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
BMJ Open. 2021 May 5;11(5):e047126. doi: 10.1136/bmjopen-2020-047126.
Most countries including Malaysia have set goals to incorporate a strong primary care into the healthcare system. The aim of this study was to evaluate the strength of service delivery process dimensions in Malaysia and compare it with England, the Netherlands, Spain, North Macedonia, Romania and Turkey which participated in the Quality and Costs of Primary Care (QUALICOPC) study.
This cross-sectional study utilised the QUALICOPC study data on primary care performance, which was conducted in 2011-2013 (QUALICOPC in Europe Australia, New Zealand and Canada) and 2015-2016 (Malaysia). A standardised questionnaire was completed by primary care practitioners from participating countries. Multilevel regression analysis and composite scores were constructed to compare the performance of primary care on four process dimensions: accessibility, comprehensiveness, continuity of care and coordination.
The high-income countries with strong primary care performed better in comprehensiveness, continuity and coordination but poorer in accessibility to services compared with upper-middle-income countries. Among the upper-middle-income countries, Malaysia scored the best in comprehensiveness and coordination. None of the studied countries were having consistent performance over all indicators either in their respective best or worst primary care services delivery dimensions.
There is a wide variation in primary care services delivery across and within the studied countries. The findings indicate room for quality improvement activities to strengthen primary healthcare services. This includes addressing current healthcare challenges in response to the population health needs which are essential for more integrated and efficient primary care services delivery.
包括马来西亚在内的大多数国家都制定了将强大的初级保健纳入医疗体系的目标。本研究旨在评估马来西亚服务提供过程维度的实力，并将其与参与质量和初级保健成本（QUALICOPC）研究的英国、荷兰、西班牙、北马其顿、罗马尼亚和土耳其进行比较。
本横断面研究利用 QUALICOPC 研究在欧洲澳大利亚、新西兰和加拿大进行的初级保健绩效数据（2011-2013 年）和马来西亚进行的研究数据（2015-2016 年）。来自参与国家的初级保健从业者完成了一份标准化问卷。采用多水平回归分析和综合评分来比较四个过程维度（可及性、综合性、连续性和协调性）的初级保健绩效。
与中上收入国家相比，具有强大初级保健的高收入国家在综合性、连续性和协调性方面表现更好，但在服务可及性方面表现较差。在上中等收入国家中，马来西亚在综合性和协调性方面得分最高。在所研究的国家中，没有一个国家在各自的最佳或最差初级保健服务提供维度中，在所有指标上都表现一致。
在所研究的国家和国家内部，初级保健服务的提供存在广泛差异。研究结果表明，有改进质量的空间，以加强初级卫生保健服务。这包括应对当前的医疗保健挑战，以响应人口健康需求，这对于更综合和有效的初级保健服务提供至关重要。
