Department of Family Medicine, Aga Khan University Hospital, Nairobi, Kenya.
Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa.
BMC Prim Care. 2022 May 18;23(1):120. doi: 10.1186/s12875-022-01700-3.
Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya.
A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.
Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.
These primary care clinics in Nairobi showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.
需要强调初级保健的综合卫生服务，以实现有效的初级卫生保健和全民健康覆盖。高质量初级保健的关键要素是首诊、连续性、综合性、协调性和以患者为中心。在肯尼亚，关于这些关键要素的绩效信息很少，需要这些信息来改善服务提供。因此，本研究旨在评估肯尼亚内罗毕私营部门医疗机构的初级保健绩效质量。
采用适应肯尼亚国情的初级保健评估工具进行横断面描述性研究，对 13 个初级保健诊所的 412 名系统抽样的初级保健使用者进行调查。使用社会科学统计软件包（SPSS）分析数据，以衡量初级保健绩效的 11 个领域和两个综合初级保健评分。
初级保健平均得分为 2.64（SD=0.23），扩展后的初级保健平均得分为 2.68（SD=0.19），表明整体表现较低。首诊利用率、协调（信息系统）、以家庭为中心和文化能力等领域的平均得分均大于 3.0（可接受的良好表现）。首诊可及性、协调性、综合性（提供和可获得）、持续护理和社区导向等领域的平均得分均小于 3.0（表现较差）。年龄较大的受访者（p=0.05）和对诊所认同度较高的受访者（p=0.01）更有可能将初级保健评为可接受至良好。
内罗毕的这些初级保健诊所表现出绩效差距。首诊利用、信息系统、以家庭为中心和文化能力等方面的表现被评为可接受至良好。然而，患者对首诊可及性、持续护理、护理协调、服务综合性、社区导向和提供完整的初级卫生保健团队的评价较低。通过部署家庭医生、扩大实践范围以提高综合性、激励使用这些初级保健诊所而不是三级医院、改善下班后的可及性以及向实践人群宣传诊所的使用，可以提高绩效。
