School of Public Health, the University of Queensland, Brisbane, Australia.
College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Health Serv Res. 2023 Aug 23;23(1):893. doi: 10.1186/s12913-023-09917-3.
Quality health services build communities' and patients' trust in health care. It enhances the acceptability of services and increases health service coverage. Quality primary health care is imperative for universal health coverage through expanding health institutions and increasing skilled health professionals to deliver services near to people. Evidence on the quality of health system inputs, interactions between health personnel and clients, and outcomes of health care interventions is necessary. This review summarised indicators, successes, and challenges of the quality of primary health care services.
We used the preferred reporting items for systematic reviews and meta-analysis extensions for scoping reviews to guide the article selection process. A systematic search of literature from PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), Scopus, and Google Scholar was conducted on August 23, 2022, but the preliminary search was begun on July 5, 2022. The Donabedian's quality of care framework, consisting of structure, process and outcomes, was used to operationalise and synthesise the findings on the quality of primary health care.
Human resources for health, law and policy, infrastructure and facilities, and resources were the common structure indicators. Diagnosis (health assessment and/or laboratory tests) and management (health information, education, and treatment) procedures were the process indicators. Clinical outcomes (cure, mortality, treatment completion), behaviour change, and satisfaction were the common indicators of outcome. Lower cause-specific mortality and a lower rate of hospitalisation in high-income countries were successes, while high mortality due to tuberculosis and the geographical disparity in quality care were challenges in developing countries. There also exist challenges in developed countries (e.g., poor quality mental health care due to a high admission rate). Shortage of health workers was a challenge both in developed and developing countries.
Quality of care indicators varied according to the health care problems, which resulted in a disparity in the successes and challenges across countries around the world. Initiatives to improve the quality of primary health care services should ensure the availability of adequate health care providers, equipped health care facilities, appropriate financing mechanisms, enhance compliance with health policy and laws, as well as community and client participation. Additionally, each country should be proactive in monitoring and evaluation of performance indicators in each dimension (structure, process, and outcome) of quality of primary health care services.
优质的卫生服务能够建立社区和患者对医疗保健的信任。这不仅能提高服务的可接受性，还能增加卫生服务的覆盖面。通过扩大医疗机构和增加提供服务的熟练卫生专业人员，初级卫生保健质量至关重要，这样才能让人们在更靠近的地方享受到服务。有必要了解卫生系统投入的质量、卫生人员与客户之间的相互作用以及卫生保健干预措施的结果等方面的证据。本综述总结了初级卫生保健服务质量的指标、成功经验和挑战。
我们使用系统评价和荟萃分析扩展的首选报告项目来指导文章选择过程。2022 年 8 月 23 日，我们对 PubMed、Web of Science、Excerpta Medica dataBASE（EMBASE）、Scopus 和 Google Scholar 进行了文献系统检索，但初步检索始于 2022 年 7 月 5 日。我们使用唐奈比恩的医疗服务质量框架（由结构、过程和结果组成）来操作和综合初级卫生保健质量方面的发现。
卫生人力资源、法律和政策、基础设施和设施以及资源是常见的结构指标。诊断（健康评估和/或实验室检查）和管理（健康信息、教育和治疗）程序是过程指标。临床结果（治愈、死亡率、治疗完成率）、行为改变和满意度是共同的结果指标。高收入国家的成功经验包括特定病因死亡率降低和住院率降低，而发展中国家则面临结核病死亡率高和医疗质量地域差异等挑战。在发达国家（例如，由于高入院率导致的心理健康保健质量差）也存在挑战。卫生工作者短缺是发达国家和发展中国家共同的挑战。
由于医疗保健问题的不同，医疗服务质量指标也有所不同，这导致了世界各国在成功和挑战方面存在差异。改善初级卫生保健服务质量的举措应确保提供足够的医疗保健提供者、配备适当的医疗保健设施、建立适当的融资机制、加强对卫生政策和法律的遵守以及促进社区和客户的参与。此外，每个国家都应积极主动地监测和评估初级卫生保健服务质量的每个维度（结构、过程和结果）的绩效指标。
