Peabody J W, Rahman O, Fox K, Gertler P
General Internal Medicine Division, Veterans' Administration Hospital, West Los Angeles, California.
Bull Pan Am Health Organ. 1994 Jun;28(2):122-41.
This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics. While structural measures of quality such as those employed here tend to poorly estimate health outcomes, they do serve as good indicators of access to services where resources are severely constrained. For policy-makers, the results presented here could prove useful in guiding concrete interventions, summarizing the structural elements of health care quality at different types of facilities, and providing a method for less costly evaluation of programs designed to improve services at primary health care clinics.
本文通过比较1990年全国范围内对366家公立诊所和189家私立诊所进行调查得出的各种结构质量指标，研究了牙买加初级医疗保健诊所提供的护理质量。这种比较凸显了公立与私立、城市与农村医疗机构在提供护理质量方面的重要差异，这些差异可能是未曾预料到的。该研究发现，公立诊所在提供产前诊断和咨询以及更多计划生育服务方面比私立诊所做得更好。然而，私立诊所往往状况更好、设备和物资更充足，并且更有能力及时提供某些实验室检测结果。对城市和农村公立诊所的比较表明，城市诊所的设备、物资和药品配备情况稍好一些。然而，农村诊所的维修状况似乎更好。对基础和高级公立诊所的比较显示，基础诊所的状况更好，人员配备更齐全，围产期诊断能力与高级诊所相似，不过高级公立诊所的整体情况往往更类似于私立诊所，其设备和物资比基础诊所更充足。虽然这里采用的诸如结构质量措施往往难以准确估计健康结果，但在资源严重受限的情况下，它们确实可作为获得服务的良好指标。对于政策制定者而言，这里呈现的结果可能有助于指导具体干预措施，总结不同类型医疗机构护理质量的结构要素，并提供一种成本较低的方法来评估旨在改善初级医疗保健诊所服务的项目。
