Political and technical barriers to improving quality of health care

Khan, Mishal; Hashmani, Farah Naz

doi:10.1016/s0140-6736(18)32075-0

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…Without addressing some of these systemic drivers of inappropriate use of medicines, teaching the values related to professionalism may not translate into behavioural change. Similarly, a conducive regulatory environment is critical, and generating the resources and political will to implement regulations that address poor quality of healthcare is often very challenging [63,64].…”

Section: Discussionmentioning

confidence: 99%

Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

et al. 2020

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Background: Healthcare providers' (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low-and middle-income countries (LMIC), the quality of professional education delivered to HCPs and their resulting professionalism has been neglected. The Global Action Plan on Antimicrobial Resistance (AMR) seeks to reduce inappropriate use of antibiotics by urging patients to access antibiotics only through qualified HCPs, on the premise that qualified HCPs will act as more responsible and competent gatekeepers of access to antibiotics than unqualified HCPs. Methods: We investigate whether weaknesses in HCP professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR-Pakistan and Cambodia. We conducted 85 in-depth interviews with HCPs, policymakers, and pharmaceutical industry representatives. Our thematic analysis was based on a conceptual framework of four components of professionalism and focused on identifying recurring findings in both countries.Results: Despite many cultural and sociodemographic differences between Cambodia and Pakistan, there was a consistent finding that the behaviour of many qualified HCPs did not reflect their professional education. Our analysis identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education.

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Section: Discussionmentioning

confidence: 99%

Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

et al. 2020

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“…31 Primary health care in many rural areas have the challenges of; staff recruitment, poor physical amenities; lack of accessibility to diagnostic health services which undermines quality and effective care when contrasted to urban settings. 32,33 Additional evidence is required with regard to public and private users "experiences with quality of care and operating providers" characteristics, 34 factors that drive quality variations and quality improvement approaches 21 in order to guide PHC strengthening. To date, substantial published work is available in this field [35][36][37][38][39] but none in Albania to the best of our knowledge.…”

Section: Quality Of Care and Patient Experience Across Settingsmentioning

confidence: 99%

Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care

Gabrani

Schindler

Wyss

2020

J Prim Care Community Health

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Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain “communication” (3.75) followed by “dignity” (3.65), while the lowest mean scores were given for “choice” (2.89) and “prompt attention” (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in “coordination of care” (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in “confidentiality” (3.77 vs 3.38, P = .04) and “quality of basic amenities” (3.70 vs 3.02, P < .001). “Autonomy” was reported as least important attribute of quality. Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients’ aspects concerning their health.

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“…30 Primary health care in many rural areas have the challenges of; staff recruitment, poor physical amenities; lack of accessibility to diagnostic health services which undermines quality and effective care when contrasted to urban settings. 31,32 Additional evidence is required with regard to public and private users 'experiences with quality of care and operating providers' characteristics, 33 factors that drive quality variations and quality improvement approaches 20 in order to guide PHC strengthening. To date, substantial published work is available in this eld 34,35,36, 37, 38 but none in Albania to the best of our knowledge.…”

Section: Quality Of Care and Patient Experience Across Settingsmentioning

confidence: 99%

Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania

Gabrani

Schindler

Wyss

2020

Preprint

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Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyse perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along eight non-clinical domains of quality of care. The data of 954 patients were analysed through descriptive statistics and linear mixed regression models.Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain ‘communication’ (3.75) followed by ‘dignity’ (3.65), while the lowest mean scores were given for ‘choice’ (2.89) and ‘prompt attention’ (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in ‘coordination of care’ (2.90 vs 2.12, p < 0.001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in ‘confidentiality’ (3.77 vs 3.38, p = 0.04) and ‘quality of basic amenities’ (3.70 vs 3.02, p < 0.001). For the other domains, no statistically significant differences were observed. ‘Autonomy’ was reported as least important attribute of quality. Enrolment in health insurance was a predictor of higher quality ratings (coefficient = 0.06, p = 0.02).Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to shift from a ‘paternalistic’ model to a ‘co-managing the illness’, raising awareness on autonomy.

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Political and technical barriers to improving quality of health care

Cited by 8 publications

References 8 publications

Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care

Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania

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