Primary health care quality in Iran: a systematic review and meta-analysis

Gorji, Hasan Abolghasem; Royani, Sanaz; Mohseni, Mohammad; Azami-Aghdash, Saber; Moosavi, Ahmad; Sheyklo, Sepideh Gareh

doi:10.5114/fmpcr.2019.82982

Cited by 6 publications

(10 citation statements)

References 23 publications

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“…In the present study, according to the SERVQUAL model, patients' expectations were higher than their perceptions in all dimensions of service quality, and evaluation of their perceptions indicated their dissatisfaction. Similar to the current study, multiple studies have reported large gaps between the expectations and perceptions of service quality in all dimensions (23)(24)(25)(26)(27)(28)(29). The largest gap was observed in the dimensions of responsiveness, empathy, and accessibility; nevertheless, the smallest gap was related to tangibility.…”

Section: Discussionsupporting

confidence: 80%

Assessment of HIV/AIDS Service Quality Using SERVQUAL Model in Iran: A Cross-sectional Study

Joulaei¹,

Roosta²,

Foroozanfar³

et al. 2022

Shiraz E-Med J

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Background: This study aimed to evaluate the quality of services provided in Voluntary Counseling and Testing (VCT) centers from the perspective of clients. Methods: This cross-sectional study was conducted on people living with human immunodeficiency virus (PLWH) in Shiraz, Iran, in 2019. The data were collected using a SERVQUAL questionnaire. Results: The mean scores of expected and perceived service qualities were 4.81 (95% CI: 4.741 - 4.864) and 3.96 (95% CI: 3.901 - 4.019) in male subjects and 4.85 (95% CI: 4.80 - 4.89) and 4.09 (95% CI: 4.01 - 4.135) in female subjects, respectively. There was a significant difference between the expectations and perceptions of clients in all dimensions of service quality in VCT centers. The gaps in the dimensions of responsiveness and empathy were greater than all other dimensions. Conclusions: Due to the high dissatisfaction of PLWH with the quality of services in the responsiveness, accessibility, and empathy dimensions, priority should be given to these dimensions in any improvement effort. The low education level of this group should be taken into account for any educational programs to be successful.

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Section: Discussionsupporting

confidence: 80%

Assessment of HIV/AIDS Service Quality Using SERVQUAL Model in Iran: A Cross-sectional Study

Joulaei¹,

Roosta²,

Foroozanfar³

et al. 2022

Shiraz E-Med J

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“…Previous findings also corroborate that patients who are older, are married, and have a lower level of education, lower incomes, and a good health status receive a higher level of HSQ (Pekkaya, İmamoğlu, & Koca, 2017; Schoenfelder et al, 2011). However, most studies measure the HSQ based on general hospital care or the performance of the health system (Gorji et al, 2019; Nadi et al, 2016; Price et al, 2014), and only a few studies have focused on NPP. Therefore, the aims of this study were as follows: (a) to investigate the expectations, perceptions, and gaps of the HSQ, from the patients’ perspective, and (b) to explore further the priority dimensions for improvement and the significant factors associated with the HSQ in NPP.…”

mentioning

confidence: 99%

“…One systematic review revealed that the largest gap of the HSQ dimension is in responsibility, while the smallest gap is in tangibility and empathy (Teshnizi et al, 2018). However, other studies have suggested that the largest gap is in the reliability or tangibility dimension and that the smallest gap is in the responsiveness or assurance dimension (Gorji et al, 2019;Rezaei, Hajizadeh, Zandian, Fathi, & Nouri, 2018). Consequently, the gaps of HSQ are controversial, and they may vary, based on the different healthcare systems and cultures.…”

mentioning

confidence: 99%

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

Lin

Siao

Tung³

et al. 2021

J of Nursing Scholarship

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Purpose This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients’ perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). Design A cross‐sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. Methods The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance‐Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. Findings A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = ‐2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in‐hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. Conclusions The patients’ expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients’ symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients’ perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. Clinical Relevance The managers of NPP need to pay attention to increasing NPs’ reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP‐to‐patient ratio, applying for certification programs in prescribing training, and cultivating patient‐centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

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“…The first level is related to PHC, while the second and third levels concern hospital services provided in urban areas [11]. PHC in Iran is provided through a healthcare network which was established in the mid-1980s, referred to as the first major reform in Iran's healthcare system [6]. Health houses in rural areas provide PHC through trained local residents called "Behvarz", under the supervision of rural healthcare centers.…”

Section: Primary Health Care Fps and The Referral System In Iranmentioning

confidence: 99%

“…The best approach to providing PHC is suggested to be through the use of FPP [5]. The World Health Organization (WHO) introduced the Family Physician Program (FPP) as a vital tool for improving quality, reducing costs, and ensuring effectiveness and equality [6]. Establishing an FPP within a healthcare system can support an appropriate referral system that works more efficiently and increases access to services [5,7].…”

Section: Introductionmentioning

confidence: 99%

Family physician and referral system adherence in Iranian primary healthcare system

Sokhanvar¹,

Kabir²,

Bevrani³

et al. 2020

fmpcr

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Background. One of the main strategies to improve access to and the quality and efficiency of healthcare systems is a family physician program (FPP) as the primary care provider within an appropriate referral system. Objectives. The aim of this study was to investigate the level of adherence of rural insured patients to family physicians (FP) and the referral system, as well as factors that affect self-referral. Material and methods. This multicenter, cross-sectional study was conducted between April 2018 and February 2019 in East Azerbaijan Province, Iran. A questionnaire-based survey was used to collect data on patient characteristics, adherence to the FPP and referral system, and the reasons for self-referral from 1,553 participants recruited using multistage cluster sampling. Results. Overall, 58.9% of participants adhered to the FPP and referral system. The total self-referral rate was 41.1%, including 24.3% patients who had attended an FP appointment only to obtain a referral code, and 16.8% had self-referred directly. Data on age, sex, family monthly expenditure, and place of residence were associated with self-referral. Structural pitfalls, societal knowledge and attitudes, and cultural challenges were identified as the patients' reasons for self-referring. Within these categories, the most frequent reasons included uncertainty about the knowledge and skills of FPs (74.2%), easy and inexpensive access to specialized services (66.7%), better quality of specialized services (59%), and a lack of awareness of the FPP and the services provided at level 1. Conclusions. A significant percentage of enrollees did not adhere to the FPP and referral system. Considering the unwelcome consequences of self-referral, designing and implementing practical interventions seems essential in order to encourage patients to be more compliant.

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Primary health care quality in Iran: a systematic review and meta-analysis

Cited by 6 publications

References 23 publications

Assessment of HIV/AIDS Service Quality Using SERVQUAL Model in Iran: A Cross-sectional Study

Assessment of HIV/AIDS Service Quality Using SERVQUAL Model in Iran: A Cross-sectional Study

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

Family physician and referral system adherence in Iranian primary healthcare system

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