Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Setting
2.2. Survey Content and Variable Selection
- Sociodemographic characteristics: age; gender; place of residence; type of household; income; education; employment; and insurance by national health coverage.
- Perceptions on different elements of primary healthcare service provision: geographic accessibility; organizational accessibility; financial accessibility; information accessibility; perceived competence of physicians; behavior of medical staff; and infrastructure and facilities (5-point Likert scale from very poor to very good);
- Patient experiences in terms of frequency of encountering issues with healthcare service provision: difficulties in accessing primary healthcare (e.g., appointment scheduling); lack of empathy from medical staff; perceived insufficiency of diagnostics; lack of information from medical staff; difficult reimbursement procedures; and lack of interprofessional collaboration (5-point Likert scale, from never to always).
- Self-reported overall health status of the respondent (or care recipient) rated on a 5-point Likert scale, from very poor to very good.
2.3. Analysis
- maximum number of levels: 4;
- minimum sample size for parent nodes: 10% of the sample;
- minimum sample size for child nodes: 1% of the sample.
3. Results
3.1. Sample Description
3.2. General Data on PPHQ in Primary Healthcare (Descriptive Analysis)
3.3. Main Determinants of PPHQ in Primary Healthcare (CRT Analysis)
3.3.1. Primary CRT Model
3.3.2. CRT Models with Substituted Primary Splitting Variable
4. Discussion
4.1. The main Determinants of Healthcare Quality from Patients’ Perspectives
4.1.1. The Behavior of Medical Staff Factor and Its Interaction with other PPHQ Determinants
4.1.2. Organizational Accessibility and Its Interaction with Other PPHQ Determinants
4.1.3. Financial Accessibility and Its Interaction with Other PPHQ Determinants
4.1.4. Self-Reported Overall Health Status and Sociodemographic Characteristics
4.2. CRT as a Method to Identify Patients’ Individual Needs for Targeted HQ Improvement
4.3. Implication of the Study
4.4. Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
I. Assessment of the PPHQ of primary healthcare based on patients’ personal experiences Question to respondents: How do you feel about the following determinants when you refer to your primary healthcare facility and receive services? Please rate each of the determinants according to your personal experience (5-point Likert scale, from very poor to very good) | ||
No. | Determinants | Question and description of the determinant given to the respondent during the survey |
1. | Geographic accessibility | Is the HC facility easily accessible and conveniently located? (i.e., availability of public transport, well-developed road network, car parking, etc.) |
2. | Organizational accessibility | How do you rate the way in which the HC facility organizes service provision? (the length of opening hours, appointment procedures, queuing, and waiting times; whether patient appointments run at the scheduled time; whether there is an immediate response/problem-solving such as referral for tests, issue of necessary prescriptions; whether the patient is passed from one physician to another) |
3. | Financial accessibility | How do you rate the financial accessibility of HCSs? (if a service is fully or partially paid for, does the patient think that the price of the service is financially accessible, is the price/quality ratio optimal?) |
4. | Information accessibility | How do you rate the accessibility of information and provision of patients with information? (is it easy to find/obtain accurate, complete and comprehensible information? Are patients informed about the process of medical treatment, results, etc.?) |
5. | Perceived competence of physicians | How do you rate the competence of physicians of the healthcare system? (are the professionals knowledgeable about their work?) |
6. | Behavior of the medical staff | How do you rate the behavior of the medical staff towards patients? (i.e., are they respectful, polite, empathetic, responsible? Is the physician able to recognize/listen to the patient’s needs?) |
7. | Infrastructure and facilities | How do you rate the physical environment of the healthcare system? (are the premises clean and tidy, with the necessary infrastructure, medical diagnostic equipment, supplies to provide the service, etc.?) |
II. Patient experiences in terms of frequency of encountering the following issues Question to respondents: Have you encountered issues with healthcare services? If yes, how often have you encountered the following issues? (5-point Likert scale, from never to always) | ||
No. | Determinants | Question and description of the determinant given to the respondent during the survey |
8. | Difficulties in accessing primary healthcare (e.g., appointment scheduling) | How often have you encountered difficulties with appointment and access to a primary care physician (including general practitioner (GP), pediatrician, obstetrician–gynecologist, surgeon)? |
9. | Lack of empathy from medical staff | Is there a lack of understanding, attention and empathy from the medical staff? |
10. | Perceived insufficiency of diagnostics | Do you think that the tests and comprehensive diagnostics ordered by physicians are sufficient? |
11. | Lack of information from medical staff | Is there a lack of information from the medical staff about the illness, medical treatment and procedures? |
12. | Difficulties due to unstable reimbursement process | Do you encounter issues with unclear, constantly changing procedures for reimbursement of medicines or medical supplies? |
13. | Lack of interprofessional collaboration | Do you think there is a lack of collaboration between the professionals of different healthcare facilities (information sharing, trust, complementarity of one another’s actions)? For example, does your GP collaborate with specialist physicians when necessary? |
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Sociodemographic Characteristics | Number of Respondents | Proportion (Proportions of the Lithuanian Population in 2020 from Official Statistics) |
---|---|---|
Age group | ||
0–17 years | 177 | 17.1% (20%) |
18–24 years | 66 | 6.4% (6%) |
25–34 years | 155 | 15.0% (13%) |
35–44 years | 140 | 13.6% (12%) |
45–54 years | 166 | 16.1% (14%) |
55–64 years | 144 | 13.9% (15%) |
≥65 years | 185 | 17.9% (20%) |
Male | 492 | 47.6% (47%) |
Female | 541 | 52.4% (53%) |
Place of residence | ||
Town (up to 5000 inhabitants) | 318 | 30.8% (30%) |
City (5000–80,000 inhabitants) | 218 | 21.1% (22%) |
City (>80,000 inhabitants) | 497 | 48.1% (48%) |
Education | ||
Higher | 343 | 33.2% |
Primary or lower secondary | 27 | 2.6% |
Vocational | 295 | 28.6% |
Secondary education | 368 | 35.6% |
Employment status | ||
Unemployed | 76 | 7.4% |
Employed (private sector) | 531 | 51.4% |
Employed (public sector) | 155 | 15.0% |
Retired | 115 | 11.1% |
Student | 152 | 14.7% |
Did not indicate | 4 | 0.4% |
Income (per household member) | ||
<EUR 400 | 68 | 6.6% |
EUR 401–EUR 600 | 347 | 33.6% |
EUR 601–EUR 800 | 474 | 45.9% |
>EUR 800 | 79 | 7.6% |
Did not indicate | 65 | 6.3% |
Type of household | ||
One person | 113 | 10.9% |
One adult with children | 44 | 4.3% |
Two adults with children | 250 | 24.2% |
Two adults, at least one aged 65 or over, without children | 40 | 3.9% |
Two adults aged under 65 without children | 502 | 48.6% |
Three or more adults without children | 84 | 8.1% |
Insured by national health coverage | 977 | 94.6% |
Independent Variable | Importance | Normalized Importance |
---|---|---|
Organizational accessibility | 0.181 | 100.0% |
Behavior of medical staff | 0.178 | 98.4% |
Financial accessibility | 0.175 | 96.3% |
Information accessibility | 0.156 | 86.1% |
Lack of understanding, attention and empathy from medical staff (frequency) | 0.096 | 52.7% |
Difficulties in accessing primary healthcare (frequency) | 0.093 | 51.5% |
Infrastructure and facilities | 0.087 | 47.9% |
Perceived competence of physicians | 0.058 | 32.1% |
Perceived insufficiency of diagnostics (frequency) | 0.054 | 29.7% |
Lack of information from medical staff (frequency) | 0.047 | 25.7% |
Geographic accessibility | 0.045 | 24.9% |
Subjective assessment of health status | 0.044 | 24.2% |
Type of household | 0.030 | 16.4% |
Place of residence | 0.029 | 15.9% |
Lack of interprofessional collaboration (frequency) | 0.023 | 12.6% |
Age | 0.013 | 7.1% |
Employment status | 0.010 | 5.7% |
Income status | 0.009 | 5.2% |
Difficulties due to unstable reimbursement process (frequency) | 0.006 | 3.3% |
Education status | 0.002 | 1.3% |
Insurance by national health coverage status | 0.002 | 1.2% |
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Servetkienė, V.; Puronaitė, R.; Mockevičienė, B.; Ažukaitis, K.; Jankauskienė, D. Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania. Int. J. Environ. Res. Public Health 2023, 20, 4720. https://doi.org/10.3390/ijerph20064720
Servetkienė V, Puronaitė R, Mockevičienė B, Ažukaitis K, Jankauskienė D. Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania. International Journal of Environmental Research and Public Health. 2023; 20(6):4720. https://doi.org/10.3390/ijerph20064720
Chicago/Turabian StyleServetkienė, Vaida, Roma Puronaitė, Birutė Mockevičienė, Karolis Ažukaitis, and Danguolė Jankauskienė. 2023. "Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania" International Journal of Environmental Research and Public Health 20, no. 6: 4720. https://doi.org/10.3390/ijerph20064720