An overall review of the global efforts towards the assessment of the quality of primary health care

Yıl 2023, , 505 - 513, 01.09.2023

Berna Eren

https://doi.org/10.52880/sagakaderg.1281788

Öz

The quality of health care has been the subject of research for many years. However, the studies have mostly focused on the problems of clinical medicine, and relatively little work has been done on the quality of primary health care. As the health systems around the world are faced with social, economic, and demographical challenges, countries started to lean towards primary health care which can adapt and respond to an ever-changing world. Quality primary health care is shown to provide accessible, affordable, comprehensive, continuous, coordinated and people-centered care in the community. It plays an important role in ensuring equity in health, reducing morbidity and mortality, optimizing efficient use of resources, achieving better health outcomes, and improving the health of populations. Over the past decades, quality improvement has received increasing attention as a systematic approach guided by scientific evidence-based data; and is regarded the crucial component of health systems strengthening. The global health community has made concrete efforts to improve the quality of health care across primary, secondary and tertiary levels of health systems. Several organizations have developed frameworks and quality indicators to be used as quality assessment tools, and countries have defined their own national frameworks, quality indicators and standards to assess the quality of primary health care. The current study aims to provide a chronological review of the global efforts towards quality assessment in primary health care.

Anahtar Kelimeler

Quality of health care, Primary health care, Quality of primary health care, Quality assessment, Quality indicators

Birinci basamak sağlık hizmetlerinin kalitesinin değerlendirilmesine yönelik küresel çabaların genel değerlendirmesi

Öz

Sağlık hizmetlerinin kalitesi uzun yıllardır araştırma konusu olmuştur. Bununla birlikte, çalışmalar çoğunlukla klinik tıbbın sorunlarına odaklanmış; birinci basamak sağlık hizmetlerinin kalitesi konusunda nispeten daha az çalışma yapılmıştır. Tüm dünyada sağlık sistemlerinin karşı karşıya kaldıkları sosyal, ekonomik ve demografik zorluklar sonucunda, ülkeler, sürekli değişen dünyaya uyum sağlayabilen ve yanıt verebilen birinci basamak sağlık hizmetlerine yönelmeye başlamışlardır. Kaliteli birinci basamak sağlık hizmetlerinin toplumda erişilebilir, karşılanabilir, kapsamlı, sürekli, koordine ve insan merkezli bakım sağladığı gösterilmiştir. Sağlıkta hakkaniyetin sağlanmasında, hastalık ve ölüm oranlarının azaltılmasında, kaynakların en verimli şekilde kullanılmasında, daha iyi sağlık sonuçlarına ulaşılmasında ve toplumların sağlığının iyileştirilmesinde önemli bir rol oynamaktadır. Kalite iyileştirme yaklaşımı, bilimsel kanıta dayalı verilerin rehberliğinde sistematik bir yaklaşım olarak, son onyıllarda giderek artan bir ilgi görmüş ve sağlık sistemlerinin güçlendirilmesinin önemli bir bileşeni olarak kabul edilmiştir. Küresel sağlık camiası, sağlık sistemlerinin birinci, ikinci ve üçüncü basamak düzeylerinde sağlık hizmetlerinin kalitesini iyileştirmek için somut çabalar göstermiştir. Çeşitli kuruluşlar kalite değerlendirme aracı olarak kullanılmak üzere çerçeveler ve kalite göstergeleri geliştirmiş; ülkeler birinci basamak sağlık hizmetlerinin kalitesini değerlendirmek için kendi ulusal çerçevelerini, kalite göstergelerini ve standartlarını tanımlamıştır. Bu çalışma, birinci basamak sağlık hizmetlerinde kalite değerlendirmesine yönelik küresel çabaların kronolojik olarak değerlendirilmesini amaçlamaktadır.

Anahtar Kelimeler

Sağlık hizmetlerinin kalitesi, Birinci basamak sağlık hizmetleri, Birinci basamak sağlık hizmetlerinin kalitesi, Kalite değerlendirmesi, Kalite göstergeleri

Kaynakça

• Aggarwal, A., Aeran, H., & Rathee, M. (2019). Quality management in healthcare: The pivotal desideratum. J Oral Biol Craniofac Res., 9(2), 180-182. https://doi.org/10.1016/j.jobcr.2018.06.006
• Alzoubi, M. M., Hayati, K. S., Rosliza, A. M., Ahmad, A. A., & Al-Hamdan, Z. M. (2019). Total quality management in the health-care context: Integrating the literature and directing future research. Risk Manag Healthc Policy, 12, 167-177. https://doi.org/10.2147/RMHP.S197038
• Arvidsson, E., Dahlin, S. & Anell, A. (2021). Conditions and barriers for quality improvement work: A qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care. BMC Fam Pract.,22, 113. https://doi.org/10.1186/s12875-021-01462-4
• Australian Commission on Safety and Quality in Health Care. (2021). National Safety and Quality Primary and Community Healthcare Standards. ACSQHC.
• Bowie, P., McNab, D., Ferguson, J., de Wet, C., Smith, G., MacLeod, M., McKay, J., & White, C. (2015). Quality improvement and person-centredness: A participatory mixed methods study to develop the 'always event' concept for primary care. BMJ open, 5(4), e006667. https://doi.org/10.1136/bmjopen-2014-006667
• Busse, R., Panteli, D., & Quentin, W. (2019). An introduction to healthcare quality: defining and explaining its role in health systems. In: R. Busse, N. Klazinga, D. Panteli, & W. Quentin, (Eds.), improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies. (Health Policy Series, 53). World Health Organization.
• Canadian Institute for Health Information. (2016). Primary Health Care in Canada: A Chartbook of Selected Indicator Results. Canadian Institute for Health Information.
• Chun, J., & Bafford, A. C. (2014). History and background of quality measurement. Clin Colon Rectal Surg., 27(1), 5-9. https://doi.org/10.1055/s-0034-1366912
• Council of Europe. (1997). The development and implementation of quality improvement systems (QIS) in health care. Recommendation No. R (97) 17 and explanatory memorandum. Council of Europe. Crosby, P. B. (1979). Quality is free: The art of making quality. McGraw Hill.
• Deming, W. E. (1982). Out of the crisis. Center for Advanced Engineering Study, Massachusetts Institute of Technology.
• de Silva, D. (2014). Helping measure person-centred care: Evidence review. The Health Foundation. https://www.health.org.uk/sites/default/files/HelpingMeasurePersonCentredCare.pdf Donabedian, A. (1980). The definition of quality and approaches to its assessment. Michigan Health Administration Press.
• Dudley, L., Mamdoo, P., Naidoo, S., & Muzigaba, M. (2022). Towards a harmonised framework for developing quality of care indicators for global health: A scoping review of existing conceptual and methodological practices. BMJ Health & Care Informatics;29:e100469. https://doi.org/10.1136/bmjhci-2021-100469
• European Commission. (2010). EU Actions on Patient Safety and Quality of Healthcare. European Commission, Healthcare Systems Unit. European Commission.
• Feigenbaum, A. V. (1951). Quality control: Principles, practice, and administration. McGraw-Hill. GbR Zentralstelle der Deutschen Ärzteschaft zur Qualitätssicherung in der Medizin. (2009). Programm für Nationale VersorgungsLeitlinien von BÄK, KBV und AWMF. Qualitätsindikatoren - Manual for Autoren. Make a book.
• Gérvas, J., & Fernández, M. P. (2006). Western European best practice in primary healthcare. European Journal of General Practice, 12(1), 30-33. https://doi.org/10.1080/13814780600757187 Gilmore, H. L. (1974). Product conformance cost. Quality Progress, 6(7), 16–9.
• Government of India. (2012). Indian Public Health Standards (IPHS): Guidelines for Primary Health Centres Revised 2012. Directorate General of Health Services Ministry of Health & Family Welfare.
• Groene, O. (2011). Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation. International Journal for Quality in Health Care, 23(5), 531–537. https://doi.org/10.1093/intqhc/mzr058
• Grol, R. (2006). Quality Development in Health Care in the Netherlands. The Commonwealth Fund. Heath, I., Rubinstein, A., Stange, K. C., & van Driel, M. L. (2009). Quality in primary health care: a multidimensional approach to complexity. BMJ, 338:b1242. https://doi.org/10.1136/bmj.b1242 Helsedirektoratet. (n.d.). National Health Care Quality Indicators. https://www.helsedirektoratet.no/english/national-health-care-quality-indicators
• Hines, K., Mouchtouris, N., Knightly, J. J., & Harrop, J. (2020). A Brief History of Quality Improvement in Health Care and Spinal Surgery. Global Spine Journal, 10(1S), 5S-9S. https://doi.org/10.1177/2192568219853529
• Huber. C.A., Scherer, M., Rapold, R., & Blozik, E. (2020). Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: A population-based cohort study in Switzerland. BMJ Open; 10:e032700. https://doi.org/10.1136/bmjopen-2019-032700
• Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press.
• Institute of Medicine, Committee to Design a Strategy for Quality Review and Assurance in Medicare, & Lohr, K. N. (1990). Medicare: A strategy for quality assurance: Volume 1. National Academies Press.
• International Health Facility Assessment Network. (2008). Health Facility Assessment. Working Paper Series. WP-08-107. MEASURE Evaluation.
• Juran, J. M., & De Feo, J. A. (2010). Juran’s quality handbook. The Complete Guide to Performance Excellence (6th ed.). McGraw-Hill.
• Juran, J. M., Gryna, F. M., & Bingham, R. S. (1974). Quality control handbook (3rd ed.). McGraw-Hill. Kara, P., Valentin, J. B., Mainz, J., & Johnsen, S. P. (2022). Composite measures of quality of health care: Evidence mapping of methodology and reporting. PLoS ONE, 17(5):e0268320. https://doi.org/10.1371/journal.pone.0268320
• Kelley, E., & Hurst, J. (2006). Health Care Quality Indicators Project: Conceptual framework paper. OECD Health Working Papers, No. 23. OECD Publishing. https://doi.org/10.1787/440134737301
• Klein, T. A., Seelbach, C. L., & Brannan, G. D. (2023). Quality Assurance. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK557503/
• Kontopantelis, E., Reeves, D., Valderas, J.M., Campbell, S., & Doran, T. (2013). Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: A longitudinal observational study. BMJ Qual Saf., 22, 53–64. https://doi.org/10.1136/bmjqs-2012-001033
• Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H, Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., English, M., García-Elorrio, E., Guanais, F., Gureje, O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E.T., Liljestrand, J., …, Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health, 6(11), e1196-e1252. https://doi.org/10.1016/S2214-109X(18)30386-3
• Kruk, M. E., Larson, E., & Twum-Danso, N. A. Y. (2016). Time for a quality revolution in global health. Lancet Global Health, 4(9), E594-E596. https://doi.org/10.1016/S2214-109X(16)30131-0
• Larson, E., Sharma, J., Bohren, M. A., & Tunçalp, Ö. (2019). When the patient is the expert: measuring patient experience and satisfaction with care. Bulletin of the World Health Organization, 97(8), 563–569. https://doi.org/10.2471/BLT.18.225201
• Macarayan, E. K., Gage, A. D., Doubova, S. V., Guanais, F., Lemango, E. T., Ndiaye, Y., Waiswa, P., & Kruk, M. E. (2018). Assessment of quality of primary care with facility surveys: a descriptive analysis in ten low-income and middle-income countries. Lancet Glob Health, 6(11):e1176-e1185. https://doi.org/10.1016/S2214-109X(18)30440-6
• Macinko, J., Starfield, B., & Erinosho, T. (2009). The impact of primary healthcare on population health in low- and middle-income countries. J Ambulatory Care Manage, 32(2), 150–171. https://doi.org/10.1097/JAC.0b013e3181994221
• Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. Int J Health Policy Manag., 3(2), 77-89. https://doi.org/10.15171/ijhpm.2014.65
• Norman, R. M., & Danielsen, K. (2022). Quality Indicators in General Practice in Selected Countries: A Scoping Review. Norwegian Institute of Public Health.
• O'Donnell, B., & Gupta, V. (2022). Continuous Quality Improvement. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559239/
• Organisation for Economic Cooperation and Development. (2017). OECD Reviews of Health Systems: Costa Rica. Organisation for Economic Cooperation and Development. Organisation for Economic Cooperation and Development. (n.d.). Health Care Quality and Outcomes Indicators. https://www.oecd.org/health/health-systems/health-care-quality-outcomes-indicators.htm
• Pandit, A. P., Kulkarni, M., & Sonik, S. (2015). Achieving quality in primary health care. J Nat Accred Board Hosp Healthcare Providers, 2, 37-40. https://doi.org/10.4103/2319-1880.174346
• Papp, R., Borbas, I., Dobos, E., Bredehorst, M., Jaruseviciene, L., Vehko, T., & Balogh, S. (2014). Perceptions of quality in primary health care: Perspectives of patients and professionals based on focus group discussions. BMC Fam Pract., 15, 128. https://doi.org/10.1186/1471-2296-15-128
• Peabody, J. W., Taguiwalo, M. M., Robalino, D. A., & Frenk, J. (2006). Improving the quality of care in developing countries. In: D. T. Jamison, J. G. Breman, A. R. Measham, et al. (Eds.), Disease control priorities in developing countries. (2nd edition., Chapter 70). The International Bank for Reconstruction and Development / The World Bank.
• Quentin, W., Partanen, V. M., Brownwood, I., & Klazinga, N. (2019). Measuring healthcare quality. In: R. Busse, N. Klazinga, D. Panteli, & W. Quentin, (Eds.), Improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies. (Health Policy Series, 53). World Health Organization.
• Ramalho, A., Castro, P., Goncalves-Pinho, M., Teixeira, J., Santos, J.V., Viana, J., Lobo, M., Santos, P., & Freitas, A. (2019). Primary health care quality indicators: An umbrella review. PLoS ONE, 14(8):e0220888). https://doi.org/10.1371/journal.pone.0220888
• Rezapour, R., Letaief, M., Khosravi, A., Farahbakhsh, M., Ahmadnezhad, E., Azami-Aghdash, S., & Tabrizi, J. S. (2022). Primary health care quality assessment frameworks: State of the art review. Health Scope,11(3):e126407. https://doi.org/10.5812/jhealthscope-126407
• Rifkin, S. B. (2018). Alma Ata after 40 years: Primary Health Care and Health for All-from consensus to complexity. BMJ Global Health, 3:e001188. https://doi.org/10.1136/bmjgh-2018-001188
• Rocha, K. B., Rodríguez-Sanz, M., Pasarín, M. I., Berra, S., Gotsens, M., & Borrell, C. (2012). Assessment of primary care in health surveys: a population perspective. European Journal of Public Health, 22(1), 14-19. https://doi.org/10.1093/eurpub/ckr014
• Saric, J., Kiefer, S., Peshkatari, A., & Wyss, K. (2021). Assessing the Quality of Care at Primary Health Care Level in Two Pilot Regions of Albania. Frontiers in Public Health, 9:747689. https://doi.org/10.3389/fpubh.2021.747689
• Saxena, A., Ramamoorthy, V., Rubens, M., McGranaghan, P., Veledar, E., & Nasir, K. (2022). Trends in quality of primary care in the United States, 2007–2016. Sci Rep., 12, 1982. https://doi.org/10.1038/s41598-022-06077-y
• Schang, L., Blotenberg, I., & Boywitt, D. (2021). What makes a good quality indicator set? A systematic review of criteria. International Journal for Quality in Health Care, 33(3),mzab107. https://doi.org/10.1093/intqhc/mzab107
• Schyve, P. M. (2000). The evolution of external quality evaluation: Observations from the Joint Commission on Accreditation of Healthcare Organizations. International Journal of Quality in Health Care, 12(3), 255-258.
• Sheffel, A., Karp, C., & Creanga, A. A. (2018). Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middle-income countries. BMJ Global Health, 3:e001011. https://doi.org/10.1136/bmjgh-2018-001011
• Sheingold, B. H., & Hahn, J. A. (2014). The history of healthcare quality: The first 100 years 1860–1960. International Journal of Africa Nursing Sciences, 1, 18-22. https://doi.org/10.1016/j.ijans.2014.05.002
• Shi, L., Pinto, D. M., & Guanais, F. C. (2012). Measurement of Primary Care: Report on the Johns Hopkins Primary Care Assessment Tool. Inter-American Development Bank.
• Simou, E., Pliatsika, P., Koutsogeorgou, E., & Roumeliotou, A. (2015). Quality indicators for primary health care: A systematic literature review. Journal of Public Health Management and Practice, 21(5):E8-E16 https://doi.org/10.1097/PHH.0000000000000037
• Tabrizi, J. S., & Gharibi. F. (2019). Primary healthcare accreditation standards: A systematic review. Int J Health Care Qual Assur., 32(2), 310-320. https://doi.org/10.1108/IJHCQA-02-2018-0052 The CAHPS Program. (n.d.). Agency for Healthcare Research and Quality. https://www.ahrq.gov/cahps/about-cahps/cahps-program/index.html
• The DHS Program. (n.d.). SPA Overview. https://dhsprogram.com/methodology/Survey-Types/SPA.cfm The Royal Australian College of General Practitioners. (2017). Standards for General Practices. 5th ed. The Royal Australian College of General Practitioners.
• The World Bank. (n.d.). Service Delivery Indicators: Health. Health Service Delivery Indicators | World Bank. United Nations Population Fund. (2010). Service Availability Mapping (SAM). https://www.unfpa.org/resources/service-availability-mapping-sam
• van Weel, C., & Kidd, M. R. (2018). Why strengthening primary health care is essential to achieving universal health coverage. CMAJ, 190(15): E463-E466. https://doi.org/10.1503/cmaj.170784
• Wang, W., & Haggerty, J. (2019). Development of primary care assessment tool-adult version in Tibet: Implication for low- and middle-income countries. Prim Health Care Res Dev., 20,e94. https://doi.org/10.1017/S1463423619000239
• World Health Organization & the United Nations Children’s Fund. (2022). Primary health care measurement framework and indicators: Monitoring health systems through a primary health care lens. World Health Organization and the United Nations Children’s Fund.
• World Health Organization and the United Nations Children’s Fund. (2018). A vision for primary health care in the 21st century: Towards UHC and the SDGs. World Health Organization and the United Nations Children’s Fund.
• World Health Organization, Organisation for Economic Co-operation and Development, and The World Bank. (2018). Delivering Quality Health Services: A Global Imperative for Universal Health Coverage. World Health Organization, Organisation for Economic Co-operation and Development, and The World Bank. World Health Organization. (1946, April 7). Constitution of the World Health Organization. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
• World Health Organization. (1978). Primary Health Care: Report of the International Conference on Primary Health Care. Alma Ata, USSR, 6-12 September 1978, World Health Organization.
• World Health Organization. (2007). Everybody’s business — Strengthening health systems to improve health outcomes. WHO’s framework for action. World Health Organization.
• World Health Organization. (2010a). Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. World Health Organization.
• World Health Organization. (2010b). The World Health Report: Health systems financing; the path to universal coverage. World Health Organization.
• World Health Organization. (2015). Service Availability and Readiness Assessment (SARA): An annual monitoring system for service delivery. Reference Manual Version 2.2. World Health Organization.
• World Health Organization. (2018a). Global efforts in measuring quality of care. World Health Organization.
• World Health Organization. (2018b). Handbook for national quality policy and strategy-A practical approach for developing policy and strategy to improve quality of care. World Health Organization.
• World Health Organization. (2018c). Improving the quality of health services: tools and resources: Turning recommendations into practice. World Health Organization.
• World Health Organization. (2018d). Quality in primary health care: Technical series on primary health care. World Health Organization.
• World Health Organization. (2022). Harmonized health facility assessment (HHFA): Quick guide. World Health Organization.
• World Health Organization. (n.d.). Improving Service Availability Mapping (SAM): Data Use and Dissemination. World Health Organization.