Assessing the structural and functional properties of family physician services by using the PCAS (Primary Care Assessment Survey: Primary Care Evaluation Scale) scale

Yıl 2011, Cilt: 9 Sayı: 1, 16 - 32, 01.06.2011

Tülay Lağarlı Erhan Eser Mustafa Akdeniz Bahar Aydoğdu Ümit Baklaya Canan Fıra Adnan Saatçioğlu Burak Sönmez Eylül Taner Seval Tığlı Koray Topçu Başak Yıldız Nurcan Yılmaz Hülya Yorgun

https://doi.org/10.20518/tjph.173052

Cited By: 1

Öz

Aim: The objective of this cross-sectional study is to assess the structural and functional
properties of the recently (in 2008) promoted Family Physician Services by using the PCAS
(Primary Care Assessment Survey: Primary Care Evaluation Scale) scale

Methods: The study was conducted between 20.08.2009 and 27.8.2009 in 6 Family Physician
Units (FPUs) of Manisa city. The household universe was 6900 and 381 persons living in 360
Households (sample size) were interviewed by a face to face approach. Results: The mean age of
the study sample was 41.2 ± 13.9 (min-max 18-77) and 86.4% of the sample was female. 16.5%
of respondents were illiterate; 17.0% were green card holders; 85.6% were married and 72.7%
were living in core families. 98.4% of the households had safe and clean tap water and 89.8% of
the households had an inside toilet, the rest had outdoor toilets. The dimensional scores of the
PCAS were as follows: Accessibility 53.56 ± 17.41; Continuity 74.01 ± 11; Comprehensiveness
49.04 ± 20.51; Coordination 43.13 ± 43.3; Service satisfaction 70.01 ± 13.57; Trust 71.94 ± 17.41
and Interpersonal treatment 71.95 ± 11, 96. Among the four structural dimensions of the PCAS,
the highest score was obtained for the Continuity dimension whereas the Accessibility,
Comprehensiveness and Coordination dimension scores were rather low. The results of the
univariate analyses indicated that the Accessibility score was significantly higher when: neonate
or children under five were in the household; health insurance and/or green card was available;
a person with a chronic disease was present in the household, and when all of the household
members were registered with the same family physician. The Continuity score was significantly
higher for persons who were older, female, or had a low educational level and in those
households with any children under five or presence of any person with a chronic disease in the
household. The Comprehensiveness score was also significantly higher for older persons, those
who had health insurance, those with a person with a chronic disease or a disabled person in the
household. The Service satisfaction dimension was better for those with a low educational level
and those aged over 65. The Personal relationships dimension score was only affected by an
older age and the Trust score was found higher in older persons and those who are chronically
ill or disabled. Service satisfaction, personal relationships and trust scores were higher if all of
the household members were registered with the same family physician. As for the results of
multivariate analysis, being covered by health insurance, age, level of education, and having the
family registered with the same family physician, were the variables that affected the dimension
scores mentioned above. Conclusion: In general, structural (four) dimension scores were found
to be low whereas patient-physician relationship (three) domain scores were found in a normal
range. In addition to these findings, the elements of the recently modified PHC system were
found to be poor in general except for the continuity element.  

Anahtar Kelimeler

Primary health care assessment, family physician services, PCAS

Bazı aile hekimliği pilot uygulama birimlerinde birinci basamak değerlendirme ölçeği (BDÖ) (Primary Care Assessment Survey) ile sağlık hizmet özelliklerinin değerlendirilmesi

Öz

Amaç: 1 Ocak 2008’de başlayan Aile Hekimliği Manisa İli pilot uygulamasının yapısal ve işleyiş
özelliklerini PCAS (Primary Care Assessment Survey) Birinci Basamak Değerlendirme Ölçeği ile
değerlendirmektir. Yöntem: Çalışma 20.8.2009 - 27.8.2009 tarihleri arasında Manisa merkez
ilçede 6 aile sağlığı birimine bağlı bölgede yürütülmüştür. Araştırma bölgesindeki toplam hane
sayısı 6900 dür. Küme örnekleme yöntemi ile 360 haneden birer kişiye ulaşılarak, 18 yaş üstü
381 bireye PCAS anketi yüz yüze görüşme yöntemiyle uygulanmıştır. Araştırmaya katılım oranı
(327/360) %90’dır. Bulgular: Örneğin yaş ortalaması 41.2±13.9 dur. Araştırma kapsamındaki
kişilerin %86.4’ü kadındır. Araştırma grubunun %16.5’i eğitimsiz, %17.0’ı ise sağlık güvencesi
olmayanlar ve yeşil kart sahipleridir. Ölçek puanları, boyutlara göre: Ulaşılabilirlik:53.56±17.41;
Süreklilik: 74.01±11.95; Kapsayıcılık: 49.04±20.51; Eşgüdüm: 43.13±43.3; Hizmet memnuniyeti
:70.01±13.57; Hekimin kişisel yakınlığı :71.94±17.41 ve Güven :71.95±11.96 ‘dır. En başarılı
özellik sürekliliktir. Ulaşılabilirlik: Hanede 5 yaş çocuk ve 0-12 aylık bebek varlığında, sağlık
güvencesi ve yeşil kart sahibi olanlarda, hanede kronik hastalığı olan birey varlığında ve ailenin
tüm bireyleri aynı aile hekimine kayıt olanlarda daha yüksektir. Süreklilik: Yaşlı ve kadınlarda ve
eğitimsizlerde, beş yaş altı çocuk ve kronik hasta bulunmayan hanelerde daha yüksek
bulunmuştur. Kapsayıcılık: Yaş ilerledikçe ve sağlık güvencesi olanlarda, hanede kronik
hastalıklı ve engelli birey varlığında daha yüksektir. Çok değişkenli analizler sonucunda sağlık
güvencesi, yaş, eğitim, aynı aile hekimine kayıtlı olma etkili bulunmuştur. Yapısal özet boyut,
ilişki özet boyutuna göre daha düşük puan almıştır. Sonuç: Manisa Merkez İlçede Aile Hekimliği
uygulamasında, kadın ve beş yaş altı çocuk risk gruplarına öncelikli yaklaşımın sürdüğü, yaşlılık
sağlık sorunları ile ilgili yeni bir yaklaşımın oluşmakta olduğu görülmüştür

Anahtar Kelimeler

Birinci basamak sağlık hizmeti özellikleri, aile hekimliği, PCAS

Kaynakça

• Institute of Medicine. A Manpower Policy for Primary Health Care. IOM Publication 78-02. Academy of Sciences, 1978. DC:National
• Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York: Oxford University Press1998
• The World Health Report 2008.
• Donabedian A. The Quality of Care: How can it be assessed? Journal of the American 1988;260:743-1748. Association
• Donabedian A. The quality of care: How can it be assessed? Archives of Pathology & 121(11):1145-50. Medicine 1997;
• Starfield B. Primary Care Concept, Evaluation and Policy. Oxford University Press, 1992, New York, US.
• Haggerty J, Martin CM. Evaluating Primary Health Care in Canada:The Right Questions to Ask The National Evaluation Strategy for Primary Health Care. Ottawa, Ontario, Canada: Health Canada; 2005.
• Institute of Medicine. Defining primary care: an interim report. Washington, DC; 1994.
• Primary Care America's Health in a New Era Committee on the Future of Primary Care Division of Health Care Services Instıtute Of Medıcıne Natıonal Academy Press Washington, D.C.1996.
• Starfield B. Comprehensiveness of Care: Concept and Importance, Presented at: RNZCGP Annual Quality Symposium Wellington, NZ February 14, 2009 Erişim tarihi Ocak 2010.
• The European Defınıtıon Of General Practıce / Famıly Medıcıne Wonca Europe 2005 Edition.
• Shi L, Starfield B, Xu J. Validating the Adult Primary Care Assessment Tool. J Fam Pract 2001;50(2).
• Safran D G,Kosınskı M, Tarlov AR.The Primary Care Assessment Survey Tests of Data Quality and Measurement Performance 1998;36(5):728-739. Medical Care,
• Murphy J, Chang H, Montgomery JE, Rogers WH, Safran DG. The quality of physician-patient relationships. Patients' experiences 1996-1999. J Fam Pract. 2001;50;(2):123-9.
• Hartley LA . Examination of Primary Care Characteristics in a Community- based Scholarshıp, 2002; 34(4);377-382. of Nursıng
• Hsıao CJ, Roche KB, Marsteller JA, Leff BA. The effect of disability on personal quality of primary care received by older adults. Disability and Rehabilitation, 2009 31;22: 835–1842.
• Shadmi E, Boyd C M, , Hsiao CJ, Sylvia M, Schuster A, Boult C. Morbidity and Older Persons’ Perceptions of the Quality of Their Primary Care.The American Geriatrics Society 2006;54:330–34.
• Boyd CM., Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, Sylvia M, and Boult C. J. A Pilot Test of the Effect of Guided Care on the Quality of Primary Care Experiences for Multimorbid Older Adults.Gen Intern Med;23(5):536–42.
• Fleming D A, Sheppard V B, Mangan P A, Taylor KL, Tallarico M, Adams I. Caregiving at the End of Life: Perceptions of Health Care Quality and Quality of Life Among Patients and Caregivers. Journal of Pain and Symptom Management 2006;31(5):407-20.
• Saitz R, Horton NJ, Cheng DM, Samet JH. Alcohol Counseling Reflects Higher Quality of Primary Care J Gen Intern Med 2008;23(9):1482–6.
• Weia X, Barnsleyb J, Zakusc D, Cockerillf R, Glazierg R,Sunh X. Assessing continuity of care in a community diabetes program: Initial questionnaire development and validation.Journal of Clinical Epidemiology 2008;61:925-31.
• Murray A, Safran D G,. Rogers W H, Inui T, Montgomery J E. Part-time Physicians :Physician Workload and Patient-Based Assessments Performance.Arch Fam Med. 2000;9:327- 332. Primary Care
• Duberstein P, Meldrum S , Fiscella K, Shields CG , Epstein RM . Influences on patients’ Physicians personality. Patient Education and Counseling 2007;65(2):270–4. and Basamak Sağlık Hizmet
• Eser E, Lağarlı T ve arkadaşları. Birinci Basamak Değerlendirme Ölçeğinin (Pcas; Primary Care Assessment Survey) Bazı Aile Birimlerine Ayaktan Tanı Tedavi İçin Başvuranlardaki Psikometrik Özellikleri. Yayınlanmamış makale, 6. Saykad Kongresi 2007. Pilot Uygulama
• Safran DA, Jana F , Montgomery At .All Predictors Of Voluntary Disenrollment .The Journal of Family Practice 2001;50:130-136.
• Boratav K. Sınıfların ve grupların sosyoekonomik Ankara. İmge Kitapevi Yayınları, 2004, s. 33-60. 2.Baskı.
• Jeannie L, Haggerty, Pineault R, at all. Practice Features Associated With Patient-Reported Continuity, and Coordination of Primary Health Care Ann Fam Med 2008;6:116- 123. Accessibility,
• Evaluation of the organizational model of primary care in Turkey. World Health Organization, 2. Edition. 2009;38-39.
• Crampton P, Dowell A, Woodward A, Salmond C. Utilization rates in capitated primary car centres serving low income populations. N Z Med J 2000;113(112 0):436-8.
• Brown CJ, Pagan JA, Rodriguez-Oreggia E. The decisionmaking process of health care utilization in Mexico. HealthPolicy 2005;72(1):81-91.
• İlhan M, Tüzün H ,Aycan S, Aksakal FN , Özkan S, Birinci Basamak Sağlık Kuruluşuna Başvuranların Sağlık Hizmeti Kullanma Sosyoekonomik Belirteçlerle Değişimi: Sağlık Reformu Öncesi Son Saptamalar Toplum 2006;25(3);33-41. ve Bazı Hekimliği Bülteni