Journals / Turkish Journal of Public Health / 2011 / Cilt: 9 Sayı: 1
Assessing the structural and functional properties of family physician services by using the PCAS (Primary Care Assessment Survey: Primary Care Evaluation Scale) scale
- Pages
- 16–32
- DOI
- —
Abstract
Aim: The objective of this cross-sectional study is to assess the structural and functionalproperties of the recently (in 2008) promoted Family Physician Services by using the PCAS(Primary Care Assessment Survey: Primary Care Evaluation Scale) scaleMethods: The study was conducted between 20.08.2009 and 27.8.2009 in 6 Family PhysicianUnits (FPUs) of Manisa city. The household universe was 6900 and 381 persons living in 360Households (sample size) were interviewed by a face to face approach. Results: The mean age ofthe 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% ofthe households had an inside toilet, the rest had outdoor toilets. The dimensional scores of thePCAS were as follows: Accessibility 53.56 ± 17.41; Continuity 74.01 ± 11; Comprehensiveness49.04 ± 20.51; Coordination 43.13 ± 43.3; Service satisfaction 70.01 ± 13.57; Trust 71.94 ± 17.41and 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 theunivariate analyses indicated that the Accessibility score was significantly higher when: neonateor 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 householdmembers were registered with the same family physician. The Continuity score was significantlyhigher for persons who were older, female, or had a low educational level and in thosehouseholds with any children under five or presence of any person with a chronic disease in thehousehold. The Comprehensiveness score was also significantly higher for older persons, thosewho had health insurance, those with a person with a chronic disease or a disabled person in thehousehold. The Service satisfaction dimension was better for those with a low educational leveland those aged over 65. The Personal relationships dimension score was only affected by anolder age and the Trust score was found higher in older persons and those who are chronicallyill or disabled. Service satisfaction, personal relationships and trust scores were higher if all ofthe household members were registered with the same family physician. As for the results ofmultivariate analysis, being covered by health insurance, age, level of education, and having thefamily registered with the same family physician, were the variables that affected the dimensionscores mentioned above. Conclusion: In general, structural (four) dimension scores were foundto be low whereas patient-physician relationship (three) domain scores were found in a normalrange. In addition to these findings, the elements of the recently modified PHC system werefound to be poor in general except for the continuity element.
Özet
Amaç: 1 Ocak 2008’de başlayan Aile Hekimliği Manisa İli pilot uygulamasının yapısal ve işleyişözelliklerini PCAS (Primary Care Assessment Survey) Birinci Basamak Değerlendirme Ölçeği iledeğerlendirmektir. Yöntem: Çalışma 20.8.2009 - 27.8.2009 tarihleri arasında Manisa merkezilçede 6 aile sağlığı birimine bağlı bölgede yürütülmüştür. Araştırma bölgesindeki toplam hanesayısı 6900 dür. Küme örnekleme yöntemi ile 360 haneden birer kişiye ulaşılarak, 18 yaş üstü381 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 kapsamındakikişilerin %86.4’ü kadındır. Araştırma grubunun %16.5’i eğitimsiz, %17.0’ı ise sağlık güvencesiolmayanlar 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 başarılıözellik sürekliliktir. Ulaşılabilirlik: Hanede 5 yaş çocuk ve 0-12 aylık bebek varlığında, sağlıkgüvencesi ve yeşil kart sahibi olanlarda, hanede kronik hastalığı olan birey varlığında ve ailenintüm bireyleri aynı aile hekimine kayıt olanlarda daha yüksektir. Süreklilik: Yaşlı ve kadınlarda veeğitimsizlerde, beş yaş altı çocuk ve kronik hasta bulunmayan hanelerde daha yüksekbulunmuştur. Kapsayıcılık: Yaş ilerledikçe ve sağlık güvencesi olanlarda, hanede kronikhastalıklı ve engelli birey varlığında daha yüksektir. Çok değişkenli analizler sonucunda sağlıkgüvencesi, 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 Hekimliğiuygulamasında, kadın ve beş yaş altı çocuk risk gruplarına öncelikli yaklaşımın sürdüğü, yaşlılıksağlık sorunları ile ilgili yeni bir yaklaşımın oluşmakta olduğu görülmüştür