|Abstract:||Background. Primary health care (PHC) is an integral part of health care systems, and the predominant model of care in Europe in PHC is family medicine. Functional systems need adequate financing and work organization, both of which are necessary for good access, which is an element of equity in PHC.
Purpose. To define quality indicators (QI) and analysis of access to PHC in terms of work organization and financing. The goals were to assess QI for PHC in terms of structure/conditions, procedures/processes and outcomes, evaluation of PHC quality elements and comparison of results for Slovenia (SLO) with other countries.
Patients and methods. The survey was part of the survey Quality and Costs of Primary care in Europe (QUALICOPC) in 34 countries in the period from year 2011 to 2013. Data for ten Central and Eastern European countries (CEECs): Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia and SLO were used. We analyzed the answers from two questionnaires for 2103 randomly selected family physicians and 18819 of their patients. Used statistical methods were: presentation of data with descriptive statistics, frequency distributions, means and variations, definition of QI with proportions, testing assumptions with different tests and finding connections between variables with factor analysis.
Results. Analysis of the patient's answers in SLO and CEECs regarding their assessment of the organization of PHC work showed a small number of patients with negative experiences for longer time and distance to the practice, inability to get a home visit, ability to obtain evening, night and weekend services, and regarding their assessment of the affordability: the doctor was too much concerned about money, having to postpone a doctor's visit because they did not have insurance or for other financial reasons, or having to postpone or cancel a doctor's visit for other reasons. Typical variables for the organization of work were computer use, number of disciplines in the practice/centre, the use of medical records from previous doctor, the percentage of patient consultations by appointment, the possibility for patients to visit the practice/medical centre after 6:00 p.m., and how many hours in working day the practice/medical centre is open for patients.
Statistically significant differences were found in a comparison of QI between SLO and CEECs. In the structure QI, Slovenian doctors, compared to doctors in CEECs, had a statistically significantly different and 1) more equipment (SLO 15,30, CEECs 13,0), 2) larger number of disciplines of experts (SLO 4,18, CEECs 2,60), 3) higher capitation (SLO 1950,01, CEECs 1894,7), 4) higher number of contacts with patients during the working day (SLO 45,27, CEECs 33,7), 5) shorter consultations with patients (SLO 9,59, CEECs 13,1 minutes), 6) lower number of home visits (SLO 2,21, CEECs 6,9), 7) the most common form of their employment was salaried employment (SLO 73,7 %, CEECs 30,1 %), 8) more frequent source of their income was salary (SLO 85,2 %, CEECs 61,5 %), 9) working more often with a nurse (SLO 98,1 %, CEECs 87,8 %), 10) cooperating more often with practice nurses (SLO 76 %, CEECs 41,8 %). For the process QI, Slovenian physicians used statistically significantly different and 1) more clinical guidelines (SLO 3,85, CEECs 3,15), 2) participated in more chronic disease treatment programs (SLO 1,71, CEECs 1,13), 3) were involved in the treatment of more diagnoses (SLO 11,42, CEECs 9,09), and 4) performed more procedures (SLO 2,43 , CEECs 1,30).
Conclusion. Several changes should be made to PHC in SLO. In terms of funding, we propose to implement financial incentives for quality of work, as a tool for measuring quality QI for procedures/processes and outcomes of care, in terms of work organization multidisciplinary model of care, continuing to reduce capitation and at the state level, the establishment of an independent technical institution.|