Quality of primary health care in Poland from the perspective of the physicians providing it

Abstract

Background: Primary care (PC) allows patients to address most of their health needs and is essential for high quality healthcare systems. The aim of the study was to analyze the insight of nine core dimensions of Polish PC system: "Economic conditions", "Workforce", "Accessibility", "Comprehensiveness", "Continuity", "Coordination", "Quality of care", "Efficiency" and "Equity" and to identify the characteristics of the providing physicians that influence their perception of the quality of care.

Methods: A cross-sectional study was conducted as part of an international QUALICOPC project. In Poland a nationally representative sample of 220 PC physicians was selected from the database of Polish National Health Fund by a stratified random sampling procedure. The research tool was a standardized 64-item questionnaire. Each of the respondents' answers were assigned a numerical value ranging from-1 (extremely negative) to +1 (extremely positive). The quality indicators were calculated as an arithmetic mean of variables representing particular PC dimensions.

Results: The mean scores for the majority of the dimensions had negative values. Accessibility of care was perceived as the best dimension, while the economic conditions were evaluated most negatively. Only a small part of variation in quality evaluation could be explained by physicians' characteristics.

Conclusions: The negative evaluation of primary care reflects the growing crisis in the health care system in Poland. There is an urgent need to apply complex recovery measures to improve the quality of primary care.

Keywords: General practice; Health policy; Health services research; Primary care; Quality of care.

Fig. 1

Perception of eight core dimensions of primary care. ACCS-accessibility, COMP-comprehensiveness, CONT-continuity, COOR-coordination, ECON-economic conditions, EQ-equity, QUAL-quality, WORK-workforce, Q1 - the first quartile, Q3 - the third quartile, MIN - the minimum, MAX - the maximum

Fig. 2

Positive and negative perceptions of eight core dimensions of primary care. ACCS-accessibility, COMP-comprehensiveness, CONT-continuity, COOR-coordination, ECON-economic conditions, EQ-equity, QUAL-quality, WORK-workforce Negative evaluation: quality indicator <−1, 0>. Positive evaluation: quality indicator (0, 1>.

Fig. 3

Linear regression model: associations of quality indicators in particular PC dimensions with physicians’ characteristics. ACCS-accessibility, COMP-comprehensiveness, CONT-continuity, COOR-coordination, ECON-economic conditions, EQ-equity, QUAL-quality, WORK-workforce Negative association (b < 0; p ≤ 0,05). Positive association (b > 0; p ≤ 0,05). No association (p > 0;05).

Fig. 4

Logistic regression model: associations of positive quality evaluation in particular PC dimensions with physicians’ characteristics. ACCS-accessibility, COMP-comprehensiveness, CONT-continuity, COOR-coordination, ECON-economic conditions, EQ-equity, QUAL-quality, WORK-workforce Negative association (OR < 0; p ≤ 0,05). Positive association (OR > 0; p ≤ 0,05). No association (p > 0;05).