Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

Abstract

Objectives: To identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.

Design: A cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.

Setting: Exit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July-August 2018.

Participants: Representative sample of 629 adults ≥18 years of age.

Main outcomes measures: (1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients' decision to attend a given provider. Data were analysed using mixed logistic regression models.

Results: Nearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were 'quality of care' and 'healthcare professionals' attitudes. Solely looking at patients using a public provider, 'geographical proximity' was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider's patients, the 'availability of diagnostic devices' was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).

Conclusion: The use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.

Keywords: complementary medicine; health policy; international health services; primary care; quality in health care.

Figure 1

The concept of access: definition and relationship to consumer satisfaction. Adapted from Penchansky and Thomas. Concept of access first elaborated in 1981.

Figure 2

Principal reasons for using healthcare facility type†. †Percentage of positive agreements were obtained by patients ‘ratings of each item as ‘important’ or ‘very important’ when consulting public and private facilities. PHC, primary healthcare.

Figure 3

Radar chart plots: mean scores of access domains in patients of public and private clinics. PHC, primary healthcare.