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Evaluation of the Correlation Between the Utilization and Quality Indicators of PHC Services (Multivariate Analysis)

L.Gumbaridze; T.Chanadiri; L.baramidze; I.Zarnadze, Georgia

Health system quality may be an underappreciated level for influencing utilization of primary care services. It is topical that in conditions of expanding coverage by universal state healthcare program many Georgians still do not consistently utilize primary healthcare services. The purpose of our research is to evaluate how utilization parameters within the framework of these state program could act to quality improvements and provide more effective primary health care, and are they been in strong associative relationship.
This study was a prospective study among a representative sample of 300 adults, registries in primary healthcare centers in Tbilisi (capital of Republic of Georgia) area (with a population of 1.114 million). The research sample population was constituted in 2016 using a 3-level random sampling method. The refusal rate among the contacted people was 10.7% and research was completed within 268 participants. Variable value's sets, such 'owning/ using an additional private healthcare insurance package" as well as age, employments status and gender" was collected by a self-administered, pre-designed, pre-tested anonymous questionnaire and was examined drawing cross-tab, Pearson's correlations, and multivariate logistic regression models. Data were imported into SSPS software. Statistical significance was set at P<0.05.
The multivariate analysis of the study reveals that the level of PH service's satisfaction within implemented state health program correlated with frequency of PH service's usage in general. Private Health Insurance additional Package (PHIaP) was most often used by beneficiaries aged <35 YY (4.5 times more frequently, CI95% 1.82 to 10.94, P = 0.0001) and, beneficiaries aged 36-45YY (3.5 times, CI95% 1.31 to 9.28, P = 0.0011); in addition, employed people were 40 times more likely participated in supplemental healthcare insurance schemes (CI95% 12.47 to 126.86, P <0.0001). The highest rate of satisfaction with the PH services was found in sub-group of beneficiaries, who have applied for services to PHC once or more per month (3,9130 SD = 0.4706) , the lowest in sub-group, who never have applied for services at all (2,6346 SD = 0.3473). Positive perception (> 75%, highest rate 4,1034 SD = 0.2996) of state-funded primary healthcare services matching to their medical needs have had 13.9% of total population; a significantly larger group, including the satisfied group of beneficiaries, noted that their medical needs were not even covered by 2/3. Level of satisfaction was much lower both in sub-group, who had used the hospital services when a medical need arises (2, 8364 SD = 0.5369) and in the sub-group who had been self-treated or treated by familiar physicians (3, 4167 SD = 0.5764).
Health systems and primary healthcare sub-system, as part of whole, continue to shift their perspectives about the patient experience, seeing it more as a prime indicator of healthcare organizations' overall health. More future research is needed to eager for more information about how patient satisfaction and experience fits into the bigger healthcare picture and improves quality and quantity measures and it even more important for the new universal state healthcare system in Georgia.

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