The Evaluation toward Primary Care Quality and Family Physician Project between Patients in Family Physician Groups and Non-Family Physician Groups-- An Application of Hierarchical Linear Modeling
Date Issued
2008
Date
2008
Author(s)
Yeh, Te-Feng
Abstract
Background: Excellent primary care can reduce health care expenditure, improve health status, and diminish health inequity. Since the implementation of National Health Insurance, primary care has been going down the slope resulting from inappropriate care-seeking behavior and the restriction of payment systems. Although there were some studies that evaluated the effect of family physician project since its implementation in 2003. However, there still lack of an evaluation tool to understand what type of primary care patients want. bjective: This study aimed to explore the expectation, perception, and gap of primary care quality, and to evaluate the family physician project. It also examined the influence of individual level and group level simultaneous by using hierarchical linear modeling (HLM).ethods: This study selected 50 family physician groups and 50 non-family physician groups from the webpage of the Bureau of National Health Insurance (BNHI) as of April, 2006. Totally 4753 patients and 100 physicians were selected for interview. Primary care quality tool was based on Primary Care Assessment Tool-Adult Edition (PCAT-AE) and modified by the concept of SERVQUAL. Self-administrated questionnaire included the evaluation of primary care quality and family physician project. Because of the nested structure of the study sample, hierarchical linear modeling was used.esults: Patients expected their primary care physicians to be the traditional “healer”, coordinator of care, health consultant, but prevention services were less expected. The perception of primary care quality and the evaluation of family physician project were the highest among the enrollees in family physician groups and the lowest among patients in non-family physician groups. The relationship between the perception of primary care quality and the intent of enroll in and designate the usual care physician was moderated by the policy evaluation of family physician project. But the perception of primary care quality was the most significant factor for patient satisfaction. Physicians’ demographic characteristics and their evaluation of primary care quality and family physician project were less relative to their patients’ evaluation of primary care quality and family physician project. Many of the variables showed significant association in the multiple regression became non-significant in hierarchical linear models.onclusion: Both patients and physicians showed positive evaluation for family physician project; the health authority should promote this project continuously. Patients should be educated and give incentive to seek their usual care physician for the coordination and comprehensiveness of care. Well-performed physicians should receive additional incentive. For primary care physicians, enhance the primary care quality is the key success factor for improving patient satisfaction and the competitive competence of primary care.
Subjects
primary care quality
fmaily physician
family physician project
hierarchical linear modeling
Type
thesis
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