Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey

BMJ Open Quality

article

Hannah L Ratcliffe¹  Griffith Bell¹  Koku Awoonor-Williams²  Asaf Bitton¹  June-Ho Kim¹  Stuart Lipstiz¹  Erlyn Macarayan⁴  Anthony Ofosu⁵  Easmon Otupiri⁶  Dan Schwarz¹  Lisa R Hirschhorn¹ 

[1] Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public Health;Division of Policy, Planning, Monitoring and Evaluation , Ghana Health Service;Division of General Internal Medicine and Primary Care, Department of Medicine , Brigham and Women's Hospital;Harvard Global Health Institute , Harvard University T.H. Chan School of Public Health;Ghana Health Service;Department of Population, Family and Reproductive Health , Kwame Nkrumah University of Science and Technology;Division of Global Health Equity, Department of Medicine , Brigham and Women's Hospital;Department of Medical Social Science , Northwestern University Feinberg School of Medicine

关键词: global health;    patient-centred care;    patient satisfaction;    quality measurement;   

DOI  :  10.1136/bmjoq-2019-000886

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Introduction Person-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries.Methods A multistage cluster sample design was used to obtain a nationally representative sample of women of reproductive age in Ghana. Women were interviewed in their homes regarding their demographic characteristics, recent care-seeking characteristics, satisfaction with care, patient-reported outcomes, and—using questions from the World Health Survey Responsiveness Module—the seven domains of responsiveness of outpatient care to assess patient experience. Using Poisson regression with log link, we assessed the relationship between responsiveness and satisfaction, as well as patient-reported outcomes.Results Women who reported more responsive care were more likely to be more educated, have good access to care and have received care at a private facility. Controlling for respondent and visit characteristics, women who reported the highest responsiveness levels were significantly more likely to report that care was excellent at meeting their needs (prevalence ratio (PR)=13.0), excellent quality of care (PR=20.8), being very likely to recommend the facility to others (PR=1.4), excellent self-rated health (PR=4.0) and excellent self-rated mental health (PR=5.1) as women who reported the lowest responsiveness levels.Discussion These findings support the emerging global consensus that responsiveness and patient experience of care are not luxuries but essential components of high-performing health systems, and highlight the need for more nuanced and systematic measurement of these areas to inform priority setting and improvement efforts.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND