The quality of primary care in Malta: patients' experiences, views and actions

Abstract

Extensive literature showed that strong primary care is conducive to reaching important health care system goals by improving population health, reducing socio-economic inequalities and avoiding unnecessary hospitalizations. Due to demographic changes, technological developments and rising expectations, analysis of patient-perceived quality of primary care in the public and private sectors is crucial. This study aims to identify the patients' experiences, views and actions in primary care. The dataset of the Maltese arm of the QUALICOPC Project was analysed for this purpose. A descriptive, cross-sectional, retrospective study was designed. 70 practicing GPs were selected randomly from the Malta Medical Council Family Medicine register after systematically removing the inactive doctors. 10 patients presenting in each primary care clinic completed a self-administered questionnaire. Trained fieldworkers provided assistance when necessary. Internal comparison subgroup analyses were performed using statistical tests such as chi-squared test. Direct logistic regression was used to estimate the influences on primary care quality in the private-public sectors and in the urban-rural areas. The mean age of participants was 48.2 years and the majority were females (62%). The youngest and the oldest age groups tended to visit the public GP service. Only a limited number of patients abstained from a visit to the GP because of financial reasons. The majority of patients were satisfied with their GP consultation. No statistically significant association was found between doctors' attitudes in the public sector and in the private sector. Factors found to be significantly associated with the private primary care sector included female patients, GP knowing the patients' living situation, patients visiting their own doctor and difficulty in accessing out-of-hours care. Such findings provide information for clinicians and policy makers to improve equity in health care and resource allocations. A number of recommendations are drawn up to serve as guidelines for GPs' clinical practice, policy makers, public health education and research.