Assessment of primary care services in an urban district by using structured phc measuring instruments

Assessment of Primary Care Services in an urban district by usingstructured PHC measuring instruments (PCAS & PCAT) .Objective: There two main objectives: (1)To measure and assess theoperational characteristics of the primary care (Family Medicine) practicesin Manisa by using Primary Care Assessment Survey (PCAS) and (2) to testthe reliability and validity of the "Primary Care Assessment Tool (PCAT)"adult version on a representative sample in the city centre of Manisaprovince.Methods:The target population (universe) of this crossectional & methodological studyis Manisa city centre population .(n=279.000). The study sample wascalculated as 800 and multistage cluster sampling method were applied withat least one cluster (n=10) for each of the 79 Family Physicial Unit (FPU)district.PCAS and PCAT were applied with face to face interviews and only onesubject were interviewed for each of the households that was systematicallyselected. Univariate parametric (Student?s t test & One Way ANOVA, ChiSquare) and non parametric tests (Kruskal Wallis ve Mann Whitney U) andMultivariate (backward stepwise logistic regression) anlyses were usedduring the statistical analyses.Confirmatory approach were used during the cultural adaptation andpsychometric analyses of the PCAT adult version. Descriptive distributioncharacteristics (mean values, skewness, kurtosis, floor & ceiling effects, itemanalyses) ; reliability anlyses (internai consistency with Cronbach?s alpha &item-scale correlaiton matrix for scale success) and contruct validity analyses(Confirmatory factor analyses and Convergent-divergent validity) wereapplied.Results: The mean age of the participants was 40.33 ± 13.85; 23.3% maleand 76.7% female.Low PSAC dimension scores were obtained in general compared to thewestern (mainly US) countries figures. These dimension scores wereaffected by a number of sociodemographic variables such as: Accessibilityand Comprehensiveness dimension scores were higher in man than women;among higher social class comminty than lower clasess; among those whowere well educated and who were insured and those who were living insuburban settlements. In contrary with accessibility and comprehensivenessdimensions, higher Longitidunality dimension scores were obtained amonglow socioeconomic classes compared to advantaged popualtions. Forexample Longitidunality dimension scores were higher in people who wereliving in suburban areas compred to those living in urban areas.Coordination dimension score differs from the other 3 dimensions in that itwas sensitive to a more heterogenious socioeconomic variables.Coordination dimension score was found higher among well educatedpeople; those who belong to higher social clasess living in urban areas; thosewho currently have a neonate (baby) at home; and those who are uninsured.PCAT scale showed acceptable distribution properties (Skewness, Kurtosis ,floor and ceiling percentages) Scale success showed a rnage between(%86.7- %100) for the dimensions of the PCAT. Cronbach alpha valueswere satisfactory in general (0.80-0.90) All of the sclae items were inculdedin the Confirmatory Factor Analyses and the results of CFA revealedRMSEA :0.10, CFI:0.84 for main (Accessibility, Longitidunality,Comprehensiveness & Coordination) dimensions and RMSEA :0.12, CFI:0.88 for derivated dimensions (Family Centeredness, Community Orientation,Culturally Competancy)Conclusion: Cross sectional findings for PCAS revealed that advantagedgroups in the community have more access and get more comprehensiveprimary health care services, but disadvantaged groups get PHC morecontinuously that advantaged groups most probably because of the structureof the PHC system based on the monitoring of the high risk population(reproductive aged women, pregrnant women, neonates and children) of thecommunity.As for the PCAT: The psychometric findings of the PCAT Turkish versionshowed that this instrument may be used to evaluate the primary careperformance and in the health inequalities research in Turkey although somemodifications are needed.Key words:Primary Care, performance assessment, PCAT,PCAS