Defining practices in primary care

Abstract

Aim The aim of the study is to outline the activity in the private primary care sector on the island of Malta and to compare it to the public sector.

Methodology After considering different study designs, a cross-sectional survey was considered to be more appropriate. The quantitative research design was perceived to be the best suited. In order to collect data for the study, a specific question form was designed and filled in by the researcher, who personally attended the consultations. The study was conducted in four districts of Malta. Eight private practitioner practices were observed and compared to eight public health centres from the same geographical area. An attempt was made to balance GPs by gender and whether full-time and part-time practitioners. The recommended sample size was around three hundred and eighty. In order to increase statistical power of the study the sample was increased to four hundred patients, two hundred within the public sector and two hundred from the private sector. Taking into consideration the fact that in the Health Centres the case mix is organised, treatment rooms and diabetic clinics were excluded from the study in order to reduce the sampling bias.

Results The mean age of the participants was 48.5 years, and were predominantly females. The difference between doctors in the public and private sector was estimated as not significant (p=0.674). While 182 participants presented with health complaints (45.5%), 218 (54.5%) were seeking consultation for some other reason, namely: to get a prescription (18.7%), blood pressure checks (8%), administrative procedure (12.4%), test or procedure results (8.5%), blood/urine test (2%), sick leave certification (2.4%), health examination for different reasons (1.6%), doctors advice (1 %). While there was no difference in gender distribution, difference in age distribution between patients attending the public and private sectors was estimated as highly significant (p=0.001). Patients attending the public sector tended to be older. Besides, the number of prescriptions in the public sector was more than twice higher than in the private sector, whilst the number of blood pressure checkups was nearly four times higher in the public sector. Patients who attended the private sector tended to be of a younger age and were more likely to present with health complaints. Age-adjusted proportions were generated using multiple regression modelling to determine the link between the age of the patient and measured outcomes. The results showed no association between age of the patient and measured outcomes.

Discussion This study highlighted the differences in practice between the public and private primary care providers. Despite the fact that there is room for improvement in both sectors, private practice is more in line with the objectives of primary health care, as defined by WHO,2010 (a).

Recommendations The results of the study might be used in order to improve current service provision in Primary Care System, especially in the public sector.