Patient Experiences of Primary Care

in Malta

Dr Glorianne BezzinaDr Philip Sciortino

Background

Health care quality has been a topic of increasing international debate. In 1984, the Griffiths Report on the UK National Health Service sought the opinion of the consumers to make recommendations on management action (Griffiths Report, 1984).

Primary health care in Malta is provided by the state health service and by private general practitioners. It has been estimated that the private sector accounts for about two thirds of the workload in primary health care in Malta (Azzopardi Muscat, 1999).

Background

QUALICOPC (Quality and Costs of Primary care in Europe), a multi-country study, aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs (Schäfer et al., 2011).

This presentation explains the reported patients’ experiences of primary care which was carried out as part of the Maltese arm of the QUALICOPC project.

Aim

The study aims to qualitatively explore the patients’ experiences and views of primary care in Malta.

Method

Two focus groups were conducted in a primary care health centre with a total of 30 Maltese patients to report on recent experiences in primary care in Malta.

The focus groups were facilitated by the researcher. However, care was taken to intervene only when probing was necessary. The age of the participants varied from nineteen to seventy-two years.

Method

The focus groups lasted approximately one hour each.

Field notes were taken by a health professional who did not participate in the discussion.

Methods

The data emerging from the focus group was analyzed using thematic analysis. The researcher’s observation of the participants’ non-verbal cues and general atmosphere were used to place the data within context.

Results

Following analysis, the three themes emerging from both focus groups were:• Experiences with the general practitioner (GP)• Views on other health care professionals• Experiences in GP practices

Experiences with the GP

More than half of the participants in both focus groups stated that their experience with their GP was of good quality, when their doctor took them seriously.

Patients identified a number of barriers to a high-quality GP consultation: poor eye contact and time availability, not listening carefully, being too concerned about money.

Experiences with the GP

Participants agreed on the importance of their GP availability. One of them claimed that whenever her GP was unavailable, she “... ran to the Accident & Emergency Department.” This may lead to fragmentation of services with lack of continuity of care.

QUALICOPC patient experiences questionnaire explored these experiences with the GP so no amendments were suggested.

Views on other health care professionals

In the first focus group, seven out of fifteen participants did not understand the word “medical specialist”. Maltese people tend to refer to medical specialists as professors, even though they may not have attained Professorship status from University.

Following the group discussions, it was decided to add the word “professor” whenever the term “medical specialist” was used in the QUALICOPC questionnaire.

Experiences in GP practices

Even in a small country as Malta, participants agreed that physical access to the health centre is important. One participant in the second focus group strongly believed that “... the health centre should be close to people especially when Malta is having an ageing population.”

Applications and Conclusions

In this study, hearing Maltese patients’ experiences allowed the emergence of important themes, which may not be exposed by existing questionnaires.

This potentially improves the QUALICOPC Maltese patient experiences questionnaire design and validation.

Applications and Conclusions

This may serve as a valuable contribution to the existing literature.

The focus is to improve our primary care services tailored to our patients’ needs and to provide seamless continuity of care.

Further research is needed to explore the Maltese GP’s experiences and views to provide further assessment of the quality of primary care in Malta.

References

Schäfer, W. L. A., Boerma, W. G. W., Kringos, D. S., De Maeseneer, J., Gress, S., Heinemann, S., Rotar-Pavlic, D., et al. (2011). QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care. BMC Family Practice, 12, 115. doi:10.1186/1471-2296-12-115

References

Azzopardi Muscat N. (1999) Healthcare Systems in Transition: Malta. European Observatory on Health Care Systems. Available from: <http://www.euro.who.int/documnt/e67140.pdf>

Griffiths Report on the NHS [Internet]. Available from: <http://www.sochealth.co.uk/history/griffiths.htm>