Wong and her team have received additional funding to do a similar study in English, French, Chinese and Punjabi – photo by Martin Dee
UBC Reports | Vol. 54 | No. 10 | Oct. 2, 2008
By Catherine Loiacono
A UBC study has shed light on patients’ priorities for primary health care. According to the research, six issues are top-of-mind for British Columbians when interacting with family physicians: accessibility, continuity of care, responsiveness, interpersonal communication, technical effectiveness and whole-person care.
“We want to understand whether there are disparities in healthcare delivery from the patient’s perspective, and if so, what is of most concern to the patient,” says Sabrina Wong, assistant professor and faculty at UBC’s School of Nursing and Centre for Health Services and Policy Research. “Information about a patient’s views and experiences on what could be improved could be used to identify priorities for quality improvement.”
The study, funded by the B.C. Ministry of Health inquires about patients’ experiences in the primary healthcare system and which parts of the system work or fail to meet their needs. Seventy-five people were recruited to participate in 11 focus groups held across British Columbia. Each focus group was asked about the features of care that were important to them when making an appointment and visiting a healthcare provider.
“Increasingly, healthcare decision makers are actively seeking public and patient involvement in health policy decisions,” says Wong, who is lead author of the study. “Public reports on healthcare system performance are more likely to be useful when they include patient priorities as indicators for improvement.”
The participants were asked about the features of care important to them when visiting a healthcare provider.
Accessibility relates to geographic location and timeliness of appointments. “This came up as the most important issue,” says Wong. “Participants agreed that waiting more than one week to visit their provider or waiting extended periods of time in a waiting room is unacceptable. Also, participants living in smaller communities found that their geographic location often affected access to necessary health care services.”
Continuity and whole-person care emerged as two other important issues. Participants identified building a long-term relationship with the healthcare professional as important as it enables them to share personal health habits that they would not otherwise feel comfortable sharing. “Developing a relationship will build trust and respect,” says Wong. “In doing so, participants feel this will help them address the underlying causes of their health problems instead of treating symptoms.”
“It’s no good seeing somebody different every time—you start all over again, and they change your medication. It is important to have ongoing care,” said one participant. “That’s why I don’t really like to go to walk-in clinics because you get a different doctor all the time,” said another participant. “They give you a different treatment – sometimes it works and sometimes it doesn’t.”
Participants identified gaps in communication and information among providers, stating that information technology that permitted access to their health information at any point of care would make efficient use of time. “Why doesn’t the hospital have access to the files at my doctor’s office, and how come the doctor’s office can’t access the hospital computer?” said a participant.
The study also reveals that information continuity of care is, in some cases, more important than privacy. “Patients, particularly those who are chronically ill, would rather have their medical documents accessible to providers who were assisting in managing their care,” says Wong.
Research suggests that patients are open to seeing qualified alternative health care professionals. “We are finding that patients are open to seeing other healthcare providers such as a midwife or nurse practitioner and recognize that some types of primary healthcare do not necessarily need a family physician,” saysWong.
“Measuring quality of healthcare is complex because it is a multifaceted concept that requires many different perspectives,” says Wong. “The results provided by studies such as ours augment discussions on measuring the performance of Canada’s healthcare system.”
“They highlight the quality of care from patients’ perspectives rather than only examining the technical quality, both of which are useful for improving processes of care,” says Wong. “These priority domains should be addressed in reports to the public on the performance of the primary healthcare sector.”
