Family Medicine as a Model of Primary Health Services Delivery: A Pilot Study in Almaty, Kazakhstan
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Аннотация
Introduction. Advanced models of delivering primary health care are being implemented in various countries of the world. This is especially true for countries undergoing a healthcare transition in Central Asia, such as Kazakhstan, which obtained independence from Soviet Union in 1991. The Kazakhstan National Program of Health Reform, implemented between 2005-2010, aimed to create an effective system of primary care. One of the key directions of healthcare reform implemented in Kazakhstan included the development of family medicine, which has become cutting-edge agenda for Kazakhstan Health Ministry over the past 10 years. While many papers have been published about the importance of family medicine and primary healthcare models, few have focused on analyzing family medicine effectiveness in Kazakhstan and its impact on access to family doctor services and patient satisfaction. The key aims of this pilot investigation were 1) to assess the model’s impact on access to primary care and patients’ satisfaction, and 2) to explore the model’s effectiveness in some Central Asian and transitional countries in the literature.
Methods. This pilot study was based on semi-structured interviews and questionnaires about the perception and impact of the primary care model to 86 respondents aged 19-51 (54% females, 46% males). The majority of respondents were Almaty city residents (71%), while the rest were Almaty Province rural residents (22%) and residents of other Kazakhstan regions (7%).
Results. Respondents from rural areas associated general practitioners, or family doctors, with community clinics (also referred to as feldsher posts). Even though urban area respondents use family doctor services, they were more likely to get those services in private rather than public clinics. Rural residents appear to have better access to primary care providers than urban residents participating in our study. Also, respondents from rural areas were more satisfied with services provided by family doctors than respondents from urban areas.
Conclusions. This pilot study helped to improve our understanding of primary health care reforms implemented in Kazakhstan, a topic that is not traditionally covered in international literature. This pilot study suggests that primary care is more effectively implemented in rural areas of Kazakhstan (Almaty Province); however, future full-scale research in this area is needed to fully understand the complexity of primary healthcare access in Kazakhstan.
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Библиографические ссылки
World Health Organization (WHO), United Nations Children's Fund. Primary health care. International Conference on Primary Health Care 1978; http://www.searo.who.int/entity/primary_health_care/documents/hfa_s_1.pdf. Accessed April 4, 2015.
Starfield B. Primary care and health: A cross-national comparison. JAMA. 1991;266(16):2268-2271.
Starfield B. Global health, equity, and primary care. JABFM. 2007;20(6):511-513.
Parfitt B. Health reform: The human resource challenges for Central Asian Commonwealth of Independent States (CIS) countries. Collegian. 2009;16(1):35-40.
Government of the Republic of Kazakhstan. The governmental program on reforming and developing the health care system of Kazakhstan for 2005-2010 periods. 2013; http://ru.government.kz/resources/docs/doc9. Accessed September 8, 2010.
Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: Is there enough time for prevention? Am J Public Health. 2003;93(4):635-641.
Jaén CR, Stange KC, Nutting PA. Competing demands of primary care: A model for the delivery of clinical preventive services. J Fam Practice. 1994;38(2):166-171.
Kringos DS, Boerma W, van der Zee J, Groenewegen P. Europe's strong primary care systems are linked to better population health but also to higher health spending. Health Affair. 2013;32(4):686-694.
Sharman A. Modernization and growth in Kazakhstan. CAJGH. 2012;1(1).
Sharman A. New era in medicine. Central Asia Monitor 2002; http://camonitor.com/archives/3994. Accessed March 31, 2015.
Sharman A. A new paradigm of primary health care in Kazakhstan: Personalized, community-based, standardized, and technology-driven. CAJGH. 2014;3(1).
World Health Organization (WHO). The training and utilization of feldshers in the USSR. 1974; http://apps.who.int/iris/bitstream/10665/39783/1/WHO_PHP_56.pdf?ua=1. Accessed April 4, 2015.
Groenewegen PP, Dourgnon P, Greß S, Jurgutis A, Willems S. Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries. Health Policy. 2013;113(1-2):170-179.
National Programme of Health Reform and Development for 2005-2010. Health Monitor2004.
Katsaga A, Kulzhanov M, Karanikolos M, Rechel B. Kazakhstan: Health system review. Health Systems in Transition. 2012;14(4).
Rawaf S, Maeseneer JD, Starfield B. From Alma-Ata to Almaty: A new start for primary health care. Lancet. 2008;372(9647):1365-1367.
Chan M. Return to Alma-Ata. Lancet. 2008;372(9642):865-866.
Beasley JW, Dovey S, Geffen LN, et al. The contribution of family doctors to primary care research: A global perspective from the International Federation of Primary Care Research Networks (IFPCRN). Prim Health Care Res Dev. 2004;5:307-316.
World Health Organization (WHO). The world health report 2000 - Health systems: Improving Health. 2000; http://www.who.int/whr/2000/en/. Accessed March 19, 2015.
World Health Organization (WHO). Social determinants of health: The solid facts. 2nd ed: World Health Organization; 2003.
World Bank. Review of experience of family medicine in Europe and Central Asia. Vol 4. Washington, DC: Kyrgyz Republic Case Study; 2005.
UNICEF. UNICEF evaluation report standards. 2004; http://www.unicef.org/evaldatabase/files/UNICEF_Eval_Report_Standards.pdf. Accessed April 4, 2015.
World Bank. Review of experience of family medicine in Europe and Central Asia. Vol 1. Washington DC: Executive Summary; 2005.
World Bank. Review of experience of family medicine in Europe and Central Asia. Vol 2. Washington, DC: Armenia Case Study; 2005.
Omarova HP. The need for family doctors in rural area of Turkmenistan. Paper presented at: International Conference N211992; Venesian Medical University.
Turcanu G, Domente S, Buga M, Richardson E. Republic of Moldova: Health system review. Health Systems in Transition. 2012;14(7).
World Health Organization (WHO). Evaluation of structure and provision of primary care in Ukraine: A survey-based project in the regions of Kiev and Vinnitsa. 2010; http://www.euro.who.int/__data/assets/pdf_file/0016/129022/e94565.pdf. Accessed April 4, 2015.