Patient-focused quality improvement in primary health care: Opportunities with the patient evaluation scale

Abstract

Background: Patient evaluation of primary health care (PHC) is an evidenced-based approach to quality assessment but its use in Nigeria is still minimal.
Objective: This article explored approaches for using the patient evaluation scale (PES) for PHC performance measurement, ranking, comparing sub-national PHC systems and undertaking patient-focused quality improvement of PHC in Nigeria.
Method: Secondary analyses of data obtained from a cross-sectional national representative exit survey of patients’ experiences of PHC which was conducted with the PES. The PES QUALISTAT is an array of analytic procedures and approaches for presenting data on PHC performance. Colour coding of performance (red colour = severe underperformance requiring urgent action, yellow = suboptimal performance requiring action and green = optimal performance) in relation to thresholds of a standard performance scale were illustrated. The implications of this for practice and policy which shows the opportunities for patient-focused quality improvement using the PES were discussed.
Results: Raw analysis shows red colours in 0-38%, 4-29% and 0-16% of attributes across the various health centres, Local Governments Areas and States, respectively. The most frequently rated attribute as being satisfactory was neatness reported in 20.8% of health centres. A preponderance of health centres had deficiencies in relation to availability of electricity (58.3%) and water supply (58.3%).
Conclusion: This study demonstrates the opportunities in patient-based review using the PES for the development of PHC in Nigeria. The use of simple, clear and actionable presentation of finding may make it suitable and attractive for use by researchers, practitioners and policy makers. Implications are the imperatives for administrative and policy support needed to institutionalised periodic nationwide patient surveys, benchmarking, performance ranking of PHC facilities and trend analysis to enhance timely identification and remediation of problems in Nigeria’s PHC system.