Assesment of primary care accessibility in Antakalnis, Karoliniskes and Seskine out-patient's clinics

Methods. Anonymous questionnaire survey of the patients (n=700) was carried out in March-April 2006 at three out- patients’ clinics in Vilnius city: Antakalnis, Karoliniškės and Šeškinė. The interview was conducted only with those patients who were seeking primary care service (excluding gynecology/obstetrics and odontologists). 534 questionnaires were filled in – the response rate was 76.28 %. The data were analyzed on PC using statistical analysis package SPSS. Results: 79 % of respondents indicated that during recent two years they visited medical care institution. More than a half (60.3 %-73.6 %) of respondents indicated that the attention to patients and the quality of work performed by doctors and nurses during recent two years became „better“ or even „extremely better“. Less than a half of respondents gave a positive evaluation concerning the changes of registration personal‘s attention to patients and organization of work at medical care institution – 49.3 % and 48.5 % respectively. 45.9 % of respondents indicated that access to a specialist doctor during recent several years became „more difficult“, but 46.3 % of respondents indicated that the capacity of medical investigation/diagnostics at primary care institution became better. 76.2 % of respondents would experience difficulties if they would be referred to a specialist based in another medical care institution. 63.3 % of respondents are positive towards the fact that in a referral to specialist there is no indication of exact medical institution. 60.9 % of respondents are negative about the fact that they have to see the family/GP doctor first instead of a specialist. 72.5 % of respondents do not consider that they have to wait „too long“at the registration desk. 53.8 % of respondents have to wait less than 15 minutes while registering. 74.3 % of respondents do not consider that they have to wait „too long“by the doctor’s door. 75.5 % of respondents indicate that before being admitted they have to wait up to 30 minutes by the doctor’s door (36.6 % wait 0 to 15 minutes, 39 % 16 to 30 minutes). 80 % of respondents do not consider that they have to wait „too long“by the door of diagnostic and other procedures. 81.3 % of respondents have to wait less than 30 minutes before being admitted for diagnostic and other procedures (57.7 % wait 0 to 15 minutes, 23.6 % 16 to 30 minutes). 62.0 % of respondents indicate that queues at medical institutions are “inevitable necessity”. 56.0 % of respondents indicate that doctors “always discuss” about the medicines prescribed and even 83.7 % indicate that the medicines are prescribed according to the demand – “as much as needed”. 77.2 % of respondents indicate that the prices of medicines prescribed by the doctor are affordable. 38.4 % of respondents indicate that “the pharmacist usually informs about the possible choice of medicines”. More often (48.9 %) the respondents indicate that they would choose the option then “the list of reimbursed medicines is longer but only a part of the price is reimbursed”. 44.6 % of respondents would rather support the reimbursement scheme then “the patient him/her self selects the medicines and pays for them but later on the reimbursement sum is paid in cash to patient”. 39.9 % of respondents tend to choose the pharmacy which is situated by the place of residence, 28.7 % - at the out-patient clinics, 23.8 % - at the shopping centre. 59.3 % of respondents have to wait less than 15 minutes at the pharmacy. 43.4 % of respondents “save time” while choosing a pharmacy and 27.3 % - “save money”. 53.6 % indicate that the Eurovaistine was the pharmacy they were buying medicines at last time. 87.4 % are satisfied with transportation/connectivity possibilities to out-patient clinics: 52.2 % indicate that the transportation is “convenient”, 35.2 ℅ - “extremely convenient”. Conclusions: 60.9 % of respondents indicated that they were negative about the fact they had to see the GP doctor first instead of being admitted by the specialist directly, but half and even more than half of the respondents evaluated positive the indicators of good access and quality such as the quality and attention of doctors’ and nurses, waiting times, quantity and price of medications. The evaluations of respondents are significantly influenced by sociodemographic factors such as age, education and incomes, on other hand gender, economic activity and place of living had no significant influence to responces. If compared to Spinter study performed in 2002 one could find the current study revealed that in twelve questions out of nineteen a positive change was observed and that was asssociated with improvement of doctors‘ and nurses‘ work quality, decrease of waiting times and prescribing habits. Responces to three questions concerning reimbursment practically showed no change but in four cases estimating the access to specialists, GP as an institution, information provided at pharmacy and convenience of transportation to primary care site showed negative changes. More efforts should be made educating the public about the functions of GP as a „goalkeeper“ and the efficasy of such system which proved it‘s economic value to society in foreign coutries