Can access to PHC services at a public health facility be measured by number of visits made? As many reserachers consider both as proxies of one and other. Simply speaking can utilization be a dependent variable for exploring access. Thanks
I see utilisation as the outcome variable instead, say, the percentage of the population of the catchment area using the service....
Apart from coverage (the percentage of the population of the catchment area using the service) and utilization (proportion of total amount of service that have been used up) which are quantitative measures of access, average distance of a health facility from peoples homes can also be used.
My dependants variables are: Delevery cost, transport cost to reach the service, health workers présence and attitudes, competencies, services available, others external variables like level of éducation, cultural believes ans perceptions....Now your may have high utilisation and low coverage! Low utilisation and high coverage. Utilisation is good then for évaluating workload.....but for community access I will use coverage......
Sorry, I was meaning my indépendant or explanatory variables .......
From my point of View, Utilization can be a dependent variable. More-so,Provision of Basic and Essential amenities(drugs,equipment's etc), tailored towards provision of Quality and Affordable Services. Accessibility with regards to visit made can be viewed as an invariable factor and not totally dependent. if the Basic and Essential Amenities are provided or put in place, ease of transport , good road network/ accessibility to the health facility will be made available as well
I like the approach of the 5-A paper. It not only looks at utilization, change in which could be a measure of access improvement or degradation, but more importantly, I believe, looks at "patient satisfaction." Fortunately, several of the items in Table 2 are not "satisfaction" but rather "patient experience" measures. The one missing thing in such an assessment of access is that one doesn't know the degree to which others in the community who did not have an encounter (yet) might think about access to these particular "available" services. That would require a general population survey.
Consider looking at the metrics used by AHRQ. They may not be applicable but may be modifiable. http://archive.ahrq.gov/research/findings/nhqrdr/nhdr02/premeasurea.html
What you are looking at is disparities in care, inequities, although equality and equity are much debated in the literature, so being clear about what you are really trying to research is important. Access is just one part of the equation, you would have to consider quality and types of services, who is providing the services and. You could examine health disparities, by examining burden of illness, injury, disability, or mortality experienced by one population group relative to another group and the impact of PHCs on these areas. Just measuring number of visits is really an output of the system and does not discriminate high users from low users, (see attached papers) or serve as an outcome of care.
Let me pay thanks to Ms. Diana Luan, Prof. Stephen C Schoenbaum, Ms. Victoria Omeche, Dr. Jean Gérard Tatou Doumtsop and Mr. Prosper Adogu for your invaulable comments and suggestions.
Dear Dr,
1. Use of services is a mean to evaluate health care services in addition to satisfactions.
2. also, it may help to evaluate equity of the health care system.
3. Use of health care services can be measure: binary (use/ not use) or continuous ( 1 visit, 2 visits, 3 visits, etc....).
4. access to health care is one factors associated with health care services use.
5. Anderson model as theoretical frame work may help to understand the issue.
Thanks a lot.
Thank you Dr. Abdullah Alkhawaldeh for your reply and explanation.
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