Abstract
This research aimed to evaluate situations of primary care services and to examine influencing factors towards providing desirable primary care in 7 dimensions: service delivery, health workforce, health information systems, accessibility to essential medicines, financing, leadership/governance, and community participation. A total of 468 respondents from the community health centers and subdistrict health promoting hospitals in the Northeast of Thailand responded to the questionnaires based on guidelines for health service systems improvement. The data were analyzed using descriptive statistics (frequency, percentage, mean and standard deviation); and inferential statistics (binary logistic regression). The results showed that the overall mean score in providing desirable primary care services was 2.29 (SD = 0.39) from full score 3. Service delivery and health workforce had the lowest scores at 1.73 (SD = 0.51) and 1.92 (SD = 0.68), respectively. Of these respondents, 66.0% reported that their patients were cared for by family doctors, 52.4% was the proactive care service provided by the 3-healthcare teams (family doctor, public health professional and village health volunteer) and 50.2% by village health volunteers. Ten of the 76 primary care providers had doctors working after office hours, 96 primary care providers had no doctors even on the rotating schedule. Village health volunteers were reported to be an active health information sender by 78.0%. Moreover, 73.7% requested for improvement of the 3-healthcare team service. The five lowest-score services needed improvement were rehabilitation, consumer protection of the health products, physical activity promotion, emergency medical service, and sanitation. Influencing factor towards the provision of desirable primary care services was the registered primary care unit (adjusted odds ratio = 5.16, 95%CI 1.33 to 20.12, p value = 0.018), while the factors of health region, size of population, size and standard of primary care units were not statistically significant. To improve primary care services, the adequate human resources as the requirement for registered primary care unit according to the Primary Care System Act should be adhered. This would help provide essential primary care services entirely, adequately, and appropriately for Thais.
