Background and purpose: This study evaluated the quality of emergency services at the primary care level and how it can be improved.
Methods: A cross sectional study was conducted to assess emergency services delivery in randomly 16 primary health care facilities (rural and urban) from the eight health districts in Alexandria city, Egypt. Data were collected about equipment, facilities, drugs, physicians’ practices and attitudes, patients’ utilization of and satisfaction with primary care emergency services. Standard univariate statistics were used. Student t-test, chi-square, Monte Carlo test, Mann-Whitney U and Fisher exact tests were used as tests for significance at the 5% level of significance.
Results: All the PHC facilities had no written clinical practice guidelines for providing primary emergency services, no guidelines for pediatric emergency triage, assessment or treatment and no referral guidelines. Lack of some essential equipment and drugs was evident. The median attitude score towards emergency cases was 82.3% for physicians 81.9% for nurses. Most physicians (94.1%) and nurses (85.0%) had practiced emergency care in the primary health care. More physicians as compared to nurses (58.8% versus 50.7%) reported greatest need for continuing medical education in the management of pediatric emergencies. More than half of physicians endorsed hospital training (58.8%) while 48.4% endorsed practical training in PHC settings. Many patients (87.1%) used the PHC facilities for emergency services. The most common reason for visiting PHCCs for emergency services were for trauma (31.1%). Large proportion of patients (64.3%) was dissatisfied with the emergency services provided by the PHC facilities.
Conclusion: The present study indicated unsatisfactory primary emergency services in terms of structure, process and outcome. The services need to be improved and defects revealed by the present study should be taken into considerations handin- hand with available resources in order to upgrade the quality of the primary emergency services.
Aida Mohey, Saadoun Faris Al azmi