In-country activities
The impact of the doctors’ bag on the doctors’ practice and quality of services
Ina Xhani / Sandro Schmidli, Health for All Project, Albania
In 2016, the Health for all Project Albania (HAP), funded by
the Swiss Agency for Development and Cooperation (SDC) distributed
“doctors’ bags” to 223 family doctors in two project regions Dibër and
Fier. Each of the doctor’s bags included 17 basic medical instruments,
such as the adult, pediatric and fetal stethoscope, the adult and
pediatric sphygmomanometer, otoscope, ophthalmoscope, peak flow meter,
oximeter, neurological hammer, glucometer including strips, pregnancy
wheel, digital thermometer, measuring tape, pocket light, tourniquet and
resuscitation mask. To find out how the provision of the ‘doctors bag’
translated into improved primary health care services, HAP conducted an
evaluation survey with the following objectives:
to
assess the availability, functionality, use and utilisation of all
seventeen tools distributed by HAP, as well as of weight, height and
length scale
to assess the family doctors’ competence and
confidence in using the pregnancy wheel, stethoscope, sphygmomanometer,
pulse oximeter and otoscope
to obtain a qualitative
feedback from the family doctors how the distribution of the doctors’
tool bag has improved the self-reported quality of care
to
obtain a feedback from the interviewers about the family doctors’
training needs, openness to training and new approaches, their opinion
about, expectations from and suggestions for the health system and HAP
Methods
In August and September 2017, we
conducted a cross-sectional evaluation survey with 40 family doctors
working in 40 different primary health care centres of the two project
regions. The sampling was done in a twostep procedure. In the first
stage, according to the percentage of family doctors working in the two
project regions, we randomly selected 29 health centres in Fier and 11
in the Dibër region. In the second stage, we randomly selected one
family doctor per selected health centre. Data was collected through
face-to-face interviews between three contracted interviewers and the
interviewee family doctors, through direct observation and through the
consultation of the patient registries. It was then entered, or audio
recorded using Open Data Kit (ODK) data collection forms and analysed
using STATA® and qualitative analyses methods.
Key resultsIn average, ninety three percent of
tools were available and ninety six percent fully functional. The most
frequently used tools were the adult sphygmomanometer, the adult
stethoscope, the pulse oximeter and the pocket light, whereas the
paediatric sphygmomanometer, the ophthalmoscope and the neurological
hammer were used very seldom.
Most family doctors were very competent and confident in
performing pulse oximetry. Due to its simplicity, fancy look, quick and
non-invasive application it seems to be the family doctors’ favourite
tool. Relatively large differences in both competence and confidence
were observed between family doctors in the estimation the expected
dates of delivery using the pregnancy wheel and in performing an
otoscopy. They were found to be relatively competent and highly
confident in measuring an adult’s blood pressure using the
sphygmomanometer and the stethoscope.
Nearly all family doctors think that the doctors’ bag has greatly
improved their quality of care. They reported that the high-quality
tools enable them to make more accurate diagnoses, to triage referrals
from self-treatable cases, make them feel empowered, more motivated and
self-confident. Patients across age groups and a variety of conditions
such as breathing, cardiac and ear conditions as well as diabetes seem
to benefit from higher quality of care services. Thereby, the pulse
oximeter and the otoscope seem to make the biggest difference.
The
interviewers reported that the family doctors interviewed generally
have a very good opinion about the Health for All Project Albania (HAP).
