Patient experience with a gatekeeping system at primary health care level in Armenia: a research grant proposal

Abstract

Patient experience is one of the most critical aspects of quality in healthcare, together with patient safety and treatment effectiveness. As previous studies have demonstrated, patient-related and external determinants are associated with good or bad patient experience. To promote the effective utilization of primary health care services and to enhance optimal management and continuity of care many countries implemented a gatekeeping system. However, there is some evidence proving that patient-related components of quality in healthcare might not always improve with the introduction of gatekeeping mainly due to lack of appropriate coordination between primary and specialty care facilities. The utilization of eHealth solutions can provide tools to improve the coordination between relevant stakeholders in the healthcare system to improve efficiency and quality of care. After the collapse of the Soviet Union, to optimize the existing regulations and to improve efficiency and quality of care Armenia adopted the gatekeeping system. Then, in late 1990s, to improve regulatory functions over the healthcare quality and to achieve higher cost-effectiveness of state-funded programs, electronic solutions in healthcare started to be implemented step by step. One of such reforms was the introduction of electronic referrals. Aim. The study aims to find potential factors affecting the patients' experience with the gatekeeping system and explore whether the shift from paper-based referrals to electronic ones can significantly improve patients' experience after adjusting for potential confounders. Methods. A cross-sectional study will be conducted among patients (n=384) referred from any primary care facility to undergo computed tomography or magnetic resonance imaging in one of the 19 major radiology centers in Yerevan. Sample size for each stratum will be proportionate to the total number of services provided by the radiology centers between January 1st, 2020 and February 29th, 2020. A self-administered questionnaire based on the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey will be used to measure the patient experience. Analysis. The patients' socio-demographic characteristics will be tested via Chi-square test for categorical variables. A logistic regression analysis will be used to analyze the association between the binary outcome (bad or good experience) and the main independent variables (use of electronic vs. paper-based referrals). All the other independent variables will be then inserted into the multivariable logistic regression model and tested for confounding (in case of at least 10% change in the slope of the outcome variable after taking out one of the independent variables from the model, it will be considered as a confounder). Significance. Since there is a scarcity of evaluations of reforms done in the healthcare sector of Armenia, this study may become a basis for future implementation and improvement of electronic solutions in the healthcare field of Armenia.