Patient Experiences
of Primary Care
in Malta
Dr Glorianne Bezzina
Dr Philip Sciortino
Background
Health care quality has been a topic of increasing
international debate. In 1984, the Griffiths Report
on the UK National Health Service sought the
opinion
of
the
consumers
to
make
recommendations on management action (Griffiths
Report, 1984).
Primary health care in Malta is provided by the
state health service and by private general
practitioners. It has been estimated that the
private sector accounts for about two thirds of the
workload in primary health care in Malta (Azzopardi
Muscat, 1999).
Background
QUALICOPC (Quality and Costs of Primary care
in Europe), a multi-country study, aims to
evaluate the performance of primary care
systems in Europe in terms of quality, equity and
costs (Schäfer et al., 2011).
This presentation explains the reported patients’
experiences of primary care which was carried
out as part of the Maltese arm of the
QUALICOPC project.
Aim
The study aims to qualitatively explore the
patients’ experiences and views of primary care
in Malta.
Method
Two focus groups were conducted in a primary
care health centre with a total of 30 Maltese
patients to report on recent experiences in
primary care in Malta.
The focus groups were facilitated by the
researcher.
However, care was taken to
intervene only when probing was necessary.
The age of the participants varied from nineteen
to seventy-two years.
Method
The focus groups lasted approximately one hour
each.
Field notes were taken by a health professional
who did not participate in the discussion.
Methods
The data emerging from the focus group was
analyzed using thematic analysis.
The
researcher’s observation of the participants’
non-verbal cues and general atmosphere were
used to place the data within context.
Results
Following analysis, the three themes emerging
from both focus groups were:
• Experiences with the general practitioner (GP)
• Views on other health care professionals
• Experiences in GP practices
Experiences with the GP
More than half of the participants in both focus groups
stated that their experience with their GP was of good
quality, when their doctor took them seriously.
Patients identified a number of barriers to a highquality GP consultation: poor eye contact and time
availability, not listening carefully, being too concerned
about money.
Experiences with the GP
Participants agreed on the importance of their GP
availability. One of them claimed that whenever her
GP was unavailable, she “... ran to the Accident &
Emergency Department.”
This may lead to
fragmentation of services with lack of continuity of
care.
QUALICOPC patient experiences questionnaire
explored these experiences with the GP so no
amendments were suggested.
Views on other health care professionals
In the first focus group, seven out of fifteen
participants did not understand the word “medical
specialist”. Maltese people tend to refer to
medical specialists as professors, even though they
may not have attained Professorship status from
University.
Following the group discussions, it was decided to
add the word “professor” whenever the term
“medical specialist” was used in the QUALICOPC
questionnaire.
Experiences in GP practices
Even in a small country as Malta, participants
agreed that physical access to the health centre is
important. One participant in the second focus
group strongly believed that “... the health centre
should be close to people especially when Malta is
having an ageing population.”
Applications and Conclusions
In this study, hearing Maltese patients’ experiences
allowed the emergence of important themes,
which may not be exposed by existing
questionnaires.
This potentially improves the QUALICOPC Maltese
patient experiences questionnaire design and
validation.
Applications and Conclusions
This may serve as a valuable contribution to the
existing literature.
The focus is to improve our primary care
services tailored to our patients’ needs and to
provide seamless continuity of care.
Further research is needed to explore the
Maltese GP’s experiences and views to provide
further assessment of the quality of primary
care in Malta.
References
Schäfer, W. L. A., Boerma, W. G. W., Kringos, D.
S., De Maeseneer, J., Gress, S., Heinemann, S.,
Rotar-Pavlic, D., et al. (2011). QUALICOPC, a
multi-country study evaluating quality, costs and
equity in primary care. BMC Family Practice, 12,
115. doi:10.1186/1471-2296-12-115
References
Azzopardi Muscat N. (1999) Healthcare Systems in
Transition: Malta. European Observatory on Health
Care
Systems.
Available
from:
<http://www.euro.who.int/documnt/e67140.pdf>
Griffiths Report on the NHS [Internet]. Available
from:
<http://www.sochealth.co.uk/history/griffiths.htm>