Health system performance assessment among AIDS patients in Brazil
C. Landmann Szwarcwald, P.R. Borges de Souza-Júnior
Fundação Oswaldo Cruz, ICICT, Rio de Janeiro, Brazil
Background: Although the availability of free universal ARV treatment has resulted in a substantial improvement in patients' survival in Brazil, the need of obtaining even more impact of HAART requires assessment of health system performance among AIDS patients, from the user viewpoint
Methods: In 2008, a national survey was carried out among 1245 AIDS patients selected in a 2-stage cluster sampling. The questionnaire included the following modules: socio-demographic variables; clinical and treatment-related characteristics; self-rated health; health system performance; and quality of life. In this paper, aspects of satisfaction with physician's assistance and health services were analyzed. Using a scale of maximum value of 100 (excellent evaluation) and a minimal value of 0 (very bad evaluation), health care satisfaction scores were calculated for each item. Degree of satisfaction with complementary health services was also assessed. Analysis of variance was used to test effects of health care satisfaction on quality of life perception.
Results: The mean score of overall satisfaction with health care was 73.8 (moderate satisfaction). The best score corresponded to physician's assistance (86.7), meaning a very good evaluation of aspects such as professional ability, time for questions, privacy and confidentiality. As to items related to health services, the satisfaction mean score was much lower (75.9). The worst scores were related to access and waiting time, while the best to availability of medicines. In regard to satisfaction with other health services, the majority reported insufficient offer of additional services. Among cases who reported intense depression feelings, 40% reported no utilization of psychotherapy. Quality of life perception was significantly associated to satisfaction with health system performance.
Conclusions: Supply of complementary health services, appropriate treatment and management of depression, as well as easing access to health care providers are aspects that should be improved to maximize quality of life of patients receiving ARV therapy in Brazil.
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