Primary care in Bosnia and Herzegovina. Health care and health status in general practice ambulatory care centres.
OBJECTIVE
To assess the health care and health status of patients attending primary care clinics in Bosnia and Herzegovina.


METHODS
Assisted administration patient survey.


METHODS
Two ambulatory care clinics (ambulantas) in each of three cities in Bosnia and Herzegovina: Tuzla, Mostar, and Banja Luka.


METHODS
Patients attending the ambulantas during a 1-week period in March 1999; 885 answered questionnaires.


METHODS
Each patient listed demographic characteristics and answered questions on satisfaction with health care and with the physical and financial accessibility of health care services and medications. A validated health status questionnaire (EuroQoL), previously used in parts of the former Yugoslavia, was administered.


RESULTS
Only 22% of patients were employed; 57% could not pay the nominal fee to see a physician; 71% walked to the clinic; mean distance from patients' homes to the clinics was 2.3 km; 63% could not get the medications prescribed (in 85% of cases because of cost, not availability); 80% to 90% of answers to satisfaction questions suggested high satisfaction with the care patients received from their doctors; 67% of the time patients were referred to a specialist by general practitioners; 33% had problems walking; 17% had problems with self-care; 36% had problems with usual daily activities; 72% had at least some pain or discomfort; and 62% described at least some anxiety or depression. The three cities showed significant differences; patients in Tuzla generally had lower health status and more problems with health care.


CONCLUSIONS
Unemployment and financial considerations reduced health care access in Bosnia and Herzegovina. While only one third of patients had physical difficulties, two thirds had emotional problems or pain. Satisfaction with physicians' care was high.
Department of Family Medicine, Queen's University in Kingston, Ont. godwinm@post.queensu.ca
M
M
Godwin
G
G
Hodgetts
E
E
Bardon
R
R
Seguin
D
D
Packer
J
J
Geddes
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D017522:Bosnia and Herzegovina; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012036:Refugees; D014478:Unemployment