title: Addressing the phenomenon of bypassing in Albania: the impact of a primary health care strengthening intervention.
abstract: The purpose of this study is to assess the impact of a primary health care strengthening intervention on bypassing behavior in Albania, a middle-income country that has experienced substantial structural changes that affect PHC and where bypassing among health care clients is common. The intervention aimed to improve the quality of health care in low-level facilities through improved availability and use of health information, the adoption of clinical practice guidelines, and provider training. The study employs a quasi-experimental research design to evaluate the impact of the intervention on health care utilization. The survey findings suggest that the pilot areas outperformed the control areas with respect to a number of key population-based indicators of health care utilization. For example, in the 2-year period between December 2002 and December 2004, bypassing for treatment of simple acute health problems during the month prior to the survey decreased by 47%, and the percentage of chronically ill health care clients who utilized PHC facilities for treatment in the month prior to the survey increased by 29%. These differences, which are statistically significant at the 10% level or better, suggest that the improved performance in the pilot areas is attributable to the intervention.
authors.affiliation: Tulane University, 1440 Canal Street, New Orleans, Louisiana, USA. david.hotchkiss@tulane.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Hotchkiss
authors.forename: Linda
authors.initials: L
authors.lastname: Piccinino
authors.forename: Altin
authors.initials: A
authors.lastname: Malaj
authors.forename: Andrés A
authors.initials: AA
authors.lastname: Berruti
authors.forename: Sujata
authors.initials: S
authors.lastname: Bose
mesh_terms: D000328:Adult; D000415:Albania; D003695:Delivery of Health Care; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000592:standards* / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000592:standards*; D011635:Public Health Administration; D011787:Quality of Health Care