Comparative assessment of the quality of the primary care system: A survey of family physicians' perspective at a tertiary health facility and a new family medicine training facility in the Lagos State health system

Background: Revitalizing the primary health care (PHC) centers has been at the top of the priority list of the Lagos State Government. Achieving this goal should restore the confidence of the people in and increase their utilization of PHC centers in their communities. At the forefront of the provision of comprehensive, continuous and coordinated care for individuals within the context of the family and community are family physicians (FPs), who are equally saddled with the task of clinical governance by virtue of their strategic position in the health system. It became expedient to expand human resource capacity building as a primary care quality improvement initiative of the state through the introduction of a post-graduate training program in family medicine at its biggest multi-specialist secondary health care facility. Objectives: To identify the strengths and weaknesses of the primary care system at the new training center and also, to compare the strengths and the weaknesses of the primary care system between the new training facility and the tertiary facility. Methods: Cross-sectional study design was employed to survey the perspective of the FPs and FPs -in-training at the new training facility and tertiary health facility about the primary care system in their facilities through self-administration of the Primary Care Assessment Tool-primary care practitioner (provider) survey. Results: A total of 33 FPs and FPs-in-training participated in the survey. They were on full-time employment and had spent an average of 51 and 66 months in service at the new family medicine training facility and the tertiary facility, respectively. They perceived that patients' waiting time at their facilities doubled (1 h 47 min at the new training center) and tripled (2 h 23 min) their expectations of a reasonable time to wait respectively. The weakest primary care quality dimensions were the same in both centers and the scores were closely comparable between the new and the old as follows: Coordination (43.8%; 52.9%), community orientation (44.1%; 63.2%), ongoing care (61.9%; 61.3%), and access (63.1%; 65.1%). However, the tertiary center had higher scores in all dimensions except ongoing care and the differences in scores between the new and the old were statistically significant in three dimensions namely: Comprehensiveness (P = 0.038), community orientation (P = 0.049), and cultural competence (P = 0.035). Conclusion: The new training facility may leverage the experience of the old in the dimensions where the latter has demonstrated statistically significant differences in strengths (cultural competence, comprehensiveness, and community orientation). Health administrators/policymakers should consider doctors' feedback as a necessity for planning and implementing changes to continuously improve the quality of the primary care system at these training facilities.