Patient-centered care and associated factors among outpatient attendees in primary hospitals in South Gondar Zone, Northwest Ethiopia: a mixed methods study

Abstract

According to the Picker Institute model, patient-centred care (PCC) includes respect for patients’ values, preferences, and expressed needs; information, communication, and education; access to care; emotional support; involvement of family and friends; continuity and transition; physical comfort; and coordination and integration of care. It is one of the six aims for quality improvement guiding today’s health care systems. However, PCC remains underutilized by both patients and professionals, and significant challenges persist in its implementation worldwide. Additionally, few studies have examined the level of and factors associated with PCC practices in Ethiopia. To assess PCC practices and their associated factors among outpatient attendants at primary hospitals in the South Gondar Zone, Northwest Ethiopia, in 2024. A facility-based explanatory sequential mixed-methods study was conducted from March 18 to May 10, 2024. A total of 567 participants were selected using systematic random sampling. Binary logistic regression with adjusted odds ratios (AORs), 95% CIs, and p-values was used for quantitative data analysis. For the qualitative part, nine participants were selected for in-depth interviews. Thematic analysis was performed using Open Code 4.3, and the qualitative findings were used to explain the quantitative results. The proportion of PCC was 50.5% (95% CI: 46.3%-54.7%). In the qualitative analysis, PCC was categorized into two sub-themes: satisfactory PCC and not satisfactory PCC. The multivariable analysis showed that age above 34 years (AOR = 1.85; 95% CI: 1.186–2.89), consultation and empathy (AOR = 2.26; 95% CI: 1.39–3.7), shared decision-making (SDM) (AOR = 3.70; 95% CI: 2.36–5.75), perceived quality of services (AOR = 3.26; 95% CI: 2.014–5.26), medical care (AOR = 1.87; 95% CI: 1.16-3.00) and perceived workload on providers (AOR = 1.72; 95% CI: 1.033–2.847) were significantly associated with PCC. The qualitative findings indicated that informational factors, provider intimacy, shared-decision making, social support, availability of medicines, and medical care were factors affecting PCC. Half of the outpatients received good PCC at primary hospitals in the South Gondar Zone. Age, perceived quality of services, consultation and empathy, SDM, and perceived workload on providers were among the variables associated with PCC. This suggests that increased attention needed including awareness creation for patients, attendants, and providers, as well as close supervision of healthcare professionals’ interactions with patients, to enhance the implementation of PCC.