Assessment of Quality of Healthcare among the Elderly Patients Utilising the Korle-Bu Teaching Hospital, Accra.

Abstract

Background: The elderly tend to have a disproportionately high need for utilisation of healthcare services because they exhibit multiple disorders, have limited regenerative abilities, and are prone to diseases, syndromes, and sicknesses. These elderly persons are relatively regular consumers of the Out Patient Department’s care. The seeming lack of provision of suitable and quality healthcare services to the elderly is emerging as one of the main impediments of this era. The fundamental requirement to increase utilisation for the elderly persons is to improve the quality of healthcare services delivered in hospitals. Objective: The study sought to assess the quality of healthcare services among the elderly patients utilising the Korle-Bu Teaching Hospital, Accra. Methods: The study was a descriptive cross-sectional survey using a sequential explanatory mixed methods approach. In the quantitative study, questionnaires were used to elicit information from three hundred and sixty-one (361) elderly persons. Purposive sampling was used to select elderly persons from the seven Out-Patient Departments in the Korle-Bu Teaching Hospital in Accra. Simple random sampling [lottery method] was used to select the elderly persons in the inclusion criteria. The quantitative data was analysed by the use of chi-square test to determine the relationship between the socio-demographic characteristics of the elderly and the variables measuring utilisation of healthcare services (cost, accessibility, health personnel attitude, physical support, information and waiting time). In addition, Ordinal Logistic Regression was used to determine the relationship between the predisposing, enabling and need factors of the elderly and each of the variables measuring utilisation of healthcare services. Furthermore, one-way analysis of variance and Generalised Linear Model were used to examine the socio-demographic characteristics and quality of healthcare. In the qualitative study, purposive sampling method and then convenience sampling method were used to select seventy-six (76) elderly persons from the seven selected Out- Patient Departments. Qualitative study was conducted to obtain an in-depth understanding of the quality of healthcare services by the elderly patients utilising the Korle-Bu Teaching Hospital. Thematic content analysis was used to analyse the data. The interview transcripts were read to identify emerging themes and sub-themes, and were exported into Nvivo version 11 software for data organisation. Quantitative Results: The study showed that, the elderly persons who were accompanied to the health facility were 1.86 times more likely (OR=1.86, 95% CI; 1.13-3.08) to rate accessibility of healthcare services on a higher scale than the elderly persons who visited the hospital by themselves (p=0.016). The elderly who were beneficiaries of NHI were 0.42 times less likely (OR=0.42, 95% CI; 0.18-0.97) to rate accessibility of healthcare services on a higher scale compared with the elderly who were non-beneficiaries (p=0.042). The elderly persons with secondary school education and above were 0.53 times less likely (OR=0.53, 95% CI; 0.34-0.84) to rate cost on utilisation of healthcare services on a higher scale compared with the elderly persons with pre-secondary education (p=0.006). Adjusting for other factors, the elderly persons with multiple chronic conditions were 1.56 times more likely to rate cost on a higher scale compared with the elderly with one chronic condition (OR=1.56, 95% CI=1.04-2.34) (P=0.03). Furthermore, the study reported that, there was a decreasing trend in the rating of quality of healthcare services with increasing number of chronic conditions (p=0.042). The results indicated that both female and male elderly persons regarded quality of healthcare to be the same (p=0.808). Qualitative Findings: The elderly persons described the waiting time as long and stressful. They developed swollen feet and bodily pains due to the long waiting time. They clarified that the diagnostic investigation, medication and consultation fees were expensive, leading to postponement of their subsequent visits and deterioration of their health. Additionally, the elderly persons specified that they woke up very early to report timely at the Out-Patient Departments by means of ‘drop in’ taxi that was very costly. Furthermore, at the Out-Patient Department, they faced cumbersome procedures before seeing the doctors. With respect to the quality of healthcare provided at the hospital, feedback from the health personnel was reported harshly, and they provided negligible physical assistance. The elderly described the seats at the waiting rooms as being very low and uncomfortable. Nevertheless, the elderly persons described the health personnel as skillful and knowledgeable. Unexpectedly, the elderly were satisfied with the healthcare services at the Korle-Bu Teaching Hospital. For the elderly participants, satisfaction meant improvement in their health. Conclusion: Cost was a determining factor in utilising healthcare by the elderly patients. The health personnel were described as being skillful and knowledgeable in providing healthcare. The improvements in the general health of the elderly made them satisfied with healthcare services. Recommendations: The study recommends that policy makers should include elderly persons from age 60 years to 69 years in the National Health Insurance exemption policy to enable the majority of them to utilise the healthcare services. Additionally, there is the need to review visits to the healthcare units to schedule time appointments to reduce the long and stressful waiting time.