Competencies of family

physicians from patients‘

viewpoint in postwar Kosovo

Gazmend Bojaj 1,2, Fitim Skeraj 2

1. Main Family Medicine Center, Klina, KOSOVO;

2. University of Medicine, Tirana, Albania.

WONCA EUROPE CONFERENCE 15 -18 June 2016 • Copenhagen • Denmark

04.03.2019 Dr.Med.Gazmend Bojaj 1

 Introduction

 There is sufficient evidence indicating that the quality of health

services is highly determined by the organizational structure of
services provided.

 During their daily work, family physicians need to continuously

improve the quality of health services provided.

 From this perspective, general practitioners and family physicians

face the inevitable need of continuous training to enhance their
competencies.

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 Introduction

 This level is based on 7 elements:

1. Competency-based education
2. Improvement of competency level
3. Improvement of customer satisfaction
4. Improvement of quality and performance assesment
5. Improvement of quality and customer care
6. Self-evaluation of professionals of the PHC
7. Assesment of patient perception

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 Main purpose:

 This study aims to evaluate the level of skills and

competencies of family physicians in different fields
and issues related to health services, from the
viewpoint of patients in post-war Kosovo, which
would determine the capacity building aimed at
improving the quality of services and health status of
the patients.

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 Purpose and objectives

 We developed and tested an international instrument aimed at

assessing the level of skills, abilities and competencies of family
physicians from the perspective of patients and physicians.
 Using the certified version of the international instrument
developed with the support of the Lifelong Learning Programme of
the European Community.
 This standardized tool handles competence level of family
physicians in different fields.

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 Objectives

 Assessment of the competencies and skills of family physicians

in Kosovo from the viewpoint of patients.
 Assessment of patient care and safety.
 Assessment of the effectiveness and efficiency at work.
 Assessment of ethical principles.
 Assessment of working methods and tools.
 Assessment of leadership and management.
 Assessment of continuous professional development.

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 Methodology

 A nationwide cross-sectional study was conducted in Kosovo in the

period January-December 2013.
 The research methodology was based on the principles of
quantitative research.
 The population studied
A nationwide study sample of 1,340 primary health care users (of
both genders aged ≥ 18 years) was included in this study.
Calculating the level of the sample was made with the
implementation of WINPEPI for a number of hypotheses related to
the corresponding socio-demographic and socio-economic
development of the patients, such as gender, age and level of
education.

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 Methodology

 Instrument of data collection was the administration of a

structured questionnaire which includes data on patient safety,
effectiveness and efficiency at work, ethical principles, working
methods and tools, as well as leadership and managerial skills of
family physicians involved in this study.
 Statistical analysis of the data was carried out through statistical
package SPSS (Statistical Package for Social Sciences, version
17.0).
 From 1500 targeted individuals, 160 did not participate in the
study. Overall, 1,340 primary care users have been involved in
our survey [661 (49%) males and 679 (51%) females, the overall
percentage : 1340/1500 = 89.3%]

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 Data collection

 Through the questionnaire, we have asked the patients to assess the level
of competencies.
 The questionnaire included 37 points grouped into six subfields/ fields of
quality of care:
 "The safety of patient care" (eight points);
 "Effectiveness and efficiency" (seven points);
 "The principle of ethics and fairness" (eight points);
 “Work methods and tools " (five points);
 "Leadership and management" (four points), and;
 "Continuing Professional Development" (five points).
 Responses to each item of each subfield are ranked from one (physicians
= "beginners" have little or no knowledge / skills, or no previous
experience of competence described and need guidance or close
supervision) to five (physicians= "specialists / experts" are the primary
sources of knowledge and information in the field of medicine).

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 Statistical analysis

 Cronbach's Alpha was used to assess the internal consistency of the

instrument with 37-points, the measurement of competence of family
physicians in terms of primary health care users.

 The Spearman's rho was used to assess linear association (correlation) of

subfield points (areas) of the instrument.

 The general linear model was applied to assess the overall result
connecting the competence of family physicians, from the standpoint of
patients, their demographic characteristics and socio-economic.

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 Results

 The overall average age of survey participants was 50.5 ± 17.9 years - it was
similar in males and females (Table I).

 Study participants reported a significantly high degree of satisfaction with

primary health care services: 75% of individuals perceived the medical visit
as "good" or "very good", compared with only 3.4% of individuals who
assessed the quality of primary health care services as "poor" or "very
poor”.

 The average value of total summary results for the instrument with 37 -
point was 118.0 ± 19.7 [ranging from 37 (minimum competency) to 185
(maximum competency)]. The average value of total summary results of
competence of family physicians from the standpoint of patients was higher
among younger participants (<45 years) than those older (≥ 45 years), (119
vs. 117, respectively, P = 0:04)

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Distribution of socio-economic characteristics and satisfaction with health care services, in a representative sample
of primary health care users in Kosovo in 2013

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PATIENTS
The gender distribution of sample representative patients in the
nationwide study led in Kosovo in 2013 (N = 1340)

50.7% 49.3%

Male Female
PATIENTS
The prevalence of high education level of the sampled patients in a
nationwide study in Kosovo in 2013 (N = 1340)

Total 19.3%

Female 15.2%

Male 23.6%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

 PATIENTS
Regional distribution of sampled patients in a nationwide study
conducted in Kosovo in 2013 (N = 1340)
50.0%
45.6%
45.0%

40.0%

35.0%

30.0%

25.0%

20.0% 18.0%
14.7%
15.0%
11.1% 10.6%
10.0%

5.0%

0.0%

Prishtinë Gjilan Gjakovë Prizren Pejë

 PATIENTS
Distribution of sampled patients by settlement in a nationwide
survey in Kosovo in 2013 (N = 1340)
City Village
70.0%

60.0%
66.1% 64.7% 65.4%
50.0%

40.0%

30.0% 35.3% 34.6%

33.9%
20.0%

10.0%

0.0%

Male Female Total

PATIENTS
The prevalence of low economic level of the sampled patients in a
nationwide study in Kosovo in 2013 (N = 1340)

Total 19.8%

Female 21.5%

Male 18.0%

16.0% 17.0% 18.0% 19.0% 20.0% 21.0% 22.0%

The unemployment rate in sampled patients in a nationwide study
conducted in Kosovo in 2013 (N = 1340)

Total 38.0%

Female 53.5%

Male 22.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

PATIENTS
The prevalence of low social class of patients sampled in a
nationwide survey in Kosovo in 2013 (N = 1340)

Total 22.2%

Female 23.4%

Male 21.0%

19.5% 20.0% 20.5% 21.0% 21.5% 22.0% 22.5% 23.0% 23.5% 24.0%
PATIENTS
Attendance of health services by the sampled patients during the
nationwide study conducted in Kosovo in 2013 (N = 1340)

1.2%

18.4% 19.1%
0
1-2
3-4
25.4% 5-6

36.0% ≥7
PATIENTS
The perception of the quality of health services in sampled patients
during a nationwide study led Kosovo in 2013 (N = 1340)

3.4%

21.7%
Very good/good
Average
Bad/very bad
74.9%
04.03.2019 Dr.Med.Gazmend Bojaj 22
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CONCLUSION (1)

 This is the first study that informs on scientific basis

about the level and determinants of competence of
family physicians in Kosovo from the patients'
perception and their self-reporting.
 This work was conducted on a national scale in a large
representative sample of users of primary health care
services and a sample of family physicians who serve
this population.
CONCLUSION (2)

 Self-reported level of general competence of family

physicians was much higher compared to the
perception of patients.
 The level of competence for each category of quality of
care was significantly higher according to the self-
reporting by physicians compared with patients'
perception of their service.
 The strong correlation between the total score of self-
perceived competence by family physicians and results
of competence from the perspective of patients served
by these doctors.
CONCLUSION (3)

 The level of competence was slightly higher in male

patients than females, but this difference was not
statistically significant.
 In fact, for any sub-scale (category, or dimension) of
the instrument there was no statistically significant
difference between males and females in the result of
the competence level of family physicians.
 Therefore, patients of both genders in Kosovo
demonstrate almost the same degree of perception
regarding the level of knowledge, skills and
competencies of their family physicians.
 Discussion
 This study provides valuable evidence for cross-cultural adaptation of an
international instrument (questionnaire) to measure the level of knowledge, skills
and competencies of family physicians from the perspective of physicians and
patients in the population of Kosovo, which is in transition.
 The results provide significant information on the level of skills, abilities and
competencies of family physicians.
 Internal consistency in our study was 0.96% higher than the study that was done
in Albania.
 The reliability of the tool is the same in the two genders, a finding that is
consistent with the report in Albania.
 The general level of competence of family physicians in our study is high.
 In our study 75% of participants perceived the visits as good or very good.
 Our study provides higher data compared to previous studies conducted so far.
 Future studies in Kosovo and Albania should compare the results of the
evaluation of primary health care users with self-assessment results of their
family physicians to identify potential gaps in perceived levels of skills and
competencies.

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 THANK YOU!

Supported by the Ministry of Education, Science and Technology .of the

Republic of Kosovo.
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