Cargando…
Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial
Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on t...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324646/ https://www.ncbi.nlm.nih.gov/pubmed/25671664 http://dx.doi.org/10.1371/journal.pone.0115274 |
_version_ | 1782356704221986816 |
---|---|
author | Planas, Maria-Elena García, Patricia J. Bustelo, Monserrat Carcamo, Cesar P. Martinez, Sebastian Nopo, Hugo Rodriguez, Julio Merino, Maria-Fernanda Morrison, Andrew |
author_facet | Planas, Maria-Elena García, Patricia J. Bustelo, Monserrat Carcamo, Cesar P. Martinez, Sebastian Nopo, Hugo Rodriguez, Julio Merino, Maria-Fernanda Morrison, Andrew |
author_sort | Planas, Maria-Elena |
collection | PubMed |
description | Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0·7% (p = 0·23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima. |
format | Online Article Text |
id | pubmed-4324646 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-43246462015-02-18 Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial Planas, Maria-Elena García, Patricia J. Bustelo, Monserrat Carcamo, Cesar P. Martinez, Sebastian Nopo, Hugo Rodriguez, Julio Merino, Maria-Fernanda Morrison, Andrew PLoS One Research Article Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0·7% (p = 0·23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima. Public Library of Science 2015-02-11 /pmc/articles/PMC4324646/ /pubmed/25671664 http://dx.doi.org/10.1371/journal.pone.0115274 Text en © 2015 Planas et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Planas, Maria-Elena García, Patricia J. Bustelo, Monserrat Carcamo, Cesar P. Martinez, Sebastian Nopo, Hugo Rodriguez, Julio Merino, Maria-Fernanda Morrison, Andrew Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial |
title | Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial |
title_full | Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial |
title_fullStr | Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial |
title_full_unstemmed | Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial |
title_short | Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial |
title_sort | effects of ethnic attributes on the quality of family planning services in lima, peru: a randomized crossover trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324646/ https://www.ncbi.nlm.nih.gov/pubmed/25671664 http://dx.doi.org/10.1371/journal.pone.0115274 |
work_keys_str_mv | AT planasmariaelena effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT garciapatriciaj effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT bustelomonserrat effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT carcamocesarp effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT martinezsebastian effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT nopohugo effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT rodriguezjulio effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT merinomariafernanda effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial AT morrisonandrew effectsofethnicattributesonthequalityoffamilyplanningservicesinlimaperuarandomizedcrossovertrial |