The concept of patient empowerment, although acknowledged by the medical community as important, is rarely understood and seldom given priority in the illness trajectory of the cancer patient. A pilot study of a Shared Care Model amongst haematological cancer patients highlighted the fact that some patients spoke of a sense of empowerment and an overall sense of greater control when more fully included in the treatment and management of their condition. The research which forms the basis of this thesis focused on the role of empowerment in the wellbeing of cancer patients. There were three objectives to be met by completing this research. Firstly, to demonstrate that empowerment is a uniquely identifiable concept and can be measured separately from other quality of life indicators. Secondly, the study sought to explore that concept that empowerment takes into account the way in which patients act upon their prognosis and optimise the outcomes of treatment. Thus it is believed that accessing tailored resources and support structures benefit cancer patients and those who are caring for them such as close family members and friends by helping the patient achieve an individual level of empowerment. Finally, the research sought to explore the concept that empowerment improves psychological outcome in patients. The benefits are increased empowerment and an active use of coping strategies amongst patients in order to regain a measure of control over their illness. The Patient Empowerment Scale was developed to measure empowerment as an individual construct. '...' The Patient Empowerment Scale (15 items) was shown to be a reliable measure of empowerment and fitted the model well. A qualitative methodological approach sought to address and explore the second and third concepts. In addition, the concept of empowerment as it relates to motivation and self-efficacy was investigated qualitatively using in-depth interviewing technique. A phenomenological methodology was used to explore the 'lived experience of cancer patients' in regard to regaining control of their illness and the management thereof. Participants were interviewed using concepts identified for the Patient Empowerment Scale such as support strategies and use of resources. A series of interviews with breast cancer patients were conducted whereby patients responded to a number of questions. The questions explored areas such as support mechanisms in relation to cancer, their relationships with health professionals and significant others and their attitude toward and use of other resources and support systems such as support groups, spirituality, complementary therapies. In addition their views on acceptance and adaptation to their altered health status were explored. Results The research confirmed that it is feasible to measure empowerment as a separate quality of life indicator. Furthermore, that empowerment is linked to motivation and self-efficacy beliefs. The research also demonstrated that there are a number of core areas which are fundamental to regaining control and increasing empowerment for patients. These core areas are linked to support mechanisms, willingness to adapt and to access resources tailored to meet their needs. Patient empowerment emerged as a key aspect of enhanced quality of life regardless of prognosis and improved psychological outlook.

[Truncated abstract] Background Emergency department (ED) presentations of respiratory infections are not well described. Baseline ED data are needed to monitor trends, and to help evaluate the impact of health interventions, and assess changes in clinical practice for these conditions. Aims: To describe the epidemiology of respiratory infections diagnosed in Western Australian hospital EDs from 2000 to 2003; to determine the extent and usefulness of bacterial cultures ordered in hospital, and to describe and evaluate the antibiotic prescribing pattern in the ED setting. Methods: The cohort consisted of patients diagnosed with a respiratory infection at the ED of Perth's major metropolitan teaching hospitals from 1 July 2000 to 30 June 2003. The analysis was based on a linked data set containing patient data from the Emergency Department Information System, the Hospital Morbidity Data Set, the death registry, and the Ultra Laboratory Information System. Further, a sample of patient medical records from 1 adult hospital was examined to assess antibiotic prescribing practice. Results: Overall, there were 37,455 presentations (28,885 patients) given an ED diagnosis of a respiratory infection. Of these, 14,884 (39.7%, 95% CI: 39.2 to 40.2) were admitted and 715 (1.9%, 95% CI: 1.8 to 2.0) died in hospital. The infections included; 48.1% acute upper respiratory infections (URI), 18.5% pneumonia, 23.5% other acute lower respiratory infections (LRI), 7.4% chronic obstructive pulmonary disease with lower respiratory infection (COPD+), 1.3% influenza or viral pneumonia and 1.2% other URI. Children accounted for 80.7% of acute URI diagnoses, COPD+ mainly affected the elderly, just over 40% of pneumonia diagnoses were in patients 65 years or older and 30.7% in patients younger than 15 years. ... The most common pathogen isolated from blood was Streptococcus pneumoniae and 10.4% (95% CI: 4.8 to 16.0) had reduced susceptibility to penicillin. For those diagnosed with pneumonia, Strep. pneumoniae accounted for over 90% of pathogens isolated from the blood of young children and isolation of Enterobacteriaceae from blood increased with age. Around 30% of patients had positive sputum cultures and from these Haemophilus influenzae, Strep. pneumoniae and Pseudomonas aeruginosa were the most common organisms grown. Of those diagnosed with pneumonia, acute LRI or COPD+, 34.7% (95% CI: 26.1 to 43.3) of S. aureus isolated from sputum and 16.4% (95% CI: 7.1 to 25.7) from blood were methicillin resistant. Of 366 adult patient medical records reviewed, 56.8% (95% CI: 51.7 to 61.9) noted that an antibiotic was prescribed in the ED and amoxycillin was the most frequently prescribed. For those with pneumonia, concordance between prescribing guidelines and practice was low. Conclusions The administrative data sets used in the present study are useful for monitoring outcomes for respiratory infections diagnosed in the ED. Pneumonia continues to place a burden on the hospital system. Routine blood and sputum cultures have limited value. However, an appropriately designed surveillance program is needed to monitor potential Abstract v respiratory pathogens and assist in monitoring the appropriateness of current empiric antimicrobial therapy.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

This manuscript-based thesis attempts to scrutinize the current crisis surrounding access to primary health care (PHC) in Quebec, Canada through mixed methods and multiple perspectives. Using logistic regression, the relationship between socioeconomic status and access to PHC was closely examined from the individuals' perspective (i.e. access from 'below'). These results reveal that household income, size of household, region of residence and marital status are all factors which threaten equitable access to family doctors in the province. From a micro perspective in Montreal, Quebec, access from 'above' was then studied through in-depth qualitative interviews with family physicians. Arduous access to PHC in Quebec was thus found to be the possible result of supply-side regulation mechanisms adopted by the provincial government in an attempt to cut healthcare costs. In response to these findings, a series of recommendations was finally made to improve access to PHC in the province, all whilst balancing the sometimes conflicting goals of universal healthcare and curbing costs. / Cette thèse vise à mieux comprendre la crise concernant l'accès aux soins de santé primaires au Québec, en employant de multiples méthodes et perspectives. Avec l'aide de la régression logistique, le lien entre le statut socio-économique et l'accès aux soins primaires a été étudié à partir de la perspective de l'individu (c'est-à-dire, la demande de soins). Ces résultats démontrent que le revenu du ménage, la taille du ménage, la région de résidence et le statut marital sont tous des facteurs qui affectent l'accès équitable aux médecins de famille dans la province. Ensuite, en employant une perspective plus microsociale, l'offre de soins a été étudiée à l'aide d'entrevues avec des médecins de famille à Montréal, Québec. La difficulté d'accès aux soins de santé primaires semble être le résultat d'une série de politiques qui régulent l'offre des soins afin de réduire les coûts associés à la santé. À la lumière de ces résultats, des recommandations sont offertes afin d'à la fois améliorer l'accès aux soins de santé primaires tout en étant conscient du but à long-terme de limiter l'augmentation des coûts de santé.

Auf der Grundlage der DETECT-Studie wird die querschnittliche Assoziation depressiver Störungen mit einem weiten Spektrum körperlicher Erkrankungen in einer bundesweit repräsentativen Stichprobe von 51.000 Patienten aus der primärärztlichen Versorgung in Deutschland sowie der Zusammenhang mit gesundheitsbezogener Lebensqualität und Arbeitsunfähigkeit untersucht. Das Vorliegen einer Depression wurde über den Depression Screening Questionnaire (DSQ) mit seinem ICD-10 Algorithmus ermittelt. Bei einer Gesamt-Querschnittsprävalenz depressiver Störungen von 7,5 % ergaben sich erhöhte Depressionsraten und signifikante Assoziationen für nahezu alle untersuchten Krankheitsgruppen. (1) Ko- und Multimorbidität somatischer als auch somatischer mit depressiven Störungen sind die Regel: „Reine“ (nicht komorbide) Depressionen sind ebenso wie reine somatische Erkrankungen die Ausnahme. (2) Das Depressionsrisiko steigt stetig mit der Anzahl komorbider Krankheiten. (3) Besonders ausgeprägte Assoziationen ergaben sich für schwergradige Herzinsuffizienzen (OR: 5,8), diabetische Folgekomplikationen (OR: 1,7–2,0), koronare Herzerkrankungen (KHK) (OR: 1,7), zerebrale Insulte (OR: 2,5) sowie muskuloskelettäre Erkrankungen (OR: 1,5). Demgegenüber waren z. B. die Raten bei Hyperlipidämie (OR: 1,1) nur leicht erhöht. (4) Komorbide Depression und steigende Multimorbidität waren mit stetig zunehmenden Arbeitsunfähigkeits- raten und absinkender gesundheitsbezogener Lebensqualität assoziiert. Angesichts der quantitativen Bedeutung der Depression sowie des mit Multimorbidität drastisch ansteigenden Depressionsrisikos und der damit verbundenen hohen direkten und indirekten Krankheitslast für das Gesundheitssystem und die Gesellschaft ist das hohe Ausmaß der Unterschätzung von Depression in der Routineversorgung besorgniserregend. / As part of the DETECT study, a nationwide representative clinical-epidemiological study, the frequency and associated problems of comorbid depression with a wide range of somatic illnesses were studied in N = 51,000 primary care patients. Further the association with health related quality of life and disability is examined. Depression was assessed with the Depression Screening Questionnaire (DSQ) with an ICD-10 algorithm. Results: (1) 7.5 % of all primary care patients met criteria for ICD-10 depressive disorders. (2) Depression risk was increased whenever any somatic disorder was present and increased in a dose-response relationship by number of comorbid conditions. (3) Elevation of depression risk was fairly independent of type of diagnosis, although associations with coronary heart disease (OR: 1.7), diabetic complications (OR: 1.7– 2.0), stroke (OR: 2.5) and pain-related chronic disorders (OR: 1.5) were particularly pronounced. Moderate associations were found for hyperlipidaemia (OR: 1.1). (4) Associated with the increasing number of comorbid conditions, patients with comorbid depression had increasingly more disability days and lower health related quality of life. It is concluded that the degree to which the frequency and the deleterious effects of comorbid depression is underestimated and unrecognized is alarming. The use of comorbidity indices might improve recognition.

Proefschrift Universiteit van Amsterdam. / Met lit. opg. - Met samenvatting in het Nederlands.

Thesis (MPhil)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Health service utilization by people with mental health problems seem to be a large public health issue, especially in low-income countries. In Malawi, the situation is not different from other developing countries in Sub-Saharan Africa as far as access to services for people with mental health problems is concerned. Non specialized health care workers provide mental health services in the primary care settings in Malawi and, given the workload at primary health care (PHC) setting level, little time is available to screen for mental disorders, hence these may go unrecognized. Therefore, there is a possibility that a significant proportion of patients attending primary care in Malawi may have common mental disorders (CMD) and may be deprived of routine screening. Consequently, the possibility of misdiagnosis may lead to higher service utilization by people with common mental health problems. However, no study has been carried out to assess the health service utilization by people with common mental disorders in Malawi. Aim: The aim of the study was to evaluate health services utilization patterns of patients with CMDs in primary care clinics. Methods: This was a quantitative study employing a cross-sectional descriptive design. The study was conducted in two primary health care clinics in one of the 28 districts in Malawi. The study included all consecutive patients aged 18 years and older who attended the primary health care clinics for any reason. Face-to-face interviews using the Self-Reporting Questionnaires (SRQ-20) were conducted in a sample of 323 primary health care attendees. Findings: The prevalence of probable CMD was 20.1%. People with CMD had a higher average number of health facility visits in the previous three months compared to those without probable CMD thus 1.6 vs. 1.19 (p-value 0.02). There was no significant difference in the average number of traditional healer visits in the previous three months between those with probable CMD and those without thus 0.05 vs. 0.08 (p-value = 0.565). The total average number of both health facility and traditional healer visits was 1.68 vs. 1.24 (p-value 0. 019), people with probable CMD having a higher average compared to those without a probable CMD. It was found that people who have visited the health care facility repeatedly in the past 3 months were likely to be suffering from CMD. The odds of probable CMD increased with each visit to a health facility by 1.2 (p-value=0.024). Almost all those who had probable CMD had no treatment prescribed for CMD by PHC clinicians. Conclusion: The study reveals high utilization of health services for people with CMD, as well as a treatment gap of mental health care in primary care settings. PHC workers are misdiagnosing patients with CMDs leading to high utilization of PHC services. There is need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendances and improving patient outcomes. There is also need to direct effort towards creating awareness about mental health and encourage patient disclosure of psychological or mental health problems. / AFRIKAANSE OPSOMMING: Agtergrond: Dit blyk dat veral in lae-inkomste lande, die gebruik van gesondheidsdienste onder mense met geestesgesondheidsprobleme `n kwellende gesondheidskwessie te wees. Malawi, soos ander ontwikkelende lande in Sub-Sahara Afrika, ervaar die probleem van toegang tot gesondheidsdienste vir mense met geestesgesondheidsprobleme. In die primêre gesondheidsdienste in Malawi, word pasiënte met geestesgesondheidsprobleme behandel, deur algemene gesondheidswerkers wat nie gespesialiseerd is in geestesgsondheid. Verder veroorsaak die arbeidslas in primêre gesondheidsorg dat daar nie altyd tyd is om pasiënte voldoende vir geestesgversteurings te ondersoek nie. Dit is daarom moontlik dat `n merkwaardige aantal pasiënte wat gebruik maak van primêre gesondheidsorg in Malawi aan algemene geestesversteurings lei, maar hulle word nie voldoende ondersoek nie en gevolglik word hulle of nie gediagnoseer nie of verkeerdelik gediagnoseer. Dit kan daartoe lei dat `n groter aantal pasiënte, met algemene geestesversteurings, gebruik maak van primêre gesondheidsdienste. Die probleem is dat daar nog geen navorsing in Malawi gedoen is, oor die gebruik van gesondheidsdienste onder mense met algemene geestesversteurings. Doelwit: Die doel van die studie is om pasiënte, met algemene geestesversteurings, se gebruik van primêre gesondheidsorg klinieke te ondersoek. Metodes: `n Dwarssnee kwantitatiewe beskrywende studie-ontwerp was gebruik. Data-insameling het by twee primêre gesondheidsorg klinieke, in een van die 28 distrikte in Malawi, plaasgevind. Pasiënte, 18-jaar en ouer, wat die primêre gesondheidsklinieke vir enige rede besoek het, was ingesluit in die studie. Die steekproef het bestaan uit 323 pasiënte wat gebruik gemaak het van primêre gesondheidsorg klinieke. Onderhoude was met pasiënte gevoer deur middel van `n self-relaas vraelys (ook verwys na as „Self-Reporting Questionnaires‟). Bevindinge: Daar was `n voorkomssyfer van 20.1% pasiënte wat waarskynlik aan algemene geestesversteurings gelei het. Mense wat waarskynlik aan algemene geestesversteurings gelei het, het in `n tydperk van drie maande gemiddeld meer gebruik gemaak van gesondheidsdienste, in vergelyking met diegene wat waarskynlik nie aan algemene geestesversteurings gelei het nie, dus 1.6 teenoor 1.19 (p-waarde van 0.02). In die gegewe drie maande was daar geen betekenisvolle verskil in die gemiddelde aantal besoeke afgelê aan tradisionele geneeshere deur pasiënte wat waarskynlik aan algemene geestesversteurings gelei het, in vergelyking met diegene wat waarskynlik nie aan geestesversteurings gelei het nie, dus 0.05 teenoor 0.08 (p-waarde= 0.565). In totaal het diegene met geestesversteuring ook gemiddeld meer besoeke, 1.68 teenoor 1.24 (p-waarde 0.019), aan beide gesondheidsorg en traditionele geneeshere afgelê het, as diegene wat waarskynlik nie aan geestesversteurings gelei het nie. Die bevindinge dui daarop dat mense wat in die afgelope drie maande herhaaldelik gebruik gemaak het van gesondheidsdienste, waarskynlik aan algemene geestesversteurings gelei het. Die moontlikheid dat `n pasiënt aan `n algemene geestesversteuring gelei het, het met 1.2 (p-waarde=0.024) verhoog met elke besoek aan die gesondheidsdienste. Byna al die pasiënte wat waarskynlik aan `n algemene geestesversteuring gelei het, het nie behandeling ontvang nie. Gevolgtrekking: Daar is bevind dat mense met algemene geestesversteurings geredelik gebruik maak van gesondheidsdienste en dat daar `n gaping is in die voorsiening van geestesgesondheidsdienste in primêre gesondheidsfasiliteite. Primêre gesondheidsorg personeel se hantering van pasiënte lei daartoe dat pasiënte met algemene geestesversteurings meer geredelik gebruik maak van primêre gesondheidsorg. Daar is `n behoefte aan die verbetering van primêre gesondheidsorg personeel se vaardighede en vermoë om pasiënte met geestesversteuring te diagnoseer en sodoende ook herhaaldelike besoeke te verminder en die gesondheidsuitkomste van pasiente te verbeter. Daar is `n behoefte aan groter bewusmaking van geestesgesondheid en om pasiënte aan te moedig om hulle sielkundige en geestesgesondheidsprobleme aan personeel te openbaar.

Thesis (MPhil (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The research was conducted to explore the experiences of people living with Acquired Immunodeficiency Syndrome (AIDS) (PLWAs), especially women, as well as the factors influencing their non-participation in development projects aimed at improving their socio-economic status. The study was conducted amongst PLWAs who are members of the Tembisa Main Clinic and Winnie Mandela Clinic support groups in Tembisa, South Africa. The researcher was motivated to conduct the research because in her work as a social worker she is confronted daily with PWLAs who are from disadvantaged backgrounds and are struggling to make ends meet. Initiatives have been undertaken to try and encourage self–reliance and improve the health status of these women by developing food gardens to provide them with fresh vegetables and possible income sources from these gardens. The reluctance of members of two support groups of PLWAs to stay involved in these projects encouraged the researcher to explore these issues. The researcher consulted various sources to obtain literature on the factors influencing non-participation in development projects. In addition she undertook a qualitative study, wherein twenty participants participated. The data from this study was then interpreted and compared to the literature. The findings of this study highlighted several factors such as discrimination, local beliefs, stigma and lack of support, which influence the non- participation of PWLAs in sustainable development projects. The findings of this research also indicate that developments projects often fail to thrive because of topdown decisions about the projects, the fact that there is no start-up funding available for the projects and participants who become demotivated to participate. The research therefore concludes with recommendations in order to address these problems. / AFRIKAANSE OPSOMMING: Die navorsing is onderneem om die ondervinding van mense, veral vroue, wat met Verworwe Immuniteitsgebrek Sindroom (VIGS) lewe, te ondersoek, asook die faktore wat hulle daarvan weerhou om deel te neem aan ontwikkelingsprojekte wat daarop gemik is om hul sosio-ekonomiese status te verbeter. Die studie is onderneem onder pasiënte wat lede was van ondersteuningsgroepe by Tembisa Hoofkliniek en Winnie Mandela Kliniek in Tembisa, Suid-Afrika. Die navorser is gemotiveerd om die studie te onderneem omdat sy daagliks in haar werk as sosiale werker gekonfronteer is deur mense wat met VIGS lewe, wat uit minder bevoorregte agtergronde kom en wat sukkel om te oorleef. Inisiatiewe is onderneem om hierdie vroue se selfstandigheid te bevorder en om hul gesondheidstatus te verbeter deur groente tuine te ontwikkel om hulle van vars groente te verskaf, asook moontlike inkomstebronne uit hierdie tuine. Die onwilligheid van die lede van twee ondersteuningsgroepe om in hierdie projekte betrokke te bly, het die navorser aangemoedig om hierdie aangeleentheid verder te ondersoek. Die navorser het verskeie bronne geraadpleeg om literatuur te verkry oor die faktore wat die nie-deelname in ontwikkelingsprojekte beïnvloed. Sy het ook kwalitatiewe studie onderneem waaraan twintig respondente deelgeneem het. Die data van hierdie navorsing is daarna geïnterpreteer en met die literatuur vergelyk. Die bevindinge van hierdie navorsing het verskeie faktore uitgelig wat die niedeelname beïnvloed van mense wat met VIGS lewe, soos diskriminasie, plaaslike gelowe, stigma en gebrek aan ondersteuning. Die navorsing het ook bevind dat ontwikkelingsprojekte dikwels nie floreer nie as gevolg van die ‘topdown’ besluitneming oor die projekte en omdat daar nie genoegsame vooraf befondsing beskikbaar is vir die projekte nie en die deelnemers dus demotiveer om verder deel te neem. Die navorsing sluit dus af met voorstelle om hierdie probleme aan te spreek.

Magistro darbe suformuluotos nedidelio sveikatos priežiūros centro veiklos strategijos formavimo ir valdymo problemos, išanalizuoti Lietuvos ir užsienio autorių teiginiai veiklos strategijos formavimo ir valdymo aspektu. Darbe išsiaiškintas gyventojų požiūris į sveikatos priežiūros paslaugų prieinamumą ir kokybę, identifikuoti pagrindiniai veiksniai, įtakojantys medicininių paslaugų prieinamumą ir kokybę, nustatytas šių veiksnių ir demografinių faktorių tarpusavio ryšys, taip pat nustatyti veiksniai, įtakojantys medicinos darbuotojų darbo sąlygas ir patį darbą, išanalizuotas jų ryšys su demografiniais rodikliais. Patvirtinta autorės suformuluota mokslinio tyrimo hipotezė, kad nedidelės pirminės sveikatos priežiūros įstaigos, aptarnaujančios kaimo apylinkių gyventojus, gali sėkmingai plėtoti savo veiklą konkurencinėmis sąlygomis. Magistro darbo pabaigoje pateikiamos išvados ir rekomendacijos. / The focus of this thesis is strategy development and management problems of a small health care center as well as study of propositions made by Lithuanian and foreign researchers with respect to development and management of certain policies and strategies. This study also presents an attitude of residents towards the quality and availability of health care services, identifies main factors that affect quality and availability such services as well as working conditions and work itself of the health care personnel, analyses how such factors correlate with the existing demographic indicators. The research gives evidence the authors’ hypothesis stating that small primary health care institutions that provide services to the rural population of the country can establish themselves as successfully operating and competitive entities under the existing market conditions. The final part of the study sets forth conclusions and recommendations of the author.

Darbo tikslas - Ištirti mieto ir kaimo pirminės sveikatos priežiūros centrų teikiamų paslaugų prieinamumą pacientų požiūriu. Darbo uždaviniai:1) Ištirti pacientų pasitenkinimą teikiamomis pirminiuose sveikatos priežiūros centrų paslaugomis; 2) Nustatyti veiksnius, turėjusius įtakos nepakankamam sveikatos priežiūros paslaugų prieinamumui. 3) Palyginti kaimo ir miesto pirminių sveikatos priežiūros centrų paslaugų prieinamumą pacientų požiūriu. 4) Pateikti praktines rekomendacija šių centrų darbo kokybei pagerinti. Tyrimo metodika. 2007 metų sausio 3 – balandžio 15 dienomis Kauno Centro poliklinikoje ir Simno poliklinikoje Alytaus rajone vyko anoniminė anketinė apklausa. Jos metu apklausta 510 pacientų, kurie laukė eilė pas savo šeimos gydytoją. Statistinė duomenų analizė buvo atliekama naudojant kompiuterinį paketą SPSS 10, 0 versijos statistinį duomenų analizės paketą bei Excel duomenų analizės paketą. Skirtumai buvo laikomi statistikai patikimi kai apskaičiuotoji p reikšmė neviršijo 0,05. Rezultatai. 45 proc. respondentų buvo patenkinti gydytojo teikiama pagalba. Dažniausios nepasitenkinimo priežastys gydytojo darbu buvotos, jog reikėjo ilgai laukti, kol pateko pas gydytoją (58 proc.), nebuvo reikalingų gydytojų – specialistų PSP įstaigoje(57 proc.) bei nepakankamai suteikė informacijos apie gydymosi galimybes (56 proc.), sveikatos būklę bei gydymą (51 proc.). Dauguma tyrime dalyvavusių pacientų buvo nepatenkinti PSP teikiamomis paslaugomis. Juos vargino eilės prie... [toliau žr. visą tekstą] / Aim. To evaluate accessibility, satisfaction on patients’ quality of health services in primary health care centers in rural and urban settings in Lithuania. Research objectives were as following: 1) to establish patient’s satisfaction in primary health care centers; 2) to identify what factors affects the poor accessibility to health care; 3) to compare opinion, attitudes of patients on health care services in urban and rural settings. Methods. Two samples of respondents (patients of one primary health care center in small rural town Simnas and one in big city Kaunas) were selected. Anonymous questionnaire was filled in by 308 patients in Simnas (Primary Health care Centre) and 202 in Kaunas (Central Policlinic), response rate was 77% and 26%, respectively. Questionnaire form was developed by the authors has covered 31 question on different issues of quality of health care services: health status and reasons of visit to health care center; different issues on accessibility to health services (waiting time, registration for services, transportation and distance), satisfaction by competencies of physician, reasons of dissatisfaction, satisfaction by services provided by the health care institution. SPSS 10,0 and Excel statistical packages were used for making statistical data anlysis. Statistically significant difference was established when p<0,05. Results. 45 % of respondents were satisfied by the competencies of their family doctors. 58% of patients were not satisfied by... [to full text]