Appraisal of Home-Based Primary Care Services Provided by Select Primary Healthcare Centers in Lebanon: A Mixed-Methods Approach

Abstract

Introduction: Home-based primary care (HBPC) emerged as a significant solution to meet the complex health needs of patients who are unable to receive the “clinic-based” model of primary health care (PHC) service delivery. In Lebanon, HBPC services were not commonly available and often expensive. International Medical Corps (IMC) was among the leading organizations that provided HBPC services for COVID-19 and non-COVID-19 patients through its supported primary healthcare centers (PHCCs). The aim of this research is to appraise IMC’s HBPC project in Lebanon, using the Donabedian framework’s assessment of structure, process, and outcome in health service delivery.

Methods: A parallel mixed-methods design was used to conduct this study to address structure, process, and outcome measures of the HBPC initiative launched by IMC. The quantitative aspect used a retrospective approach and analyzed IMC/Ministry of Public Health (MoPH) data collected as part of the HBPC project. Whereas, the qualitative approach, consisting of in-depth interviews and focus group discussions with the project team members and frontline nurses, examined fidelity, facilitators, and barriers in delivering HBPC services.

Results: Findings demonstrated the presence of comprehensive SOPs and KPIs for COVID-19, but a lack-thereof for non-COVID-19 cases; thereby affecting the process and outcomes of HBPC program. Additionally, resource deficits were highlighted, especially the inconsistent provision of diagnostic tests and disability-specific services. The main facilitators were organizational, with coordination and enthusiasm of PHCCs being pivotal in the success of the program. The project was also found to have a positive impact on health outcomes and patient satisfaction. As for challenges, they were mainly resource limitations, adaptability of PHCC staff to new routines and regulations related to HBPC, and bureaucratic procedures slowing project operations. A major limitation was found with respect to service packages provided to eligible Non-Communicable Diseases (NCD) patients. Challenges were mainly with respect to medication shortages, social disputes between local and native communities, and administrative and logistic mishaps.

Conclusion: The study highlighted the strengths and weakness of a pilot HBPC within the Lebanese community, provided through PHCCs. Financial barriers remain the biggest threat to service sustainability, risking the services to be halted or suspended. To mitigate this, MoPH can include HBPC as part of the national PHC protocol, or in other words, to enforce it as a standard of care within Lebanon, which could be used to lobby for future funds and improve overall healthcare for homebound patients.