Evidence brief: Exploring patient and provider perspectives on outpatient care and the family practice model at a university hospital in Ghana

Abstract

Fragmented outpatient care, and disrupted patient–provider continuity hinder progress towards the achievement of Universal Health Coverage (UHC) in many low- and middle-income countries including Ghana. Despite efforts such as the National Health Insurance Scheme and Community-based Health Planning and Services, continuity of care remains a challenge. This study explored stakeholders’ perspectives on implementing a Family Practice Model to strengthen primary care and advance UHC at a University Hospital in Ghana.

A descriptive-analytical qualitative study was conducted from September 2023 to May 2024 at the University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi. Twenty-eight participants were purposively selected, comprising nine healthcare providers (physicians and physician assistants) and 19 care recipients (university staffs). Semi-structured interviews, guided by the Consolidated Framework for Implementation Research, explored experiences with the current outpatient system and views on the proposed FPM. Data were audio-recorded, transcribed verbatim, and thematically analyzed using NVivo version 14.

Two major themes emerged: “Therapeutic Disconnection” and “A Doctor to Call My Own.” Participants described the existing care system as fragmented, impersonal, and marked by rotating providers, poor documentation, and rushed consultations. These issues weakened trust and care continuity. In contrast, stakeholders supported a dedicated, relationship-based model that would ensure continuity, streamline care processes, and foster long-term provider–patient connections.

The Family Practice Model could transform outpatient care at the university hospital and beyond by enhancing continuity, trust, and overall service quality. However, successful implementation depends on tailored strategies encompassing policy support, and pilot testing to assess feasibility and impact on UHC goals in Ghana.

Introduction

Primary healthcare is widely recognized as the cornerstone of effective health systems, as it enhances essential services, strengthens disease prevention, and ensures coordinated care throughout a person’s life course [1–3]. The outpatient department (OPD) often serves as the critical first point of contact for non-emergency medical issues. Nevertheless, the structure and quality of OPD services vary considerably across countries due to differences in resource allocation, provider training, and organizational models, particularly in low- and middle-income countries (LMICs) such as Ghana [4]. In many Ghanaian healthcare settings, OPD services operate on a fragmented, episodic model where patients see different providers at each visit. This often leads to repeated recounting of medical histories and undermines the development of trust and continuity [5,6]. This fragmentation has prompted calls for innovative healthcare delivery models that emphasize long-term relationships, seamless coordination, and comprehensive care [7].

One promising approach is the Family Practice Model (FPM), in which a designated physician provides continuous, comprehensive, and personalized care to an individual and their family [8,9]. In contrast to episodic care in the conventional OPD setting, the FPM establishes continuity by enabling regular monitoring of medical histories, family health patterns, and psychosocial factors, which are essential for effective chronic disease management [10]. Evidence from high-income countries such as Canada, and the United Kingdom indicates that such a model not only improves patient satisfaction and clinical outcomes but also reduces hospitalizations and overall healthcare costs [11,12]. By proactively coordinating care to match individual and family health needs, the FPM aligns with best practices for chronic disease management and prevention [9,10].