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      Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey Translated title: Évaluer le potentiel d'amélioration des soins de santé primaires dans 34 pays: une enquête transversale Translated title: Evaluación del potencial de mejora de la atención primaria en 34 países: un estudio transversal Translated title: تقييم احتمالات تحسين الرعاية الأولية في 34 بلداً: مسح متعدد القطاعات Translated title: 评估34个国家初级保健进行改善的可能性:横断面调查 Translated title: Оценка потенциала улучшения первичной медицинской помощи в 34 странах: перекрестное исследование

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          Abstract

          Objective

          To investigate patients’ perceptions of improvement potential in primary care in 34 countries.

          Methods

          We did a cross-sectional survey of 69 201 patients who had just visited general practitioners at primary-care facilities. Patients rated five features of person-focused primary care – accessibility/availability, continuity, comprehensiveness, patient involvement and doctor–patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. We calculated the potential for improvement by multiplying the proportion of negative patient experiences with the mean importance score in each country. Scores were divided into low, medium and high improvement potential. Pair-wise correlations were made between improvement scores and three dimensions of the structure of primary care – governance, economic conditions and workforce development.

          Findings

          In 26 countries, one or more features of primary care had medium or high improvement potentials. Comprehensiveness of care had medium to high improvement potential in 23 of 34 countries. In all countries, doctor–patient communication had low improvement potential. An overall stronger structure of primary care was correlated with a lower potential for improvement of continuity and comprehensiveness of care. In countries with stronger primary care governance patients perceived less potential to improve the continuity of care. Countries with better economic conditions for primary care had less potential for improvement of all features of person-focused care.

          Conclusion

          In countries with a stronger primary care structure, patients perceived that primary care had less potential for improvement.

          Résumé

          Objectif

          Examiner la perception des patients quant au potentiel d'amélioration des soins de santé primaires dans 34 pays.

          Méthodes

          Nous avons mené une enquête transversale sur 69 201 patients qui venaient juste de consulter des médecins généralistes dans des établissements de soins de santé primaires. Les patients ont évalué cinq caractéristiques des soins de santé primaires axés sur la personne: accessibilité/disponibilité, continuité, exhaustivité, implication du patient et communication entre le médecin et le patient. Un dixième des patients ont classé l'importance de chaque caractéristique sur une échelle allant d'un à quatre, et neuf dixièmes ont noté leur expérience des soins reçus. Nous avons calculé le potentiel d'amélioration en multipliant la proportion d'expériences négatives des patients avec le score moyen d'importance danschaque pays. Les scores ont été répartis en potentiels d'amélioration faible, moyen et élevé. Nous avons effectué des corrélations par paire entre les scores d'amélioration et les trois dimensions de la structure des soins de santé primaires: gouvernance, conditions économiques et constitution de la main-d'œuvre.

          Résultats

          Dans 26 pays, une ou plusieurs caractéristiques des soins de santé primaires présentaient des potentiels d'amélioration moyen ou élevé. L'exhaustivité des soins avait un potentiel d'amélioration moyen à élevé dans 23 des 34 pays. Dans tous les pays, la communication entre le médecin et le patient présentait un potentiel d'amélioration faible. Une structure globale plus forte des soins de santé primaires était corrélée avec un potentiel plus faible d'amélioration pour la continuité et l'exhaustivité des soins. Dans les pays avec une gouvernance plus forte des soins de santé primaires, les patients percevaient un moindre potentiel pour améliorer la continuité des soins. Les pays présentant de meilleures conditions économiques pour les soins de santé primaires avaient un moindre potentiel pour l'amélioration de toutes les caractéristiques des soins de santé axés sur la personne.

          Conclusion

          Dans les pays avec une structure plus forte des soins de santé primaires, les patients perçoivent un moindre potentiel d'amélioration pour les soins de santé primaires.

          Resumen

          Objetivo

          Investigar las percepciones de los pacientes acerca de la mejora en la atención primaria en 34 países.

          Métodos

          Se realizó una encuesta transversal de 69 201 pacientes que acababan de visitar médicos generales en centros de atención primaria. Los pacientes evaluaron cinco características de la atención primaria centrada en la persona: accesibilidad y disponibilidad, continuidad, exhaustividad, implicación del paciente, así como comunicación entre médico y paciente. Una décima parte de los pacientes clasificó la importancia de cada característica en una escala de uno a cuatro y nueve de cada diez pacientes evaluaron sus experiencias de la atención recibida. Se calculó el potencial de mejora multiplicando la proporción de experiencias negativas de pacientes con la puntuación media de la importancia en cada país. Las puntuaciones se dividieron en potencial de mejora bajo, medio y alto. Se realizaron correlaciones por pares entre las puntuaciones de mejora y las tres dimensiones de la estructura de atención primaria, a saber, gestión, condiciones económicas y desarrollo laboral.

          Resultados

          En 26 países, una o más características de la atención primaria tenían potenciales de mejora medios o altos. El carácter integral de la atención tenía un potencial de mejora entre medio y alto en 23 de 34 países. En todos los países, la comunicación entre médico y paciente tenía un potencial de mejora bajo. Una estructura global más fuerte de la atención primaria se correlacionó con un menor potencial de mejora en la continuidad y exhaustividad de la atención. En los países con una política de dirección de la atención primaria más sólida, los pacientes percibieron un potencial menor de mejora de la continuidad de la atención. Los países con mejores condiciones económicas para la atención primaria presentaron un potencial menor para la mejora de todas las características de la atención centradas en la persona.

          Conclusión

          En países con una estructura de atención primaria más sólida, los pacientes perciben un menor potencial de mejora de la atención primaria.

          ملخص

          الغرض

          تحري تصورات المرضى حول احتمالات التحسين في مجال الرعاية الأولية في 34 بلداً.

          الطريقة

          أجرينا مسحاً متعدد القطاعات على 69201 مريضاً قاموا للتو بزيارة الممارسين العموميين في مرافق الرعاية الأولية. وقام المرضى بتقييم خمس سمات للرعاية الأولية الشخصية - التوافر/الإتاحة والاستمرارية والشمولية وإشراك المرضى والتواصل بين الأطباء والمرضى. وقام عُشر المرضى بترتيب أهمية كل سمة من السمات باستخدام مقياس من واحد إلى أربعة وسجل تسعة أعشار المرضى خبراتهم بشأن تلقي الرعاية. وقمنا بحساب احتمالات التحسين بضرب نسبة الخبرات السلبية للمرضى بمتوسط درجة الأهمية في كل بلد. وتم تقسيم الدرجات إلى احتمالات تحسين منخفضة ومتوسطة ومرتفعة. وتم إيجاد الارتباطات الثنائية بين درجات التحسين والأبعاد الثلاثة لهيكل الرعاية الأولية وهي - تصريف الشؤون والظروف الاقتصادية وتنمية القوى العاملة.

          النتائج

          حظيت واحدة أو أكثر من سمات الرعاية الأولية في 26 بلداً باحتمالات تحسين متوسطة أو مرتفعة. وحظيت شمولية الرعاية باحتمالات تحسين من متوسطة إلى مرتفعة في 23 بلداً من أصل 34 بلداً. وفي جميع البلدان، حظي التواصل بين الأطباء والمرضى باحتمالات تحسين منخفضة. وارتبط ازدياد هيكل الرعاية الأولية الأقوى بشكل عام بانخفاض احتمالات التحسين في الاستمرارية وشمولية الرعاية. وكان تصور المرضى في البلدان التي تتميز بتصريف شؤون أقوى فيما يتعلق بالرعاية الأولية هو انخفاض احتمالات التحسين في استمرارية الرعاية. وانخفضت احتمالات التحسين في جميع سمات الرعاية الشخصية لدى البلدان ذات الظروف الاقتصادية الأفضل للرعاية الأولية.

          الاستنتاج

          في البلدان ذات هيكل الرعاية الأولية الأقوى، تتسم الرعاية الأولية باحتمالات تحسين أقل وفق تصورات المرضى.

          摘要

          目的

          调查34个国家病人对初级保健改善可能性的看法。

          方法

          我们对最近前往初级保健设施的全科医生就医的69201名患者进行横断面调查。病人以个人为中心的初级保健的五个特性评级:可达性/可用性、连续性、综合性、病人参与和医患沟通。十分之一的患者按每个特性从一到四的重要性等级排名,十分之九的患者按所接受护理的体验评分。我们这样计算改善的可能性:负面病人体验比例乘以每个国家重要性平均值。改善可能性分数分为低、中、高等。在改善分数和初级保健结构的三个维度(治理、经济条件和人力发展)之间进行两两相关分析。

          结果

          在26个国家,初级保健的一个或多个特性有中或高的改善可能性。在34个国家中有23个国家的护理综合性有中到高等的改善可能性。在所有国家中,医患沟通改善可能性较低。初级保健整体更强的结构与较低的护理连续性和综合性改善可能性相关。在初级保健治理更强的国家,患者认为不太可能改善医疗服务的连续性。初级护理经济条件更好的国家提高所有特性个人为中心护理的可能性更低。

          结论

          在初级保健结构更强的国家,病人能意识到的初级保健改善可能性更低。

          Резюме

          Цель

          Исследовать восприятие пациентами потенциала улучшения первичной медицинской помощи в 34 странах.

          Методы

          Было проведено перекрестное исследование 69  201 пациента, которые посещали только терапевтов в учреждениях первичной медицинской помощи. Пациенты дали оценку пяти характеристикам целенаправленной первичной медицинской помощи: доступность/наличие, непрерывность, комплексность, участие пациента и коммуникация между врачом и пациентом. Одна десятая пациентов расположила по важности каждую характеристику на шкале от одного до четырех, а девять десятых пациентов оценили свой опыт получения медицинской помощи. Потенциал улучшения рассчитывался путем умножения части пациентов с отрицательным опытом на средний балл важности в каждой стране. Баллы делились на низкий, средний и высокий потенциал улучшения. Попарные корреляции выводились между баллами улучшения и тремя характеристиками структуры первичной медицинской помощи: руководством, экономическим положением и подготовкой трудовых ресурсов.

          Результаты

          В 26 странах одна или более характеристик первичной медицинской помощи обладали средним или высоким потенциалом улучшения. Комплексность медицинской помощи обладала потенциалом улучшения от среднего до высокого в 23 из 34 стран. Во всех странах коммуникация между врачом и пациентом имела низкий потенциал улучшения. В целом сильная структура первичной медицинской помощи была связана с низким потенциалом улучшения непрерывности и комплексности медицинской помощи. В странах с эффективным руководством первичной медицинской помощью пациенты усматривали меньший потенциал для улучшения непрерывности медицинской помощи. Страны с лучшим экономическим положением в первичной медицинской помощи обладали меньшим потенциалом улучшения всех характеристик целенаправленной помощи пациенту.

          Вывод

          В странах с эффективной структурой первичной медицинской помощи пациенты усматривали меньший потенциал улучшения в данной области.

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          Most cited references26

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          The breadth of primary care: a systematic literature review of its core dimensions

          Background Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health.
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            The strength of primary care in Europe: an international comparative study.

            A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.
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              QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

              Background The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design of the QUALICOPC study is described. Methods/design QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey) and in Australia, Israel and New Zealand. This study uses a three level approach of data collection: the system, practice and patient. Surveys will be held among general practitioners (GPs) and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight in the professional behaviour of GPs and the expectations and actions of their patients. An important aspect of this study is that each patient's questionnaire can be linked to their own GP's questionnaire. To gather data at the structure or national level, the study will use existing data sources such as the System of Health Accounts and the Primary Health Care Activity Monitor Europe (PHAMEU) database. Analyses of the data will be performed using multilevel models. Discussion By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will advance the state of the art in primary care research and contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development.
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                Author and article information

                Journal
                Bull World Health Organ
                Bull. World Health Organ
                BLT
                Bulletin of the World Health Organization
                World Health Organization
                0042-9686
                1564-0604
                01 March 2015
                28 January 2015
                : 93
                : 3
                : 161-168
                Affiliations
                [a ]NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, Netherlands.
                [b ]Scuola Superiore Sant’Anna, Istituto di Management, Pisa, Italy.
                Author notes
                Correspondence to Willemijn LA Schäfer (email: w.schafer@ 123456nivel.nl ).
                Article
                BLT.14.140368
                10.2471/BLT.14.140368
                4371491
                25883409
                5b4bf706-4734-4426-8e9a-bc3e3b949758
                (c) 2015 The authors; licensee World Health Organization.

                This is an open access article distributed under the terms of the Creative Commons Attribution IGO License ( http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

                History
                : 22 April 2014
                : 10 December 2014
                : 18 December 2014
                Categories
                Research

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