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      The european primary care monitor: structure, process and outcome indicators

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          Abstract

          Background

          Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited.

          There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU) aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor) for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care.

          Methods

          A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1) the dimensions of primary care and their relevance to outcomes at (primary) health system level; (2) essential features per dimension; (3) applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems).

          Results

          The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators reflect the quality, and efficiency of primary care.

          Conclusions

          A standardized instrument for describing and comparing primary care systems has been developed based on scientific evidence and consensus among an international panel of experts, which will be tested to all configurations of primary care in Europe, intended for producing comparable information. Widespread use of the instrument has the potential to improve the understanding of primary care delivery in different national contexts and thus to create opportunities for better decision making.

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          Most cited references 12

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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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            Is primary care essential?

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              The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998.

              To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades. Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n = 504). Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression. Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts. The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p<0.05 in fixed effects, multivariate regression analyses). This relationship was significant, albeit reduced in magnitude, even while controlling for macro-level (GDP per capita, total physicians per one thousand population, percent of elderly) and micro-level (average number of ambulatory care visits, per capita income, alcohol and tobacco consumption) determinants of population health. (1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care.
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                Author and article information

                Journal
                BMC Fam Pract
                BMC Family Practice
                BioMed Central
                1471-2296
                2010
                27 October 2010
                : 11
                : 81
                Affiliations
                [1 ]NIVEL, Netherlands Institute for Health Services Research, Otterstraat 114-118, 3500 BN Utrecht, Netherlands
                [2 ]Institute for Research and Information in Health Economics IRDES, 10 rue Vauvenargues, 75018 Paris, France
                [3 ]University of Tromsø, Department of Community Medicine ISM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway
                [4 ]University of Sheffield, School of Health and Related Research ScHARR, Regent Court 30, Regent Street, S1 4DA Sheffield, UK
                [5 ]University of Tartu, Department of Polyclinical and Family Medicine, Ülikooli 18, 50090 Tartu, Estonia
                [6 ]Jagiellonian University Medical College, Department of Family Medicine, Bochenska 4, 31-061 Krakow, Poland
                [7 ]University of Ljubljana, Department of Family Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia
                [8 ]Bocconi University, Centre for Research on Health and Social Care Management CERGAS, Via Sarfatti 25, 20135 Milan, Italy
                [9 ]University of Leicester, Department of Health Sciences, 22-28 Princess Road West, LE1 6TP Leicester, UK
                [10 ]Primary Care Research Institute IDIAP Jordi Gol, Av. Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, CIF G-60954104, Spain
                [11 ]Private University Witten/Herdecke gGmbH, Institute of General Practice and Family Medicine, Alfred-Herrhausen-Straße 50 D - 58448 Witten, Germany
                Article
                1471-2296-11-81
                10.1186/1471-2296-11-81
                2975652
                20979612
                Copyright ©2010 Kringos et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Medicine

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