Evaluating primary care networks in low-income and lower middle-income countries: a scoping review

Abstract

IntroductionPrimary care networks (PCNs) are claimed to be an effective model to organise and deliver primary healthcare through collaborative relationships and effective coordination of primary care activities. Though increasingly implemented in different contexts, there is limited evidence on the effectiveness of PCNs in low-income and lower middle-income countries (LLMICs).ObjectiveOur scoping review aims to understand how PCNs in LLMICs have been conceptualised, implemented and analysed in the literature and further explores the evidence of the effectiveness of these networks.MethodsWe structured our review using Arksey and O’Malley’s framework for scoping reviews and recommendations by Levacet al. We also used the population, concept and context (PCC) guide of the Joanna Briggs Institute (JBI) methodology for scoping reviews to define the search strategy. The identified documents were then mapped, using Cunningham’s evaluation framework for health networks, to understand how PCNs are conceived in LLMIC settings.ResultsWe identified 20 documents describing PCNs in five LLMICs. The selected documents showed differing forms and complexities of networks, with a majority resourced by government, non-governmental and donor entities. Most networks were mandated, and established with defined goals, although these were not always understood by stakeholders. Unlike PCNs in developed settings, the scoping review did not identify integration of care as a major goal for the establishment of PCNs in LLMICs. Network evaluation relationships, outputs and outcomes also varied across the five networks in the identified documents, and perceptions of effectiveness differed across stakeholder groups.ConclusionPCNs in LLMICs benefit from clearly stated goals and measurable outcomes, which facilitates evaluation. In order to maximise the benefits, careful attention to the aspects of network design and operation is required. Future research work could shed light on some of the missing pieces of evidence on their effectiveness by, for example, considering differential consequences of modes of network establishment and operation, including unintended consequences in the systems within which they reside, and evaluating long-term implications.

Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study

“…3 Internationally, collaborative network models for primary care aim to improve care coordination for target populations, increase emphasis on preventative and population health, improve management of chronic conditions and reduce hospital admissions, 2 improve outcomes, sustainability, quality of care, efficiency and health equity. 1 The implementation of PCNs in English general practice involves larger-scale healthcare provision and the introduction of a wider range of healthcare professional (HCP) roles, in part through the Additional Roles Reimbursement Scheme (ARRS) (https://www.england.nhs.uk/gp/expanding-ourworkforce/). Continuity of care has been the bedrock of general practice in the United Kingdom since its inception, 3 but it has been eroding.…”

“…Primary care provision has been undergoing reorganisation in several countries over the past two decades 1,2 . In the United Kingdom, the policy response to increasing patient demand and general practitioner (GP) workforce pressures putting strain on general practice has been to foster collaboration between practices in the form of primary care networks (PCNs) 3 .…”

“…In the United Kingdom, the policy response to increasing patient demand and general practitioner (GP) workforce pressures putting strain on general practice has been to foster collaboration between practices in the form of primary care networks (PCNs) 3 . Internationally, collaborative network models for primary care aim to improve care coordination for target populations, increase emphasis on preventative and population health, improve management of chronic conditions and reduce hospital admissions, 2 improve outcomes, sustainability, quality of care, efficiency and health equity 1 . The implementation of PCNs in English general practice involves larger‐scale healthcare provision and the introduction of a wider range of healthcare professional (HCP) roles, in part through the Additional Roles Reimbursement Scheme (ARRS) (https://www.england.nhs.uk/gp/expanding-our-workforce/).…”

“…Primary care provision has been undergoing reorganisation in several countries over the past two decades. 1,2 In the United Kingdom, the policy response to increasing patient demand and general practitioner (GP) workforce pressures putting strain on general practice has been to foster collaboration between practices in the form of primary care networks (PCNs). 3 Internationally, collaborative network models for primary care aim to improve care coordination for target populations, increase emphasis on preventative and population health, improve management of chronic conditions and reduce hospital admissions, 2 improve outcomes, sustainability, quality of care, efficiency and health equity.…”