Primary Care Research Priorities in Low-and Middle-Income Countries

Abstract

PURPOSE To identify and prioritize the needs for new research evidence for primary health care (PHC) in low-and middle-income countries (LMICs) about organization, models of care, and financing of PHC. METHODS Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, via web-based surveys. Iterative literature review conducted in parallel. Round 1 (pre-Delphi survey) elicited possible research questions to address knowledge gaps about organization and models of care and about financing. Round 2 invited panelists to rate the importance of each question, and in round 3 panelists provided priority ranking. RESULTS One hundred forty-one practitioners and academics from 50 LMICs from all global regions participated and identified 744 knowledge gaps critical to improving PHC organization and 479 for financing. Four priority areas emerged: effective transition of primary and secondary services, horizontal integration within a multidisciplinary team and intersectoral referral, integration of private and public sectors, and ways to support successfully functioning PHC professionals. Financial evidence priorities were mechanisms to drive investment into PHC, redress inequities, increase service quality, and determine the minimum necessary budget for good PHC. CONCLUSIONS This novel approach toward PHC needs in LMICs, informed by local academics and professionals, created an expansive and prioritized list of critical knowledge gaps in PHC organization and financing. It resulted in research questions, offering valuable guidance to global supporters of primary care evaluation and implementation. Its source and context specificity, informed by LMIC practitioners and academics, should increase the likelihood of local relevance and eventual success in implementing research findings.

Health Complexity Assessment in Primary Care: a validity and feasibility study of the INTERMED tool

“…including one RCT that used the INTERMED tool (35) Further investigations are also needed to establish how, integrated on centralized electronic health records (EHS) (75) and telemedicine (76,77), INTERMED could become a component of a computerized health decision support tool, profile-guided and action-oriented, to deliver personalized care planning in health services networks (78,79). In this way, INTERMED could to help direct health system networks towards the much-needed biopsychosocial, people-centered and integrated care, including in Brazil and other low-and-middle income countries (80)(81)(82)(83)(84).…”

Needs and Resources of People With Type 2 Diabetes in Peri-urban Cochabamba, Bolivia: a People-centred Perspective

“…Despite their seemingly positive short-term effects, managing chronic conditions requires a long-term strategy which involves more than performing a series of disconnected interventions [21]. To identify what works within the local context, and to promote sustainable improvement in community health, existing needs and resources of individuals with T2D, their families and communities are to be considered [22][23][24][25][26]. This type of healthcare design is known as 'People-Centred Health Care', de ned as 'an approach to care that consciously adopts individuals', carers', families' and communities' perspectives as participants in, and bene ciaries of, trusted health systems that respond to their needs and preferences in humane and holistic ways' [27].…”

In This Issue: Humans of Primary Care Research

“…An international team led by Goodyear-Smith surveyed family medicine researchers around the globe to identify the evidence needs for primary health care in low-and middle-income countries. 13 The resulting priority list should help make research more relevant, useful, and meaningful to local communities.…”