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

Abstract

BackgroundEven 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.MethodsA 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.ResultsEighty-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.ConclusionsA primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health.

Tipologia da estrutura das unidades básicas de saúde brasileiras: os 5 R

“…Kringos et al 11 realizaram revisão sistemática da literatura veiculada em periódicos de língua inglesa, identificando dimensões centrais para os três níveis de análise (estrutura/processo/resultados). A análise da estrutura incluiria as dimensões da governança, condições econômicas e desenvolvimento da força de trabalho.…”

“…As subdimensões identificadas na literatura por Kringos et al 11 para a avaliação da estrutura da atenção primária à saúde podem ser consideradas importantes, mas não suficientes para a análise da estrutura em países de baixa e média rendas. A rede de atenção à saúde, na sua maioria, ainda jovem; o subfinanciamento; as imensas desigualdades sociais e territoriais cobram a análise de questões já superadas em outras realidades.…”

Health policy and the policymaking system: A case study of primary care in Ireland

“…There is a considerable body of evidence that shows that countries with strong primary care systems generally have healthier populations, more equitable access to health services, and lower overall costs for health care [6,7,8]. The positive evidence in relation to primary care reform and improved equity in health is particularly relevant to the subject of this study where the radical reform of primary care services was central to the goal of reducing health inequalities that underpinned the Government's overarching health strategy introduced in 2001.…”

Cervical cancer screening: barriers to access and potential solutions for Nigeria

“…• Published before January 1,1990 Manual search for literature that was not available was done by tracing references and snowballing. Non-journal and grey literature was used in order to ensure a more complete search and to access literature that was not available on the academic databases listed above.…”

“…The misconception that cancer is a disease that can only be diagnosed and treated in specialist care facilities is fast shifting grounds with the increasing recognition that primary care has a role in all stages of the cancer control and care continuum 1 . The cancer transition, which is a part of the ongoing epidemiologic transition faced by developing countries, is projected to lead to a 75% increase in cancer incidence in the low and middle income countries (LMICs) between the year 2000 and 2020 2 .…”