Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China

Abstract

Background Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe major policy changes including key ‘components’, impacts of new models of care, and barriers and facilitators to PCT implementation. Methods We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened the titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed. Results A total of 107 studies from 15 countries were included. The most frequently employed component of PCT was the expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with < 20% measuring patient views or satisfaction. Only three studies evaluated the effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes. Conclusions Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation and mixed findings on impacts. Only a minority of studies described the impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.

Primary care transformation in Scotland: a qualitative evaluation of the views of patients

“… 19 Expansion of the MDT is the most common policy response by high income countries to primary care transformation. 9 The current finding that patients with multimorbidity were the least comfortable with these changes agreed with studies in other high-income countries. 20 , 21 A recent report from England also found similar findings to this study regarding patients living in deprived areas.…”

“…As far as the authors are aware, this is the first study to seek patients’ qualitative views on the new Scottish GP contract. The finding that patients were unaware of the new contract was in line with international evidence that patients are rarely consulted about proposed reforms or included in the evaluation of such reforms, 9 despite the evidence that patient engagement can meaningfully inform policies and enhance service delivery and governance. 19 Expansion of the MDT is the most common policy response by high income countries to primary care transformation.…”

“…These efforts to transform primary care in Scotland to better meet the needs of the population are in line with approaches taken by many other countries. 9 Although multiple approaches are being taken to primary care transformation, expansion of the MDT is the most common in high-income countries and China, 9 and is specifically encouraged by the World Health Organization. 10 It has been noted that patients’ views are rarely included in large scale reforms of primary care, 9 , 11 with little attention paid to health inequalities and the needs of older patients.…”

“…10 It has been noted that patients’ views are rarely included in large scale reforms of primary care, 9 , 11 with little attention paid to health inequalities and the needs of older patients. 9 …”

Patients’ experiences of GP consultations following the introduction of the new GP contract in Scotland: a cross-sectional survey

“…Policies of reform in primary care have been central to the efforts of healthcare systems globally in addressing the challenges of population ageing, multimorbidity, and health inequalities. 11 , 12 A recent scoping review found considerable heterogeneity in how reform plays out in different systems and noted that the views of patients are often overlooked in their design and evaluation. 12 …”