Academic journal article Bulletin of the World Health Organization

Assessing the Potential for Improvement of Primary Care in 34 Countries: A Cross-Sectional survey/Evaluer le Potentiel D'amelioration Des Soins De Sante Primaires Dans 34 Pays: Une Enquete transversale/Evaluacion del Potencial De Mejora De la Atencion Primaria En 34 Paises: Un Estudio Transversal

Academic journal article Bulletin of the World Health Organization

Assessing the Potential for Improvement of Primary Care in 34 Countries: A Cross-Sectional survey/Evaluer le Potentiel D'amelioration Des Soins De Sante Primaires Dans 34 Pays: Une Enquete transversale/Evaluacion del Potencial De Mejora De la Atencion Primaria En 34 Paises: Un Estudio Transversal

Article excerpt

Introduction

Due to the increased prevalence of comorbid conditions, people often have more than one disease that needs to be managed consistently over time. (1,2) Health-care providers can do this through a person-focused approach, which entails goal-oriented, rather than disease-oriented care. The goal is to manage people's illnesses through the course of their life. (1,2) Therefore, person-focused care should be continuous, accessible and comprehensive. It should also be coordinated when patients have more than one provider. (1)

Patients' assessment of health care can be divided into what patients find important and what they have experienced. (3-5) Importance refers to what people see as desired features of health care--i.e. patients' instrumental values. (6) The combination of instrumental values and patients' experiences constitute quality judgments, which provides insight on the extent to which health-care providers meet these values. Both instrumental values and experiences of primary care patients vary between countries. (6-8) These judgements can be transformed into a measure of improvement potential. When an aspect of care is experienced as poorly performed, but not considered important, this can be seen as less of a quality problem than if patients consider the aspect important. (9) More important aspects of care thus have higher improvement potential.

The structure of primary care can relate to person-focused care in various ways. In stronger primary care structures the providers are more likely to be involved in a wide range of health problems at different stages of the patients' lives. This is expected to increase continuity of care and providers' responsiveness to the patients' values regarding continuity, comprehensiveness and communication. Patients will use services more readily if they know a broad spectrum of care is offered. (10) A stronger primary care structure is associated with more accessible primary care, (11) which is one of the core features of person-focused care. Therefore, we expect that in countries with a stronger primary care structure, the patient-perceived improvement potential of person-focused primary care is lower.

The primary care structure comprises governance, economic conditions such as the mode of financing of providers and expenditures on primary care, and workforce development --the profile and the education of the primary-care providers. (12,13)

We wished to quantify the extent to which the structure of primary care at the national level in 34 countries is related to patient-perceived improvement potential for features of person-focused care. To study this relationship, the empirical relations between the providers--general practitioners--and patients need to be considered (Fig. 1). The primary care structure influences the behaviour of the practitioners, which will influence patients' experiences. Patients' characteristics--e.g. age and income--influence patients' individual experiences and values. We focus on the system level to study characteristics that are amenable to policy interventions.

Methods

We derived aggregated data on patient-perceived improvement potential in 34 countries from the QUALICOPC study (Quality and Costs of Primary Care in Europe). In this study, patients in 31 European countries (Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, the former Yugoslav Republic of Macedonia, Turkey, the United Kingdom of Great Britain and Northern Ireland) responded to surveys. Three non-European countries (Australia, Canada, New Zealand) were also included. In each country, patients of general practitioners filled in the questionnaires (target: n = 2200 per country; Cyprus, Iceland and Luxembourg n = 800). …

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