Abstract
This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
Highlights
Effective health systems must be accessible and responsive to the health and social needs of people
primary care (PC) is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences
A broader range of services is associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians
Summary
Effective health systems must be accessible and responsive to the health and social needs of people. In developed countries, health needs have changed considerably while health systems have not adjusted their services adequately. Chronic conditions and multimorbidity, which have come along with the aging of populations, are challenging health systems. Curative care continues to be provided predominantly in fragmented single-disease approaches, whereas large-scale efforts to systematically identify groups at risk and develop programmes for behavioural change to reduce or prevent chronic diseases are still scarce. In addition to the increases in costs due to developments in medical technology, the absence of lifestyle medicine and goal-oriented care could be an important reason why countries fail to curb the trend of rising health expenditures (De Maeseneer and Boeckxstaens, 2012)
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