Abstract
ObjectiveTo address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms.MethodsA systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied.ResultsA vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization.DiscussionA challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.
Highlights
Chronic disease and multimorbidity represent major challenges, increasing the health demand in many countries.[1]
Our analysis found little evidence of chronic disease management (CDM) programmes targeting chronic disease multimorbidity, a concern raised by Horvarth[24] who was critical of the continued episodic approach to CDM in Australia following implementation of Medicare Locals in primary healthcare (PHC)
Our review showed a consistent trend in the vision for healthcare system reforms from predominately hospital-centric to PHC services towards an integrated health system for the management of populations with chronic conditions
Summary
Chronic disease and multimorbidity represent major challenges, increasing the health demand in many countries.[1] The World Health Organization (WHO)[2] reported that 15 million people aged 30–69 years old die each year from non-communicable diseases, and this number is expected to rise to an estimated 52 million by 2030. In responding to the burden of chronic disease, the WHO Global Status Report on Non-Communicable Diseases 20103 highlighted the importance of strengthening the health system with more emphasis on primary healthcare (PHC) as the first point of care and partnership between health services providers as key to success. The HDI, as reported annually by the United Nations Development Programme, is a measure of a country’s human development in terms of a long and healthy life expectancy, mean years of education, and gross national income per capita contributing to standards of living.[11]
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