Primary Health Care Attributes Research Articles

The therapeutic journey of families of children with respiratory diseases in the public health service

This study's purpose was to identify the therapeutic journey of families seeking health care for their children with respiratory diseases. This qualitative study had the participation of parents of children younger than five years old who were hospitalized with respiratory diseases. Path mapping was used as an instrument to collect data, which was analyzed through thematic analysis. The findings indicate that families sought the health services as soon as they perceived symptoms and had access to medical care, however such care was not decisive in resolving their health issues. Even though the families returned to the service at least another three times, the children had to be hospitalized. The attributes of primary health care were not observed in the public health services, while therapeutic encounters had no practical success.

Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective

BackgroundPrimary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To analyze the extent to which important PHC attributes are covered in validated instruments measuring quality of care from the patient perspective.MethodWe systematically identified validated instruments from the literature and by consulting experts. Using a Delphi consensus-building process, Canadian PHC experts identified and operationally defined 24 important PHC attributes. One team member mapped instrument subscales to these operational definitions; this mapping was then independently validated by members of the research team and conflicts were resolved by the PHC experts.ResultsOf the 24 operational definitions, 13 were evaluated as being best measured by patients, 10 by providers, three by administrative databases and one by chart audits (some being best measured by more than one source). Our search retained 17 measurement tools containing 118 subscales. After eliminating redundancies, we mapped 13 unique measurement tools to the PHC attributes. Accessibility, relational continuity, interpersonal communication, management continuity, respectfulness and technical quality of clinical care were the attributes widely covered by available instruments. Advocacy, management of clinical information, comprehensiveness of services, cultural sensitivity, family-centred care, whole-person care and equity were poorly covered.ConclusionsValidated instruments to evaluate PHC quality from the patient perspective leave many important attributes of PHC uncovered. A complete assessment of PHC quality will require adjusting existing tools and/or developing new instruments.

Experiencia de implementación de un modelo de Atención Primaria

Identifying barriers and dynamic factors in setting up a primary health care (PHC) model in the Santander department during the last decade. This was a qualitative study, focusing on pluralism and triangulating sources and actors, with a critical analysis of limits and judgments values (boundary critique). Philosophical/conceptual and operational management problems were found from the emergent categories related to appropriating PHC attributes. The theoretical model design was in fact not developed in practice. The PHC strategy is selective and state-led (at department level), focusing on rural interventions developed by nursing assistants and orientated towards fulfilling public health goals in the first healthcare level. Difficulties at national, state and local level were identified which could be useful in other national and international contexts. Structural healthcare system market barriers were the most important constraints since the model operates through the contractual logic of institutional segmentation and operational fragmentation. Human resource management focusing on skills, suitable local health management and systematic evaluation studies would thus be suggested as essential operational elements for facing the aforementioned problems and encourage an integral PHC model in Colombia.

Avaliação da associação entre qualificação de médicos e enfermeiros em atenção primária em saúde e qualidade da atenção

This study sought to establish the association between the attributes of primary healthcare (PHC) and the professional qualification of physicians and nurses. For data collection, the child version of the Primary Care Assessment Tool (Child PCA-Tool) was applied to the caregivers of children resident and registered in the areas covered by the family health teams. The attributes of PHC were evaluated using the scores of the caregivers in the test. After bivariate analysis, seeking an association between the degree of orientation to the PHC and the socioeconomic and demographic characteristics, as well as the professional characteristics of the health units, a multivariate model was established using Poisson regression. The teams in which there were professionals with residence in family health or family and community medicine achieved higher scores than those in which the professionals did not have this qualification. The authors concluded that specialization in residence in family and community medicine for physicians, and residence in family health for nurses, have higher potential for the transformation of the care model, based on the attributes of the PHC.

Characteristics of general practice care: What do senior citizens value? A qualitative study

BackgroundIn view of the increasing number of senior citizens in our society who are likely to consult their GP with age-related health problems, it is important to identify and understand the preferences of this group in relation to the non-medical attributes of GP care. The aim of this study is to improve our understanding about preferences of this group of patients in relation to non-medical attributes of primary health care. This may help to develop strategies to improve the quality of care that senior citizens receive from their GP.MethodsSemi-structured interviews (N = 13) with senior citizens (65-91 years) in a judgement sample were recorded and transcribed verbatim. The analysis was conducted according to qualitative research methodology and the frame work method.ResultsContinuity of care providers, i.e. GP and practice nurses, GPs' expertise, trust, free choice of GP and a kind open attitude were highly valued. Accessibility by phone did not meet the expectations of the interviewees. The interviewees had difficulties with the GP out-of-office hours services. Spontaneous home visits were appreciated by some, but rejected by others. They preferred to receive verbal information rather than collecting information from leaflets. Distance to the practice and continuity of caregiver seemed to conflict for respondents.ConclusionsPreferences change in the process of ageing and growing health problems. GPs and their co-workers should be also aware of the changing needs of the elderly regarding non-medical attributes of GP care. Meeting their needs regarding non-medical attributes of primary health care is important to improve the quality of care.

Policy characteristics facilitating primary health care in Thailand: A pilot study in transitional country

BackgroundIn contrast to the considerable evidence of inequitable distribution of health, little is known about how health services (particularly primary care services) are distributed in less developed countries. Using a version of primary health care system questionnaire, this pilot study in Thailand assessed policies related to the provision of primary care, particularly with regard to attempts to distribute resources equitably, adequacy of resources, comprehensiveness of services, and co-payment requirement. Information on other main attributes of primary health care policy was also ascertained.MethodsQuestionnaire survey of 5 policymakers, 5 academicians, and 77 primary care practitioners who were attending a workshop on primary care. Descriptive statistics with Fischer's exact test were used for data analysis.ResultsAll policymakers and academicians completed the mailed questionnaire; the response rate among the practitioners was 53.25% (41 out of 77). However, the responses from all three groups were consistent in reporting that (1) financial resources were allocated based on different health needs and special efforts were made to assure primary care services to the needy or underserved population, (2) the supply of essential drugs was adequate, (3) clinical services were distributed equitably, (4) out-of-pocket payment was low, and that some primary health care attributes, particularly longitudinality (patients are seen by same doctor or team each time they make a visit), coordination, and family- and community-orientation were satisfactory. Geographical variations were present, suggesting inequitable distribution of primary care across regions. The questionnaire was robust across key stakeholders and feasible for use in a transitional country.ConclusionA primary care systems questionnaire administered to different types of health professionals was able to show that resource distribution was equitable at a national level but some aspects of primary care practice across regions is still of concern, in at least in this transitional country.

Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts

In 2004, we undertook a consultation with Canadian primary health care experts to define the attributes that should be evaluated in predominant and proposed models of primary health care in the Canadian context. Twenty persons considered to be experts in primary health care or recommended by at least 2 peers responded to an electronic Delphi process. The expert group was balanced between clinicians (principally family physicians and nurses), academics, and decision makers from all regions in Canada. In 4 iterative rounds, participants were asked to propose and modify operational definitions. Each round incorporated the feedback from the previous round until consensus was achieved on most attributes, with a final consensus process in a face-to-face meeting with some of the experts. Operational definitions were developed and are proposed for 25 attributes; only 5 rate as specific to primary care. Consensus on some was achieved early (relational continuity, coordination-continuity, family-centeredness, advocacy, cultural sensitivity, clinical information management, and quality improvement process). The definitions of other attributes were refined over time to increase their precision and reduce overlap between concepts (accessibility, quality of care, interpersonal communication, community orientation, comprehensiveness, multidisciplinary team, responsiveness, integration). This description of primary care attributes in measurable terms provides an evaluation lexicon to assess initiatives to renew primary health care and serves as a guide for instrument selection.