Quality Of Primary Health Care Research Articles

The quality of primary care services, vocational training and the More Doctors Program in a health region of southwest Goiás.

Primary health care must assume the centrality of care so that health systems address and solve the health needs of the population. To evaluate the quality of primary health care from the perspective of health professionals, including those associated with the Mais Médicos Brasil Program, verifying associations between quality of services and professional qualification. A cross-sectional study where interviews with health professionals were carried out. The quality of care was measured by means of interviews about the experience of doctors and nurses with the services, using the Primary Care Assessment Tool (PCATool-Brasil). The presence and the extension of the primary health care attributes of the Southwest II region of Goiás state, constituted by 10 municipalities, were investigated. The lowest APS Overall Score was for the first contact access attribute (3.71). The bivariate analysis showed statistical difference between the variables profession and the essential, derived and general scores. Doctors of the More Doctors Program had higher average scores (7,68 essential; 9,11 derivative; 8,04 general) when compared to other medical professionals and nurses. The findings highlight the importance of permanent evaluation of health services, especially primary care, due to its importance and centrality to the organization of other levels of care. Only from this monitoring is possible a better management orientation for strategic and resolutive investments.

Care coordination and longitudinality in primary health care in the Brazilian Amazon.

to evaluate the attributes of primary health care, care coordination and longitudinality, from the perception of the professional and patients in the state of Amazonas, Brazil. quantitative evaluative study, in which was used an external evaluation instrument with 469 professionals and 1,888 patients from 367 primary health care facilities that adhered to the Program for Improving Access and Quality of primary health care (Portuguese acronym: PMAQ) standardized by the Ministry of Health. Data were grouped by multivariate cluster analysis in order to find a classification of primary health care from the perspective of professionals and patients. the attributes of coordination and longitudinality are still expressed in a weak and undeveloped way in the Brazilian Amazon scenario. it is necessary to recognize the organizational barriers and what could promote conditions for the performance of health care teams in the perspective of a continuous, integral and coordinated care.

Healthcare Reform and Gender Specific Child Investment in Developing Countries

We estimate whether a large scale health care reform benefits young boys more than young girls in terms of health and cognitive outcomes in the context of a developing country with labor market bias and cultural preferences favoring sons. We use exogenous variation of a health care reform, the National Health Policy, which was implemented in Nepal in 1991 along with data from the Nepal Living Standard Survey 1996. By using healthcare quality measures of health posts that provide primary healthcare as well as a constructed cost measure for accessing hospitals that provide tertiary (curative) care, we evaluate the effects of the health care reform on infant and child mortality by gender. Our results suggest that improvements in primary health care quality and cost reductions in tertiary care reduces the mortality rates of boys but does not affect the mortality rate of girls. Additionally, the findings provide suggestive evidence that differences in child health investments affect educational outcomes. We highlight the household's innate gender preference for sons, neglect of daughters' health, and differences in borrowing patterns across households with sons and daughters as potential drivers of some of the observed differences in the human capital investments of parents into boys vs. girls. Our research highlights the importance of cultural norms in the overall success of health reforms.

Менеджмент доступности первичного звена здравоохранения в субъектах России с высокой долей сельского населения (Primary Health Care Accessibility Management in Russian Regions With a High Share of the Rural Population)

Russian Abstract: Проблема доступности медицинской помощи на селе является одним из фокусных направлений национальных целей и стратегических задач развития здравоохранения, определенных Указом Президента РФ от 7 мая 2018 года No204 и основными направлениями Паспортов развития здравоохранения субъектов РФ на период 2018-2024 гг. Вопросы охраны здоровья населения, проживающего в сельской местности, находятся в компетенции субъектов РФ, а качество и доступность ПМСП напрямую связаны с районированием сети районных больниц (РБ), фельдшерско-акушерских пунктов (ФАП), сельских амбулаторий. English Abstract: The problem of access to medical care in the countryside is one of the focal areas of national goals and strategic objectives of healthcare development, defined by Decree of the President of the Russian Federation No. 204 of May 7, 2018 and the main directions of Health Development Passports of the constituent entities of the Russian Federation for the period 2018-2024. The health of the population living in rural areas is within the competence of the constituent entities of the Russian Federation, and the quality and availability of primary health care are directly related to the regionalization of the network of district hospitals (RB), feldsher-obstetric centers (FAP), and rural outpatient clinics.

Factors associated with service user embracement by Primary Health Care teams in Brazil, 2012: a cross-sectional study.

To evaluate prevalence and factors associated with service user embracement by Primary Health Care teams in Brazil. This is a cross-sectional study that included teams that took part in the 2012 National Program for Primary Health Care Access and Quality Improvement (PMAQ-AB) (Cycle I). The outcome used was 'user embracement by the health team'. The independent variables were macro-region, municipal profile, Gini index and Family Health Strategy population coverage, team meetings, study of spontaneous demand, consideration of user opinions and existence of continuing education. Multilevel Poisson regression analysis was performed. The sample consisted of 13,751 teams. User embracement prevalence was 78.3% (95%CI 77.6;79.1). In the hierarchical analysis, the highest prevalence of user embracement was found among Southern region teams (PR=1.37 - 95%CI 1.27;1.48) taking the Northeast region as a reference. There is an uneven distribution of Primary Care teams practicing user embracement in Brazil, possibly associated with regional inequalities.

Primary care initiatives focused on the secondary prevention and management of chronic pain: a scoping review of the Australian literature

The aim of this scoping review was to identify initiatives focused on the secondary prevention and management of chronic pain in Australian primary care to understand options available to Primary Health Networks and to identify evidence gaps. The Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Cochrane databases, as well as relevant websites, were searched for eligible records published from 2007 to 2018. Initiative characteristics and outcomes evaluated were extracted and synthesised. In all, 84 initiatives from 167 published and grey literature records were identified, including: (1) consumer initiatives that aimed to improve access to multidisciplinary care, health literacy and care navigation (n=56); (2) health professional capacity building initiatives that aimed to ensure health professionals are skilled and provide best-practice evidence-based care (n=21); and (3) quality improvement and health system support initiatives (n=7). Evidence gaps were found relating to initiatives addressing the secondary prevention of chronic pain, those targeting vulnerable and regional populations, health professional capacity building initiatives for all primary health care providers and quality improvement and system support initiatives. Addressing evidence gaps related to effectiveness, cost-effectiveness and implementation should be the focus for future chronic pain initiatives in primary care settings.

A cross sectional study on factors influencing the quality of primary health care services provided by multi-purpose health workers in Tiruvallur district, Tamil Nadu

Background: Primary health care definition extends beyond physical aspect to mental and social wellbeing. Health care providers starting from physicians till basic level workers, play a vital role in identifying and meeting client’s health care needs. Quality care is the ability of to meet the health related needs of the population consistent with local and national goals, as well as resource constraints and considered as complex variable encompassing both tangibles and intangibles. Multipurpose workers are the frontline workers were the health problems were sorted out or referred to the next level of health care.Objective: The objective of the study is to identify enablers to a quality primary health care service in Tiruvallur district, state Tamil Nadu.Methodology: This is an analytical cross sectional study carried out on 149 Multi-purpose Health Workers calculated assuming maximum variability and 80% power. The study area Thiruvallur was selected through random sampling and five blocks namely Kadambathur, Minjur, Ellapuram, Tiruvalangadu and Tirutani were selected using lottery method. Parks The study was carried out during the period between January 2019 and June 2019. A structured questionnaire was used to elicit responses. Data were entered on MS Excel sheet. Statistical analysis was done with SPSS 17 version.Results and Discussion: Out of the total 149 Multi-purpose worker included in the study, 98 (65.77%) were females. Majority of them (34.90%) fall within the age group of 3 to 31-40 years. Among them 49.66% have completed their higher secondary level education. Around 57.04% have completed more than 15 years of service. Their structural indicators were below the expected standards compared to process and outcome indicators.Conclusion: Majority of the works were done properly except some defects in the structural level. Resources and Budgets should be reassessed and reallocated. Accredited activities should be made mandatory and should be considered as achievement by the entire health team. Regular audit and appraisal sessions are necessary. MPHW and client satisfaction survey should be done periodically to ensure the quality of services.

Welcome to The Lucky Country: the Royal Australian College of General Practitioners deters overseas-trained academic general practitioners.

In assessing overseas-trained general practitioners (GPs) applying for specialist recognition in Australia, the Royal Australian College of General Practitioners (RACGP) sets a minimum requirement of 2 days per week 'undertaking general practice activities' over the 3 years prior to application. The RACGP does not consider academic practice (i.e. relevant teaching and research) to be a 'general practice activity', thereby blocking overseas-trained full-time academic GPs from specialist recognition in Australia. The actions of the RACGP have implications for access to quality primary health care in Australia.

Financing primary healthcare for rural areas.

Context:Primary healthcare in India is provided by both public and private providers. However, access to good quality primary healthcare is lacking in underserved populations such as communities in rural and remote areas and families in low income quartiles. While there are government programs on comprehensive primary healthcare, stagnant investments restrict their reach and quality. At the same time, there are several for-profit and not-for-profit primary healthcare providers that fill the gap, but are limited in scale and geographical reach. They also often find it challenging to provide affordable comprehensive primary healthcare.Aims:The Consultation on Financing Primary Healthcare was organized to draw lessons for financial sustenance of comprehensive and equitable primary healthcare initiatives. Eighteen academicians and practitioners, representing different institutions from across India, presented and engaged in discussions around the theme of financing primary healthcare.Methods and Material:The Consultation proceedings were recorded, transcribed, analyzed, and synthesized to bring out the key insights.Results:The Consultation drew insights from the experiences and evidence shared by the participants on the ways to finance primary healthcare services sustainably, especially for underserved populations. The financing models discussed include public-private partnership, user fees, community financing, subscription and cross-subsidy. Cost-reduction strategies such as task-shifting and use of appropriate technology were also identified as key to improving efficiency in service delivery.

Impact evaluation of contracting primary health care services in urban Bangladesh

BackgroundThe Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness.MethodsThe effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation.ResultsOver the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased.ConclusionsUPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.

Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare

BackgroundUniversal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision.MethodsMixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements.ResultsThe results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts.ConclusionTogether with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.

Primary care in five European countries: A citizens' perspective on the quality of care for children.

ObjectiveAs part of the Models of Child Health Appraised (MOCHA) project, this study aimed to answer the following research questions: 1) How do European citizens perceive the quality of primary health care provided for children? And 2) What are their priorities with respect to quality assessment of primary health care aimed at satisfying children’s needs?MethodsNine potential attributes of quality of primary care were operationalized in 40 quality aspects. An online survey was used to elicit opinions in a representative sample of citizens of Germany, the Netherlands, Poland, Spain, and the United Kingdom. Data collection comprised: background characteristics; perceived quality of primary health care for children; and priority setting of quality aspects. Descriptive analysis was performed and differences between groups were tested using Chi-Square test and ANOVA.ResultsValid results were obtained from 2403 respondents. Mean satisfaction with quality of primary care ranged from 5.5 (Poland) to 7.2 (Spain). On average, between 56% (Poland) and 70% (Netherlands) of respondents had a positive perception of the primary health care system for children in their country. The ability of a child to limit their parents’ access to the child’s medical records was judged most negatively in all countries (average agreement score 28%, range 12–36%). The right of a child to a confidential consultation was judged most differently between countries (average agreement score 61%, range 40–75%). Overall top-10 priorities in ensuring high quality primary care were: timeliness (accessibility); skills/competences, management, facilities (appropriateness); no costs (affordability); information, dignity/respect (continuity); and swift referrals, collaboration (coordination).DiscussionBetween countries, significant differences exist in the perceived quality of primary care and priorities with regard to quality assessment. Taking into account the citizens’ perspective in decision-making means that aspects with low perceived quality that are highly prioritized warrant further action.

Building a model to evaluate use of the National Program for Improving Primary Health Care Access and Quality in Brazil.

to build a model to evaluate use of the National Program for Improving Primary Health Care Access and Quality (PMAQ-AB) in Brazil. document analysis and literature review followed by a consensus workshop with specialists, 19 specialists were invited who were selected because of their teaching or research experience, professional activities or publications related to the subject; validation took place on an online platform where participants were asked to analyze the evaluation proposal and to give their opinion based on the categories 'I totally agree', 'partially agree', and 'disagree'. 15 specialists confirmed their participation; at the end of three rounds, the specialists emphasized the clarity of the proposal and the clarity of the object of evaluation presented in both the Logic Model and the Theoretical Logic Model; the specialists fully agreed with the Evaluation Matrix and confirmed its theoretical consistency. this model will be applied to evaluate the use of PMAQ-AB in Primary Health Care management and health team actions.

Psychosocial Factors Affecting Artificial Intelligence Adoption in Health Care in China: Cross-Sectional Study.

BackgroundPoor quality primary health care is a major issue in China, particularly in blindness prevention. Artificial intelligence (AI) could provide early screening and accurate auxiliary diagnosis to improve primary care services and reduce unnecessary referrals, but the application of AI in medical settings is still an emerging field.ObjectiveThis study aimed to investigate the general public’s acceptance of ophthalmic AI devices, with reference to those already used in China, and the interrelated influencing factors that shape people’s intention to use these devices.MethodsWe proposed a model of ophthalmic AI acceptance based on technology acceptance theories and variables from other health care–related studies. The model was verified via a 32-item questionnaire with 7-point Likert scales completed by 474 respondents (nationally random sampled). Structural equation modeling was used to evaluate item and construct reliability and validity via a confirmatory factor analysis, and the model’s path effects, significance, goodness of fit, and mediation and moderation effects were analyzed.ResultsStandardized factor loadings of items were between 0.583 and 0.876. Composite reliability of 9 constructs ranged from 0.673 to 0.841. The discriminant validity of all constructs met the Fornell and Larcker criteria. Model fit indicators such as standardized root mean square residual (0.057), comparative fit index (0.915), and root mean squared error of approximation (0.049) demonstrated good fit. Intention to use (R2=0.515) is significantly affected by subjective norms (beta=.408; P<.001), perceived usefulness (beta=.336; P=.03), and resistance bias (beta=–.237; P=.02). Subjective norms and perceived behavior control had an indirect impact on intention to use through perceived usefulness and perceived ease of use. Eye health consciousness had an indirect positive effect on intention to use through perceived usefulness. Trust had a significant moderation effect (beta=–.095; P=.049) on the effect path of perceived usefulness to intention to use.ConclusionsThe item, construct, and model indicators indicate reliable interpretation power and help explain the levels of public acceptance of ophthalmic AI devices in China. The influence of subjective norms can be linked to Confucian culture, collectivism, authoritarianism, and conformity mentality in China. Overall, the use of AI in diagnostics and clinical laboratory analysis is underdeveloped, and the Chinese public are generally mistrustful of medical staff and the Chinese medical system. Stakeholders such as doctors and AI suppliers should therefore avoid making misleading or over-exaggerated claims in the promotion of AI health care products.

Assessment of clients 'satisfaction with primary health care services in Basra City, South of Iraq 2012

Client satisfaction has been defined as the degree of congruency between a client’s expectation of ideal care and his/her perception of the real care receive. In Iraq, there has been a recent concern at the Ministry of Health (MOH) about improving the quality of Primary Health Care (PHC) services being considered the first health “gate” for the community. This study aimed to assess the level of clients’ satisfaction with PHC services in Basra, Iraq, 2012. A cross-sectional study was performed on 12 randomly selected PHC centers from the total eight PHC districts at Basra Health Directorate, where 1200 clients aged 18 years and above were selected systematically. Data was collected via a direct interview with clients using an Arabic language questionnaire. The satisfaction was rated at a scale of 1-5 points, and the data was analyzed using c. The results of the current study revealed that the overall clients’ satisfaction was 90.8%. The highest score for clients’ satisfaction was for nurses’ staff domain of PHC services (91.9%), and the lowest was for waiting for the domain (74.5%). Old age, females, retired and illiterate clients showed significantly the highest overall satisfaction. Clients reported their main dissatisfaction for the availability of the medicines item (53.4%) and the waiting time to see medical staff item (59%). The present study concluded that overall clients’ satisfaction was relatively high, and socio-demographic characteristics played major roles in deciding the extent of clients’ satisfaction.

Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996\u20132013: assessing the development of equity in primary health care through clustering of geographic areas \u2013 an observational retrospective study

BackgroundDue to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs).MethodsACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996–2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories.ResultsThree trajectories – and thus separate clusters of health centre areas – emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40–63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1–41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13–16% of health centre areas, in rural northern cluster, had 47–92% higher ACSC rates – but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage.ConclusionsWe identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC.

Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry.

BackgroundPatient-centered care (PCC) offers opportunities for African health systems to improve quality of care. Nonetheless, PCC continually faces implementation challenges. In 2015, Uganda introduced PCC as a concept in their national quality improvement guidelines. In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders’ views on the current quality of primary health care services and their understanding of PCC. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda.MethodsThis qualitative study was conducted in Uganda at national, district and facility level, with a focus on three public and three private health centres. Data collection consisted of in-depth interviews (n = 49); focus group discussions (n = 7); and feedback meetings (n = 14) across the four main categories of stakeholders identified: patients/communities, health workers, policy makers and academia. Interviews and discussions explored stakeholder perceptions on the interpersonal aspects of quality primary health care and meanings attached to the concept of PCC. A content analysis of Ugandan policy documents mentioning PCC was also conducted. Thematic content analysis was conducted using NVivo 11 to organize and analyze the data.Findings and conclusionWhile Ugandan stakeholder groups have varying perceptions of PCC, they agree on the following: the need to involve patients in making decisions about their health, the key role of healthcare workers in that endeavor, and the importance of context in designing and implementing solutions. For that purpose, three avenues are recommended: Firstly, fora that include a wide range of stakeholders may offer a powerful opportunity to gain an inclusive vision on PCC in Uganda. Secondly, efforts need to be made to ensure that improved communication and information sharing–important components of PCC–translate to actual shared decision making. Lastly, the Ugandan health system needs to strengthen its engagement of the transformation from a community health worker system to a more comprehensive community health system. Cross-cutting the entire analysis, is the need to address, in a culturally-sensitive way, the many structural barriers in designing and implementing PCC policies. This is essential in ensuring the sustainable and effective implementation of PCC approaches in low- and middle-income contexts.

Variation in primary health care services after implementation of quality improvement policy in Brazil.

Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). To evaluated whether progress generally has been made within Brazil's PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000-20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil's PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.

Primary health care quality indicators: An umbrella review.

Nowadays, evaluating the quality of health services, especially in primary health care (PHC), is increasingly important. In a historical perspective, the Department of Health (United Kingdom) developed and proposed a range of indicators in 1998, and lately several health, social and political organizations have defined and implemented different sets of PHC quality indicators. Some systematic reviews in PHC quality indicators are reported but only in specific contexts and conditions. The aim of this study is to characterize and provide a list of indicators discussed in the literature to support managers and clinicians in decision-making processes, through an umbrella review on PHC quality indicators. The methodology was performed according to PRISMA Statement. Indicators from 33 eligible systematic reviews were categorized according to the dimensions of care, function, type of care, domains and condition contexts. Of a total of 727 indicators or groups of indicators, 74.5% (n = 542) were classified in process category and 89.5% (n = 537) with chronic type of care (n = 428; 58.8%) and effective domain (n = 423; 58.1%) with the most frequent values in categorizations by dimensions. The results of this overview of reviews are valuable and imply the need for future research and practice regarding primary health care quality indicators in the most varied conditions and contexts to generate new discussions about their use, comparison and implementation.

The performance measurement of the primary health care quality

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)