Background
A need for up-to-date comparable primary care information
An instrument for a multidimensional system
PC Dimension | Feature |
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Governance of the PC system | 1. Health (care) goals; 2. Policy on equity in access; 3. (De)centralization of PC management and service development; 4. Quality management infrastructure; 5. Appropriate technology in PC; 6. Patient advocacy; 7. Ownership of PC practices; 8. Integration of PC in the health care system. |
Economic conditions of the PC system | 1. Health care expenditure; 2. PC expenditures; 3. Health care funding system; 4. Employment status of PC workforce; 5. Remuneration system of PC workforces; 6. Income of PC workforce. |
PC workforce development | 1. Profile of PC workforce; 2. Recognition and responsibilities of PC disciplines; 3. Education and retention; 4 Professional associations; 5. Academic status of PC disciplines; 6. Future development of PC workforce. |
Access to PC services | 1. Availability of PC services; 2. Geographic access of PC services; 3. Accommodation of accessibility (incl. physical access); 4. Affordability of PC services; 5. Acceptability of PC; 6. Utilisation of PC services; 7. Equality in access. |
Continuity of care | 1. Longitudinal continuity of care; 2. Informational continuity of care; 3. Relational continuity of care; 4. Management continuity of care. |
Coordination of care | 1. Gatekeeping system; 2. PC practice and team structure; 3. Skill-mix in PC; 4. Integration of PC-secondary care; 5. Integration of PC and public health. |
Comprehensiveness of PC | 1. Medical equipment available; 2. First contact for common health problems; 3. Treatment and follow-up of diseases; 4. Medical technical procedures and preventive care; 5. Mother/child/reproductive health care; 6. Health promotion. |
Quality of PC | 1. Prescribing behaviour of PC providers; 2. Quality of diagnosis and treatment in PC; 3. Quality of chronic disease management; 4. Quality of mental health care; 5. Quality of maternal and child health care; 6. Quality of health promotion; 7. Quality of preventive care; 8. Effectiveness; 9. Practice safety. |
Efficiency of PC | 1. Allocative and productive efficiency; 2. Technical efficiency; 3. Efficiency in performance of PC workforce. |
Equity in health | 1. Equity in health |
Objective
Methods
Systematic literature review
Development of indicators
Further reduction of the long list of indicators
Results
Evaluation of provisional indicators
Dimension | Results of evaluation: selected indicators with the highest (H) and lowest (L) average score* | |
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Governance of the PC system | H | Is (near) universal financial coverage for PC services guaranteed by a publicly accountable body (government, or government-regulated insurer)? (3.42); Has a national primary care policy been formulated? (3.30); Is a national survey system or surveillance systems in place for monitoring the performance of the PC system (e.g. morbidity, mortality and process features)? (3.21) |
L | Provide a summary of the content of national standards on PC service delivery that allow PC practices to develop differently in their services delivery (1.63); Tasks and professionals included in legislation on possibilities of task substitution or delegation in PC (2.00); PC-oriented patient organisations currently being active (name, purpose, and number of members) (2.01) | |
Economic conditions of the PC system | H | Payment methods used for general practitioners?(Fee-for-service; Capitation payment; Salary; Mixed) (3.58); % of population covered for out-patient medical care by soc. health insurance (3.40); Method of health care financing for majority of (3.16) |
L | Public expenditure on dental services as % of GDP (1.42); Private expenditure on dental services as % of GDP (1.50); Public expenditure on over-the-counter medicines as % of GDP (1.68) | |
PC workforce development | H | Vocational training for general practice/family medicine in place? (3.55); Status of vocational training for general practice/family medicine (obligatory or voluntary) (3.57); Total nr. of active GPs as a ratio to total nr. of active specialists (3.39) |
L | % of (re)trained PC professionals (other than general practitioners, physiotherapists, pharmacists, dentists or midwives) active in their profession of training (1.26); Total number of posts of PC professionals (other than the previously listed PC professions) currently vacant per 1000 inhabitants (1.42); % of active female PC professionals (other than the previously listed PC professions) (1.49) | |
Access to PC services | H | Number of general practitioners per 100,000 population (3.74); Number of PC nurses per 100,000 population (3.56); Number of general practice consultations per capita per year (3.32) |
L | Differences in dentist visits by income quintile (or education) (1.73); Number of consultations with PC professionals (other than general practitioners, physiotherapists, pharmacists, dentists, midwives) per capita per year (1.76); Differences in physiotherapy visits by income quintile (or education) (1.86) | |
Continuity of care | H | Population/patients registered with a general practitioner (3.51); Average PC practice list size (3.45); Items normally recorded in patients' medical file for every encounter (reason of visit; problem and/or diagnosis; supporting data; treatment plan; medication details) (3.43) |
L | Usual Provider Continuity Index: proportion of visits to one's own PC physician relative to the total nr. of visits to all physicians in the past year (1.91); Average length of PC provider-patient relationship (2.08); Average practice list turnover: Nr. of new patients in a period divided by the nr. of registered patients at the end of the period (2.16) | |
Coordination of care | H | Patients having the possibility to directly access hospital based specialists (3.62); Patients having possibility to directly access emergency departments? (3.54); Patients having the possibility to directly access general practitioners? (3.49) |
L | Predominant PC-Public Health Collaboration models in place (1.85); Specialist outreach models available for specific (chronic) conditions (2.18); If no direct access to speech therapists, can these be consulted if paid out of pocket (2.21) | |
Comprehensiveness of PC | H | (Estimated) % of PC facilities usually carrying out immunizations for flu or tetanus (3.15); (Est.) % of PC providers usually providing first contact care to a man aged 28 with a first convulsion (3.09); (Est.) % of PC facilities usually involved in influenza vaccination for high-risk groups (3.08) |
L | (Est.) % of PC providers that regularly pay attention to social services (1.81); (Est.) % of PC facilities involved in blood typing and antibody screening for prenatal patients (1.90); (Est.) % of PC facilities involved in school health care (1.92) | |
Quality of PC | H | % of infants vaccinated against hepatitis B (2.99); % of infants vaccinated against invasive disease due to Haemophilius influenza type b (2.99); % of women aged 21-64 yrs who had at least 1 Pap test in the past 3 yrs (2.99) |
L | Mortality for persons with severe psychiatric disorders per 100,000 (1.24); % of pregnant women having received a hepatitis B screening during their pregnancy (1.28); Potential life years lost of premature mortality from bronchitis (1.35) | |
Efficiency of PC | H | Number of GP consultations per capita per year (3.34); Average consultation length (in minutes) of GPs (2.83); Number of new referrals from GPs to medical specialists per 1000 listed patients per year (2.82) |
L | Nr. of GP consultations in the surgery as % of all GP-patient contacts (2.24); Nr. of home visits as % of all GP-patient contacts (2.63); Nr. of telephone consultations as % of all GP-patient contacts (2.72) | |
Equity in health | H | Relative inequality (ratio between the rate of mortality in lowest and highest educational group) for avoidable mortality (2.34); Relative inequality for cardio-respiratory conditions (2.29); Relative inequality for mortality of infectious diseases (2.17) |
L | Relative inequality for mortality of tuberculosis (1.73); same for pneumonia and influenza (1.73); same for asthma (1.92) |