The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Patient satisfaction with healthcare provided by family doctors: primary dimensions and an attempt at typology

<p>Abstract</p> <p>Background</p> <p>Patient satisfaction is a complex and difficult concept to measure, thus precluding the use of exclusively quantitative methods for its description. The purpose of this survey was firstly to identify particular healthcare dimensions that determine a patient's satisfaction or dissatisfaction; and secondly to attempt to typologise the patients' responses based on their evaluation of healthcare.</p> <p>Methods</p> <p>Using a qualitative research design, thirty-six in-depth interviews with patients of family physicians were conducted: four patients from each of 9 family practices in different regions of Poland were interviewed. The main outcome measure was factors associated with patient satisfaction/dissatisfaction.</p> <p>Results</p> <p>In their evaluations of their contacts with family doctors, the patients cited mostly issues concerning interpersonal relationships with the doctor. Nearly 40% of the statements referred to this aspect of healthcare, with nearly equal proportions of positive and negative comments. The second most frequent category of responses concerned contextual factors (21%) that related to conditions of medical service, with two-thirds of the evaluations being negative. Statements concerning the doctor's competencies (12.9%) and personal qualities (10.5%) were less common.</p> <p>Conclusion</p> <p>To improve the quality of healthcare, family doctors should take special care to ensure the quality of their interactions with patients.</p

Temporal changes in HCV genotype distribution in three different high risk populations in San Francisco, California

Abstract Background Hepatitis C virus (HCV) genotype (GT) has become an important measure in the diagnosis and monitoring of HCV infection treatment. In the United States (U.S.) HCV GT 1 is reported as the most common infecting GT among chronically infected patients. In Europe, however, recent studies have suggested that the epidemiology of HCV GTs is changing. Methods We assessed HCV GT distribution in 460 patients from three HCV-infected high risk populations in San Francisco, and examined patterns by birth cohort to assess temporal trends. Multiple logistic regression was used to assess factors independently associated with GT 1 infection compared to other GTs (2, 3, and 4). Results Overall, GT 1 was predominant (72.4%), however younger injection drug users (IDU) had a lower proportion of GT 1 infections (54.7%) compared to older IDU and HIV-infected patients (80.5% and 76.6%, respectively). Analysis by birth cohort showed increasing proportions of non-GT 1 infections associated with year of birth: birth before 1970 was independently associated with higher adjusted odds of GT 1: AOR 2.03 (95% CI: 1.23, 3.34). African-Americans as compared to whites also had higher adjusted odds of GT 1 infection (AOR: 3.37; 95% CI: 1.89, 5.99). Conclusions Although, HCV GT 1 remains the most prevalent GT, especially among older groups, changes in GT distribution could have significant implications for how HCV might be controlled on a population level and treated on an individual level

Assessment and physical activities of daily living among patients under long-term home care nursing

Purpose: To assess the degree of independence in physical activities of daily living for patients under long-term in-home nursing care; to evaluate any changes in physical activities of daily living at entry and after 90 days of in-home nursing care. Materials and methods: InterRAI-HC (Residental Assessment Instrument – Home Care) questionnaire was used as a tool according to the protocol and assessed patients at entry and again after 90 days. The participants consisted of 100 consecutive patients who were newly admitted to long-term in-home nursing care.Results: The analysis of total dependence showed that more than 50% of patients were entirely dependent in eight out of ten specified physical activities of daily living (except mobility in bed and food consumption). Intention to treat analysis was performed; the percentages of patients totally dependent in performing eating and mobility in bed actions increased significantly by the 90-day follow-up. Also a comparison of the mean value of independence for analyzed activities did not change significantly over the 90 days, with the only exception being the mean value of independence for dressing up the upper part of the body, which significantly improved after 90 days per protocol analysis. A high mortality rate is noted among these patients (15% by the 90 day follow-up). This probably resulted from the restrictive qualification criteria used in Poland for patients to receive this form of in-home healthcare service.Conclusions: The majority of patients who are under long-term in-home nursing care in Poland are entirely dependent when it comes to the physical activities of daily living