Are people's health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries.

Autor:	Schäfer WLA; Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL 60611, USA.; NIVEL - Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands., Boerma WGW; NIVEL - Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands., van den Berg MJ; Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, 22660, 1100 DD, Amsterdam., De Maeseneer J; Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium., De Rosis S; Scuola Superiore Sant'Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy., Detollenaere J; KCE - Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, 1000 Brussels, Belgium., Greß S; Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany., Heinemann S; Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany.; Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany., van Loenen T; Pharos - Centre of Expertise on Health Disparities, PO box 13318, 3507 LH Utrecht, The Netherlands., Murante AM; Scuola Superiore Sant'Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy., Pavlič DR; Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia., Seghieri C; Scuola Superiore Sant'Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy., Vainieri M; Scuola Superiore Sant'Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy., Willems S; Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium., Groenewegen PP; NIVEL - Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands.; Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Primary health care research & development [Prim Health Care Res Dev] 2019 Jul 01; Vol. 20, pp. e104. Date of Electronic Publication: 2019 Jul 01.
DOI:	10.1017/S1463423619000434
Abstrakt:	Aim: This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. Background: Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. Methods: Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. Findings: Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. Conclusions: The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
Databáze:	MEDLINE
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