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

Kringos, D.S., Boerma, W.G.W., Hutchinson, A., van der Zee, J. and Groenewegen, P.P. (2010) The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Services Research , 10. Art no.65. ISSN 1472-6963

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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.

Item Type: Article
Copyright, Publisher and Additional Information: © 2010 Kringos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Primary-Health-Care; Quality-of-Care; General-Practice; Conceptual-Framework; Patient Satisfaction; Sensitive Conditions; European Countries; Continuity; Access; Indicators
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Depositing User: Miss Anthea Tucker
Date Deposited: 30 Apr 2010 10:31
Last Modified: 06 Jun 2014 12:20
Published Version: http://dx.doi.org/10.1186/1472-6963-10-65
Status: Published
Publisher: Biomed Central
Identification Number: 10.1186/1472-6963-10-65
URI: http://eprints.whiterose.ac.uk/id/eprint/10782

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