Wednesday, March 24, 2010

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

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

Kringos DS, Boerma WG, Hutchinson A, van der Zee J, Groenewegen PP
1 NIVEL-Netherlands Institute for Health Services Research, Utrecht, the Netherlands 

2 ScHARR-School of Health and Related Research, University of Sheffield, UK

3 Department of Human Geography, Department of Sociology, University of Utrecht - The Netherlands

4 Faculty of Health Sciences, Department of International Public Health, University of Maastricht - The Netherlands

BMC health services research. 2010 Mar 13; vol. 10(1) pp. 65

Available online at: http://www.biomedcentral.com/content/pdf/1472-6963-10-65.pdf


“……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.

 

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.

 A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health…..”
PMID: 20226084 - URL  - http://www.ncbi.nlm.nih.gov/pubmed/20226084?dopt=Citation


 

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[EQ] Drivers of Inequality in Millennium Development Goal Progress: A Statistical Analysis

Drivers of Inequality in Millennium Development Goal Progress: A Statistical Analysis

David Stuckler1,2*, Sanjay Basu3,4, Martin McKee2,5

1 Oxford University, Department of Sociology, Oxford, United Kingdom,
2 London School of Hygiene & Tropical Medicine, Department of Public Health and Policy,London, United Kingdom,
3 Department of Medicine, University of California San Francisco, San Francisco, California, United States of America,
 4 Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California, United States of America,
 5 European Observatory on Health Systems and Policies, Brussels, Belgium


PLoS Med 7(3): e1000241. doi:10.1371/journal.pmed.1000241

Academic Editor: Simon Hales, University of Otago, New Zealand  Published March 2010

Available online at; http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000241

Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of available domestic funds), or health system infrastructure.

 

We also examined the impact of joint epidemics of HIV/AIDS and noncommunicable diseases (NCDs), which may limit the ability of households to address child mortality and increase risks of infectious diseases.

 

Methods and Findings:
We calculated each country’s distance from its MDG goals for HIV/AIDS, tuberculosis, and infant and child mortality targets for the year 2005 using the United Nations MDG database for 227 countries from 1990 to the present. We studied the association of economic development (gross domestic product [GDP] per capita in purchasing-powerparity), the relative priority placed on health (health spending as a percentage of GDP), real health spending (health system expenditures in purchasing-power-parity), HIV/AIDS burden (prevalence rates among ages 15–49 y), and NCD burden (agestandardised chronic disease mortality rates), with measures of distance from attainment of health MDGs.

 

To avoid spurious correlations that may exist simply because countries with high disease burdens would be expected to have low MDG progress, and to adjust for potential confounding arising from differences in countries’ initial disease burdens, we analysed the variations in rates of change in MDG progress versus expected rates for each country. While economic development, health priority, health spending, and health infrastructure did not explain more than one-fifth of the differences in progress to health MDGs among countries, burdens of HIV and NCDs explained more than half of between-country inequalities in child mortality progress (R2-infant mortality = 0.57, R2-under 5 mortality = 0.54). HIV/AIDS and NCD burdens were also the strongest correlates of unequal progress towards tuberculosis goals (R2 = 0.57), with NCDs having an effect independent of HIV/AIDS, consistent with micro-level studies of the influence of tobacco and diabetes on tuberculosis risks.

 

Even after correcting for health system variables, initial child mortality, and tuberculosis diseases, we found that lower burdens of HIV/ AIDS and NCDs were associated with much greater progress towards attainment of child mortality and tuberculosis MDGs than were gains in GDP. An estimated 1% lower HIV prevalence or 10% lower mortality rate from NCDs would have a similar impact on progress towards the tuberculosis MDG as an 80% or greater rise in GDP, corresponding to at least a decade of economic growth in low-income countries.

 

Conclusions:

Unequal progress in health MDGs in low-income countries appears significantly related to burdens of HIV and NCDs in a population, after correcting for potentially confounding socioeconomic, disease burden, political, and health system variables. The common separation between NCDs, child mortality, and infectious syndromes among development programs may obscure interrelationships of illness affecting those living in poor households—whether economic (e.g., as money spent on tobacco is lost from child health expenditures) or biological (e.g., as diabetes or HIV enhance the risk of tuberculosis)….”

 

 

 *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.