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Research ArticleOriginal Research

Primary Care Research Priorities in Low-and Middle-Income Countries

Felicity Goodyear-Smith, Andrew Bazemore, Megan Coffman, Richard Fortier, Amanda Howe, Michael Kidd, Robert L. Phillips, Katherine Rouleau and Chris van Weel
The Annals of Family Medicine January 2019, 17 (1) 31-35; DOI: https://doi.org/10.1370/afm.2329
Felicity Goodyear-Smith
1Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
MD, FRNZCGP
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  • For correspondence: f.goodyear-smith@auckland.ac.nz
Andrew Bazemore
2Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC
MPH
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Megan Coffman
2Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC
MS
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Richard Fortier
1Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
BSc
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Amanda Howe
3Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
MD
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Michael Kidd
4Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
5Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
MD, FAHMS
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Robert L. Phillips
6American Board of Family Medicine, Lexington, Kentucky
MSPH
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Katherine Rouleau
7The Besrour Centre for Global Family Medicine at the College of Family Physicians of Canada, Mississauga, Ontario, Canada
MHSc
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Chris van Weel
8Department of Primary and Community Care, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
9Department of Health Services Research, Australian National University, Canberra, Australia
PhD
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    Figure 1

    Countries of enrolled participants.

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    Table 1

    Demographics of Panelists in the 3 Rounds

    Round 1n = 70Round 2n = 84Round 3 n = 68
    n (%)n (%)n (%)
    Sex
    Male42 (60)46 (55)39 (57)
    Female28 (40)38 (45)29 (43)
    Age, y
    <302 (3)4 (5)3 (4)
    30-3916 (23)21 (25)15 (22)
    40-4922 (31)24 (29)18 (27)
    50-5918 (26)22 (26)22 (32)
    >6012 (17)13 (15)10 (15)
    Location
    Urban50 (71)62 (74)52 (76)
    Rural20 (29)22 (26)16 (24)
    Global region
    Europe9 (13)13 (15)10 (15)
    Africa31(44)35 (42)31 (46)
    Eastern Mediterranean1 (1)1 (1)1 (1)
    South Asia10 (14)11 (13)7 (10)
    Asia Pacific6 (9)6 (7)6 (9)
    North America Caribbean2 (3)5 (6)2 (3)
    South America11 (16)13 (16)11 (16)
    Health practitionera54 (77)61 (73)50 (74)
    Family doctor52 (74)57 (68)46 (68)
    Other doctor1 (1)3 (4)3 (4)
    Nurse1 (1)1 (1)1 (1)
    Tenure as health professional, y54 (77)61 (73)50 (74)
     <56 (9)9 (11)8 (12)
     5-1014 (20)13 (15)12 (18)
     11-1512 (17)13 (15)11 (16)
     16-207 (10)7 (8)6 (9)
     >2015 (21)19 (23)13 (19)
    Primary care academica55 (79)58 (69)47 (69)
    Junior academic role24 (34)37 (44)20 (29)
    Senior academic role31 (44)21 (25)27 (40)
    Tenure as academic, y55 (79)58 (69)47 (69)
     <518 (26)17 (20)12 (18)
     5-1019 (27)24 (29)19 (28)
     11-155 (7)7 (8)3 (4)
     16-207 (10)5 (6)8 (12)
     >206 (9)5 (6)5 (7)
    Policy makera18 (26)16 (19)14 (21)
    Tenure as policy maker, y18 (26)16 (19)14 (21)
     <59 (13)6 (7)5 (7)
     5-105 (7)6 (7)4 (6)
     11-152 (3)2 (2)2 (3)
     16-201 (1)2 (2)1 (1)
     >201 (1)0 (0)2 (3)
    • WONCA = World Organization of Family Doctors.

    • Note: For WONCA global regions see http://www.globalfamilydoctor.com/AboutWonca/Regions.aspx.

    • ↵a Some panelists hold more than 1 role, hence total >100%.

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    Table 2

    Four Top-Ranked Research Questions for PHC Organization and Financing (Country-Specific Version)

    PHC OrganizationPHC Financing
    1. What are the factors to be considered and negotiated for successful referral from primary to secondary care and back (in Brazil)?1. What is the most appropriate payment system to increase access and availability of quality PHC (in Croatia)?
    2. How should care be horizontally integrated and coordinated among the multidisciplinary PHC team (in South Africa)?2. What mechanisms have been found to be effective in persuading governments to invest in PHC (in Kenya)?
    3. How can the public and private sectors work more collaboratively to improve and integrate PHC coverage and prevent segmentation of the services (in Malaysia)?3. What are the factors or incentives that can improve distribution of PHC workforce or equity of accessing PHC services (in the Caribbean)?
    4. How can different stakeholders (eg, policy makers, health system managers, health workforce organizations, academic institutions and communities) support and assist the primary health care workforce and successful team functioning (in Nigeria)?4. What is the ideal proportion of the total health care budget that guarantees the development of quality PHC (in Turkey)?
    • PHC = primary health care.

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    Supplemental Appendix & Tables

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    • Supplemental data: Appendix & Tables - PDF file
  • The Article in Brief

    Primary Care Research Priorities in Low- and Middle-Income Countries

    Felicity Goodyear-Smith , and colleagues

    Background Primary health care research has advanced in high-income countries, while many low- and middle-income countries are still establishing family medicine as a specialty. As a result, capacity and funding for research on primary health care priorities in low- and middle-income countries is limited. This study aimed to identify and prioritize evidence gaps about the organization of primary health care for practitioners and researchers in low- and middle-income countries.

    What This Study Found Primary care research priorities in low- and middle-income countries include integration of care at the public/private interface, secondary care, community services, and models of care and finance to promote equitable access to care. These priorities were developed by a three-round modified Delphi expert panel of primary care practitioners and academics in low- and middle-income countries sampled from global networks using web-based surveys. They generated an initial list of more than 1,000 research ideas, which researchers synthesized into 36 organizational and 31 finance questions. The final four prioritized questions on organization address primary/secondary care transitions, horizontal integration within a multidisciplinary team, integration of private and public sectors, and ways to support successfully functioning primary health care teams. Corresponding finance questions address payment systems to increase access and availability of primary care, mechanisms to encourage governments to invest in primary care, the ideal proportion of a health care budget devoted to primary care, and factors to improve workforce distribution. Panelists have developed country-specific research implementation plans for prioritized questions, which will be presented to potential research funders.

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The Annals of Family Medicine: 17 (1)
The Annals of Family Medicine: 17 (1)
Vol. 17, Issue 1
January/February 2019
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Primary Care Research Priorities in Low-and Middle-Income Countries
Felicity Goodyear-Smith, Andrew Bazemore, Megan Coffman, Richard Fortier, Amanda Howe, Michael Kidd, Robert L. Phillips, Katherine Rouleau, Chris van Weel
The Annals of Family Medicine Jan 2019, 17 (1) 31-35; DOI: 10.1370/afm.2329

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Primary Care Research Priorities in Low-and Middle-Income Countries
Felicity Goodyear-Smith, Andrew Bazemore, Megan Coffman, Richard Fortier, Amanda Howe, Michael Kidd, Robert L. Phillips, Katherine Rouleau, Chris van Weel
The Annals of Family Medicine Jan 2019, 17 (1) 31-35; DOI: 10.1370/afm.2329
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Subjects

  • Methods:
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Keywords

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  • developing countries
  • economics
  • organization and administration
  • knowledge
  • research gaps

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