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Research ArticleOriginal Research

Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts

Jeannie Haggerty, Fred Burge, Jean-Frédéric Lévesque, David Gass, Raynald Pineault, Marie-Dominique Beaulieu and Darcy Santor
The Annals of Family Medicine July 2007, 5 (4) 336-344; DOI: https://doi.org/10.1370/afm.682
Jeannie Haggerty
PhD
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Fred Burge
MD, MSc
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Jean-Frédéric Lévesque
MD, PhD
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David Gass
MD
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Raynald Pineault
MD, PhD
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Marie-Dominique Beaulieu
MD, MSc
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Darcy Santor
PhD
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    Figure 1.

    Evolution of primary health care dimensions in Delphi consultation.

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    Table 1.

    Attributes of Primary Health Care, Grouped by Type, Showing Specificity to Primary Health Care and Best Information Source for Measurement

    Best Information Source for Evaluation
    Attribute*Specific to Primary CarePatientClinician ReportAdministrative DataChart
    + = Appropriate source mentioned by 1 or 2 experts; ++ = best source according to several experts (this attribute was introduced at the last consensus event); +++ = best source according to all experts.
    * Attributes in alphabetical order within groupings.
    † Although the quality of comprehensiveness is not specific to primary health care, the content is.
    ‡ Proposed at the last meeting but not submitted for consensus.
    Clinical practice attributes
    Accessibility, fist-contactYes+++
    Accessibility-accommodationNot assessed
    Comprehensiveness of servicesNo (?)†++++++
    Informational continuity (new)‡Not assessed
    Management continuityNo++++
    Technical quality of clinical careNo++ (peer)++
    Practice structural dimensions
    Clinical information managementNo+++++
    Multidisciplinary teamNo++++
    Quality improvement processNo++++
    System integrationNo++++
    Person-oriented dimensions
    AdvocacyNo++++
    Continuity – relationalYes++++
    Cultural sensitivityNo++++
    Family-centered careYes+++++
    Interpersonal communicationNo++++
    RespectfulnessNo+++
    Whole-person careNo++++
    Community-oriented dimensions
    Client/community participationNo++++
    EquityNot assessed++++
    Intersectoral teamYes++++
    Population orientationYes++++
    System performance dimensions
    AccountabilityNo++ (peer) 
 + (self)++
    AvailabilityNo++ (self)++
    Efficiency/productivityNo++++
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    Table 2.

    Attributes of Primary Health Care: Final Operational Definitions and Degree of Consensus Achieved

    Concept: Operational DefinitionDegree of Consensus
    Note: New attributes were suggested at the last meeting but not submitted to the consensus process.
    * This definition is nonoperational.
    Clinical practice attributes
    First-contact accessibility: The ease with which a person can obtain needed care (including advice and support) from the practitioner of choice within a time frame appropriate to the urgency of the problemHigh
    Accessibility-accommodation: The way primary health care resources are organized to accommodate a wide range of patients’ abilities to contact health care clinicians and reach health care services. (The organization of characteristics such as telephone services, flexible appointment systems, hours of operation, and walk-in periods)New
    Comprehensiveness of services: The provision, either directly or indirectly, of a full range of services to meet patients’ health care needs. This includes health promotion, prevention, diagnosis and treatment of common conditions, referral to other clinicians, management of chronic conditions, rehabilitation, palliative care and, in some models, social servicesHigh
    Informational continuity: The extent to which information about past care is used to make current care appropriate to the patientNew
    Management continuity: The delivery of services by different clinicians in a timely and complementary manner such that care is connected and coherentHigh
    Technical quality of clinical care: The degree to which clinical procedures reflect current research evidence and/or meet commonly accepted standards for technical content or skillHigh
    Structural dimensions
    Clinical information management: The adequacy of methods and systems to capture, update, retrieve, and monitor patient data in a timely, pertinent, and confidential mannerHigh
    Multidisciplinary team: Practitioners from various health disciplines collaborate in providing ongoing health careHigh
    Quality improvement process: The institutionalization of policies and procedures that provide feedback about structures and practices and that lead to improvements in clinical quality of care and provide assurance of safetyHigh
    System integration: The extent to which the health care unit organization has established and maintains linkages with other parts of the health care and social service system to facilitate transfer of care and coordinate concurrent care between different health care organizationsHigh
    Person-oriented dimensions
    Advocacy: The extent to which clinicians represent the best interests of individual patients and patient groups in matters of health (including broad determinants) and health careModerate
    Continuity-relational: A therapeutic relationship between a patient and one or more clinicians that spans various health care events and results in accumulated knowledge of the patient and care consistent with the patient’s needsHigh
    Cultural sensitivity: The extent to which a clinician integrates cultural considerations into communication, assessment, diagnosis, and treatment planningHigh
    Family-centered care: The extent to which the clinician considers the family (in all its expressions) and understands its influence on a person’s health and engages it as a partner in ongoing health careModerate
    Interpersonal communication: The ability of the clinician to elicit and understand patient concerns, explain health care issues, and engage in shared decision making, if desiredHigh
    Respectfulness: The extent to which health professionals and support staff meet users’ expectations about interpersonal treatment, demonstrate respect for the dignity of patients, and provide adequate privacyHigh
    Whole-person care: The extent to which a clinician elicits and considers the physical, emotional, and social aspects of a patient’s health and considers the community context in their careModerate
    Community-oriented dimensions
    Client/community participation: The involvement of clients and community members in decisions regarding the structure of the practice and services provided (eg, advisory committees, community governance)Moderate
    Equity: The extent to which access to health care and quality services are provided on the basis of health needs, with-out systematic differences on the basis of individual or social characteristicsHigh
    Intersectoral team: The extent to which the primary care clinician collaborates with practitioners from nonhealth sectors in providing services that influence healthLow
    Population orientation: The extent to which the primary care clinicians assess and respond to the health needs of the population they serve. (In professional models, the population is the patient population served; in community models, it is defined by geography or social characteristics)High
    System performance
    Accountability: The extent to which the responsibilities of professionals and governance structures are defined, their performance is monitored, and appropriate information on results is made available to stakeholdersModerate
    Availability: The fit between the number and type of human and physical resources and the volume and types of care required by the catchment population served in a defined period of timeHigh
    Efficiency/productivity: Achieving the desired results with the most cost-effective use of resources*Low

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  • The Article in Brief

    Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts

    Jeannie Haggerty, PhD, and colleagues

    Background In 2004, the authors consulted with Canadian primary health care experts. Their goal was to develop definitions of key primary care system features to be evaluated in Canada�s health care system.

    What This Study Found This process resulted in 25 operational definitions of features of primary health care. Those that are specific to primary care are first-contact, accessibility, relational continuity, family-centered care, population orientation, and intersectoral teamwork. (The last 2 refer to community-oriented models of primary care.)

    Implications

    • These measurable definitions will help in efforts to assess initiatives to renew primary health care and will serve as a guide for instrument selection.
    • To get a valid and global evaluation of primary health care, data are needed from a variety of sources, including patients, clinicians, and administrative data.
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The Annals of Family Medicine: 5 (4)
The Annals of Family Medicine: 5 (4)
Vol. 5, Issue 4
1 Jul 2007
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Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts
Jeannie Haggerty, Fred Burge, Jean-Frédéric Lévesque, David Gass, Raynald Pineault, Marie-Dominique Beaulieu, Darcy Santor
The Annals of Family Medicine Jul 2007, 5 (4) 336-344; DOI: 10.1370/afm.682

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Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts
Jeannie Haggerty, Fred Burge, Jean-Frédéric Lévesque, David Gass, Raynald Pineault, Marie-Dominique Beaulieu, Darcy Santor
The Annals of Family Medicine Jul 2007, 5 (4) 336-344; DOI: 10.1370/afm.682
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