Attributes of Primary Health Care: Final Operational Definitions and Degree of Consensus Achieved
| Concept: Operational Definition | Degree 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 problem | High |
| 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 services | High |
| Informational continuity: The extent to which information about past care is used to make current care appropriate to the patient | New |
| Management continuity: The delivery of services by different clinicians in a timely and complementary manner such that care is connected and coherent | High |
| 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 skill | High |
| 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 manner | High |
| Multidisciplinary team: Practitioners from various health disciplines collaborate in providing ongoing health care | High |
| 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 safety | High |
| 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 organizations | High |
| 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 care | Moderate |
| 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 needs | High |
| Cultural sensitivity: The extent to which a clinician integrates cultural considerations into communication, assessment, diagnosis, and treatment planning | High |
| 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 care | Moderate |
| Interpersonal communication: The ability of the clinician to elicit and understand patient concerns, explain health care issues, and engage in shared decision making, if desired | High |
| 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 privacy | High |
| 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 care | Moderate |
| 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 characteristics | High |
| Intersectoral team: The extent to which the primary care clinician collaborates with practitioners from nonhealth sectors in providing services that influence health | Low |
| 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 stakeholders | Moderate |
| 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 time | High |
| Efficiency/productivity: Achieving the desired results with the most cost-effective use of resources* | Low |