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