Table 1 Operational definitions of primary healthcare attributes and best data sources for their assessment
Attribute | Operational Definition | Best data source |
|---|---|---|
Clinical practice attributes dimension | ||
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. | Patient |
Accessibility-accommodation | The way primary healthcare resources are organized to accommodate a wide range of patients' abilities to contact healthcare clinicians and reach healthcare services. | Patient |
Comprehensiveness of services | The provision, either directly or indirectly, of a full range of services to meet patients' healthcare 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. | Patient, provider, administrative |
Informational continuity Management continuity | The extent to which information about past care is used to make current care appropriate to the patient The delivery of services by different clinicians in a timely and complementary manner such that care is connected and coherent. | Patient |
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. | Provider, chart audit |
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 healthcare. | Patient |
Relational continuity- | A therapeutic relationship between a patient and one or more clinicians that spans various healthcare events and results in accumulated knowledge of the patient and care consistent with the patient's needs. | Patient |
Cultural sensitivity | The extent to which a clinician integrates cultural considerations into communication, assessment, diagnosis and treatment planning. | Patient |
Family-centred 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 healthcare. | Patient |
Interpersonal communication | The ability of the clinician to elicit and understand patient concerns, explain healthcare issues and engage in shared decision making, if desired. | Patient |
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. | Patient |
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 the patient's care. | Patient |
Community-oriented dimensions | ||
Client/community participation | The involvement of clients and community members in decisions regarding the structure of the practice and services provided (e.g. advisory committees, community governance). | Patient, provider |
Equity | The extent to which access to healthcare and quality services are provided on the basis of health needs, without systematic differences on the basis of individual or social characteristics. | All |
Intersectoral team | The extent to which the primary care clinician collaborates with practitioners from non-health sectors in providing services that influence health. | Provider |
Population orientation | The extent to which the primary care clinicians assess and respond to the health needs of the population they serve. | Patient, provider |
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. | Provider |
Multidisciplinary team | Practitioners from various health disciplines collaborate in providing ongoing healthcare. | Provider |
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. | Provider |
System integration | The extent to which the healthcare unit organization has established and maintains linkages with other parts of the healthcare and social service system to facilitate transfer of care and coordinate concurrent care between different healthcare organizations. | Provider |
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. | Provider |
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. | Administrative |
Efficiency/productivity | Achieving the desired results with the most cost-effective use of resources. | Administrative |