What is primary care?
In 1919 Sir Bertrand Dawson was commissioned by the new Ministry of Health to chair a council to advise on the systematised provision of health services. The report in 1920 proposed the linkage of hospitals into a single system. The report suggested that the organisation of medicine had become insufficient and was failing to bring the advance of medical knowledge adequately within the reach of the people: ‘The insufficiency of organisation has become more apparent with the growth of knowledge, and with the increasing conviction that the best means of maintaining health and curing disease should be made available to all citizens.’ [Ref-1] [Ref-Original Report]
The report outlined the following service model:’
- Doctors surgery
- Primary health centers
- Secondary health centers
- Teaching hospitals
1978 – WHO definition of PHC is the Alma Ata declaration Ref
Primary Health Care – PHC
- The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal:
- reducing exclusion and social disparities in health (universal coverage reforms)
- organizing health services around people’s needs and expectations (service delivery reforms)
- integrating health into all sectors (public policy reforms)
- pursuing collaborative models of policy dialogue (leadership reforms);
- increasing stakeholder participation
Primary Health Care – PHC
- is essential health care
- universally accessible to individuals and families in the community by means acceptable to them
- at a cost that the community and country can afford
- integral part both of the country’s health care system, of which it is the nucleus, and of the overall social and economic development of the community.
- It is the first contact of individuals, family and the community with the national health care system, bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process.
- PHC addresses the main health problems of the community, providing promotive, preventive, curative, supportive and rehabilitative services accordingly.
2018 Declaration of Astana – 30 years after Alma Ata [Ref]
On 25-26 October 2018, the world came together in Astana, Kazakhstan, at the Global Conference on Primary Health Care to renew a commitment to primary health care to achieve universal health coverage and the Sustainable Development Goals. The Conference was held at the Palace of Independence and was cohosted by the Government of Kazakhstan, WHO and UNICEF.
Barbara Starfield (Brooklyn – New York City, December 18, 1932 / Menlo Park – California, June 10, 2011) was an American pediatrician. She was an advocate for primary health care worldwide. Her academic and professional life was almost fully dedicated to the Johns Hopkins University.
Contribution of Primary Care to Health Systems and Health by BARBARA STARFIELD, LEIYU SHI, and JAMES MACINKO [Ref]
Primary Care: America’s Health in a New Era Page 33 [LINK]
“The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of the family and the community.”
BOX 2-1 DEFINITION OF PRIMARY CARE
Primary care in the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
Integrated is intended in this report to encompass the provision of comprehensive, coordinated, and continuous services that provide a seamless process of care. Integration combines events and information about events occurring in disparate settings, levels of care and over time, preferable throughout the life span. Comprehensive. Comprehensive care addresses any health problem at any given stage of a patient’s life cycle. Coordinated. Coordinated ensures the provision of a combination of health services and information that meets a patient’s needs. It also refers to the connection between, or the rational ordering of, those services, including the resources of the community. Continuous. Continuity is a characteristic that refers to care over time by a single individual or team of health care professionals (“clinician continuity”) and to effective and timely communication of health information (events, risks, advice, and patient preferences) (“record continuity”).
Accessible refers to the ease with which a patient can initiate an interaction for any health problem with a clinician (e.g., by phone or at a treatment location) and includes efforts to eliminate barriers such as those posed by geography, administrative hurdles, financing, culture, and language.
Health care services refers to an array of services that are performed by health care professionals or under their direction, for the purpose of promoting, maintaining, or restoring health (Last, 1988). The term refers to all settings of care (such as hospitals, nursing homes, clinicians’ offices, intermediate care facilities, schools, and homes).
Clinician means an individual who uses a recognized scientific knowledge base and has the authority to direct the delivery of personal health services to patients.
Accountable applies to primary care clinicians and the systems in which they operate. These clinicians and systems are responsible to their patients and communities for addressing a large majority of personal health needs through a sustained partnership with a patient in the context of a family and community and for (1) quality of care, (2) patient satisfaction, (3) efficient use of resources, and (4) ethical behavior.
Majority of personal health care needs refers to the essential characteristic of primary care clinicians: that they receive all problems that patients bring— unrestricted by problem or organ system—and have the appropriate training to diagnose and manage a large majority of those problems and to involve other health care practitioners for further evaluation or treatment when appropriate. Personal health care needs include physical, mental, emotional, and social concerns that involve the functioning of an individual.
Sustained partnership refers to the relationship established between the patient and clinician with the mutual expectation of continuation over time. It is predicated on the development of mutual trust, respect, and responsibility.
Patient means an individual who interacts with a clinician either because of illness or for health promotion and disease prevention.
Context of family and community refers to an understanding of the patient’s living conditions, family dynamics, and cultural background. Communities refers to the population served, whether they are patients or not. Community can refer to a geopolitical boundary (a city, county, or state), or to neighbors who share values, experiences, language, religion, culture, or ethnic heritage.
- ‘Is more than just the level of care or gate keeping; it is a key process in the health system. It is first-contact, accessible, continued, comprehensive and coordinated care.
- First-contact care is accessible at the time of need;
- Ongoing care focuses on the long-term health of a person rather than the short duration of the disease;
- Comprehensive care is a range of services appropriate to the common problems in the respective population and
- Coordination is the role by which primary care acts to coordinate other specialists that the patient may need.
- PC is a subset of PHC’.
Primary Care (PC) and Primary Health Care (PHC)
What is the Difference?
Primary Care and Primary Health Care are very similar terms which are often employed interchangeably, but which are also used to denote quite different concepts. Much time and energy is spent discussing which term is the appropriate one for a particular application. There is a growing recognition internationally that the two terms describe two quite distinct entities. Recent Canadian uses of the two terms are, for the most part, consistent with the international uses. Primary Care, the shorter term, describes a narrower concept of “family doctor-type” services delivered to individuals. Primary Health Care is a broader term which derives from core principles articulated by the World Health Organization and which describes an approach to health policy and service provision that includes both services delivered to individuals (Primary Care services) and population- level “public health-type” functions. [Ref]