The importance of measuring and improving the strength of primary care in Europe: results of an international comparative study
Journal Name:
- Türkiye Aile Hekimliği Dergisi
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Keywords (Original Language):
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Abstract (2. Language):
Strong primary care (PC) is supposed to improve the capacity of a country to achieve a responsive, high quality and cost-effective health care system. The available evidence-base supporting pro-pri¬mary care policies originates from studies with a limited geograph¬ical scope, narrow use of dimensions to measure PC strength, and use relatively old data. The recently published PhD Thesis by Dionne Sofia Kringos (Health Systems Researcher from The Netherlands) aimed to get insight into the elements that form (the strength of) primary care in Europe and their impact on health care system out¬comes. This article summarizes the results of this work, which has been published in more detail in different scientific publications. The strength of PC was measured by 3 dimensions of PC structure: PC governance, PC workforce development, and economic condi¬tions of PC. The strength of PC services delivery process was meas¬ured by 4 dimensions of: accessibility, continuity, coordination, and comprehensiveness of PC. The PC dimensions were operationalized by a total of 77 indicators for which data was collected in 31 European countries. The results show variation in PC strength across Europe, indicating a discrepancy in the responsibility given to PC in (inter)national policy initiatives and the needed investments in PC to solve e.g. future shortages of workforce. Countries are con¬sistent in their PC focus on all important structure dimensions. Countries need to improve their PC information infrastructure to facilitate PC performance management. This study was able to show that strong PC has a positive impact on population health, reducing disparity in health, and avoiding unnecessary hospitaliza-tions.
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Abstract (Original Language):
Guglu bir birinci basamak (BB), bir ulkenin turn gereksinimlere yanit veren, yuksek nitelikli ve maliyet etkili bir saglik sistemine ulajma ka-pasitesine katkida bulunacaktir. $u anda var olan ve BB saglik hiz-metlerini onceleyen politikalara temel olujturan kanitlar, dar cograf-yalarda yapilmij, sinirli olgutlerin kullanildigi ve gorece eski verilere dayanan galijmalardan gelmektedir. Hollanda'da Saglik Sistemleri Arajtirmacisi olan Dionne Sofia Kringos'un yakin zamanda yayinlan-mifl doktora tezi, Avrupa'da BB'yi (ve onun gucunu) olujturan bile-jenleri ve bunlarin saglik sistemi gktilari uzerindeki etkisini inceleme-yi amaglamaktadir. Bu makalede farkli yerlerde yayinlanmifl soz ko-nusu galijmanin sonuglari ozetlenmektedir. Birinci basamagin yapisal gucu, bu yapinin ug boyutu ile olgulmujtur: Yonetim, BB ijgucunun gelijmijligi ve ekonomik kojullar. Birinci basamak saglik hizmetleri sunumu surecinin gucu ise dort boyutta degerlendirilmifltir: Eriflilebi-lirlik, sureklilik, ejgudum ve kapsamlilik. Bu boyutlar, 31 Avrupa ul-kesinden toplanan verilerde toplamda 77 gosterge kullanilarak de-gerlendirilmifltir. Sonuglar Avrupa ulkelerinin birinci basamagin gucu agisindan farkliliklar gosterdigini ortaya koymakta ve ulusal veya uluslararasi politika yapicilarin birinci basamaga yukledikleri sorumlu-luk ve ornegin gelecekteki ijgucu agiginin gozumu igin birinci basa-makta gereksinim duyulan yatirim bakimindan ayrijmalara ijaret et-mektedir. Ulkeler, tum onemli yapisal boyutlar agisindan tutarli bir jekilde BB odaklidirlar ve daha iyi bir performans yonetimi saglayabil-mek igin BB bilgi altyapilarini gelifltirmelidirler. Bu galijma, guglu bir birinci basamagin toplum sagligi uzerindeki olumlu etkisini, ejitsizlik-lerin azaltilmasinda ve gereksiz hastane yatifllarinin onlenmesindeki katkisini gostermektedir.
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