| |  | Haggerty, J. | Operational definitions of attributes of primary health care: consensus among Canadian experts read moreAbstract: PURPOSE: In 2004, we undertook a consultation with Canadian primary health care experts to define the attributes that should be evaluated in predominant and proposed models of primary health care in the Canadian context. METHOD: Twenty persons considered to be experts in primary health care or recommended by at least 2 peers responded to an electronic Delphi process. The expert group was balanced between clinicians (principally family physicians and nurses), academics, and decision makers from all regions in Canada. In 4 iterative rounds, participants were asked to propose and modify operational definitions. Each round incorporated the feedback from the previous round until consensus was achieved on most attributes, with a final consensus process in a face-to-face meeting with some of the experts. RESULTS: Operational definitions were developed and are proposed for 25 attributes; only 5 rate as specific to primary care. Consensus on some was achieved early (relational continuity, coordination-continuity, family-centeredness, advocacy, cultural sensitivity, clinical information management, and quality improvement process). The definitions of other attributes were refined over time to increase their precision and reduce overlap between concepts (accessibility, quality of care, interpersonal communication, community orientation, comprehensiveness, multidisciplinary team, responsiveness, integration). CONCLUSION: This description of primary care attributes in measurable terms provides an evaluation lexicon to assess initiatives to renew primary health care and serves as a guide for instrument selection. | 2007 |
| | | Gofin, Jaime | Community-Oriented Primary Care and Primary Health Care read moreAbstract: Sorry no abstract available for this article | 2005 |
| | | Dresang, L. T. | Family medicine in Cuba: community-oriented primary care and complementary and alternative medicine read moreAbstract: Family physicians in Cuba and the United States operate within very different health systems. Cubas health system is notable for achieving developed country health outcomes despite a developing country economy. The authors of this study traveled to Cuba and reviewed the literature to investigate which practices of Cuban family physicians might be applicable for US family physicians wishing to learn from the Cuban experience. We found that community-oriented primary care (COPC) and complementary and alternative medicine (CAM) are well developed within the Cuban medical system. Because COPC and CAM are already recommended by US family medicine professional bodies, US family physicians may want to learn from the Cuban experience and perhaps incorporate elements into their individual practices. | 2005 |
| | | Al-Assaf, Assaf | Quality improvement in primary health care: a practical guide read moreAbstract: Sorry no abstract available for this article | 2004 |
| | | Haggerty, Jeannie L. | Continuity of care: a multidisciplinary review read moreAbstract: Sorry no abstract available for this article | 2003 |
| | | Mullan, F. | Community-oriented primary care: new relevance in a changing world read moreAbstract: Since its inception in rural, pre-apartheid South Africa, community-oriented primary care (COPC) has intrigued and informed public health and primary care leaders worldwide. COPC has influenced such programs as the US community health center movement, the general practice movement in the United Kingdom, and recent reforms in the public health system of South Africa. We provide a global overview of COPC, tracing its conceptual roots, reviewing its many manifestations, and exploring its future prospects as an organizational paradigm for the democratic organization of community health services. We examine the pitfalls and paradoxes of COPC and suggest its future utility. COPC has important values and methods to offer disparate but powerful movements in public health worldwide. | 2002 |
| | | Longlett, S. K. | Community-oriented primary care: historical perspective read moreAbstract: BACKGROUND: Community-oriented primary care (COPC) is a systematic approach to health care based upon principles derived from epidemiology, primary care, preventive medicine, and health promotion. We describe the development of COPC from an historical perspective. A critical assessment of current trends and implication for physician education and practice of COPC will be discussed in a companion article in the next issue of The Journal. METHODS: MEDLINE was searched using the key phrase community-oriented primary care Other sources of information included books and other documents. RESULTS AND CONCLUSIONS: In the 1950s, Sydney Kark showed dramatic positive changes in the health status of the population of Pholela, South Africa, using this approach. Similar approaches showed positive change in the health status of poor and underserved populations in the United States. The results were so impressive that the Institute of Medicine recommended widespread application of COPC in the United States. Successful COPC practices, however, have historically required considerable external funding from private and government sources. Thus, controversy about the feasibility of implementation of COPC in mainstream primary care practices developed. Schools of medicine and the discipline of family medicine have struggled to implement effective training in COPC within traditional medical school and residency structures. Yet, the societal need for recognition of and intervention in community health problems and coordination of community health resources continues. | 2001 |
| | | Walsh, J. A. | Selective primary health care: an interim strategy for disease control in developing countries read moreAbstract: Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year. | 1979 |
| | | Newell, K. W. | Health by the People read moreAbstract: In this book 10 groups of people describe the dramatic changes in the delivery of health care that occurred in their areas or countries. Their starting points were different, as were their methods and the end results, but all are successes. This chapter examines some of the goals, the methods, and the results to determine if their were some general principles that could be used to help other countries and communities to improve their health. In all of the examples described the new system of primary health care was either linked with the indigenous system or attempted to play a role having some of the same qualities that existing systems had. Each country or area also started with the formation, reinforcement, or recognition of a local community organization. This appeared to have 5 relevant functions: it laid down the priorities; it organized community action for problems that could not be resolved by individuals; it controlled the primary health care service by selecting, appointing, or legitimizing the primary health worker; it assisted in financing services; and it linked health actions with wider community goals. Another common element is the use of a primary health care worker who does not fit the expected description of a doctor or nurse. Frequently, this person is a villager selected by the community and trained locally for a period that could be as short as 3-4 months initially, an unpaid volunteer, or a person possibly partially or totally supported by the village people in cash or kind, and with responsibilities for aspects of promotional, preventive, or curative health. The relationship of the primary health worker to the remainder of the health services warrants a separate study. In no example presented is there a separation of the promotional, preventive, and curative health actions at the primary health care level. Arguments for a linkage between financing and service are not so clear. The need for primary health care to be self sufficient has been expressed many times. The examples presented fall into 3 overlapping types: national change (China, Cuba, Tanzania); extensions of the existing system (Iran, Niger, and Venezuela); and local community development (Guatemala, India, and Indonesia). The countries that started the process of national change by a political process have a clear advantage in speed and coherence, but the forces that influence such a change are beyond the scope of this discussion. It is concluded that in most countries health development as a part of rural development is possible if one goes about it in acceptable ways. These ways include the quick evolution of a village based development organization and a primary health care system designed for that country and accompanied by a parallel national effort to build such a peripheral expession into the national scene. | 1975 |
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