BackgroundA suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking.

BackgroundScientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited.There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU) aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor) for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care.MethodsA systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1) the dimensions of primary care and their relevance to outcomes at (primary) health system level; (2) essential features per dimension; (3) applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems).ResultsThe developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators reflect the quality, and efficiency of primary care.ConclusionsA standardized instrument for describing and comparing primary care systems has been developed based on scientific evidence and consensus among an international panel of experts, which will be tested to all configurations of primary care in Europe, intended for producing comparable information. Widespread use of the instrument has the potential to improve the understanding of primary care delivery in different national contexts and thus to create opportunities for better decision making.

L’article rapporte un programme de patients-enseignants (PEP13) conçu en collaboration avec des patients, un laboratoire éducations et pratiques de santé (LEPS) EA3412 et le Département universitaire de médecine générale (DUMG) de la faculté de médecine de l’université Paris 13. PEP13 s’adosse au principe selon lequel la perspective des patients permet d’améliorer la qualité des soins au moyen de la formation d’internes en médecine générale. L’article décrit PEP13, les recherches qui l’encadrent et présente leurs premiers résultats. Sont questionnés les effets de PEP13 sur les apprentissages des internes et les conditions permettant à terme sa transférabilité à d’autres facultés de médecine. La partie conceptuelle de la recherche s’adosse à la théorie du cours d’action. À ce stade de l’expérience, le constat est fait que les patients-enseignants promeuvent des soins respectueux des droits et de la dignité des malades, interrogent les habitus , apportent des connaissances sur le système de santé, sur ses lois récentes. Ils font preuve de compétences émotionnelles, pédagogiques, et relationnelles. Le succès actuel du programme repose sur la détermination d’un DUMG, son adossement à un laboratoire de recherche, l’intégration de patients-leaders dans le DUMG, l’effort apporté au recrutement des patients et sur le fait que les contenus pédagogiques constitutifs de la perspective des patients sont issus d’une élaboration collective.

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