Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts

Abstract

PURPOSE In 2004, we undertook a consultation with Canadian primary health care experts to defi ne 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 defi nitions. Each round incorporated the feedback from the previous round until consensus was achieved on most attributes, with a fi nal consensus process in a face-to-face meeting with some of the experts. RESULTSOperational defi nitions were developed and are proposed for 25 attributes; only 5 rate as specifi c 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 defi nitions of other attributes were refi ned 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. Med;5:336-344. DOI: 10.1370/afm.682. Ann Fam INTRODUCTIONH ealth systems based on a strong primary health care system are more effective and effi cient than those centered on specialty and tertiary care.1 In Canada, various national and provincial commissions on health care [2][3][4][5][6][7][8] concluded that strengthening and expanding primary health care will meet Canadians' needs for prompt access to comprehensive evidence-based services. Major initiatives have also been undertaken in New Zealand and the United Kingdom to strengthen primary health care. 9,10 As health systems worldwide engage in evaluation efforts to assess the impacts of primary health care renewal initiatives, there is a critical need to provide evaluation frameworks and tools to facilitate these efforts.An important starting point for evaluation is an operational defi nition of the dimension being evaluated. An operational defi nition is a description of a concept in measurable terms. It is used to remove ambiguity, to serve as a guide for the selection of measurement tools, and to reduce the likelihood of disparate results between different data collections. 337 AT T R IBU T ES O F PR IM A RY HE A LT H C A R Edevelop a common lexicon of operational defi nitions of attributes to be evaluated in predominant and emerging models of primary health care in Canada, but many of these defi nitions will be relevant to primary health care mode...

Perception of ‘Comprehensiveness of Care’: a qualitative study amongst dentists in the Brazilian Health System

“…It is a large city, with an area of 330 km 2 and approximately 2,400,000 inhabitants. Data collection occurred between November and December 2011.…”

“…1 To obtain any measurement strategy to assess how well comprehensiveness is understood and achieved, it is essential to have a clear operational definition of the concept, especially among human resources. 2 The term is defined from two different perspectives: the first is the comprehensive services, and the second is whole-person care. 2,3 The interpretation of and debate about the meanings of comprehensiveness are all derived from the relationships between patients, health professionals and managers within the service.…”

“…2 The term is defined from two different perspectives: the first is the comprehensive services, and the second is whole-person care. 2,3 The interpretation of and debate about the meanings of comprehensiveness are all derived from the relationships between patients, health professionals and managers within the service. These interrelations converge at the Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.…”

“…1,4,5 General concepts of 'patient welcoming,' 'bonding' and 'quality of care' have been applied and used to evaluate the comprehensiveness approach. 1,2,5,6,7 It is important for the comprehensiveness element to be reinforced in the critical awareness of health professionals and the community to enable the realisation of transformative actions. 2,5 The importance of comprehensiveness for oral health outcomes involves strengthening community actions, developing personal skills and reorienting health services.…”

“…1,2,5,6,7 It is important for the comprehensiveness element to be reinforced in the critical awareness of health professionals and the community to enable the realisation of transformative actions. 2,5 The importance of comprehensiveness for oral health outcomes involves strengthening community actions, developing personal skills and reorienting health services. This approach could also generate a longer lasting, effective and efficient treatment, decreasing the likelihood of a patient returning in a short time.…”