Primary care is often considered a cornerstone of health care systems, and measuring its performance plays an important role in improving system effectiveness and efficiency, and creating a focus on patients. Research suggests that health systems based on strong primary health care have better and more equitable health outcomes, are more efficient, and can achieve higher user satisfaction than health systems with only a weak primary care orientation.
In a study published in the Pan American Journal of Public Health, a World Health Organization publication, researchers at NYU Steinhardt, UCLA, and the Pan American Health Organization studied the structure and functions of primary care in Dominica, an island nation in the western Caribbean.
To document Dominica’s primary care, the researchers adapted, implemented, and combined data from two versions of the Primary Care Assessment Tools (PCAT), a set of questionnaires that evaluate primary care functions. The systems PCAT survey gathered national-level data from key informants about health system characteristics and primary care performance, and the provider version of the survey collected data on primary care performance from nurses and physicians at all primary care facilities in the country.
From the systems perspective, results showed several knowledge gaps in primary care policy, financing, and structure. Respondents gave “good” ratings for “first contact” care, continuity of care, comprehensive care, and coordinated care; moderate scores for family-centered care and community-oriented care; and low scores for access to care. Primary care providers assessed access to care, continuity of care, information systems, family-centered care, and community-oriented care as “very good”; comprehensive care as “good”; and coordinated care as “reasonable.” Overall, the scores for the country’s health districts were good, although the ratings varied by specific primary care domain.
“The assessments were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving primary care, and identification of priority areas for further investigation,” said study author Geronimo Jimenez, assistant research scientist in the Department of Nutrition, Food Studies, and Public Health at NYU Steinhardt.
“Our study could serve as a model for primary health care evaluations to be implemented in other countries moving toward the goal of making universal access to high-quality primary care a reality.”