NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands.
BMC Fam Pract. 2010 Oct 27;11:81. doi: 10.1186/1471-2296-11-81.
Scientific 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.
A 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).
The 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.
A 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.
科学研究已经提供了有关完善的初级保健系统益处的证据。但是，其中一些研究对欧洲的情况相关性有限。目前，缺乏有关初级保健发展差异的最新、全面和可比的信息，也缺乏了解有利于加强欧洲初级保健的结构和战略。该 EC 资助项目“欧洲初级保健活动监测器”（PHAMEU）旨在通过开发用于 31 个欧洲国家的初级保健监测系统（PC Monitor）来填补这一空白。本文介绍了 PC Monitor 指标的开发情况，这将使我们能够创建一个用于全面分析初级保健的替代模型。
对 2003 年至 2008 年 7 月期间发表的初级保健文献进行了系统回顾。这导致了以下方面的概述：（1）初级保健的各个方面及其与（初级）卫生系统水平结果的相关性；（2）每个方面的基本特征；（3）用于衡量初级保健维度特征的应用指标。项目团队根据相关性、精确性、灵活性和区分能力标准对指标进行了评估。由来自不同欧洲国家的初级保健专家组成的小组对该指标集进行了评估，以确定其在欧洲范围内比较初级保健系统的适宜性（代表各种初级保健系统）。
所开发的 PC Monitor 将欧洲的初级保健视为一个多维概念。它描述了初级保健系统的主要维度，分为三个层次：结构、过程和结果水平。在结构层面上，它包括治理、经济条件和劳动力发展方面的指标。在过程层面上，指标描述了初级保健服务的可及性、全面性、连续性和协调性。在结果层面上，指标反映了初级保健的质量和效率。
基于科学证据和国际专家小组的共识，已经开发出一种用于描述和比较初级保健系统的标准化工具，将对欧洲所有初级保健配置进行测试，旨在提供可比信息。该工具的广泛使用有可能提高对不同国家背景下初级保健提供情况的理解，从而为更好的决策创造机会。
