Family medicine attributes related to satisfaction, health and costs

OBJECTIVE

To identify, from a systematic review of the literature, the attributes of Family Medicine (FM) that influence the primary health care outcome as measured by users' satisfaction, improvement in patient health and in costs.

DATA SOURCES

Literature search of Medline and the Cochrane library using MeSH terms 'Primary Health' or 'Family Practice' or 'Family Physicians' and 'Outcome Assessment' or 'Process Assessment'. Papers were excluded if they lacked a based on primary data, if no single component of FM was assessed; if indicators of evaluation were not related to health, satisfaction or costs.

RESULTS

A total of 356 articles were initially identified and 19 finally met the inclusion criteria. Study methods were a systematic review of randomized control trials, a double-blind randomized trial, 4 systematic reviews of observational studies, 2 cohort studies and 12 descriptive cross-sectional studies.

CONCLUSIONS

There was evidence of relationships between the attributes of FM and the service outcomes measured by indicators of satisfaction, health and cost. User satisfaction was associated with accessibility, continuity of care, consultation time and the doctor-patient relationship. Improvement in patient's health was related to continuity, consultation time, doctor-patient relationship and the implementation of preventive activities. Coordination of care showed mixed results with health outcomes. Continuity, consultation time, doctor-patient communication and prevention were cost-effective in the primary care setting.

El producto de la atención primaria definido por profesionales y usuarios

OBJECTIVE

To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation.

METHODS

Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account.

RESULTS

Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified.

CONCLUSION

There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.