The strength of primary care in Europe: an international comparative study

TLDR

A suitable definition of primary care that captures the diverse international organisation and service‑delivery models is lacking, prompting a 2009‑2010 cross‑sectional study of 31 European countries that evaluated primary‑care strength across governance, economic, workforce, accessibility, comprehensiveness, continuity, and coordination dimensions. The study operationalised these dimensions with 77 indicators, collecting data from national and international literature, governmental publications, statistical databases, and expert consultations across 31 countries. The study found marked variation in primary‑care strength across Europe, with Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK ranking strongest; most countries either have extensive policies and resources or very few, yet there is no correlation between access, continuity, coordination, and comprehensiveness, underscoring a need for better information infrastructure to support performance management.

Abstract

A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking.Evaluation of strength of primary care in Europe.International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey.Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations.Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries.Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.