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

Background
A suitable definition of primary care to capture
the variety of prevailing international organisation
and service-delivery models is lacking.
Aim
Evaluation of strength of primary care in Europe.
Design and setting
International comparative cross-sectional
study performed in 2009–2010, involving 27
EU member states, plus Iceland, Norway,
Switzerland, and Turkey.
Method
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.
Results
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.
Conclusion
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.