Publicatie datum

The delivery of primary care services.

Wilson, A., Windak, A., Oleszczyk, M., Wilm, S., Hasvold, T., Kringos, D. The delivery of primary care services. In: Kringos, D.S., Boerma, W.G.W., Hutchinson, A., Saltman, R.B. Building primary care in a changing Europe. Kopenhagen: World Health Organization, 2015. 67-102
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This chapter will be devoted to the dimensions which have been grouped in the framework as “process” and that focus on essential features of service delivery in primary care. In addition to the breadth of services delivered, a comparative overview will be provided of variation in access to services, and continuity and coordination of care. In addition to the volume and type of primary care services, accessibility is determined by the remoteness of services and the practice organization (e.g. appointment system, after-hours care arrangements, (home visits). Financial barriers, such as co-payments, determine the financial accessibility of primary care. The extent to which access to primary care services is provided on the basis of health needs, without systematic differences on the basis of individual or social characteristics, indicates the level of equality in access that is achieved. Continuity of care comprises relationship and management continuity. The coordination function reflects the ability of primary care providers to coordinate use of services within primary care and in other levels of health care. It is determined by the presence of a gatekeeping system, practice structure and teamwork, diversification and substitution of primary care providers, and integration and collaboration of primary care with secondary care and the public health sector. This chapter will conclude with a mapping exercise of the breadth of services delivered, accessibility, continuity and coordination of care in countries across Europe, showing also the interrelations across dimensions. (aut. ref.)