Primary care. On the mend?

Alternative provider medical services contracts are encouraging primary care trusts to innovate in the way they invite tenders--but private companies have had mixed success in winning business. However, now the situation seems to be changing, with about half of all out-of-hours contracts run under APMS rules and a small number of prison and general practice 'wins'.     

Primary care. Who's sorry now?

Almost two-thirds of health authorities believe their relationships with GPs have improved since the merger. Forty-four percent of LMCs think there has been no change, and 42 per cent report a deterioration. More than half the LMCs believe knowledge and understanding of GPs' contracts, and payments, have declined since the merger.     

„Primary Health Care“ und Urbanisierung

Background

The world of the twenty-first century will be a predominantly urban world. By the year 2008, for the first time in human history, more people were residing in cities than in rural areas. The process of urbanization was mostly completed in the industrialized countries by the mid-twentieth century. In developing countries, however, both number and proportion of city dwellers are increasing.

Methods

To review the process of urbanization in developing countries, its relevance for the social and health situation of urban populations and the consequences arising thereof for the concept of Primary Health Care (PHC).

Results

A rapid urbanization poses great challenges to city councils, e. g. concerning infrastructure and distribution of societal wealth. Today, the process of urbanization is accompanied by a lack of jobs in the formal sector and a change in lifestyle which is not conducive to health, e.g. high calorie and fatty foods. A disaggregation of the health situation shows strong intra-city differentials between wealthy neighbourhoods and slum areas. Slum dwellers remain exposed to communicable diseases and are in addition at risk for non-communicable, chronic diseases. Many of the most prevalent health problems have social causes. Such health problems will persist as long as their social causes are not mended. Evidence-based interventions for tackling social causes of illness are lacking, however.

Discussion

Urbanization poses new challenges to PHC. The present strategies, e.g. prevention, are often restricted to health symptoms and reach the middle classes rather than the urban poor. Instead, strategies directed towards a more human urbanization are required. They would have to make full use of the primary health care approach.     

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care–Sensitive Conditions

PURPOSEWe aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care–sensitive conditions.METHODSWe conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care–sensitive infectious and chronic conditions.RESULTSThere were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care–referred admissions was falling before the reforms, and there were further sharp reductions in 2004.CONCLUSIONSThe introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care–sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care–sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission.     

„Primary Health Care“ und Effizienz der Gesundheitsversorgung

Background

: The Alma-Ata Declaration does not use the term “efficiency.” The economic dimension of health care is mentioned, but economic considerations are not used as rationale for the concept of primary health care (PHC). It is the objective of this paper to demonstrate that the striving for efficiency strongly supports the necessity to implement the core elements of Alma-Ata. Furthermore, this article analyses whether PHC has potential for the health care systems of some regions of Germany.

Methods

This paper elaborates on the basic concept of efficiency and demonstrates the relationship of PHC and health economics. Based on the example of the healthcare system in Mecklenburg-Vorpommern, a state in northeastern Germany, it is demonstrated that applying different economic approaches will result in quite different health care systems, with strong consequences for the population in this lightly populated area.

Conclusions

An efficient health care system leads to a concept that is quite similar to PHC. Thus, economic thinking is a rationale for the need to implement PHC. It can be shown that PHC was not only an appropriate approach for developing countries 30 years ago but that it is of great relevance for some regions in Germany in the new millennium.     

Primary health care in Turkey: a passing fashion?

The Alma-Ata Declaration has long been regarded as a watershed in the health policy arena. The global goal of the World Health Organization, 'Health for All by the Year 2000' through primary health care, has attracted many countries both in the developed and the developing world and commitments to this end have been made at every level. However, albeit this consensus on the paper, a common and explicit definition of the concept has not been reached yet. This paper aims at discussing various definitions of primary health care that emerged after the Declaration and also presenting a case study from Turkey, a country that advocates primary health care in her recent health policy reform attempts. After setting the conceptual framework for discussion the Turkish case is presented by using research carried out among Turkish policy-makers at different levels of the State apparatus. It has been concluded that application of primary health care principles as defined in the broad definition of the concept requires major changes or rather shake-ups in Turkey. These areas are outlined briefly at the end of the paper.     

Primary care: is there enough time for prevention?

OBJECTIVES: We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. METHODS: We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. RESULTS: To fully satisfy the USPSTF recommendations, 1773 hours of a physician's annual time, or 7.4 hours per working day, is needed for the provision of preventive services. CONCLUSIONS: Time constraints limit the ability of physicians to comply with preventive services recommendations.