[EQ] Reinventing primary health care: the need for systems integration

Reinventing primary health care: the need for systems integration

 

Julio Frenk, Harvard School of Public Health, Boston, MA, USA

The Lancet, Volume 374, Issue 9684, Pages 170 - 173, 11 July 2009

 

Available online at:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60693-0/fulltext

 

“……..The world has come a long way since the Alma Ata Declaration 30 years ago. However, achievements have fallen short of expectations. This is therefore the time to launch a renewed effort to strengthen health systems as the fundamental strategy for integrating primary health care.

 

“…………..In particular, the developments in telecommunications such as mobile phones are mobilising cutting-edge innovations that are now available even in the poorest communities. Appropriate technology should no longer be identified with primitive methods. Nowadays a patient can be diagnosed and treated in the first level of care in a rural community by a provider working in a high-specialty urban hospital.

 

Therefore, we should be able to launch a fundamental shift from the rigid pyramidal structures that have prevailed in the health sector to adaptable networks that improve access to all levels of care. A related transformation means moving beyond health centres, which by definition concentrate human and technological resources, into health spaces, which extend the reach of comprehensive care into schools, workplaces, recreational areas, and the homes of those who live with a chronic condition.

The present interest by major global health actors in strengthening health systems offers a unique opportunity. We have to take advantage of this opportunity to reinvent primary health care for the 21st century. We should leave behind the ideological debates of the past and focus instead on developing primary care networks that are seamlessly integrated into the rest of the health system.

 

The vision is thus to assure that high-quality services are provided on the basis of a defined population, through proactive strategies, favouring continuity of care, guaranteeing an explicit set of entitlements, and assuring universal social protection in health. Therein may lie the key to finally unlocking the full potential of Alma Ata………….”

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[EQ] Survey of Primary Care Physicians in Eleven Countries, 2009: Perspectives on Care, Costs, and Experiences

A Survey Of Primary Care Physicians In Eleven Countries, 2009:
Perspectives On Care, Costs, And Experiences

Cathy Schoen, senior vice president, Research and Evaluation, at the Commonwealth Fund in New York City
Robin Osborn, vice president, International Program in Health Policy and Practice, at the Commonwealth Fund
Michelle Doty, assistant vice president, Survey Research; and David Squires, a program associate, International Program
Jordon Peugh, vice president, Government and Academic Research, at Knowledge Networks in New York City
Sandra Applebaum, research manager at Harris Interactive, New York City
Health Affairs, 28, no. 6 (2009): w1171-w1183  Published online 2 November 2009) doi: 10.1377/hlthaff.28.6.w1171

Website: http://content.healthaffairs.org/cgi/content/full/28/6/w1171

“…..This 2009 survey of primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States finds wide differences in practice systems, incentives, perceptions of  access to care, use of health information technology (IT), and programs to improve quality.

Response rates exceeded 40 percent except in four countries: Canada, France, the United Kingdom, and the United States. U.S. and Canadian physicians lag in the adoption of IT. U.S. doctors were the most likely to report that there are insurance restrictions on obtaining medication and treatment for their patients and that their patients often have difficulty with costs. We believe that opportunities exist for cross-national learning in disease management, use of teams, and performance feedback to improve primary care globally. ^….”

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[EQ] Disparities in Chronic Disease Among Canada's Low-Income Populations

Disparities in Chronic Disease Among Canada’s Low-Income Populations

Raymond Fang, Andrew Kmetic, John Millar, Lydia Drasic
Prev Chronic Dis 2009;6(4) - Volume 6: No. 4, October 2009

Available online at: http://www.cdc.gov/pcd/issues/2009/oct/08_0254.htm

Introduction
Many studies have found inequities in health among income groups in Canada. We report the variations in the major chronic disease risks among low-income populations, by province of residence, as a proxy measure of social environment.

Methods
We used estimates from the 2005 Canadian Community Health Survey to study residents who were aged 45 years or older and from the lowest income quintile nationally. Multivariate logistic regression was used to examine the relationship between province of residence and risk of chronic diseases.

Results
British Columbia is the healthiest province overall but not in terms of its low-income residents, whereas Quebec’s low-income residents are at the least risk for major chronic diseases. The significant differences in risk of hypertension, diabetes, and heart disease in favor of British Columbia over Quebec for the entire population disappear when considering only the low-income subset.

Conclusions
Quebec’s antipoverty strategy, formalized as law in 2002, has led to social and health care policies that appear to give its low-income residents advantages in chronic disease prevention. Our findings demonstrate that chronic disease prevalence is associated with investment in social supports to vulnerable populations.

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