Published 2 April 2009, doi:10.1136/bmj.b1242
Cite this as: BMJ 2009;338:b1242

Analysis

Quality in primary health care: a multidimensional approach to complexity

Iona Heath, general practitioner1, Adolfo Rubinstein, professor of family medicine and public health, president2,3, Kurt C Stange, professor of family medicine, epidemiology and biostatistics, sociology, and oncology4, Mieke L van Driel, professor of general practice5,6

1 Caversham Group Practice, London NW5 2UP, 2 Division of Family and Community Medicine, Hospital Italiano, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina, 3 Institute of Clinical Effectiveness and Health Policy, Buenos Aires, 4 Case Western Reserve University, Cleveland, OH 44106, USA, 5 Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld 4229, Australia , 6 Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium

Correspondence to: I Heath iona.heath@dsl.pipex.com

Good care is much more than meeting disease specific targets. Iona Heath and colleagues argue that assessments of quality must take into account all the complexities of primary health care

The first 150 words of the full text of this article appear below.

In his 1913 novel Chance, Joseph Conrad wrote about the changing fashion for certain words: "You know the power of words. We pass through periods dominated by this or that word—it may be development, or it may be competition, or education, or purity or efficiency or even sanctity. It is the word of the time." Today’s word is quality.

In order to assess the quality of primary health care, we have to define what quality means in this context. But who should make the definition, and whose perspective should take priority? The easy assumption is that quality should be defined by patients rather than by policymakers, politicians, or healthcare professionals—but who is the representative patient? How generalisable can any measure of the quality of primary health care be across different economic, social, and cultural contexts?

The process and structure of primary care are highly dependent on the nature of . . . [Full text of this article]


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  • Stange, K. C., Ferrer, R. L. (2009). The Paradox of Primary Care. Ann Fam Med 7: 293-299 [Full text]  
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