Primary care: how can you judge value without measuring outcomes?BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5500 (Published 04 December 2017) Cite this as: BMJ 2017;359:j5500
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In all countries of the world, there are changes that require a redesign of health care to respond more effectively to new and complex needs, such as demographic transition, epidemiological transition, technological evolution and increased expectations with respect to health and vital well-being. These and many other changes require sanitary answers, above all they ask for an organized and strong Primary Health Care.
The so-called essential attributes of Primary Health Care are the access of the individual's first contact with the health system, which is the accessibility and use of the health service as a source of care for each new problem or new episode of the same problem. Health aspects include the longitudinality, the existence of a continuous source of attention, as well as its use throughout the time. Integrality is the range of services from the biopsychosocial point of view of the health-disease process, such as promotion, prevention, cure and rehabilitation, available and appropriate to the context of Primary Health Care, including referrals. Coordination of care presupposes some form of continuity, either by the same professional or through medical histories, or both, in addition to the recognition of problems addressed in other services and the integration of that care in the whole patient care.
Three other characteristics, called derived attributes, also qualify the actions of the Primary Health Care services. Family orientation in the evaluation of individual needs must take into account the family context and its potential for care and also threat to health. Community orientation is the recognition of community health needs through epidemiological data and direct contact with the community, as well as joint planning and evaluation of services. Cultural competence is the adaptation of the provider to the special cultural characteristics of the population to facilitate the relationship and communication with it.
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Competing interests: No competing interests