title: Primary care services. In search of alternative ways of providing services that are affordable, accessible and appropriate. A review of recent literature.
abstract: Services where the G.P. is the central health professional or "team leader" may satisfactorily provide first-contact medical services. Major problems reported in literature are related to inequity in distribution, and the fee-for-service practice that limits access for those on lower incomes and encourages high throughput. There is a heavy reliance on pharmaceuticals as the main treatment, with health promotion and educative services, and counselling, being generally low. While alternative or complementary therapies may address problems of "failed medicine", these don't answer issues of accessibility, or self-responsibility. Studies on nurse practitioners as the first contact in primary level care demonstrate that technically they can function competently and safely amongst a similar clientele, and that the clients find nurses both satisfactory and acceptable as health care providers. While the quality of care is comparable to that offered by a G.P., the cost is less, both directly to user, or more generally to society. This is related to lower costs of education and remuneration, and that lower costs of pharmaceuticals and diagnostic tests are generated. In addition, the health promotion and educative functions of nurses are overall more prominent, and effective in enhancing peoples self-responsibility in health through improving competence and awareness. User-participation and involvement in health services, and empowerment and self responsibility in health, are therefore more likely to be an outcome of a service in which health promotion and educational activities are central, rather than when medical interventions are the focus. In conclusion, this review of recent literature has raised questions about services currently provided by general practitioners, and as presently funded.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.forename: N
authors.initials: N
authors.lastname: North
mesh_terms: D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009722:Nurse Practitioners / Q000592:standards / Q000706:statistics & numerical data*; D010358:Patient Participation; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D000078329:Workforce