title: The quality of primary care in a country with universal health care coverage.
abstract: BACKGROUND
  Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.
  
  
  OBJECTIVE
  To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.
  
  
  METHODS
  Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university primary care settings.
  
  
  METHODS
  We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.
  
  
  RESULTS
  Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including >75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients <65 years (70.1% vs 68.0% in those ≥ 65 years, p = 0.047).
  
  
  CONCLUSIONS
  Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.
authors.affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Bugnon 44, 1011 Lausanne, Switzerland.
authors.forename: Tinh-Hai
authors.initials: TH
authors.lastname: Collet
authors.forename: Sophie
authors.initials: S
authors.lastname: Salamin
authors.forename: Lukas
authors.initials: L
authors.lastname: Zimmerli
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.forename: Carole
authors.initials: C
authors.lastname: Clair
authors.forename: Michel
authors.initials: M
authors.lastname: Picard-Kossovsky
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Edouard
authors.initials: E
authors.lastname: Battegay
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011315:Preventive Medicine; D011322:Primary Prevention / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D013223:Statistics as Topic; D013557:Switzerland; D019472:Universal Health Insurance / Q000592:standards*