title: The strength of primary care in Europe: an international comparative study.
abstract: BACKGROUND
  A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking.
  
  
  OBJECTIVE
  Evaluation of strength of primary care in Europe.
  
  
  METHODS
  International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey.
  
  
  METHODS
  Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations.
  
  
  RESULTS
  Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries.
  
  
  CONCLUSIONS
  Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.
authors.affiliation: Academic Medical Centre of the University of Amsterdam, Department of Social Medicine, the Netherlands.
authors.forename: Dionne
authors.initials: D
authors.lastname: Kringos
authors.forename: Wienke
authors.initials: W
authors.lastname: Boerma
authors.forename: Yann
authors.initials: Y
authors.lastname: Bourgueil
authors.forename: Thomas
authors.initials: T
authors.lastname: Cartier
authors.forename: Toni
authors.initials: T
authors.lastname: Dedeu
authors.forename: Toralf
authors.initials: T
authors.lastname: Hasvold
authors.forename: Allen
authors.initials: A
authors.lastname: Hutchinson
authors.forename: Margus
authors.initials: M
authors.lastname: Lember
authors.forename: Marek
authors.initials: M
authors.lastname: Oleszczyk
authors.forename: Danica
authors.initials: D
authors.lastname: Rotar Pavlic
authors.forename: Igor
authors.initials: I
authors.lastname: Svab
authors.forename: Paolo
authors.initials: P
authors.lastname: Tedeschi
authors.forename: Stefan
authors.initials: S
authors.lastname: Wilm
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Adam
authors.initials: A
authors.lastname: Windak
authors.forename: Jouke
authors.initials: J
authors.lastname: Van der Zee
authors.forename: Peter
authors.initials: P
authors.lastname: Groenewegen
mesh_terms: D054976:Clinical Governance; D003266:Continuity of Patient Care / Q000191:economics / Q000592:standards; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D005060:Europe; D006282:Health Personnel; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D012017:Referral and Consultation / Q000191:economics / Q000592:standards; D013192:Staff Development