title: Quality of care in primary health care settings in the Eastern Mediterranean region: a systematic review of the literature.
abstract: OBJECTIVE
  This systematic review aims at offering a comprehensive synthesis of studies addressing quality of care in the primary healthcare (PHC) sector of the Eastern Mediterranean Region (EMR).
  
  
  METHODS
  A systematic search was conducted using Medline, Embase and Global Health Library (IMEMR) electronic databases to identify studies related to quality in PHC between years 2000 and 2012.
  
  
  METHODS
  One hundred and fifty-nine (159) studies fulfilled the eligibility criteria. Each paper was independently reviewed by two reviewers, and the following information was extracted/calculated: dimension of care investigated (structure, processes and outcomes), focus, disease groups, study design, sample size, unit of analysis, response rate, country, setting (public or private) and level of rigor (LOR) score.
  
  
  RESULTS
  Most of the studies were descriptive/cross-sectional in nature with a relatively modest LOR score. Assessment of quality of care revealed that the process dimension of quality, specifically clinical practice and patient-provider relationship, is an area of major concern. However, interventions targeting enhanced quality in PHC in the EMR countries had favorable and effective outcomes in terms of clinical practice.
  
  
  CONCLUSIONS
  These findings highlight gaps in evidence on quality in PHC in the EMR; such evidence is key for decision-making. Researchers and policy-makers should address these gaps to generate contextualized information and knowledge that ensures relevance and targeted high-impact interventions.
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Shadi
authors.initials: S
authors.lastname: Saleh
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon ma164@aub.edu.lb.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alameddine
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Yara
authors.initials: Y
authors.lastname: Mourad
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa, USA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Natafgi
mesh_terms: D006801:Humans; D019083:Mediterranean Region; D008877:Middle East; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care
keywords: Eastern Mediterranean Region; performance measurement; primary healthcare; quality indicators; quality of care; systematic review