Primary care performance in Dominica.
OBJECTIVE
To document the structure and functions of primary care (PC) in the country of Dominica using the Primary Care Assessment Tools (PCAT), a set of questionnaires that evaluate PC functions.


METHODS
This cross-sectional study combined data from two surveys. The systems PCAT (S-PCAT) survey gathered national-level data from key informants about health system characteristics and PC performance. The provider version (P-PCAT) survey collected data on PC performance from health providers (nurses and physicians) at all PC facilities in the country. Provider-level data were aggregated to obtain national and district-level results for PC domains scored from 0.00 (worst) to 1.00 (best).


RESULTS
From the systems perspective, results showed several knowledge gaps in PC policy, financing, and structure. Key informants gave Good (adequate) ratings for first-contact care (0.74), continuity of care (0.77), comprehensive care (0.70), and coordinated care (0.78); middling scores for family-centered care and community-oriented care (0.65); and low scores for access to care (0.57). PC providers assessed access to care (which included first-contact care, in the P-PCAT surveys) (0.84), continuity of care (0.86), information systems (0.84), family-centered care (0.92), and community-oriented care (0.85) as Very Good; comprehensive care as Good (0.79); and coordinated care as Reasonable (0.68). Overall, the scores for the country's health districts were good, although the ratings varied by specific PC domain.


CONCLUSIONS
The assessments described here were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving PC, and identification of priority areas for further investigation. This two-staged approach could be adapted and used in other countries.
Center for Health Sciences, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California, United States of America.
James
J
Macinko
Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, United States of America.
Geronimo
G
Jimenez
Health Systems and Services Consultant, Pan American Health Organization, San Jose, Costa Rica.
Mario
M
Cruz-Peñate
D003153:Community Health Services / Q000191:economics / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D019424:Dominica; D019538:Health Care Surveys; D006285:Health Planning; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008499:Medical Records; D005791:Patient Care; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011795:Surveys and Questionnaires