title: Trends towards stronger primary care in three western European countries; 2006-2012.
abstract: Strong primary care systems are believed to have an important role in dealing with healthcare challenges. Strengthening primary care systems is therefore a common policy goal for many countries. This study aims to investigate whether the Netherlands, the UK and Germany have strengthened their primary care systems in 2006-2012.
  
  
  
  For this cross-sectional study, data from the International Health Policy surveys of the Commonwealth Fund in 2006, 2009 and 2012 were used. The surveys represent the experiences and perspectives of primary care physicians with their primary care system. The changes over time were researched in three areas: organization of primary care processes, use of IT in primary care and use of benchmarking and financial incentives for performance improvement.
  
  
  
  Regarding organization of primary care processes, in all countries the use of supporting personnel in general practice increased, but at the same time practice accessibility decreased. IT services were most advanced in the UK. The UK and the Netherlands showed increased use of performance feedback information. German GPs were least satisfied with how their system works across the 2006-2012 timeframe.
  
  
  
  All three countries show trends towards stronger primary care systems, although in different areas. Coordination and comprehensive care through the assignment of assisting personnel and use of disease management programs improved in all countries. In the Netherlands and the UK, informational continuity is in part ensured through better IT services. All countries showed increasing difficulties upholding primary care accessibility.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, 114 IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Tessa.vanloenen@radboudumc.nl.|National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Tessa.vanloenen@radboudumc.nl.
authors.forename: Tessa
authors.initials: T
authors.lastname: van Loenen
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Social Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: van den Berg
authors.affiliation: Department of General Practice, University of Göttingen, Göttingen, Germany.|Department of Health Sciences, University of Applied Sciences Fulda, Fulda, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Heinemann
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, 114 IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Faber
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, 114 IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000639:trends*; D005858:Germany; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011314:Preventive Health Services / Q000191:economics / Q000639:trends; D011320:Primary Health Care / Q000458:organization & administration* / Q000639:trends*; D017064:Process Assessment, Health Care; D012052:Reimbursement, Incentive; D006113:United Kingdom
keywords: Accessibility of care; Continuity of care; Healthcare systems; Primary health care