Measuring valued output in primary care: challenges and reconciliation

ABSTRACT

Introduction

Strong primary care has positive impact on patients’ and population health, and high continuity of care is one of its hallmarks. Insight into the underlying mechanisms is limited and research on this topic requires measures of primary care outputs, which are states that mediate between processes and outcomes of primary care.

Areas covered

Nine potential outputs of high continuity of care were specified to examine 45 validated patient questionnaires, which were identified in a systematic review. Eighteen questionnaires covered one or more primary care outputs, yet at variable and mostly limited extent.

Expert opinion

Measures of primary care outputs can strengthen clinical and health services research, but such measures have yet to be developed and validated for most primary care outputs. The use of these measures in outcome evaluations of interventions in healthcare would enhance the interpretation of intervention effects. Validated measures are also needed to tap the full potential of advanced methods of data-analysis in clinical and health services research. Better understanding of the primary care outputs may also help to mitigate broader challenges in healthcare systems.

KEYWORDS:

• primary care
• outcomes research
• questionnaires
• measurement validation
• patients’ experiences
• continuity of care
• health services research

Article highlights

• Research on the working mechanisms of primary care requires valid measures of outputs, which mediate between process and outcomes of healthcare delivery.

• Many patient questionnaires have been published, but few explicitly concern primary care outputs.

• This review identified 18 validated patient questionnaires, which (partly) cover one or more primary care outputs.

• Most frequently covered are ‘’supportive counseling’’ and ‘’coherence of treatment across providers’’.

• Relevant items tend to be scattered across different questionnaires, which reduces their practical usefulness.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.