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> Introduction to Primary Care
This presentation explains the purpose and organization of the following chapters.
Selected Presentations in Primary Care
> Chapter 1: Benefits of Primary Care in Healthcare Reform - Sommer Memorial Lecture (Portland, Oregon, 2010) and Herbert Vaughan Lecture (Boston, Massachusetts, 2010)
This presentation summarizes evidence, primarily from cross-national comparisons, for the impact of a primary care orientation on population health, equity in health, and costs of health systems. It concludes by describing attempts in the early decades of the 21st century, to improve primary care.
> Chapter 2: Diseases, Chronic Care, and Primary Care - Sommer Memorial Lecture (Portland, Oregon, 2010)
Similar to the presentation entitled Diseases, Comorbidity, and Multimorbidity, this presentation delves deeper into the issues of chronic illnesses and multimorbidity in the context of quality of primary care in practice.
> Chapter 3: Primary Care/Specialty Care in the Era of Multimorbidity - 19th WONCA World Conference of Family Doctors (Cancun, Mexico, 2010); ACG User Group (Tucson, Arizona, 2010); European Forum for Primary Care Keynote Address (Pisa, Italy, 2010)
This presentation describes important characteristics of health systems: the importance of primary are to the health of populations, threats to primary care from a disease and specialty focus of health systems, challenges to primary care from increasing comorbidity and multimorbidity, and approaches to dealing with these threats and challenges through better conceptualization of health problems and their management.
> Chapter 4: Population Health: New Paradigms and Implications for Health Statistics - National Committee on Vital and Health Statistics (Washington, DC, 2002)
This presentation shows why population health is not the sum of individual health and why population health measures must reflect clustering of ill health within population subpopulations and the need to take into account more aspects of health than individual diseases.
> Chapter 5: Prevention, Public Health, and Equity - Sommer Memorial Lecture (Portland, Oregon, 2010)
This presentation focuses on practical aspects of preventive activities in primary care as distinguished from prevention at the population level by public health actions. It reviews evidence that primary care professional groups should consider when deciding on the relative merits of preventive activities in practice, where a major imperative is to be responsive to peoplesâ€™ problems and concerns.
> Chapter 6: Structure, Process, and Outcome in Health System Improvement - Avedis Donabedian Award in Quality Improvement Session (Washington, DC, 2007)
This presentation reviews an approach to understanding where primary care fits in an overall scheme for relating structural, behavioral, and outcome aspects of health services, and provides evidence for its utility in assessing the impact of primary care in different areas.
A Course in Primary Care - Cape Town 2007 and Barcelona 2009
> Chapter 7: Defining Primary Care
This presentation explains why primary health care and primary care are a worldwide imperative and how they can be conceptualized and measured to provide accountability for achievement in different areas and countries.
> Chapter 8: Diseases, Cormorbidity, and Multimorbidityin Primary Care
The purpose of this presentation is to explore the concepts of "disease" and "chronic disease" and to show why a more appropriate focus is on a continuum of care ("primary care") for all people and populations rather than on care for targeted diseases and types of diseases.
> Chapter 9: Effectiveness of Primary Care
This presentation provides evidence from the 1990s and early 2000s (concomitant with the growth of interest in primary care in the world) concerning the impact of primary care-oriented health systems on population health outcomes and on distribution of these outcomes ("equity") from cross-national and selected within-nations studies.
> Chapter 10: Equity in Health and Health Services
This presentation first provides a definition of equity that is amenable to measurement of ill health. It then discusses major findings concerning influences on equity in health, findings from research on achievement of equity in health in various countries, and indicators of equity for future studies of equity in health.
> Chapter 11: Features of Primary Care: First Contact, Person-focused over Time, Comprehensiveness, and Coordination
Primary care is characterized by four essential functions. This presentation summarizes evidence for the utility of each of these functions.
> Chapter 12: Primary Care & Prevention
This presentation summarizes evidence on the utility of both population and clinically-oriented approaches to prevention. Its conclusion is that caution is needed before mounting a prevention strategy, in order to assure that it does not lead to unintended harm to essentially well people and populations.
> Chapter 13: Primary Care & Public Health
This presentation presents the difference between care of patients (Primary Care) and the care of populations (Public Health) The differences are becoming blurred over time, and the roles differ from place to place, as shown in a study carried out in eight different countries.
> Chapter 14: Primary Care & Specialty Care Issues
This presentation discusses the role of specialists, i.e., non-primary-care physicians, in health systems at a time of increasing recognition of the importance of a primary care orientation in health systems. It concludes that a reassessment of their roles is an imperative, at least in some countries.
> Chapter 15: Primary Care Assessment - The PCAT
This presentation describes an instrument to assess experiences with the various aspects of primary care from the viewpoint of consumers, patients, practitioners, and managers, as well as from an overall systems view. All versions are comparable in that they each address the achievement of important functions of primary care.
> Chapter 16: Primary Care: Enhancements & Innovations
This presentation deals with three major approaches to modifying primary care: subspecialization in primary care; "the chronic care model"; and the Patient-Centered Medical Home. It also presents the thrust of a few innovations in different wealthy countries and presents some principles for reform in the future.
> Chapter 17: Quality of Care: Principles Applicable to Primary Care
This presentation discusses the various aspects of "quality" within a health systems framework and shows how quality assessments should focus more broadly than on specific diseases or types of diseases.