Performance of primary health care according to PCATool instrument: a systematic review

Prates, Mariana Louzada; Machado, Juliana Costa; Silva, Luciana Saraiva da; Avelar, Patrícia Silva; Prates, Luciana Louzada; Mendonça, Erica Toledo de; Costa, Glauce Dias da; Cotta, Rosângela Minardi Mitre

doi:10.1590/1413-81232017226.14282016

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Review • Ciênc. saúde colet. 22 (6) • June 2017 • https://doi.org/10.1590/1413-81232017226.14282016 copy

Performance of primary health care according to PCATool instrument: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aims to analyze studies that evaluated the performance of Primary Health Care (PHC) services by using the Primary Care Assessment Tool (PCATool) under a worldwide user perspective. This is a systematic review that implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, from the following databases: Lilacs, Medline, SciELO, PubMed and the Coordination for the Improvement of Higher Education Personnel (CAPES) Journals Website, using descriptors Primary Care Assessment Tool and PCATool. Considering inclusion and exclusion criteria, we analyzed 22 research papers published from 2007 to 2015. The best-evaluated attributes were cultural competence, first contact use and longitudinality. On the other hand, the worst evaluated were first contact accessibility, family orientation, community orientation and comprehensiveness. Most of the health services evaluated were from Brazil, applied to “traditional” primary care clinic (UBS) and the Health Family Strategy (FHS). Services evaluated should strengthen structure and process components to achieve a better performance in PHC.

Primary care assessment tool; Primary Health Care; PCATool; Systematic review; Health evaluation

Author	Objective	Study population	Location
Araújo et al., 2014¹⁶	Identifying the extent of attributes of family and community orientation in child health care in PHC^a.	548 caregivers of children under 12 years of age of the 24 health facilities (23 UBS^b and 2 FHS^c).	Brazil
Araújo et al., 2014¹⁸	Assessing the quality of PHC from the perspective of the elderly.	Interview with 100 elderly enrolled in 10 FHS teams of the 20 municipal primary health care facilities.	Brazil
Berra et al., 2014¹⁹	Evaluating the health perceptions of the child user.	2,196 caregivers of children under 15 years of age in all 36 health areas called “Arees Integrals de Salut” according to the National Health System in the region of Catalonia.	Espanha
Carneiro et al., 2014²⁰	Evaluating the quality of PHC by verifying the coordination attribute.	607 adult users of the 48 FHS facilities of the municipality. FHS professionals.	Brazil
Carvalho, et al., 2013²¹	Evaluating the PHC orientation level with regard to the quality of life of the elderly attended.	509 elderly (> 60 years) coming from 21 municipal PHCs, 13 of the 33 FHSs and 8 of the 23 UBS	Brazil
Mesquito-Filho et al. 2014²²	Evaluating the attributes of primary health care for children from zero to two years of age	343 caregivers of children aged 0 to 2 years attended at the municipal PHC services	Brazil
Furtado et al., 2013³⁰	Analyzing the existence and extent of PHC attributes and the level of user enrollment vis-à-vis the FHS.	44 mothers of children under one year of age monitored at an FHS.	Brazil
Haggerty, et al., 2007³¹	Evaluating Quebec primary care services from patients’ care experiences in PHC.	3,441 patients and caregivers of 100 primary care services (Group practice, Solo practice, Stand-alone, walk-in clinic, Community Health Center) in urban and rural areas.	Canada
Autor	Appropriate	Performance Inappropriate
Araújo et al., 2014¹⁶	_________	Family Orientation Community Orientation
Araújo et al., 2014¹⁸	First Contact sub-item Use Coordination sub-item Information System	First Contact First Contact sub-item Accessibility Coordination Coordination sub-item Integrated Care Comprehensiveness Comprehensiveness sub-item Services Provided Comprehensiveness sub-item Available Services Community Orientation Family Orientation
Berra et al., 2014¹⁹	First Contact Longitudinality Coordination Comprehensiveness sub-item Available Services Comprehensiveness sub-item Services Provided Cultural Competence	_________
Carneiro et al., 2014²⁰	_________	Coordination
Carvalho, et al., 2013²¹	First Contact sub-item Use (FHS)	First Contact sub-item Use (UBS) First Contact sub-item Accessibility (UBS) (FHS) Longitudinality (UBS) (FHS) Coordination (UBS) (FHS) Comprehensiveness (UBS) (FHS) Family Orientation (UBS) (FHS)
Mesquito-Filho et al. 2014²²	Longitudinality	First Contact sub-item Accessibility Coordination Comprehensiveness sub-item Available Services Comprehensiveness sub-item Services Provided Family Orientation Community Orientation
Furtado et al., 2013³⁰	First Contact sub-item Accessibility First Contact sub-item Use Longitudinality Coordination sub-item Integrated Care Coordination sub-item Information System Comprehensiveness sub-item Available Services Family Orientation Community Orientation	Comprehensiveness sub-item Services Provided
Haggerty, et al., 2007³¹	First Contact sub-item Accessibility Longitudinality Coordination	_________
Author	Objective	Study population	Location
Haggerty et al., 2008³²	Identifying the characteristics of clinical organization and professional practice in the prediction of accessibility, longitudinality and coordination of care.	2,725 patients from 100 PHC services (10 Community Health Centers, 57 private clinics, 16 private physician offices, 10 Walk in Clinics) in rural and urban areas.	Canadá
Jeon, 2011³³	Adapting and validating the short version of the US Consumer Primary Care Assessment Tool in primary care in the Republic of Korea.	606 users over the age of 17 were interviewed from 245 rural and urban Community Health Centers as well as from private clinics providing general practice, general surgery, family medicine, gynecology and obstetrics services.	South Korea
Leão e Caldeira, 2011¹⁷	Verifying the association between PHC attributes and the professional qualification promoted by the Family and Community Medicine Residency and by the Family Health Multidisciplinary Residency.	Caregivers of children from 0 to less than 2 years of age of 350 families enrolled and monitored in 43 of the 44 FHSs located in urban area. The sample was divided into children from FHSs with professionals with family medicine and related areas residency (RF) and those without residency in the area (sRF).	Brazil
Leão et al., 2011²³	Comparing PHC in child health care in the family health teams with that of other childcare services at the municipal level from the viewpoint of caregivers.	Caregivers of children from 0 to less than 2 years of age of 350 families enrolled and accompanied in 43 of the 44 FHSs located in urban areas.	Brazil
Lima et al., 2015²⁴	Evaluating FHS quality from the perspective of female users and verifying the association between PHC attributes.	215 female users aged 20 to 49 years from the FHS services of the municipality of Serra, ES.	Brasil
Marques et al., 2014²⁵	Evaluating PHC attributes focusing on child health.	Caregivers of children from 0 to 5 years of age from the 76 families enrolled in the FHS of the quilombola rural community Buriti do Meio in the North of Minas Gerais.	Brazil
Oliveira e Veríssimo, 2015²⁶	Comparing the existence and extent of PHC attributes to child health between the traditional municipal FHS and UBS facilities.	482 caregivers of children over one year of age (247 children in UBS and 235 in FHS) from the 21 municipal health facilities.	Brazil
Autor	Appropriate	Performance Inappropriate
Haggerty et al., 2008³²	Longitudinality Coordination sub-item Integrated Care	First Contact sub-item Accessibility
Jeon, 2011³³	First Contact sub-item Use Comprehensiveness Cultural Competence	First Contact sub-item Accessibility Longitudinality Coordination Community Orientation
Leão e Caldeira, 2011¹⁷	Longitudinality (RF) (sRF) Coordination (sRF) Comprehensiveness sub-item Services Provided (RF) (sRF)	First Contact (RF) (sRF) Coordination (RF) Comprehensiveness sub-item Available Services (RF) (sRF) Family Orientation (RF ) (sRF) Community Orientation (RF) (sRF)
Leão et al., 2011²³	Longitudinality (FHS) (OS) Coordination (OS) Comprehensiveness sub-item Services Provided (FHS) (OS)	First Contact (FHS) (OS) Coordination (FHS) Comprehensiveness sub-item Available Services (FHS) (OS) Community Orientation (FHS) (OS)
Lima et al., 20 1 5²⁴	First Contact sub-item Use	First Contact sub-item Accessibility Longitudinality Coordination sub-item Integrated Care Coordination sub-item Information System Comprehensiveness sub-item Available Services Comprehensiveness sub-item Services Provided Family Orientation Community Orientation
Marques et al., 2014²⁵	First Contact sub-item Use Coordination sub-item Information System	First Contact sub-item Accessibility Longitudinality Coordination sub-item Integrated Care Comprehensiveness sub-item Services Provided Comprehensiveness sub-item Available Services Family Orientation Community Orientation
Oliveira e Veríssimo, 2015²⁶	First Contact sub-item Use (FHS) Coordination sub-item Integrated Care (FHS)	First Contact sub-item Accessibility (FHS) (UBS) First Contact sub-item Use (UBS) Longitudinality (FHS) (UBS) Coordination sub-item Integrated Care (UBS) Coordination sub-item Information System (FHS) (UBS) Comprehensiveness (FHS) (UBS) Family Orientation (FHS) (UBS) Community Orientation (FHS) (UBS)
Author	Objective	Study population	Location
Pereira et al., 2011³⁷	Evaluating organizational and performance characteristics from users.	55 users (adults and companions of children under 14 years) from a UBS of the 14 PHC services facilities of a municipality in rural São Paulo.	Brazil
Reis et al., 2013²⁷	Evaluate the access and use of the FHS as the gateway to the SUS, identifying the structural and procedural elements that strengthen or hamper the accomplishment of this role.	882 users (adults and children caregivers) enrolled and monitored in 44 of the 89 FHS teams.	Brazil
Silva et al., 2014²⁸	Evaluating the PHC Comprehensiveness process from the users’ viewpoint.	373 adult users, 124 (33.6%) covered by the FHS and 249 (66.4%) by other services – Health Center and Community Health Worker Program as the main source of PHC.	Brazil
Silva e Fracolli, 2014²⁹	Evaluating attributes of first contact access, comprehensiveness, care coordination, longitudinality, family orientation and community orientation, FHS attributes from the perspective of users.	527 adults over 18 years of age enrolled in 33 municipal FHS facilities.	Brazil
Sung, et al., 2010³⁵	Comparing different PHC services from the perspective of patients.	602 patients enrolled in different PHC care services (private clinics, school hospitals, public health centers and clinical cooperatives).	South Korea
Tourigny et al., 2010³⁴	Assessing how primary care reform affects patients’ experience with regard to the essential realms of PHC.	1,046 adult users interviewed in 5 of the 13 Family Medicine Group at the onset of implementation and after 18 months of operation.	Canada
Wang et al., 2014³⁶	Evaluate PHC attributes in CHC through user evaluation.	3,360 adult PHC users serviced at the Community Health Center.	China
Autor	Appropriate	Performance Inappropriate
Pereira et al., 2011³⁷	First Contact Longitudinality Comprehensiveness Coordination	Family orientation Community orientation
Reis et al., 2013²⁷	___________	First Contact First Contact sub-item Use First Contact sub-item Accessibility
Silva et al., 2014²⁸	First Contact sub-item Use (FHS) Longitudinality (FHS)	First Contact sub-item Use (OS) First Contact sub-item Accessibility (FHS/ OS) Longitudinality (OS)
Silva e Fracolli, 2014²⁹	First Contact sub-item Use Longitudinality	First Contact sub-item Accessibility Coordination sub-item Integrated Care Coordination sub-item Information System Comprehensiveness sub-item Available Services Comprehensiveness sub-item Services Provided Community Orientation
Sung, et al., 20 1 0³⁵	First Contact Longitudinality	Coordination Community/Family Orientation
Tourigny et al., 2010³⁴	Coordination sub-item Integrated Care (AR / DR) Longitudinality (AR/ DR)	First Contact sub-item Accessibility (AR / DR)
Wang et al., 20 1 4³⁶	First Contact sub-item Accessibility First Contact sub-item Use Coordination Service Integration System Longitudinality Coordination sub-item Information System Comprehensiveness sub-item Available Services Comprehensiveness sub-item Services Provided Family Orientation Community Orientation	___________

	Total number of evaluations	Good performance

	N	N	%
Essential attributes
First Contact	9	3	33,33
FC Accessibility	19	3	15,78
FC Use	14	10	71,42
Longitudinality	25	16	64
Coordination	14	5	35,71
Coord. Integrated Care	11	6	54,54
Coord. Information System	8	3	37,5
Comprehensiveness	7	2	28,57
Comp. Available Services	12	3	25
Comp. Services Provided	12	6	50
Derivative attributes
Family Orientation	15	2	13,33
Community Orientation	18	2	11,11
Cultural competence	2	2	100

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[1] Collaborators

M Louzada-Prates: Conception, draft elaboration, search in databases, identification of manuscripts, data analysis, writing and other stages of production of the manuscript. JC Machado: Research planning and critical review of the manuscript. LS da Silva: critical review of the manuscript. PS Avelar: Search in databases and identification of manuscripts. LL Prates: Identification of manuscripts, critical review of the manuscript and translation of abstract. ET Mendonça: Research planning and critical review of the manuscript. GD Costa: Research planning. RMM Cotta: Research planning and critical review of the manuscript.