What contributes to Primary Health Care effectiveness? Integrative literature review, 2010-2020

Chaves, Ana Cláudia Cardozo; Scherer, Magda Duarte dos Anjos; Conill, Eleonor Minho

doi:10.1590/1413-81232023289.15342022EN

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REVIEW • Ciênc. saúde coletiva 28 (09) • Sept 2023 • https://doi.org/10.1590/1413-81232023289.15342022EN copy

What contributes to Primary Health Care effectiveness? Integrative literature review, 2010-2020

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Primary Health Care (PHC) intends to rearrange services to make it more effective. Nevertheless, effectiveness in PHC is quite a challenge. This study reviews several articles regarding the effectiveness improvements in PHC between 2010 and 2020. Ninety out of 8,369 articles found in PubMed and the Virtual Health Library databases search were selected for thematic analysis using the Atlas.ti® 9.0 software. There were four categories identified: strategies for monitoring and evaluating health services, organizational arrangements, models and technologies applied to PHC. Studies concerning the sensitive conditions indicators were predominant. Institutional assessment programs, PHC as a structuring policy, appropriate workforce, measures to increase access and digital technologies showed positive effects. However, payment for performance is still controversial. The expressive number of Brazilian publications reveals the broad diffusion of PHC in the country and the concern on its performance. These findings reassure well-known aspects, but it also points to the need for a logical model to better define what is intended as effectiveness within primary health care as well as clarify the polysemy that surrounds the concept. We also suggest substituting the term “resolvability”, commonly used in Brazil, for “effectiveness”.

Key words:
Primary Health Care; Effectiveness

ID	Study	Place of origin
1	Báscolo, 2010³⁰30 Báscolo E. Gobernanza de las organizaciones de salud basados en Atención Primaria de Salud. Rev Salud Publica 2010; 12(1):8-27.	Argentina
2	Perron et al., 2010³¹31 Perron NJ, Dao MD, Kossovsky MP, Miserez V, Chuard C, Calmy A, Gaspoz JM. Reduction of missed appointments at an urban primary care clinic: a randomised controlled study. BMC Fam Pract 2010; 11:79.	Switzerland
3	Vieira-da-Silva et al., 2010³²32 Vieira-da-Silva LM, Chaves SC, Esperidião MA, Lopes-Martinho RM. Accessibility to primary healthcare in the capital city of a northeastern state of Brazil: an evaluation of the results of a programme. J Epidemiol Community Health 2010; 64(12):1100-1105.	Brazil
4	Miller et al., 2010³³33 Miller WL, Crabtree BF, Nutting PA, Stange KC, Jaén CR. Primary care practice development: a relationship-centered approach. Ann Fam Med 2010; 8(Supl. 1):S68-S79.	USA
5	Yavich et al., 2010³⁴34 Yavich N, Báscolo EP, Haggerty J. Construyendo un marco de evaluación de la atención primaria de la salud para Latinoamérica. Salud Publica Mex 2010; 52(1):39-45.	Argentina
6	Nedel et al., 2011³⁵35 Nedel FB, Facchini LA, Bastos JL, Martín-Mateo M. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions. Cien Saude Colet 2011; 16(Supl. 1):1145-1154.	Brazil
7	Sohrabi and Albalushi, 2011³⁶36 Sohrabi MR, Albalushi RM. Clients' satisfaction with primary health care in Tehran: A cross-sectional study on Iranian Health Centers. J Res Med Sci 2011; 16(6):756-762.	Iran
8	Wilson, 2011³⁷37 Wilson T. Improving primary health care delivery: still waiting for the magic bullet. CMAJ 2011; 183(18):E1280-E1281.	United Kingdom
9	Szecsenyi et al., 2011³⁸38 Szecsenyi J, Campbell S, Broge B, Laux G, Willms S, Wensing M, Goetz K. Effectiveness of a quality-improvement program in improving management of primary care practices. CMAJ 2011; 183(18):E1326-E1333.	Germany
10	Rehem et al., 2012³⁹39 Rehem TCMSB, Ciosak SI, Egry EY. Internações por condições sensíveis à atenção primária no hospital geral de uma microrregião de saúde do município de São Paulo, Brasil. Texto Contexto Enferm 2012; 21(3):535-542.	Brazil
11	Baratieri et al., 2012⁴⁰40 Baratieri T, Mandu ENT, Marcon SS. Longitudinalidade no trabalho do enfermeiro: relatos da experiência profissional. Rev Esc Enferm USP 2012; 46(5):1260-1267.	Brazil
12	Grills et al., 2012⁴¹41 Grills NJ, Robinson P, Phillip M. Networking between community health programs: a case study outlining the effectiveness, barriers and enablers. BMC Health Serv Res 2012; 12:206.	India
13	Albalushi et al., 2012⁴²42 Albalushi RM, Sohrabi MR, Kolahi AA. Clients' satisfaction with primary health care in muscat. Int J Prev Med 2012; 3(10):713-717.	Oman
14	Ortiz and Wan, 2012⁴³43 Ortiz J, Wan TH. Performance of rural health clinics: an examination of efficiency and Medicare beneficiary outcomes. Rural Remote Health 2012; 12:1925.	USA
15	Alkmim et al., 2012⁴⁴44 Alkmim MB, Figueira RM, Marcolino MS, Cardoso CS, Pena de Abreu M, Cunha LR, et al. Improving patient access to specialized health care: the Telehealth Network of Minas Gerais, Brazil. Bull World Health Organ 2012; 90(5):373-378.	Brazil
16	Oliveira et al., 2017⁴⁵45 Oliveira ESBE, Oliveira VB, Caldeira AP. Internações por condições sensíveis à atenção primária em Minas Gerais, entre 1999 e 2007. Rev Baiana de Saude Publica 2017; 41(1):144-157.	Brazil
17	Viacava et al., 2012⁴⁶46 Viacava F, Ugá MAD, Porto S, Laguardia J, Moreira RS. Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise. Cien Saude Colet 2012; 17(4):921-934.	Brazil
18	Greaves et al., 2012⁴⁷47 Greaves F, Millett C, Pape UJ, Soljak M, Majeed A. Association between primary care organisation population size and quality of commissioning in England: an observational study. Br J Gen Pract 2012; 62(594):e46-e54.	England
19	Mold et al., 2012⁴⁸48 Mold JW, Lawler F, Schauf KJ, Aspy CB. Does patient assessment of the quality of the primary care they receive predict subsequent outcomes?: An Oklahoma Physicians Resource/Research Network (OKPRN) study. J Am Board Fam Med 2012; 25(4):e1-e12.	USA
20	Lima et al., 2012⁴⁹49 Lima RN, Medeiros Junior ME, Martins JS, Santos EP, Bourget MMM. Desempenho de indicadores nos municípios com alta cobertura da Estratégia Saúde da Família no Estado de São Paulo. Rev Bras Med Fam Comunidade 2012; 7(24):164-170.	Brazil
21	Campo, 2012⁵⁰50 Campo CB. Modelo de salud familiar en Chile y mayor resolutividad de la atención primaria de salud: ¿contradictorios o complementarios? Medwave 2012; 12(11):e5571.	Chile
22	Sanabria and Orta, 2012⁵¹51 Sanabria T, Orta M. The MANIAPURE Program-Lessons Learned from a Rural Experience: Two Decades Delivering Primary Healthcare Through Telemedicine. Telemed J E Health 2012; 18:544-548.	Venezuela
23	Dookie and Singh, 2012⁵²52 Dookie S, Singh S. Primary health services at district level in South Africa: a critique of the primary health care approach. BMC Fam Pract 2012; 13:67.	South Africa
24	Kirschner et al., 2012⁵³53 Kirschner K, Braspenning J, Jacobs JE, Grol R. Design choices made by target users for a pay-for-performance program in primary care: an action research approach. BMC Fam Pract 2012; 13:25.	The Netherlands
25	Lavoie et al., 2013⁵⁴54 Lavoie JG, Wong ST, Chongo M, Browne AJ, MacLeod MLP, Ulrich C. Group medical visits can deliver on patient-centred care objectives: results from a qualitative study. BMC Health Serv Res 2013; 13:155.	Canada
26	Liddy et al., 2013⁵⁵55 Liddy C, Rowan MS, Afkham A, Maranger J, Keely E. Building access to specialist care through e-consultation. Open Med 2013; 7(1):e1-e8.	Canada
27	Hinchcliff et al., 2013⁵⁶56 Hinchcliff R, Greenfield D, Westbrook JI, Pawsey M, Mumford V, Braithwaite J. Stakeholder perspectives on implementing accreditation programs: a qualitative study of enabling factors. BMC Health Serv Res 2013; 13:437.	Australia
28	Keely et al., 2013⁵⁷57 Keely E, Liddy C, Afkham A. Utilization, benefits, and impact of an e-consultation service across diverse specialties and primary care providers. Telemed J E Health 2013; 19(10):733-738.	Canada
29	Ashworth et al., 2013⁵⁸58 Ashworth M, Schofield P, Doran T, Cookson R, Sutton M, Seed PT, Howe A, Fleetcroft R. The Public Health Impact score: a new measure of public health effectiveness for general practices in England. Br J Gen Pract 2013; 63(609):e291-e299.	England
30	Heard et al., 2013⁵⁹59 Heard A, Nath DK, Loevinsohn B. Contracting urban primary healthcare services in Bangladesh - effect on use, efficiency, equity and quality of care. Trop Med Int Health 2013; 18(7):861-870.	Bangladesh
31	Kirschner et al., 2013⁶⁰60 Kirschner K, Braspenning J, Akkermans RP, Jacobs JE, Grol R. Assessment of a pay-for-performance program in primary care designed by target users. Fam Pract 2013; 30(2):161-171.	The Netherlands
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35	Porter et al., 2013⁶⁴64 Porter ME, Pabo EA, Lee TH. Redesigning Primary Care: A Strategic Vision to Improve Value By Organizing Around Patients' Needs. Health Affairs 2013; 32(3):516-525.	USA
36	Maini et al., 2014⁶⁵65 Maini R, Van Den Bergh R, Van Griensven J, Tayler-Smith K, Ousley J, Carter D, Mhatre S, Ho L, Zachariah R. Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study. BMC Health Serv Res 2014; 14:504.	D. Republic of Congo
37	Costa et al., 2014⁶⁶66 Costa JP, Jorge MSB, Vasconcelos MGF, De Paula ML, Bezerra IC. Resolubilidade do cuidado na atenção primária: articulação multiprofissional e rede de serviços. Saude Debate 2014; 38(103):733-743.	Brazil
38	Roots and Macdonald, 2014⁶⁷67 Roots A, Macdonald M. Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: a mixed methods study. Hum Resour Health 2014; 12:69.	Canada
39	Rao and Pilot, 2014⁶⁸68 Rao M, Pilot E. The missing link - the role of primary care in global health. Glob Health Action 2014; 7:23693.	United Kingdom and The Netherlands
40	Piropo and Amaral, 2015⁶⁹69 Piropo TGN, Amaral HOS. Telessaúde, contextos e implicações no cenário baiano. Saude Debate 2015; 39(104):279-287.	Brazil
41	Campbell et al., 2015⁷⁰70 Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V, Richards DA, Richards SH, Salisbury C, Taylor RS, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Price L, Roscoe J, Varley A, Warren FC. The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial). Health Technol Assess 2015; 19(13):1-212, vii-viii.	England
42	Castro et al., 2015⁷¹71 Castro ALB, Andrade CLT, Machado CV, Lima LD. Condições socioeconômicas, oferta de médicos e internações por condições sensíveis à atenção primária em grandes municípios do Brasil. Cad Saude Publica 2015; 31(11):2353-2366.	Brazil
43	Goetz et al., 2015⁷²72 Goetz K, Hess S, Jossen M, Huber F, Rosemann T, Brodowski M, Künzi B, Szecsenyi J. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study. BMJ Open 2015; 5(4):e007443.	Switzerland
44	Farias et al., 2015⁷³73 Farias DC, Celino SDM, Peixoto JBS, Barbosa ML, Costa GMC. Acolhimento e Resolubilidade das Urgências na Estratégia Saúde da Família. Rev Bras Educ Med 2015; 39(1):79-87.	Brazil
45	Ford et al., 2015⁷⁴74 Ford JA, Jones AP, Wong G, Steel N. Weekend opening in primary care: analysis of the General Practice Patient Survey. Br J Gen Pract 2015; 65(641):e792-e798.	England
46	Mobula et al., 2015⁷⁵75 Mobula LM, Okoye MT, Boulware LE, Carson KA, Marsteller JA, Cooper LA. Cultural Competence and Perceptions of Community Health Workers' Effectiveness for Reducing Health Care Disparities. J Prim Care Community Health 2015; 6(1):10-15.	USA
47	Fung et al., 2015⁷⁶76 Fung CS, Wong CK, Fong DY, Lee A, Lam CLK. Having a family doctor was associated with lower utilization of hospital-based health services. BMC Health Serv Res 2015; 15:42.	China
48	Lemak et al., 2015⁷⁷77 Lemak CH, Nahra TA, Cohen GR, Erb ND, Paustian ML, Share D, Hirth RA. Michigan's Fee-For-Value Physician Incentive Program Reduces Spending and Improves Quality in Primary Care. Health Aff 2015; 34(4):645-652.	USA
49	Nouwens et al., 2015⁷⁸78 Nouwens E, Van Lieshout J, Wensing M. Determinants of impact of a practice accreditation program in primary care: a qualitative study. BMC Fam Pract 2015; 16:78.	The Netherlands
50	Markwick et al., 2015⁷⁹79 Markwick L, Mcconnochie K, Wood N. Expanding Telemedicine to Include Primary Care for the Urban Adult. J Health Care Poor Underserved 2015; 26(3):771-776.	USA
51	Brugués et al., 2016⁸⁰80 Brugués A, Peris Grao A, Pavón Rodríguez F, Mateo Viladomat E, Gascón Ferret J, Flores Mateo G. Evaluación de la gestión enfermera de la demanda en atención primaria. Aten Primaria 2016; 48(3):159-165.	Spain
52	Whittaker et al., 2016⁸¹81 Whittaker W, Anselmi L, Kristensen SR, Lau YS, Bailey S, Bower P, Checkland K, Elvey R, Rothwell K, Stokes J, Hodgson D. Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis. PLoS Med 2016; 13(9):e1002113.	England
53	Leite et al., 2016⁸²82 Leite RS, Santos APM, Lima CA, Ribeiro CDAL, Brito MFSF. Estratégia Saúde da Família versus centro de saúde: modalidades de serviços na percepção do usuário. Cad Saude Colet 2016; 24(3):323-329.	Brazil
54	Penm et al., 2017⁸³83 Penm J, Mackinnon NJ, Strakowski SM, Ying J, Doty MM. Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries. Ann Fam Med 2017; 15(2):113-119.	Australia, Canada, France, Germany, The Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and USA
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56	Ebert et al., 2017⁸⁵85 Ebert ST, Pittet V, Cornuz J, Senn N. Development of a monitoring instrument to assess the performance of the Swiss primary care system. BMC Health Serv Res 2017; 17(1):789.	Switzerland
57	Murante et al., 2017⁸⁶86 Murante AM, Seghieri C, Vainieri M, Schäfer WLA. Patient-perceived responsiveness of primary care systems across Europe and the relationship with the health expenditure and remuneration systems of primary care doctors. Soc Sci Med 2017; 186:139-147.	Europe
58	Zarlotti et al., 2017⁸⁷87 Zarlotti C, Scudese E, Sena GW, Tonini T, Lopes T, Pestana C. Internações por condições sensíveis à atenção primária após a implantação da estratégia saúde da família no município de Petrópolis/RJ. R Pesq Cuid Fundam Online 2017; 9(3):811-817.	Brazil
59	Miclos et al., 2017⁸⁸88 Miclos PV, Calvo MCM, Colussi CF. Evaluation of the performance of actions and outcomes in primary health care. Rev Saude Publica 2017; 51:86.	Brazil
60	Mendonça et al., 2017⁸⁹89 Mendonça CS, Leotti VB, Dias-da-Costa JS, Harzheim E. Hospitalizations for primary care sensitive conditions: association with socioeconomic status and quality of family health teams in Belo Horizonte, Brazil. Health Policy and Plan 2017; 32(10):1368-1374.	Brazil
61	Molina et al., 2017⁹⁰90 Molina J, Tasca R, Suárez J, Kemper ES. More Doctors Programme and the strengthening of Primary Health Care in Brazil: Reflections from the monitoring and evaluation of the More Doctors Cooperation Project. Qual Prim Care 2017; 25(2):50-54.	Brazil
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63	Wagner et al., 2017⁹²92 Wagner EH, Flinter M, Hsu C, Cromp DA, Austin BT, Etz R, Crabtree BF, Ladden MD. Effective team-based primary care: observations from innovative practices. BMC Fam Pract 2017; 18:13.	USA
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65	Wan et al., 2018⁹⁴94 Wan S, Teichmanb PG, Latifa D, Boydc J, Gupta R. Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area. J Interprof Care 2018; 32(2):220-223.	USA
66	Zhou et al., 2018⁹⁵95 Zhou Y, Bai G, Lou L. Development of a hexagonal, mesh-based distribution method for community health centres. Geospat Health 2018;13:2.	China
67	Mukiapini et al., 2018⁹⁶96 Mukiapini S, Bresick G, Sayed A-R, Le Grange C. Baseline measures of primary health care team functioning and overall primary health care performance at Du Noon Community Health Centre. Afr J Prm Health Care Fam Med 2018; 10(1):a1458.	South Africa
68	Pandya et al., 2018⁹⁷97 Pandya A, Doran T, Zhu J, Walker S, Arntson E, Ryan AM. Modelling the cost-effectiveness of pay-for-performance in primary care in the UK. BMC Med 2018; 16:135.	United Kingdom
69	Lin et al., 2018⁹⁸98 Lin Y, Wan N, Sheets S, Gong X, Davies A. A multi-modal relative spatial access assessment approach to measure spatial accessibility to primary care providers. Int J Health Geogr 2018; 17:33.	USA
70	Tintorer et al., 2018⁹⁹99 Tintorer DL, Domínguez JMM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018; 19(1):56.	Spain
71	Arantes et al., 2018¹⁰⁰100 Arantes LJ, Shimizu HE,Mercha´n-Hamann E. Ambulatory care sensitive hospitalizations after implementation of the master plan in Minas Gerais. Rev Saude Publica 2018; 52:78.	Brazil
72	Balasubramanian et al., 2018¹⁰¹101 Balasubramanian BA, Marino M, Cohen DJ, Ward RL, Preston A, Springer RJ, Lindner SR, Edwards S, McConnell KJ, Crabtree BF, Miller WL, Stange KC, Solberg LI. Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices. Ann Fam Med 2018; 16(Supl. 1):S35-S43.	USA
73	Lima et al., 2018¹⁰²102 Lima JG, Giovanella L, Fausto MCR, Bousquat A, Silva EV. Atributos essenciais da Atenção Primária à Saúde: resultados nacionais do PMAQ-AB. Saude Debate 2018; 42(n. esp. 1):52-66.	Brazil
74	Santos et al., 2018¹⁰³103 Santos LPR, Castro ALB, Dutra CGP, Guimarães RM. Internações por condições sensíveis à atenção primária à saúde, 2008-2015: uma análise do impacto da expansão da ESF na cidade do Rio de Janeiro. Cad Saude Colet 2018; 26(2):178-183.	Brazil
75	Hayhoe et al., 2018¹⁰⁴104 Hayhoe B, Cowling TE, Pillutla V, Garg P, Majeed A, Harris M. Integrating a nationally scaled workforce of community health workers in primary care: a modelling study. J R Soc Med 2018; 111(12):453-461.	England
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77	Lima-Toivanen and Pereira, 2018¹⁰⁶106 Lima-Toivanen M, Pereira RM. The contribution of eHealth in closing gaps in primary health care in selected countries of Latin America and the Caribbean. Rev Panam Salud Publica 2018; 42:188.	Argentina, Brazil, Costa Rica and Dominican Republic
78	Wensing et al., 2018¹⁰⁷107 Wensing M, Kolle PK, Szecsenyi J, Stock C, Laux G. Effects of a program to strengthen general practice care on hospitalisation rates: a comparative observational study. Scand J Prim Health Care 2018; 36(2):109-114.	Germany
79	Cole, 2018¹⁰⁸108 Cole ES. Direct Primary Care: Applying Theory to Potential Changes in Delivery and Outcomes. J Am Board Fam Med 2018; 31(4):605-611.	USA
80	Abel et al., 2018¹⁰⁹109 Abel J, Kingston H, Scally A, Hartnoll J, Hannam G, Thomson-Moore A, Kellehear A. Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities. Br J Gen Pract 2018; 68(676):e803-e810.	United Kingdom
81	Fairall et al., 2018¹¹⁰110 Fairall L, Cornick R, Bateman E. Empowering frontline providers to deliver universal primary healthcare using the Practical Approach to Care Kit. BMJ 2018; 363:k4451.	South Africa
82	Ferreira et al., 2018¹¹¹111 Ferreira LR, Silva Júnior JA, Arrigotti T, Neves VR, Silva RA. Influences of the program for access and quality improvement in work processes in primary care. Rev Esc Enferm USP 2018; 52:e03407.	Brazil
83	Nabelsi et al., 2019¹¹²112 Nabelsi V, Lévasque-Chouinard A, Liddy C, Pilon MD. Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study. JMIR Med Inform 2019; 7(3):e13354.	Canada
84	Navathe et al., 2019¹¹³113 Navathe AS, Emanuel EJ, Bond A, Linn K, Caldarella K, Troxel A, Zhu J, Yang L, Matloubieh SE, Drye E, Bernheim S, Lee EO, Mugiishi M, Endo KT, Yoshimoto J, Yuen I, Okamura S, Stollar M, Tom J, Gold M, Volpp KG. Association Between the Implementation of a Population-Based Primary Care Payment System and Achievement on Quality Measures in Hawaii. JAMA 2019; 322(1):57-68.	Hawaii
85	Lenzi et al., 2019¹¹⁴114 Lenzi H, Ben AJ, Stein AT. Development and validation of a patient no-show predictive model at a primary care setting in Southern Brazil. PLoS ONE 2019; 14(4):e0214869.	Brazil
86	Azogil-López et al., 2019¹¹⁵115 Azogil-López LM, Pérez-Lázaro JJ, Ávila-Pecci P, Medrano-Sánchez EM, Coronado-Vázquez MV. Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria. Aten Primaria 2019; 51(5):278-284.	Spain
87	Ballart and Galais, 2019¹¹⁶116 Ballart X, Galais C. ¿Gestión pública, privada o por el tercer sector? Diferencias en los resultados en atención primaria de Cataluña. Aten Primaria 2019; 51(10):610-616.	Spain
88	Sibbald et al., 2019¹¹⁷117 Sibbald SL, Selkirk K, Cherla A, Misra V. An Opportunity for Quality: The Need for Better Evaluation of Family Health Teams in Ontario. Healthc Q 2019; 21:4.	Canada
89	Harzheim et al., 2019¹¹⁸118 Harzheim E, Chueiri PS, Umpierre RN, Gonçalves MR, Siqueira ACS, D'avila OP, Molina Bastos CG, Katz N, Dal Moro RG, Telles LF, Schmitz CAA. Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI. Rev Bras Med Fam Comunidade 2019; 14(41):1881.	Brazil
90	Tasca et al., 2020¹¹⁹119 Tasca R, Massuda A, Carvalho WM, Buchweitz C, Harzheim, E. Recomendações para o fortalecimento da atenção primária à saúde no Brasil. Rev Panam Salud Publica 2020; 44:e4.	Brazil

Thematic categories	Themes	Subthemes	Absolute number	Percentage
Strategies for PHC quality monitoring and services evaluation	General	PHC quality assessment (ID 88)	1	1.1%
	Indicators	Emergency/hospital admissions by PHC sensitive conditions (ID 71; ID 74; ID 10; ID 06; ID 42; ID80; ID 78; ID 16; ID 60; ID 58; ID 47; ID 33)	12	13.3%
	PHC Attributes	Primary Care Assessment Tool (ID 32; ID 67; ID 64); Care coordination (ID 54); Access (ID 69)	5	5.6%
	Institutional Assessment Programs	CPCQ (ID 72). SPAM (ID 56). European Practice Assessment (ID 43; ID 09). PMAQ-AB (ID 73; ID 82; ID 59). Estrategia de Evaluación Reformulada para Latinoamérica (ID 05). Pacto pela Atenção Básica/Pacto pela Saúde (ID 20). Public Health Impact (ID 29). PROADESS (ID 17)	11	12.2%
	e-Health	e-PHC Assessment Framework (ID 77)	1	1.1%
	User’s satisfaction	User’s satisfaction (ID 07; ID 13; ID 76; ID 19)	4	4.5%
Subtotal			34	37.8%
Models	General	PHC in Global Health (ID 39)	1	1.1%
	General	Governability (ID 01)	1	1.1%
	Payment	For populational basis (ID 84; ID 57)	2	2.3%
		For performance (ID 68; ID 24; ID 31)	3	3.3%
		Fee-for-service (ID 48; ID 79), fee subsidies (ID 36)	3	3.3%
	Accreditation	Accreditation (ID 27; ID 49; ID 08)	3	3.3%
	Models of Care	Care approach centered on: person (ID 35; ID 25); relationship (ID 04)	3	3.3%
	Models of Care	Patient no-show predictive model (ID 85)	1	1.1%
Subtotal category			17	18.9%
Organizational arrangements	Multidisciplinary teams	Team set-up/practices (ID 63; ID 65; ID 62; ID 51; ID 38; ID 11; ID 75)	7	7.8%
	Services organization	Extended hours (ID 52; ID 45), Team work (ID 46; ID 37), Distribution of teams/professionals (ID 66; ID 18; ID 23); urgencies (ID 44)	8	8.9%
	Structuring strategies	Family health (ID 90; ID 53; ID 55; ID 21), Rural Health Clinics (ID 14), More Doctors (ID 61), Adjusted Clinical Groups (ID 34)	7	7.8%
	Management	Non-governmental organizations (ID 30); Associative Basis Entities (ID 87); and Networking clusters (ID 12)	3	3.3%
Subtotal category			25	27.8%
Technologies applied to PHC	Digital	Telehealth and Telemedicine (ID 70; ID 40; ID 15; ID 50; ID 22; ID 89)	6	6.7%
		Virtual Appointments (ID 83; ID 26; ID 28)	3	3.3%
		Use of telephone for: scheduling appointments and waiting list (ID 03); reference/referral (ID 86); screening (ID 41); and electronic alert (ID 02)	4	4.5%
	Non-digital	Support to care: Practical Approach to Care Kit (ID 81)	1	1.1%
Subtotal category			14	15.5%
Total			90	100%

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva