Are people’s health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries

Aim: This article synthesises the results of a large international study on primary care (PC), theQUALICOPC study. Background: Since the Alma Ata Declaration, strengthening PC has beenhigh on the policy agenda. PC is associated with positive health outcomes, but it is unclear howcare processes and structures relate to patient experiences. Methods: Survey data were collectedduring 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainlyEuropean, countries. The data on the patients are linked to data on the PC physicians withineach country and analysed using multilevel modelling. Findings: Patients had more positiveexperiences when their PC physician provided a broader range of services. However, a broaderrange of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries wherepatients had a continuous relationship with PC physicians. Additionally, patients with along-term relationship with their PC physician were less likely to attend the emergency department.Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patientsvisiting multidisciplinary practices were less positive. A stronger national PC structure and higheroverall health care expenditures are related to more favourable patient experiences for continuityand comprehensiveness. The study also revealed inequities: patients with a migration backgroundreported less positive experiences. People with lower incomes more often postponed PC visits forfinancial reasons. Comprehensive and accessible care processes are related to less postponementof care. Conclusions: The study revealed room for improvement related to patient-reportedexperiences and highlighted the importance of core PC characteristics including a continuousdoctor–patient relationship as well as a broad range of services offered by PC physicians.