Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training.

Validação do instrumento de avaliação da atenção primária à saúde: PCATool-Brasil adultos / Validation of the Primary Care Assessment Tool: PCATool-Brazil for adults / Validación del instrumento para la evaluación de la atención primaria de salud: PCATool-Brasil adultos

Objetivo: traduzir e adaptar o PCATool versão usuários adultos ao contexto brasileiro e avaliar sua validade e fidedignidade. Métodos: Foi realizado um estudo transversal no qual foram entrevistados 2.404 usuários adultos residentes nas áreas adscritas da rede pública dos serviços de Atenção Primária à Saúde (APS) em Porto Alegre e usuários vinculados a um plano de autogestão. O processo de validação constituiu-se de tradução e tradução reversa, adaptação, validade de conteúdo, validade fatorial e fidedignidade. Resultados: Na análise fatorial, foram considerados 12 fatores que explicaram 50,83% da variação total. Assim, foram reconhecidos os seguintes atributos da APS: acesso - acessibilidade e utilização, longitudinalidade, coordenação - coordenação do cuidado e sistemas de informação, integralidade - serviços disponíveis e serviços prestados, enfoque familiar e orientação comunitária. Para a consistência interna, foi obtido alfa de Cronbach variando de 0,15 a 0,90. A estabilidade temporal não foi verificada para coordenação do cuidado (p<0,05), coordenação de sistema de informação (p<0,05) e integralidade de serviços prestados (p<0,05). Na razão êxito da escala, todos os componentes/atributos apresentaram valores próximos de 100%, à exceção do componente sistema de informação. Conclusões: os resultados indicaram que o PCATool-Brasil possui adequada validade e fidedignidade, podendo constituir-se em instrumento nacional de avaliação da APS para usuários adultos.

Objective: to translate and adapt the PCATool version for adult users to the Brazilian context and assess its validity and reliability. Methods: We conducted a cross-sectional study of 2404 adult users living in areas covered from public services Primary Care in Porto Alegre, and users of a self- management plan. We performed translation, reverse translation and adaptation of the instrument as well as its assessment in respect of content validity, factorial validity and reliability. Results: In the factor analysis were considered 12 factors that explained 50.83% of the total variation. In this way were recognized the attributes of Primary Care: access - accessibility and utilization; longitudinality; coordination - coordination of care and systems of information; comprehensiveness - services available and services provided; family orientation; and community orientation. In terms of internal consistency the values of Cronbach's alpha ranged from 0.15 to 0.90. The stability over time was not observed for coordination of care (p<0.05), coordination information of system (p<0.05) and comprehensiveness of services provided (p<0.05). The scaling success rate was close to 100% for all attributes, except to coordination of information system. Conclusions: the results indicated that the PCATool-Brazil has adequate validity and reliability, and it can act as a national instrument for the assessment of Primary Care from the perspective of adult users.

Objetivo: traducir y adaptar el PCATool versión usuarios adultos al contexto brasileño y evaluar su validez y fiabilidad. Métodos: Se realizó un estudio transversal en el cual se encuestaron a 2404 usuarios adultos residentes en áreas adscritas a la red pública de servicios de Atención Primaria de Salud (APS) en Porto Alegre y a otros usuarios vinculados a un seguro de salud de auto-gestión. El proceso de validación consistió en traducción y traducción reversa, adaptación, validez de contenido, validez factorial y fiabilidad. Resultados: En el análisis factorial se consideraron 12 factores que explicaron 50,83% de la variación total. Así, se reconocieron los siguientes atributos de la APS: acceso - accesibilidad y utilización, longitudinalidad, coordinación - coordinación del cuidado y sistemas de información, integralidad - servicios disponibles y servicios prestados, enfoque familiar y orientación comunitaria. Para la consistencia interna se obtuvo un alfa de Cronbach oscilando entre 0,15 y 0,90. La estabilidad temporal no se verificó para la coordinación del cuidado (p<0,05), la coordinación del sistema de información (p<0,05) y la integralidad de servicios prestados (p<0,05). En la razón de éxito de la escala todos los componentes/atributos presentaron valores próximos al 100%, con excepción del componente sistema de información. Conclusiones: los resultados indicaron que el PCATool-Brasil tiene una adecuada validez y fiabilidad, pudiendo constituirse en herramienta nacional para la evaluación de la APS en usuarios adultos.

[Validity and reliability of the Argentine version of the PCAT-AE for the evaluation of primary health care]. / Validez y fiabilidad de la versión argentina del PCAT-AE para evaluar la atención primaria de salud.

OBJECTIVE: To determine the validity and reliability of the version of the Primary Care Assessment Tool for adult users, adapted for Argentina (known as AR-PCAT-AE). METHODS: Two cross-sectional pilot studies were conducted among people over age 17, largely through self-administered questionnaires. Items that were equivalent to the original version of the PCAT and 13 others proposed for the instruments were analyzed. The factorial validity and reliability of the scores for each dimension were studied. The validity indicators were: factors that had three or more items with a factorial load of > 0.35, item-total correlation > 0.30, and interpretation of the solution according to the theoretical model. RESULTS: The factorial analysis yielded nine factors that explained 57.4% of the variability. Considering the pre-established criteria for validity, two items were excluded from the dimensions of continuity and comprehensiveness and six were added to comprehensiveness and cultural competency. In the dimensions, the percentage of questions with an item-total correlation of greater than 0.30 ranged from 67% to 100% and the Chronbach's (alpha) coefficient of internal consistency ranged from 0.44 to 0.90. CONCLUSIONS: The validity and reliability of the AR-PCAT-AE questionnaire are adequate, maintaining high equivalence with the original version. The process presented could be adopted in other contexts to advance the evaluation of primary health care functions with quality tools.

Validez y fiabilidad de la versión argentina del PCAT-AE para evaluar la atención primaria de salud / Validity and reliability of the Argentine version of the PCAT-AE for the evaluation of primary health care

OBJETIVO: Determinar la validez y la fiabilidad de los "instrumentos para evaluar la atención primaria de salud" (Primary Care Assessment Tool [PCAT, por su siglas en inglés]), versión dirigida a usuarios adultos, adaptada para Argentina (AR-PCAT-AE). MÉTODOS: Se realizaron dos estudios piloto transversales con personas mayores de 17 años, mediante cuestionarios mayoritariamente autoadministrados. Se analizaron los ítems equivalentes a la versión original de los PCAT y otros 13 propuestos para ser adicionados. Se examinó la validez factorial y la fiabilidad de las puntuaciones de cada dimensión. Los indicadores de validez fueron: factores que tuvieran tres o más ítems con una carga factorial >0,35, correlación ítem-total >0,30 e interpretación de la solución en consecuencia con el modelo teórico. RESULTADOS: El análisis factorial resultó en nueve factores que explicaron 57,4% de la variabilidad. Considerando los criterios de validez preestablecidos, se excluyeron dos ítems de las dimensiones de continuidad e integralidad y se adicionaron seis en integralidad y competencia cultural. En las dimensiones, el porcentaje de preguntas con correlación ítem-total mayor de 0,30 osciló entre 67% y 100% y el coeficiente de consistencia interna alfa de Cronbach entre 0,44 y 0,90. CONCLUSIONES: El cuestionario AR-PCAT-AE tiene validez y fiabilidad adecuadas, manteniendo una alta equivalencia con la versión original. El proceso presentado podría ser adoptado en otros contextos para avanzar en la necesidad de evaluar las funciones de la atención primaria con herramientas de calidad.

OBJECTIVE: To determine the validity and reliability of the version of the Primary Care Assessment Tool for adult users, adapted for Argentina (known as AR-PCAT-AE). METHODS: Two cross-sectional pilot studies were conducted among people over age 17, largely through self-administered questionnaires. Items that were equivalent to the original version of the PCAT and 13 others proposed for the instruments were analyzed. The factorial validity and reliability of the scores for each dimension were studied. The validity indicators were: factors that had three or more items with a factorial load of > 0.35, item-total correlation > 0.30, and interpretation of the solution according to the theoretical model. RESULTS: The factorial analysis yielded nine factors that explained 57.4% of the variability. Considering the pre-established criteria for validity, two items were excluded from the dimensions of continuity and comprehensiveness and six were added to comprehensiveness and cultural competency. In the dimensions, the percentage of questions with an item-total correlation of greater than 0.30 ranged from 67% to 100% and the Chronbach's (alpha) coefficient of internal consistency ranged from 0.44 to 0.90. CONCLUSIONS: The validity and reliability of the AR-PCAT-AE questionnaire are adequate, maintaining high equivalence with the original version. The process presented could be adopted in other contexts to advance the evaluation of primary health care functions with quality tools.

Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system.

OBJECTIVE: To obtain versions of the Primary Care Assessment Tools (PCAT)-Facility version to evaluate primary care (PC) in the Spanish context, and to analyze its feasibility, reliability and validity. METHODS: Cultural adaptation was performed through the use of forward and backward translations into Spanish and Catalan, observations and opinions of a panel of experts, and cognitive interviews with target users (PC team managers). A pilot phase was carried out in a sample of 130 managers of PC teams in Catalonia. A post-test questionnaire was sent 4-5 months later to all 194 managers of PC teams in the Barcelona health region. Analysis of metric properties included: 1) description of items and verification of Likert assumptions, since domain scores are obtained by summing item scores; 2) reliability analysis (Cronbach's alpha coefficient, Pearson's correlation coefficient, test-retest analysis); and 3) validity analysis (expert panel, cognitive interviews, and convergent and discriminant validity). RESULTS: Substantial adaptation was required for the accessory section of the questionnaire, but less was required in PC domain measurements. Items were added to the comprehensiveness domain to reflect services usually available in Spain. The lowest Cronbach's alpha scores were found for Access (0.62) and Coordination (0.59 and 0.65), while values were >0.70 for the remaining domains. CONCLUSION: The Spanish version of the PCAT-Facility questionnaire is now available and shows adequate reliability and validity. The Spanish PCAT version will facilitate national and international comparisons of PC and analysis of the determinants of quality of service provision.

Assessing primary care in Austria: room for improvement.

BACKGROUND: There is emerging evidence that strong primary care achieves better health at lower costs. Although primary care can be measured, in many countries, including Austria, there is little understanding of primary care development. OBJECTIVE: Assessing the primary care development in Austria. METHODS: A primary care assessment tool developed by Barbara Starfield in 1998 was implemented in Austria. This tool defines 15 primary care characteristics and distinguishes between system and practice characteristics. Each characteristic was evaluated by six Austrian primary care experts and rated as 2 (high), 1 (intermediate) or 0 (low) points, respectively, to their primary care strength (maximum score: n = 30). RESULTS: Austria received 7 out of 30 points; no characteristic was rated as '2' but 8 were rated as '0'. Compared with the 13 previously assessed countries, Austria ranks 10th of 14 countries and is classified as a 'low primary care' country. CONCLUSION: This study provides the first evidence concerning primary care in Austria, benchmarking it as weak and in need of development. The practicable application of an existing assessment tool can be encouraging for other countries to generate evidence about their primary care system as well.

Atención primaria: una creciente e importante colaboradora en la eficacia, la equidad y la eficiencia de los servicios de salud. Informe SESPAS 2012 / Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012

Hasta 2005, la literatura sobre los beneficios de los sistemas de salud orientados a la atención primaria ha sido consistente en mostrar una mayor eficacia, una mayor eficiencia y una mayor equidad. En los siguientes 5 años nada ha cambiado esta conclusión, pero ahora comprendemos mejor los mecanismos por los que actúa. Sabemos que, dentro de ciertos límites, ni la riqueza de un país ni el número de profesionales de la salud se relacionan con los niveles de salud. Lo que cuenta es la existencia de las características clave de la política de salud (atención primaria de salud): la cobertura financiera universal bajo el control del gobierno o regulada, los intentos de distribuir los recursos equitativamente, la integralidad de los servicios, y bajos o nulos copagos para los servicios de atención primaria. Todos estos, combinados, producen una mejor atención primaria: un mayor acceso y uso del primer contacto, más atención centrada en la persona a lo largo del tiempo, mayor gama de servicios disponibles cuando sean necesarios, y la coordinación de la atención. La evidencia ya no se limita principalmente a los países industrializados, pues nuevos estudios también lo demuestran en países con ingresos medios y bajos. El aval de la Organización Mundial de la Salud (los informes de la Comisión sobre Determinantes Sociales de la Salud y el Informe de Salud Mundial de 2009), así como una serie de comisiones internacionales, reflejan la aceptación generalizada de la importancia de la atención primaria de salud. Ahora, la atención primaria de salud puede ser medida y evaluada; todas las innovaciones y mejoras en ella deben servir a sus características esenciales con el fin de ser útil (AU)

As of 2005, the literature on the benefits of primary care oriented health systems was consistent in showing greater effectiveness, greater efficiency, and greater equity. In the ensuing five years, nothing changed that conclusion, but there is now greater understanding of the mechanisms by which the benefits of primary care are achieved. We now know that, within certain bounds, neither the wealth of a country nor the total number of health personnel are related to health levels. What counts is the existence of key features of health policy (Primary Health Care): universal financial coverage under government control or regulation, attempts to distribute resources equitably, comprehensiveness of services, and low or no copayments for primary care services. All of these, in combination, produce better primary care: greater first contact access and use, more person-focused care over time, greater range of services available and provided when needed, and coordination of care. The evidence is no longer confined mainly to industrialized countries, as new studies show it to be the case in middle and lower income countries. The endorsements of the World Health Organization (in the form of the reports of the Commission on Social Determinants of Health and the World Health Report of 2008, as well a number of other international commissions, reflect the widespread acceptance of the importance of primary health care. Primary health care can now be measured and assessed; all innovations and enhancements in it must serve its essential features in order to be useful (AU)

Impact of state laws that extend eligibility for parents' health insurance coverage to young adults.

BACKGROUND AND OBJECTIVES: The 2010 Affordable Care Act mandates that health insurance companies make those up to age 26 eligible for their parents' policies. Thirty-four states previously enacted similar laws. The authors sought to examine the impact on access to care of state laws extending eligibility of parents' insurance to young adults. METHODS: By using a difference-in-differences analysis, we examined the 2002-2004 and 2008-2009 Behavior Risk Factor Surveillance System to compare 3 states enacting laws in 2005 or 2006 with 17 states that have not enacted laws on 4 outcomes: self-reported health insurance coverage, identification of a personal physician/clinician, physical exam from a physician within the past 2 years, and forgoing care in the past year due to cost. RESULTS: For each outcome there was differential improvement among states enacting laws compared with states without laws. Health insurance differentially increased 0.2% (95% confidence interval [CI], -3.8% to 4.2%), from 67.6% to 68.1% pre-post in states enacting laws and from 68.5% to 68.7% in states without. Personal physician/clinician identification differentially increased 0.9% (95% CI -3.1% to 5.0%), from 62.4% to 65.5% in states enacting laws and from 58.0% to 60.2% in states without. Recent physical exams differentially increased significantly 4.6% (95% CI, 0%-9.2%), from 77.3% to 81.2% in states enacting laws and from 76.2% to 75.5% in states without. Forgone care due to cost differentially decreased significantly 3.9% (95% CI, -0.3% to -7.5%), from 20.4% to 18.2% in states enacting laws and from 17.8% to 19.4% in states without. CONCLUSIONS: States that expanded eligibility to parents' insurance in 2005 or 2006 experienced improvements in access to care among young adults.

Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012.

As of 2005, the literature on the benefits of primary care oriented health systems was consistent in showing greater effectiveness, greater efficiency, and greater equity. In the ensuing five years, nothing changed that conclusion, but there is now greater understanding of the mechanisms by which the benefits of primary care are achieved. We now know that, within certain bounds, neither the wealth of a country nor the total number of health personnel are related to health levels. What counts is the existence of key features of health policy (Primary Health Care): universal financial coverage under government control or regulation, attempts to distribute resources equitably, comprehensiveness of services, and low or no copayments for primary care services. All of these, in combination, produce better primary care: greater first contact access and use, more person-focused care over time, greater range of services available and provided when needed, and coordination of care. The evidence is no longer confined mainly to industrialized countries, as new studies show it to be the case in middle and lower income countries. The endorsements of the World Health Organization (in the form of the reports of the Commission on Social Determinants of Health and the World Health Report of 2008, as well a number of other international commissions, reflect the widespread acceptance of the importance of primary health care. Primary health care can now be measured and assessed; all innovations and enhancements in it must serve its essential features in order to be useful.

Reliability and validity of the Spanish version of the Child Health and Illness Profile Child-Edition/Child Report Form (CHIP-CE/CRF).

OBJECTIVES: To assess the reliability and validity of the Spanish version of the CHIP-CE/CRF. METHODS: Cross-sectional study was conducted in a representative sample of primary school children in Spain. Children were administered the Spanish version of the CHIP-CE/CRF. The Achenbach Child Behavioral Checklist was given to parents. RESULTS: The overall response rate was 75% (n = 979). Internal consistency was >0.70 for 3 out of 5 domains, and the intraclass correlation coefficient for test-retest stability ranged from 0.69 to 0.80. Confirmatory factor analysis replicated the original model. Younger children scored higher in Satisfaction than older children. Girls scored lower in Comfort but higher in Risk Avoidance than boys. CONCLUSIONS: The Spanish version of the CHIP-CE/CRF has shown acceptable reliability and validity, similar to the properties of the original US version. Future studies should analyze the instrument's sensitivity to change.

Adaptación cultural y al sistema de salud argentino del conjunto de instrumentos para la evaluación de la atención primaria de la salud / Cultural and health ststem adaptation of the primary care assessment tools for the argentinean context

INTRODUCCION: El conjunto PCAT [Primary Care Assessment Tools: instrumentos para la valoración de la atención primaria de la salud (APS)] permite medir desde varias perspectivas el grado en que se cumplen las funciones de la APS. OBJETIVO: Obtener versiones de los cuestionarios PCAT para usuarios (infantiles y adultos), proveedores y centros, con equivalencia semántica y conceptual a las versiones originales y con adecuación a la población y al sistema sanitario en Argentina. METODOS: Se realizó una adaptación cultural de medidas en las siguientes fases: 1) traducción directa y adaptación ling³ística; 2) revisión del contenido y adaptación al sistema sanitario por expertos locales y la autora del modelo teórico; 3) traducción inversa y comparación con la versión original; 4) pruebas preliminares con usuarios y profesionales. En el procedimiento se controló la equivalencia semántica, práctica y cultural, así como la comprensión y la viabilidad de los cuestionarios. RESULTADOS: Casi la mitad de los ítems recibieron alguna modificación después de la primera traducción al español. Los elementos pertenecientes a las funciones de la APS fueron, en general, levemente modificados, salvo un ítem que fue eliminado. Las preguntas de caracterización de centros, proveedores y cobertura sanitaria sufrieron cambios mayores. CONCLUSIONES: Se obtuvieron versiones del PCAT adaptadas para Argentina, equivalentes a las originales. Se estudiará su validez en próximos estudios.

INTRODUCTION: The Primary Care Assessment Tools (PCAT) measure the degree of achievement of the functions of primary care (PC) from different perspectives. OBJECTIVE: To obtain versions of the PCAT for users (children and adults), care providers and care centers, which are both semantically and conceptually equivalent to the original versions, and appropriate to the population and health system in Argentina. METHODS: Cross-cultural adaptation by the following steps: (1) direct translation and linguistic adaptation; (2) content review and adaptation to the health system by local experts and the theoretical modelÆs author; (3) back-translation and comparison with the original version; and (4) pre-test with users and health professionals. Semantic, cultural, practical equivalence, understanding and feasibility of the questionnaires were assessed. RESULTS: Almost half of the items were modified after forward translation. Items belonging to the PC domains were low or moderately modified, and one of them was removed. Questions to characterize centers, providers and health care coverage suffered major changes. CONCLUSIONS: It was possible to obtain PCAT versions adapted to Argentina and equivalent to the original. Their validity must be tested in future studies.

Adaptación cultural y al sistema de salud argentino del conjunto de instrumentos para la evaluación de la atención primaria de la salud / Cultural and health ststem adaptation of the primary care assessment tools for the argentinean context

INTRODUCCION: El conjunto PCAT [Primary Care Assessment Tools: instrumentos para la valoración de la atención primaria de la salud (APS)] permite medir desde varias perspectivas el grado en que se cumplen las funciones de la APS. OBJETIVO: Obtener versiones de los cuestionarios PCAT para usuarios (infantiles y adultos), proveedores y centros, con equivalencia semántica y conceptual a las versiones originales y con adecuación a la población y al sistema sanitario en Argentina. METODOS: Se realizó una adaptación cultural de medidas en las siguientes fases: 1) traducción directa y adaptación ling³ística; 2) revisión del contenido y adaptación al sistema sanitario por expertos locales y la autora del modelo teórico; 3) traducción inversa y comparación con la versión original; 4) pruebas preliminares con usuarios y profesionales. En el procedimiento se controló la equivalencia semántica, práctica y cultural, así como la comprensión y la viabilidad de los cuestionarios. RESULTADOS: Casi la mitad de los ítems recibieron alguna modificación después de la primera traducción al español. Los elementos pertenecientes a las funciones de la APS fueron, en general, levemente modificados, salvo un ítem que fue eliminado. Las preguntas de caracterización de centros, proveedores y cobertura sanitaria sufrieron cambios mayores. CONCLUSIONES: Se obtuvieron versiones del PCAT adaptadas para Argentina, equivalentes a las originales. Se estudiará su validez en próximos estudios.

INTRODUCTION: The Primary Care Assessment Tools (PCAT) measure the degree of achievement of the functions of primary care (PC) from different perspectives. OBJECTIVE: To obtain versions of the PCAT for users (children and adults), care providers and care centers, which are both semantically and conceptually equivalent to the original versions, and appropriate to the population and health system in Argentina. METHODS: Cross-cultural adaptation by the following steps: (1) direct translation and linguistic adaptation; (2) content review and adaptation to the health system by local experts and the theoretical modelÆs author; (3) back-translation and comparison with the original version; and (4) pre-test with users and health professionals. Semantic, cultural, practical equivalence, understanding and feasibility of the questionnaires were assessed. RESULTS: Almost half of the items were modified after forward translation. Items belonging to the PC domains were low or moderately modified, and one of them was removed. Questions to characterize centers, providers and health care coverage suffered major changes. CONCLUSIONS: It was possible to obtain PCAT versions adapted to Argentina and equivalent to the original. Their validity must be tested in future studies.

Multimorbidity and its measurement.

Multimorbidity is increasing in frequency. It can be quantitatively measured and is a major correlate of high use of health services resources of all types, especially over time. The ACG System for characterizing multimorbidity is the only widely used method that is based on combinations of different TYPES of diagnoses over time, rather than the presence or absence of particular conditions or numbers of conditions. It incorporates administrative data (as from claims forms or medical records) on all types of encounters and is not limited to diagnoses captured during hospitalizations or other places of encounter. It can be employed in any one or combination of analytic models, and can incorporate medication use if desired. It is being used in clinical care, management of health services resources, in health services research to control for degree of morbidity, and in understanding morbidity patterns over time. In addition to its research uses, it is being employed in many countries in various applications as a policy to better understand health needs of populations and tailor health services resources to health needs.

Adaptación cultural y al sistema de salud argentino del conjunto de instrumentos para la evaluación de la atención primaria en salud / Cultural and health system adaptation of the kidscreen primary care assessment tools

INTRODUCCIÓN: el conjunto PCAT [Primary CareAssessment Tools: instrumentos para la valoración de la atención primaria de la salud (APS)] permite medir desde varias perspectivas el grado en que se cumplen las funciones de la APS. OBJETIVO:obtener versiones de los cuestionarios PCAT para usuarios (infantilesy adultos), proveedores y centros, con equivalencia semántica y conceptual a las versiones originales y con adecuación a la población y al sistema sanitario en Argentina. MÉTODOS: se realizó una adaptación cultural de medidas en las siguientes fases: 1) traducción directa y adaptación lingüística; 2) revisión del contenido y adaptación al sistema sanitario por expertos locales y la autora del modelo teórico; 3) traducción inversa y comparación con la versión original; 4) pruebas preliminares con usuarios y profesionales. En el procedimiento se controló la equivalencia semántica, práctica y cultural, así como la comprensión y la viabilidad de los cuestionarios. RESULTADOS: casi la mitad de los ítems recibieron alguna modificación después de la primera traducción al español. Los elementos pertenecientes a las funciones de la APS fueron, en general, levemente modificados, salvo un ítem que fue eliminado. Las preguntas de caracterización de centros, proveedores y cobertura sanitaria sufrieron cambios mayores. CONCLUSIONES: se obtuvieron versiones del PCAT adaptadas para Argentina, equivalentes a las originales. Se estudiará su validez en próximos estudios.

INTRODUCTION: The Primary Care Assessment Tools(PCAT) measure the degree of achievement of the functions of primary care (PC) from different perspectives. OBJECTIVE:To obtain versions of the PCAT for users (children and adults),care providers and care centers, which are both semantically and conceptually equivalent to the original versions, and appropriate to the population and health system in Argentina. METHODS: Cross-cultural adaptation by the following steps:(1) direct translation and linguistic adaptation; (2) content review and adaptation to the health system by local experts and the theoretical model’s author; (3) back-translation and comparison with the original version; and( 4) pre-test with users and health professionals. Semantic, cultural, practical equivalence, understanding and feasibility of the questionnaires were assessed. RESULTS: Almost half of the items were modified after forward translation. Items belonging to the PC domains were low or moderately modified, and one of them was removed. Questions to characterize centers, providers and health care coverage suffered major changes. CONCLUSIONS: It was possible to obtain PCAT versions adapted to Argentina and equivalent to the original. Their validity must be tested in future studies.

Is patient-centered care the same as person-focused care?

Both patient-centered and person-focused care are important, but they are different. In contrast to patient-centered care (at least as described in the current literature with assessments that are visit-based), person-focused care is based on accumulated knowledge of people, which provides the basis for better recognition of health problems and needs over time and facilitates appropriate care for these needs in the context of other needs. That is, it specifically focuses on the whole person. Proposed enhancements and innovations to primary care do not appear to address person-focused care. Tools to assess person-focused care are available and deserve more widespread use in primary care.

The hidden inequity in health care/La inequidad oculta en la atención de la salud

La inequidad oculta en la atención de la salud es un material de reciente aparición en inglés cuya autora Barbara Starfield, MD, MPH, analiza en profundidad el concepto de equidad e inequidad, y establece distinciones claras así como sus aspectos esenciales y distintivos

Properties of a short questionnaire for assessing primary care experiences for children in a population survey.

BACKGROUND: The Primary Care Assessment Tool (PCAT) is an interesting set of tools for primary care research. A very short version could inform policy makers about consumer experiences with primary care (PC) through health surveys. This work aimed to investigate the validity and reliability of a selection of items from the child short edition (CS) of the PCAT. METHODS: A 24 item questionnaire permitted the identification of a regular source of care and the assessment of the key attributes of first contact, ongoing care over time, coordination, services available and services received (comprehensiveness), and cultural competence. Structural validity, reliability, and construct validity were assessed using responses from 2,200 parents of a representative sample of the population aged 0 to 14 years in Catalonia (Spain) who participated in the 2006 Health Survey. Structural validity was analyzed using exploratory and confirmatory factor analyses and reliability was assessed using Cronbach's alpha. Construct validity was assessed using linear regression analysis between PC experience scores and a measure of overall user satisfaction with healthcare services. RESULTS: A total of 2,095 (95.2%) parents provided useable responses on PC. After Confirmatory Factor Analysis (CFA), the best fitting model was a 5-factor model in which the original dimensions of first contact and ongoing care were collapsed into one. The CFA also showed a second order factor onto which all domains except services available loaded (root mean square error of approximation = 0.000; comparative fit index = 1.00). Cronbach's alpha values for one of the original scales (first-contact) was poor (alpha < 0.50), but improved using the modified factor structure (alpha > 0.70). Scores on the scales were correlated with satisfaction with healthcare services (p < 0.01), thereby providing some preliminary evidence of construct validity. CONCLUSIONS: This very short questionnaire obtained from the PCAT-CE yields information about five attributes of PC and a summary score. It has shown evidence of validity and reliability for judgments about experiences with primary care overall. If space on surveys is at a premium, the instrument could be useful as a measure of PC experiences.