Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service-delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe: major policy-changes including key “components”, impacts of new models of care, and barriers and facilitators to PCT implementation.

Methods
We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed.

Results
107 studies from 15 countries were included. The most frequently employed component of PCT was expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with <20% measuring patient views or satisfaction. Only three studies evaluated effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes.

Conclusions
Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation, and mixed findings on impacts. Only a minority of studies described impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.

Keywords
Primary Care; Ageing; Scoping review; Health Inequalities
Original languageEnglish
Article number319
Number of pages12
JournalBMC Medicine
Volume21
DOIs
Publication statusPublished - 24 Aug 2023

Keywords / Materials (for Non-textual outputs)

  • Primary Care
  • Ageing
  • Scoping review
  • Health Inequalities

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