#EAPM: Ní mór don chúram sláinte bunscoile an status quo a thréigean, deir tuarascáil an Choimisiúin

A new report released by the European Commission examines primary health care across the member states, Scríobhann Chomhghuaillíocht Eorpach do Pearsanta Leigheas (EAPM) Stiúrthóir Feidhmiúcháin Denis Horgan. 

The report, by the Expert Group on Health Systems Performance Assessment, is entitled ‘A new drive for primary care in Europe: Rethinking the assessment tools and methodologies.’ It recommends “a powerful combination of essential elements” that EU countries could use to build performance assessment of their primary care systems.

These elements include improving primary care information systems, ensuring accountability and considering patients’ experiences and values, among others.  The report says that: “Primary care is the backbone of our healthcare systems as it is the key to integration and continuity between and across levels of care and essential for patients, particularly those with complex needs.” It points out that performance assessment has the potential to strengthen such care while contributing to strengthening the health system’s overall performance.

A key goal of the expert group’s report is to provide a framework “which empowers, engages, and focuses the minds of primary care professionals”, citing the examples of dentists, dieticians, general practitioners and family physicians, nurses, midwives, occupational therapists, optometrists, pharmacists, physiotherapists, psychologists and social workers.

From a personalised medicine point of view it is vital that all of the stakeholders named are aware of the effectiveness that targeted treatment can have in primary care which, as the report recognizes, is the foundation for health systems that are effective, efficient and responsive to patients’ needs. The report bemoans the fact that primary care is not well-appreciated, especially as it “can handle most of today's chronic conditions without a specialist referral and produce benefits for the overall healthcare systems”.

Proper use and delivery of primary care aids overall quality and leads to optimal outcomes for patients, but old models need to be upgraded as fast-developing medicine and treatment moves on. The report encourages stakeholders to nurture, explore and collaborate towards higher levels of excellence in primary care services, using performance assessment to underpin decisions on relevant resource allocation throughout health-care systems. The report states that primary care performance assessment systems in Europe vary in strength and reminds us that, although performance measurement is not in its infancy, it could advance significantly.

However, EU countries struggle to move forward in performance assessment in primary care due to three main challenges. These are the complexity of the performance aspects of primary care, difficulties in integrating assessments in policies and “pitfalls associated with a culture of excellence”.

Aiseolas

The report therefore recommends what it calls “a powerful combination of seven essential elements when building primary care performance assessment”. These consist of advancing the availability and quality of primary-care data for performance assessment needs, while embedding performance assessment in policy processes.

The report also calls for the institutionalization of performance systems via the aforementioned embedding into policy frameworks, which it calls a first step to achieving growth or improvement of performance assessment in primary care.

The expert group points out that accountability is not always clearly established. There is a need to define it, “ensuring the involvement of all the relevant stakeholders”, while also ensuring that the job satisfaction of providers in primary care is monitored and at high levels.  On top of this, patients’ experiences and values must be considered - a central tenet of personalised medicine methodology, of course - and an understanding of what patients truly value in primary care should be developed, especially as it is the first point of contact.

The final two suggestions are a nudge for countries to take advantage of adaptability. This is because its objective is to support adaptability in times of changes in primary care. Meanwhile, member states should support goal-oriented approaches through better use of professional and contextual evidence. Performance assessment should be exploited much more to “trigger better results of primary care’” but professional evidence is not “systematized”, the authors say.

Primary care is crucial, the report underlines, not least because primary care deals with patients of varying ages, from diverse ethnic and socioeconomic groups, with early-stage diseases, or undefined illnesses or varying levels of multi-morbidity. Performance assessments, the authors state, reflect the needs of varied groups of patients, meaning primary care needs to have a bigger impact on general health care.  In essence, the report seeks to convince policy makers to move on from the status quo, build new capacity for growth, and align all actors in primary care as Europe moves towards new ways of operating based on ultimate patient benefit. The members of the expert group state clearly their belief that strong primary health care is a foundation of a well-performing health system. It lives in a dynamic environment, they say, and is “challenged by a need to constantly adapt to patients’ needs”.

The experts believe that changes and development of primary care can be supported by a well-functioning performance assessment. The more embodied in the organisational culture and mission it is, the better will be the results of performance assessments.  The report suggests that reforms of primary care require a holistic approach, taking into account various aspects, including training of professionals (long supported by EAPM and other personalised medicine proponents)), and increasing the public perception of primary care.

Successful systems of performance assessment have to take into account the complexities of primary care, addressing many elements as interrelated components, the report says.   And when it comes to the design of the assessment models, a key challenge is to align methodologies, indicators within the organisational structure of primary care, and relations between various stakeholders.

The application of performance assessment involves commitment and the necessary skills to handle the measurement processes, as well as accountability for results achieved upon assessments.

In the end, better-performing primary care will mean better health outcomes and more opportunities for efficiency in health care overall throughout Europe. And that’s good news for patients.

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