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Table 2 Evaluation of suitability of long list indicators; selected results

From: The european primary care monitor: structure, process and outcome indicators

Dimension   Results of evaluation: selected indicators with the highest (H) and lowest (L) average score*
Governance of the PC system H Is (near) universal financial coverage for PC services guaranteed by a publicly accountable body (government, or government-regulated insurer)? (3.42); Has a national primary care policy been formulated? (3.30); Is a national survey system or surveillance systems in place for monitoring the performance of the PC system (e.g. morbidity, mortality and process features)? (3.21)
  L Provide a summary of the content of national standards on PC service delivery that allow PC practices to develop differently in their services delivery (1.63); Tasks and professionals included in legislation on possibilities of task substitution or delegation in PC (2.00); PC-oriented patient organisations currently being active (name, purpose, and number of members) (2.01)
Economic conditions of the PC system H Payment methods used for general practitioners?(Fee-for-service; Capitation payment; Salary; Mixed) (3.58); % of population covered for out-patient medical care by soc. health insurance (3.40); Method of health care financing for majority of (3.16)
  L Public expenditure on dental services as % of GDP (1.42); Private expenditure on dental services as % of GDP (1.50); Public expenditure on over-the-counter medicines as % of GDP (1.68)
PC workforce development H Vocational training for general practice/family medicine in place? (3.55); Status of vocational training for general practice/family medicine (obligatory or voluntary) (3.57); Total nr. of active GPs as a ratio to total nr. of active specialists (3.39)
  L % of (re)trained PC professionals (other than general practitioners, physiotherapists, pharmacists, dentists or midwives) active in their profession of training (1.26); Total number of posts of PC professionals (other than the previously listed PC professions) currently vacant per 1000 inhabitants (1.42); % of active female PC professionals (other than the previously listed PC professions) (1.49)
Access to PC services H Number of general practitioners per 100,000 population (3.74); Number of PC nurses per 100,000 population (3.56); Number of general practice consultations per capita per year (3.32)
  L Differences in dentist visits by income quintile (or education) (1.73); Number of consultations with PC professionals (other than general practitioners, physiotherapists, pharmacists, dentists, midwives) per capita per year (1.76); Differences in physiotherapy visits by income quintile (or education) (1.86)
Continuity of care H Population/patients registered with a general practitioner (3.51); Average PC practice list size (3.45); Items normally recorded in patients' medical file for every encounter (reason of visit; problem and/or diagnosis; supporting data; treatment plan; medication details) (3.43)
  L Usual Provider Continuity Index: proportion of visits to one's own PC physician relative to the total nr. of visits to all physicians in the past year (1.91); Average length of PC provider-patient relationship (2.08); Average practice list turnover: Nr. of new patients in a period divided by the nr. of registered patients at the end of the period (2.16)
Coordination of care H Patients having the possibility to directly access hospital based specialists (3.62); Patients having possibility to directly access emergency departments? (3.54); Patients having the possibility to directly access general practitioners? (3.49)
  L Predominant PC-Public Health Collaboration models in place (1.85); Specialist outreach models available for specific (chronic) conditions (2.18); If no direct access to speech therapists, can these be consulted if paid out of pocket (2.21)
Comprehensiveness of PC H (Estimated) % of PC facilities usually carrying out immunizations for flu or tetanus (3.15); (Est.) % of PC providers usually providing first contact care to a man aged 28 with a first convulsion (3.09); (Est.) % of PC facilities usually involved in influenza vaccination for high-risk groups (3.08)
  L (Est.) % of PC providers that regularly pay attention to social services (1.81); (Est.) % of PC facilities involved in blood typing and antibody screening for prenatal patients (1.90); (Est.) % of PC facilities involved in school health care (1.92)
Quality of PC H % of infants vaccinated against hepatitis B (2.99); % of infants vaccinated against invasive disease due to Haemophilius influenza type b (2.99); % of women aged 21-64 yrs who had at least 1 Pap test in the past 3 yrs (2.99)
  L Mortality for persons with severe psychiatric disorders per 100,000 (1.24); % of pregnant women having received a hepatitis B screening during their pregnancy (1.28); Potential life years lost of premature mortality from bronchitis (1.35)
Efficiency of PC H Number of GP consultations per capita per year (3.34); Average consultation length (in minutes) of GPs (2.83); Number of new referrals from GPs to medical specialists per 1000 listed patients per year (2.82)
  L Nr. of GP consultations in the surgery as % of all GP-patient contacts (2.24); Nr. of home visits as % of all GP-patient contacts (2.63); Nr. of telephone consultations as % of all GP-patient contacts (2.72)
Equity in health H Relative inequality (ratio between the rate of mortality in lowest and highest educational group) for avoidable mortality (2.34); Relative inequality for cardio-respiratory conditions (2.29); Relative inequality for mortality of infectious diseases (2.17)
  L Relative inequality for mortality of tuberculosis (1.73); same for pneumonia and influenza (1.73); same for asthma (1.92)
  1. * Judgement of evaluators: 0 = 'not useful', 1 = 'less important', 2 = 'important', 3 = 'very important', 4 = 'essential for PC comparison'.