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parameter estimations for a structural equation second-order model where a single underlying construct (second-order latent variable) leads to the five subscales (first-order variables) with loadings on their respective items
Source publication
Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emoti...
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Context 1
... comprehensive service subscales have low to modest correlation with one another, and whole-person (community) subscales correlate only modestly (.32). The highest correlation (r=.49) is between the two CPCI Comprehensive Care and Community Context subscales. The PCAT-s subscales do not correlate well with each other; the services Available and First- Contact utilization subscales correlate only weakly (r=.08), suggesting that they measure dif- ferent facets of comprehensiveness. When correlated with subscales of other attributes, both CPCI subscales correlate equally or higher with measures of relational continuity (.45 to .71) than with other comprehensiveness subscales. The PCAT-s subscales correlate as well or better with measures of other attributes, though still more modestly than do the CPCI subscales; the PCAT-s Community Orientation subscale correlates most strongly (r=.37) with patient-cen- tred decision-making from the Interpersonal Processes of Care instrument (stewart et al. 2007). not change the conclusions, suggesting that we principally lost statistical power and did not introduce bias by using the more conservative approach for factor analysis. We had little expectation that all items would load on a single factor because we had two operational definitions. Indeed, a one-factor model with structural equation modelling generated fit statistics suggesting poor fit, with a root mean squared error of approximation (RmsEA) of p=.184, considerably higher than the .05 standard for good fit. We removed PCAT-s First-Contact utilization and the RmsEA fit improved (p=.134), but at the expense of the normed fit index (NFI), which went from .96 to .91, though still higher than the .90 standard for good fit. However, removing the two whole-person (community) sub- scales improved model fit overall (RmsEA, p=.125; NFI=.94). Even when items are grouped within their original subscales loading on a single construct, presumed to be comprehen- siveness (usually expected to improve fit), the model does not fit a single underlying factor (RmsEA, p=.165; NFI=.97). We concluded that the community subscales measure a sepa- rate construct and need to be examined in independent models. Figure 1 presents the model with items grouped within their parent instrument subscales as five first-order latent variables, which in turn emerge from two separate, though correlated, second-order constructs, commu- nity and comprehensive services (RmsEA, p=.165; NFI=.97). Remaining analyses examine community and comprehensive cervices constructs separately. ...
Citations
... In terms of comprehensiveness, it may represent the growing need for primary care to address complex health issues, including psychosocial factors. 28 The results for community orientation may reflect the policy emphasis on home medical care in Japan and the expectations placed on primary care providers to engage in public health practice during the pandemic. 29 During the COVID-19 pandemic, the Japanese government recognized the need to clarify and strengthen the role of primary care physicians, and in 2023 legislated the function of kakaritsukei, which reflects the attributes of primary care including first contact, longitudinality, coordination, comprehensiveness, and community orientation. ...
Background. The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. Objectives. We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensive-ness, and community orientation) and the loss or change of USC. Methods. This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). Results. Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. Conclusions. Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.
... 72 Health organizations assess client satisfaction by soliciting feedback from patients via a range of techniques, including telephone surveys, written surveys, focus group discussions, and individual interviews. 64 Bereavement midwives are part of the personnel who are assessed by institutions. Bereavement midwives help to ensure high standards. ...
When perinatal death occurs, the effect extends beyond the parents; it transcends to significant others and healthcare professionals. Caring for the bereaved parents and families is an immensely challenging duty often conducted by healthcare professionals who have little expertise in the subject. One group of professionals who are experts in perinatal bereavement care are bereavement midwives. However, very little is known about bereavement midwives. The purpose of this scoping review was to learn what was known about them. Using a systematic literature search, twenty-five relevant articles were included in the review. The conclusions drawn were bereavement midwives play a critical role in supporting bereaved parents and are meeting the needs of parents and families who experience perinatal loss. It is of enormous benefit to integrate bereavement midwives into health institutions globally. The option for existing midwives interested in perinatal bereavement care to specialize in this area is critical for optimum perinatal bereavement care. RÉSUMÉ Lorsque la mort périnatale se produit, l'effet s'étend au-delà des parents; il transcende les autres personnes importantes et les professionnels de la santé. Prendre soin des parents et des familles endeuillés est un devoir extrêmement difficile souvent exercé par les professionnels de la santé qui ont peu d'expertise dans le domaine. Un groupe de professionnels experts en soins de deuil périnatal sont des sages-femmes
... Haggerty et al. 17 Whole-person care (WPC) is a key component of comprehensiveness. It can best be measured by the patient's perspective. ...
... Haggerty et al. 17 Scope of services is a key component of providing comprehensive care. A full range of services includes prevention, diagnosis, and treatment of most common conditions. ...
... Patients expect providers to elicit the physical, emotional, and social aspects of a patient's health and consider their community context in care decisions. 17 The essence of whole-person care is a focus on the individual, rather than the disease. 20 This is especially foundational within primary care, where physicians often care for complex patients with multiple chronic conditions. ...
Introduction The term comprehensiveness was introduced into the literature as early as the 1960s and is regarded as a core attribute of primary care. Although comprehensive care is a primary care research priority encompassing patient and provider experience, cost, and health outcomes, there has been a lack of focus on consolidating existing definitions. Aim To unify definitions of comprehensiveness in primary care. Methods The PRISMA extension for scoping reviews was followed, hierarchically filtering ‘comprehensiveness’ MeSH terms and literature-defined affiliated terms. Snowballing methods were used to include additional literature from known experts. Articles were systematically reviewed with a three-clinician team. Results The initial search populated 679 607 articles, of which 25 were included. Identified key terms include: whole-person care (WPC), range of services, and referral to specialty care. WPC is the extent which primary care physicians (PCPs) consider the physical, emotional, and social aspects of a patient’s health. It has been shown to positively impact clinical costs and outcomes, satisfaction, and trust. Range of services encompasses most health problems to reduce unnecessary spending on specialty care and promote continuity. Referral to specialty care is utilized when PCPs cannot provide the necessary services – balancing depth and breadth of care with the limitations of primary care scope. Discussion This scoping review unified the interrelatedness of comprehensiveness’s main aspects – whole-person care, range of services, and referral to specialty care – framing a working, evidence-based definition: managing most medical care needs and temporarily complementing care with special integrated services in the context of patient’s values, preferences, and beliefs.
... Comprehensive PHC is characterised by the provision of a full ranges of appropriate services and meeting clients' health care needs [19,134]. In our analysis, the Australian PHC delivery is comprehensive that it provides a wide range of services for a variety of target populations. ...
... There is substantial evidence that achieving UHC, meeting diversified and dynamic health care needs [19,134] and ensuring quality of PHC have many trade-offs [137]. While there are many strategies to achieve many of the PHC goals and mitigate major bottlenecks, ensuring service comprehensiveness is an important means to minimise major trade-offs. ...
Introduction:
Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC.
Methods:
We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results:
We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units.
Conclusion:
Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.
... Continuity is defined, based on the work of Haggerty et al. (22), as the fact that a patient is treated by the same professional or the same team over time (relational continuity) and that different services are harmoniously integrated with each other (management continuity). Comprehensiveness encompasses two dimensions that make up the scope of patient management: considering all of a patient's needs and providing a complete basket of services (10,23). Responsiveness is defined here as the convergence between the patients' expectations regarding non-technical elements of the care and what the clinic offers in practice (20). ...
... Starfield explicated these four attributes as: C1: "Comprehensive care", which expands on the availability of a wide range of services in primary care to cater to a spectrum of health conditions [24]. Offering a comprehensive scope of services permits a practice to provide health promotion, prevention, diagnosis and treatment services for a range of health conditions throughout a patient's life course [25]. This can be enabled by building teams of professionals including GPs, registered nurses and allied health professionals that are based in the primary care space [26]. ...
The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN's face in chronic disease management. The objective of this study is to map features of PCN to Starfield's "4Cs" framework. The "4Cs" of primary care-comprehensiveness, first contact access, coordination and continuity offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN's empowering features that fulfil the "4Cs". On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the "4Cs". However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.
... These results suggest that healthcare professionals supporting women with hair loss after irradiation for childhood tinea capitis should be alert to a history of severe levels of hair loss, given the risk for important mental health consequences. Our results also stress the need for health policy makers to develop comprehensive services designed to meet the needs of these women, based on a whole-person care approach that takes into account the physical, emotional and social aspects of a patient's health, and addresses them in an integrated format [54,55]. By doing so, they may improve the well-being of these women. ...
Hair loss resulting from childhood irradiation for tinea capitis has been linked to mental health effects in women. However, the association of hair loss severity with mental health in this population is unknown. To address this gap, this study examined the association between hair loss severity and mental health outcomes in women irradiated for tinea capitis in childhood as well as the factors that contribute to these outcomes. Medical records, held at the archives of the Israel National Center for Compensation of Scalp Ringworm Victims, were retrospectively reviewed for 2509 women who received compensation for full or partial alopecia resulting from irradiation for tinea capitis. Mental health outcomes were determined by the number of mental health conditions reported. The results show that among women with more hair loss, risk was increased for a range of mental health problems, especially social anxiety (RR 2.44, 95% CI 2.09–2.87). Hair loss severity emerged as a significant predictor of mental health, adding to the effects of other predictors such as family, social and physical health problems (β = 0.13, 95% CI 0.27, 0.56). The effects of hair loss severity on mental health outcomes were mediated by women’s negative social experiences (indirect = 0.72, 95% bias-corrected confidence interval, 0.53–1.08). Healthcare professionals supporting women with hair loss after irradiation for childhood tinea capitis should be alert to a history of severe levels of hair loss.
... The fragmentation of instruments and research efforts to measure performance is not limited to Africa. Studies in high-income countries [46][47][48] note that many validated instruments available to measure PHC do not all address important attributes nor the same range. Such fragmentation is emphasised by several studies (excluded in Methods ...
Introduction
Countries with strong primary healthcare (PHC) report better health outcomes, fewer hospital admissions and lower expenditure. People-centred care that delivers essential elements of primary care (PC) leads to improved health outcomes and reduced costs and disparities. Such outcomes underscore the need for validated instruments that measure the extent to which essential, evidence-based features of PC are available and applied to users; and to ensure quality care and provider accountability.
Methods
A systematic scoping review method was used to identify peer-reviewed African studies and grey literature on PC performance measurement. The service delivery dimension in the Primary Healthcare Performance Initiative conceptual framework was used to identify key measurable components of PC.
Results
The review identified 19 African studies and reports that address measuring elements of PC performance. 13 studies included eight nationally validated performance measuring instruments. Of the eight, the South African and Malawian versions of Primary Care Assessment Tool measured service delivery comprehensively and involved PC user, provider and manager stakeholders.
Conclusion
40 years after Alma Ata and despite strong evidence for people-centred care, significant gaps remain regarding use of validated instruments to measure PC performance in Africa; few validated instruments have been used. Agreement on indicators, fit-for-purpose validated instruments and harmonising existing instruments is needed. Rigorous performance-based research is necessary to inform policy, resource allocation, practice and health worker training; and to ensure access to high quality care in a universal health coverage (UHC) system—research with potential to promote socially responsive, accountable PHC in the true spirit of the Alma Ata and Astana Declarations.
... 6 Comprehensiveness can also be measured from a number of perspectives, including provider report, patient report and administrative claims. Each of these methods has strengths but also methodological shortcomings, 11,12,[14][15][16] and data derived from different perspectives may not correlate well. 6,15,16 Nonetheless, measurement from different perspectives has had similar relations with outcomes. ...
... Each of these methods has strengths but also methodological shortcomings, 11,12,[14][15][16] and data derived from different perspectives may not correlate well. 6,15,16 Nonetheless, measurement from different perspectives has had similar relations with outcomes. 6 Although challenging to measure, comprehensiveness of care is a cornerstone of primary care provision 17,18 and has been shown to be associated with decreased health costs and hospital admissions. ...
... Our approach classified primary care physicians as providing or not providing comprehensive care, in contrast to the use of scales or scores. 6,12,16 This dichotomous approach was designed to inform health human resource planning but did not include part-time comprehensive care provided by physicians who spend their time in multiple settings and may therefore have underestimated the total amount of comprehensive care. ...
Background:
Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time.
Methods:
We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding those who saw patients fewer than 44 days per year, we identified physicians as providing comprehensive care if more than half of their services were for core primary care and if these services fell into at least 7 of 22 activity areas. Physicians with 50% or less of their services for core primary care but with more than 50% in a single location or type of service were identified as being in focused practice.
Results:
In 2014/15, there were 12 891 physicians in the primary care pool: 1254 (9.7%) worked fewer than 44 days per year, 1619 (12.6%) were in focused practice, and 1009 (7.8%) could not be classified. The proportion in comprehensive practice ranged from 67.5% to 74.9% between 1992/93 and 2014/15, with a peak in 2002/03 and relative stability from 2009/10 to 2014/15. Over this period, there was an increase of 8.8% in population per comprehensive primary care physician.
Interpretation:
We found that just over two-thirds of primary care physicians provided comprehensive care in 2014/15, which indicates that traditional estimates of the primary care physician workforce may be too high. Although implementation will vary by setting and available data, this approach is likely applicable elsewhere.
... A comprehensive service would be an integrated service (World Health, 2008;Fielding & Gilbert, 2006) that provides a range of services from preventive to rehabilitative (Fielding & Gilbert, 2006;Starfield & Shi, 2009), meet human needs holistically, collaborate inter-sectorally, and have a multidisciplinary team (MDT) of health care professionals. This team should conduct health promotion activities through assertive outreach and promote patient advocacy and practical support (Haggerty et al., 2011). The respondents were asked to indicate the service they predominantly render and show aspects of comprehensiveness that they offer, such as the frequency in addressing matters beyond client's concern, collaboration with and referral to other health care professionals. ...
... Service coverage involves conducting outreach and ensuring that a proportion of target groups benefit from the services without any barriers, such as costs (Haggerty et al., 2011;WHO, 2009). Table 3 summarizes the responses of service coverage within a specified period. ...
... Furthermore, this can result in building trust and improved relationship. In line with previous studies (Haggerty et al., 2011;Dickinson & Miller, 2010), the findings suggest the availability of MDT. However, their availability is not beneficial to the PWMI and their families as well as other professionals because it was revealed that the team does not attend to mental illness cases in clinics. ...
Addressing the inadequate and poor provision of mental health services in rural areas is a world-wide challenge. Most people with mental illness in these areas do not have access to mental health services. Using eight attributes of good mental health service as criteria, the purpose of this study was to assess mental health services at Mashashane, a rural area in the Limpopo Province, South Africa. A survey was conducted with a purposively selected sample of health care professionals from four health establishments serving Mashashane. Data was collected using a questionnaire with closed and open-ended questions. Quantitative and qualitative data analyses were used. The results show that out of eight attributes assessed only comprehensiveness was positively perceived. This is an indication of the inadequacy of mental health services, hence their inability to improve the well-being of people with mental illness and their families. Lack of resources was identified as the major hindrance to the delivery of appropriate mental health services. The findings highlighted aspects that contributed to the development of a framework for a community-based program to improve the well-being of people with mental illness and their families in a rural setting.
