Primary Health Care Quality Assessment Frameworks: State of the Art Review

Abstract

Context: Quality Assessment Frameworks (QAFs) are essential in monitoring progress in the primary health care (PHC) system. Different QAFs are used in countries to assess PHC quality. Objectives: This study aimed to review and compare the QAFs and highlight the most frequent quality indicators and dimensions. Methods: This state-of-the-art review was conducted on PHCQAFs. Required data were collected through search in Scopus, Web of Science, and PubMed databases, World Health Organization and World Bank websites, and Ministry of Health websites up to January 2022. The main keywords were quality, “primary healthcare”, PHC, “primary care”, “primary health services”, “basic healthcare”, assessment, evaluation, monitoring, measurement, improvement, indicator, OR index, pattern, framework, and model. Comparative tables were used to compare the defined quality dimensions (QDs) and quality assessment indicators (QAIs). Results: Finally, 14 PHCQAFs were retrieved, containing 94 QDs and 785 QAIs. Three PHCQAFs were proposed at the international level and others at the national level. Accessibility, coordination, and safety were the most frequent QDs, and QAIs related to smoking, alcohol and substance abuse, diabetes care, vaccination, chronic heart disease care, respiratory/infectious disease care, hypertension care, population coverage, community participation, customer satisfaction, maternal and child health, adverse event, health information management, staff empowerment, referral system, and patient rights were the most frequent among PHCQAFs. Conclusions: The current study illustrates the similarities and differences between PHCQAFs and highlights important QDs and QIs in PHC. Also, it provides a ready way for health policymakers to address key quality aspects that can help countries accelerate progress in the quality of PHC.