1. OECD list of selected PHC indicators
1.1 Health promotion
- Obesity prevalence
- Physical activity
- Smoking rate
- Diabetes prevalence
- Gonorrhoea/chlamydia rates
- Abortion rates
1.2 Preventive care
- Blood typing and antibody screening for prenatal patients
- HIV screen for prenatal patients
- Bacteriuria screen for prenatal patients
- Immunizable conditions
- Low birth weight rate
- Adolescent immunization
- Anaemia screening for pregnant women
- Cervical gonorrhoea screening for pregnant women
- Hepatitis B screen for pregnant women
- Hepatitis B documentation in record at time of delivery
- Hepatitis B immunization for high-risk groups
- Influenza vaccination for high-risk groups
- Pneumococcal vaccination for high-risk groups
1.3 Diagnosis and treatment: primary care
- Congestive heart failure readmission rate
- First visit in first trimester
- Smoking cessation counselling for asthmatics
- Blood pressure measurement
- Re-measurement of blood pressure for those with high blood pressure
- Initial laboratory investigations for hypertension
- Hospitalization for ambulatory care sensitive conditions.
2. European panels’ list of selected PHC indicators
2.1 Infrastructure
2.1.1 Premises
- If the practice is on another floor than the ground level, there is a lift
- The practice has a toilet with hand wash facilities for patients
- There is sufficient seating in the waiting room
- There is space for prams, buggies etc
- Patients find the practice clean
- Patients find the practice well maintained
2.1.2 Medical equipment, including drugs
- The essential basic equipment is available
- The essential emergency and resuscitation equipment is available
- The practice has an up-to-date inventory list detailing which emergency drugs must always be available on site
- The essential emergency drugs are available
- The practice has an up-to-date inventory list detailing what should be in the doctor’s bags at all times
- The content of the doctor’s bag is complete
- The content of the doctor’s bag is not over expiry dates
- The practice has a refrigerator for medicines that need to be kept cool
- The practice keeps all drugs safely stored (not accessible for children, patients)
- Hand wash facilities are present in every consulting room and examination room
2.1.3 Non medical equipment
- The practice has at least one computer for staff
- The practice has an internet connection
- All computers are protected against inappropriate access (password, firewall, virus scanner)
- The practice has a telephone system with sufficient inward and outward capacity
2.1.4 Accessibility and availability
- Patients of the practice have the opinion that they can contact the practice easily by telephone
- Clinical staff provide home visits for patients who are physically not able to travel to the practice
- Patients of the practice have the possibility to contact a GP by telephone
- The practice has an appointment system
- Patients contacting the practice out of hours have clear and rapid access to out of hours service
- Reception staff have been trained to recognise and respond appropriately to urgent medical matters
- A sign is displayed outside the practice, detailing the practice’s opening hours and how to access after hours care
2.2 Staff
2.2.1 Personnel
- All (non-GP) practice staff have signed contracts with the practice
- All staff involved in clinical care have appropriate qualifications
2.2.2 Team
- Responsibilities within the team are clearly defined
- Responsibilities within the team are understood by team members
- All staff are invited to participate in team meetings
2.2.3 Working conditions
- Staff experience a pleasant working atmosphere
- The practice has a policy which enables staff to offer suggestions for improving practice management
2.3 Information
2.3.1 Clinical data/CRM/recall
- The practice has a computerised medical record system
- Each patient medical record contains:
Telephone number; Occupation; Family history
- For every encounter the following are recorded:
Reason why the patient presented; A defined problem/diagnosis; Data supporting the defined problem/diagnosis; A treatment plan; If medication is prescribed, the length, the dose and the administration of the treatment; A note on what the patient was told
- The medical record contains laboratory and investigation results
- All patients receiving regular/repeat medications are reviewed at least annually by the GP
- The computer is used for:
Patient medical registration; Referral letters
2.3.2 Confidentiality and privacy
- Medical records, and other files containing patient information, are not stored or left visible in areas where members of the public have unrestricted access
- The conversation at the reception desk cannot be heard by other patients
- The conversation in the consultation room cannot be heard by other patients
2.3.3 System for communication/sharing information with colleagues and other health care providers
- The practice receives information about contacts with patients by out of hours GPs within 24 hours
- The practice has an up-to-date directory of local health care providers
- Copies of referral letters are kept in the patient’s record
- Referral letters contain:
Background information and history; Problem; Key examination findings; Current treatment; Reason for referral
2.3.4 System to process information
- The practice has procedures that ensure incoming clinical information is seen by the patient’s GP before filing in the patient’s medical record
- The practice has procedures that ensure incoming information (letters, test results) is filed in the appropriate patient’s medical record
2.3.5 Information for/from the patient about the practice, practice policy and local environment
- The practice information sheet contains:
Names of the GPs working in the practice; Practice address and phone numbers; Consulting hours
2.4 Finance
2.4.1 Financial leadership and responsibilities
- The responsibility for financial management in the practice is clearly defined
- Every GP is insured to cover liability
- Every member of the clinical staff is insured to cover liability
2.4.2 Annual report
- The practice produces an annual financial report, which includes all income and expenditure
2.5 Quality and Safety
2.5.1 Quality policy
- All staff are involved in quality improvement
2.5.2 Safety of the staff and patients
- Smoking is not allowed in the practice
The practice has:
- A steriliser or an autoclave
- A container for used equipment
- A leak proof container for infectious or hazardous waste
- A container for disposal of sharps
- Protective equipment when dealing with blood/fluids (gloves, goggles, apron)
- Fire extinguishers
3. The European Primary Care Monitor quality indicator list
3.1 GOVERNANCE (Structure)
GOV1. Primary care goals
GOV 1.1 Primary care goals: Have policy documents (by government or important stakeholders) been issued that reflect a clear vision on current and future PC?
GOV2. Policy on equality in access
GOV 2.1 Policy on distribution of human resources: Is there an explicit governmental policy to regulate the distribution of PC providers and facilities more evenly?
GOV3. (De)centralization of PC management & service development
GOV 3.1 PC within the Ministry of Health: Does PC has its own department or unit within the Ministry of Health?
GOV 3.2 PC policy development at regional or local level: Have responsibilities for PC been decentralized to regional or local level?
GOV 3.3 Stakeholder involvement in PC policy development: Do organisations of stakeholders contribute to PC policy development?
GOV 3.4 (De)centralization of PC service delivery: Has community influence on the provision of PC services been organised on a national or regional level?
GOV4. PC Quality Management Infrastructure
GOV 4.1 Coordination of quality management: If state inspection on health care exists, does it have a specific unit for PC?
GOV 4.2 Certification of providers: Do formal requirements exist for physicians (such as GPs/Family doctors) to work in PC?
GOV 4.3 Licensing of facilities: Do formal requirements exist for PC practices or facilities to operate?
GOV 4.4 Development of clinical guidelines: Have evidence based clinical guidelines been produced for specific use by GPs?
GOV5. Patient advocacy
GOV 5.1 Patient rights: Have any laws/regulation pertaining to the following patients’ rights in PC been implemented?
Informed consent; Patient access to own medical files; Confidential use of medical records; Availability of a procedure to process patient complaints in PC facilities.
GOV6. Multidisciplinary collaboration
GOV 6.1 Multidisciplinary collaboration: Has a governmental policy on cooperation or integration of PC services been laid down in a law or policy paper?
3.2 ECONOMIC CONDITIONS (Structure)
ECO1. Primary care expenditure
ECO 1.1 Total PC expenditure: Total expenditure on PC as % of total expenditure on health
ECO 1.2 Expenditure on prevention and public health: Total expenditure on prevention and public health as % of total expenditure on health.
ECO2. Primary care coverage
ECO 2.1 Total PC coverage: % of the population fully covered or insured for PC costs.
ECO 2.2 GP services coverage: % of the population covered or insured for costs of GP services (office and at home) .
ECO 2.3 Medicines coverage: % of the population covered or insured for medicines prescribed in primary care / GP.
ECO 2.4 Uninsured population: % of the population uninsured for medical expenses.
ECO 2.5 Out-patient medical care coverage by social insurance: Social health insurance coverage for out-patient medical care by % of population.
ECO3. Employment status of PC workforce
ECO 3.1 Employment status of GPs: % of GPs that are:
Salaried with national, regional or local authorities; Salaried with other physicians; Self-employed with contract to health insurance fund(s) or health authority; Self-employed without contract (paid by patients out-of-pocket); Other mode .
ECO4. Remuneration system of PC workforce
ECO 4.1 Remuneration system for salaried GPs: How are salaried GPs paid?
Flat salary; 2. Salary related to the number of their patients; 3. Salary related to both the number of their patients and indicators of performance
ECO 4.2 Remuneration system for self-employed GPs: How are self-employed GPs paid?
Fee-for-service payment; Capitation payment; Mix of capitation and fee-for-service payment; Mix of capitation and fee-for-service and other specific components (e.g. bonus for working in disadvantaged areas etc.).
ECO5. Income of PC workforce
ECO 5.1 Income of GPs: What is the (estimated) gross annual income (in Euros) of a ‘mid-career’ GP?
3.3 WORKFORCE DEVELOPMENT (Structure)
WFD1. Profile of PC workforce
WFD 1.1 Type of PC professionals: To which of the following medical, para-medical and nursing disciplines people have direct access (which means without referral or intervention by another medical provider)? Please, indicate on the list and add disciplines if applicable. Also indicate with each discipline whether they exclusively work in PC or also provide services on referral (for instance in another setting, such as a hospital):
GP / Family physician, Gynaecologist / obstetrician, Paediatrician, Specialist of Internal medicine, Ophthalmologist, ENT specialist, Cardiologist, Neurologist, Surgeon, Primary care / GP practice nurse, Specialised nurse (e.g. on diabetes), Home care nurse, Physiotherapists (ambulatory), Midwife (ambulatory), Occupational therapist, Speech therapist, Dentist, Other
WFD 1.2 Age distribution GPs: Average age of practicing GPs.
WFD 1.3 Workload GPs: Average number of working hours per week of GPs.
WFD2. Status & Responsibilities of PC disciplines
WFD 2.1 Recognition / responsibilities of GPs: Have tasks/duties of GPs or family doctors been described in a law or policy document?
WFD 2.2 Financial status of GPs compared to a specialist: How does the gross annual income (in Euros) of a mid-career GP (about 10 yrs experience with average size of practice) relate to the gross annual income of the following medical, para-medical and nursing disciplines of the same age? Please give an estimation whether a GP’s income is [Much lower / lower / equal / higher / much higher].
Gynaecologist / obstetrician, Paediatrician, Specialist of Internal medicine, Ophthalmologist, ENT specialist, Cardiologist, Neurologist, Surgeon, Primary care / GP practice nurse, Specialised nurse (e.g. on diabetes), Home care nurse, Physiotherapists (ambulatory), Midwife (ambulatory), Occupational therapist, Speech therapist, Dentist
WFD 2.3 Attractiveness of FM among medical students: What % of all medical graduates chooses to enrol in postgraduate training in family medicine?
WFD3. PC Workforce supply and planning
WFD 3.1 Development of workforce supply: Please indicate the % by which the supply (total number) of directly accessible medical, para-medical and nursing disciplines has increased or reduced over the most recent available 5 year period. Please also indicate the years applied.
GP / Family physician, Gynaecologist / obstetrician , Paediatrician, Specialist of Internal medicine, Ophthalmologist, ENT specialist, Cardiologist, Neurologist, Surgeon, Primary care / GP practice nurse, Specialised nurse (eg. on diabetes), Home care nurse, Physiotherapists (ambulatory), Midwife (ambulatory), Occupational therapist, Speech therapist, Dentist, Other
WFD 3.2 GP-Specialist ratio: Total nr. of active GPs as a ratio to total nr. of active specialists.
WFD 3.3 Workforce planning: Are data available from studies on PC workforce capacity needs and development in the future?
WFD4. Academic status of PC
WFD 4.1 Academic status of FM/ general practice: % of medical universities (or universities with a medical faculty) with a postgraduate programme in family medicine.
WFD 4.2 FM/ general practice education: Is family medicine subject in the undergraduate medical curriculum?
WFD 4.3 Education of nurses in PC: Is there professional training specifically for:
district- or community nurses? PC/GP practice nurses?
WFD5. Medical associations
WFD 5.1 Professional association of GPs: Do national associations or colleges of GPs exist in this country? [Yes/No]
WFD 5.2 Professional Journal on GP: Is a journal on family medicine/general practice being published in this country?
WFD 5.3 Professional association of PC nurses: Do national associations or organisations of PC nurses exist in this country?
WFD 5.4 Professional Journal on PC nursing: Is a professional journal on PC nursing being published in this country?
3.4 ACCESS (Process)
ACC1. National Availability of PC services
ACC 1.1 Density available PC workforce: Please provide the total number of directly accessible medical, para-medical and nursing disciplines available per 100,000 population:
GP / Family physician, Gynaecologist / obstetrician, Paediatrician, Specialist of Internal medicine, Ophthalmologist, ENT specialist, Cardiologist, Neurologist, Surgeon, Primary care / GP practice nurse, Specialised nurse (eg. on diabetes), Home care nurse, Physiotherapists (ambulatory), Midwife (ambulatory), Occupational therapist, Speech therapist, Dentist, Other
ACC2. Geographic availability of PC services
ACC2.1 Availability of GPs by region: Difference between region, province or state with highest and with lowest density of GPs (per 100,000 population).
ACC 2.2 Urban-Rural availability of GPs: Difference between average urban density of GPs (per 100,000 population) and average rural density of GPs.
ACC 2.3 Shortage of GPs: Do (regional or national) shortages exist of GPs according to usual national norms?
ACC 2.4 Shortage of community pharmacists: Do problems exist in the availability of medicines in rural areas due to lack of pharmacies?
ACC3. Accommodation of accessibility
ACC 3.1 Opening hours: Are GP practices or PC centres obliged to have a minimum number of opening hours or days?
ACC 3.2 Home visits: Average nr. of home visits per week per GP.
ACC 3.3 Organizational access arrangements: To what extent do the following organizational arrangements commonly exist in GP practices or PC centres?
Telephone consultations; E-mail consultations; Practices having a website; Offering special sessions or clinics for certain patient groups (e.g. diabetics, pregnant women, hypertensive patients etc); Appointment systems for the majority of the patient contacts.
ACC 3.4 After-hours PC: To what extent are the following models for the provision of after-hours PC commonly used?
Practice-based services: GPs within one practice or organized in a group of practices look after their patients on out-of-hours schedules; PC cooperatives: GPs in a region from several groups, supported by additional personnel, provide after-hours PC mostly in non-profit, large-scale organizations, which include telephone triage and advice, office for face-to-face contact, and house calls; Deputizing services (outsourcing): companies employing doctors take over the provision of after-hours care; Hospital emergency departments provide PC by taking care of health problems after office hours; After-hours PC centres: These are (walk-in) centres for face-to-face contact with a GP or nurse; Other out-of-hours PC/GP service schemes in place.
ACC4. Affordability of PC services
ACC 4.1 Cost-sharing for GP care: Do patients normally need to pay:
A visit to their GP; Medicines or injections prescribed by their GP; A visit to a specialist prescribed by their GP; A visit of their GP at the patient’s home.
ACC 4.2 Patient dissatisfaction with PC prices: % of patients that rate GP care as not very or not at all affordable.
ACC5. Acceptability of PC services
ACC 5.1 Patient satisfaction with access of PC in general: Patients that find it easy to reach and gain access to GPs.
3.5 CONTINUITY (Process)
CON1. Longitudinal continuity of care
CON 1.1 Patient list system: Do GPs have a patient list system?
CON 1.2 Stability of Patient-Provider relationship: % of patients reporting to visit their usual PC provider for their common health problems.
CON2. Informational continuity of care
CON 2.1 Medical record keeping: % of GPs keeping (or reporting to keep) clinical records for all patient contacts routinely.
CON 2.2 Electronic clinical support systems: To what extent do GPs have a computer at their disposal in their office?
CON 2.3 Referral system: To what extent are GPs using referral letters (including relevant information on diagnostics and treatment performed) when they refer to a medical specialist?
CON 2.4 Incoming clinical information procedures: Do PC practices receive information within 24 hours about contacts that patients have with out of hours services?
CON 2.5 Specialist-GP communication: To what extent do specialists communicate back to referring GP after an episode of treatment?
CON3. Relational continuity of care
CON 3.1 Physician choice: Are patients free to choose the PC centre and GP they want to register with?
CON 3.2 Patient satisfaction: % of patients who are satisfied with:
their relation with their GP/PC physician; with the available time during consultations with their GP/PC physician; their trust in their GP/PC physician; the explanation their GP or PC physician gives of problems, procedures and treatments
3.6 COORDINATION (Process)
COO1. Gatekeeping system
COO 1.1 Gatekeeping system: Do patients need a referral to access the following medical, para-medical and nursing disciplines?
Gynaecologist/obstetrician, Paediatrician. Specialist of Internal medicine, Ophthalmologist, ENT specialist, Cardiologist, Neurologist, Surgeon, Primary care / GP practice nurse, Specialised nurse (e.g. on diabetes), home care nurse, Physiotherapists (ambulatory), Midwife (ambulatory), Occupational therapist, Speech therapist, Dentist