Public Health Medicine and Primary Health Care: Convergent, Divergent, or Parallel Paths

Increasing focus of public health medicine in the UK. “Community medicine will take time to consider… clinicians will also need time to recover from their ignorance.” Overall goal of public health and primary care is the same, to improve health. Public health is broader and has more boundaries while primary care is more individualized, with direct consultations and interventions from practitioners. Different but overlapping.

*Table 1- differences between primary care and public health from perspective, professionalism, knowledge, skills, information, and materials. *

Public Health Skills in Primary Care in Southwest England

The UK is trying to expand their primary care to involve more public health topics such as environmental, social, and psychological determinants of health. They are using an integrated team to evaluate the different determinants of health with Directors of public health, directors of nursing, directors of midwifery, nursing advisors of health authorities, chief officers of primary care groups and trusts, and lastly chairmen of the boards of PCG/Ts. A survey was conducted based on the individuals mentioned above, discussing their experience with public health and how they feel they might have been obstructed in training pertaining to public health. There were also specific questions included for the individual specialties.

Primary Care and Population Health Promotion

Ontario, Canada has a mandate to provide protection, promotion, and disease prevention for all citizens. The Department of Family Medicine was funded to develop a primary health care program to collaborate with doctors and public health initiatives to provide the best care. The focus was on preventative care within the community and family level. The program utilizes research projects on the strengths of various disciplines, family doctors that work to help collaborate and enhance community health issues, easy feedback and involvement from community members and family doctors, with aspects of determining populations at risk. It is a collaboration to take preventative primary care to improve public health.

Engaging Patients in Decisions: A Challenge to Health Care Delivery and Public Health

Quality health care includes patient autonomy in their care to collaborate with doctors on how they should best move forward with their treatment. Changes in health care to involve patients within their care changes some of the fundamental ideologies of care where the doctor knows best. Building a team that can help to assess various aspects to health can help to get an idea of how to properly assess and treat a disease but letting the patient tell us what works with their body and what benefits or risks they feel they would consider with treatments; giving patients the ability to have some control over what is going on with their care.

Primary Care and Primary Health Care

Addressing differences of PC and PHC, PC being more short term and narrow with individualized care like patient care or ‘family doctors.’ Primary health care being broader and focused on the World Health Organization’s core principles.

Association of Primary Care Physician Supply with Population Mortality in the United States (2005-2015)

An association of the number of primary care physicians per 100,000 was observed with an increase in life expectancy for every 10 PC physicians. The life expectancy increase was 51.5-day with the addition of 10 PC physicians, although, over the 10 year observation, the density of physicians decreased 5.8%. Most likely due to physicians moving away from rural areas into the more populated suburban and urban areas of the country.

Public Health and Primary Care: A Framework for Proposed Linkages

The medical care system, operating largely under private aegis, has provided services that are directed at diagnosis and management of the ailments of people who seek the services: public health agencies have undertaken this role as a provider of last resort for the socially disadvantaged. On the other hand, public health has assumed the primary responsibility for organizing programs directed at environmental interventions. Clinical preventive services have been divided between the two, largely through opportunity rather than by design. Personal health care has become a high priority and the advancements of the primary health care system have explored the linkages to public health and how they can impact and help one another.

A Framework for Public Health Action: The Health Impact Pyramid

The 5-tier pyramid of public health, lower levels of the pyramid will help to assess broader health topics throughout communities, while the higher levels will be specific to high-risk groups when discussing health topics. Lower levels focus on socioeconomic factors, if focusing on interventions to help with inequity of care due to a difference in socioeconomic factors will address very large groups of people, would need to be outlined based on socioeconomic class and impact a larger population. In narrowing the pyramid, changing context to narrow the population to make the intervention more specific, for example, working with socioeconomic neighborhoods that have an average household income of less than $90,000 annually. In the middle, constructing a protective intervention program, pinpointing a health problem that needs to be addressed within the population. Clinical intervention, how can we help provide healthcare to those who need it within our population, who is most at risk. The most specific is counseling and education, who within the population is most in need of receiving care to stay healthy and where should resources be allocated to best help this group of people to better help them and the community. Determine whether to use a top-down approach or a bottom-up approach to address the problem.

Incorporating Public Health More Closely into Local Governance of Health Care Delivery: Lessons from the Quebec Experience

Quebec government health care delivery and public health. Following the two sectors of service delivery identified by the World Health Organization (WHO), personal services and collector or non-personal services. Public health and health care delivery co-exist within the Quebec healthcare system until 2004 when they integrated public health into government by creating 95 organizations that focus on Health and Social Service Centers. They evaluated how the centers improved health by population-based responsibility and placing these centers in highly populated areas in Quebec. They found that these centers improved care given to vulnerable groups, when finding their success, the centers helped to support other organizations within their territories.

Health Care and Health Care Delivery in Greenland

Publicly financed government in Greenland found the most difficult challenges with their healthcare system and delivery is the limited economic resources, their demographic structure, rapid epidemiological changes, increased demand for specialized treatment, difficulty staffing, and lack of funds for maintenance. They created a public health program that can focus on promotion and prevention to help secondary care and recruit more staff to monitor health and help determine where to best allocate their resources to provide the best care.

A Knowledge Management Tool for Public Health

Knowledge translation and exchange (KTE) help to incorporate research into policy to help make the most evidence-based informed decision making. Creating more of a collaborative team that can analyze the health trends and take a holistic approach to policy making and give the most up to date information to the public and to improve health promotion efforts. Systematic reviews were conducted through 7 online databases, and 20 journals then reviewed for reliability and quality through independent reviewers. 78% of these were assessed with strong to moderate quality identifying the importance of utilizing the information found within the reviews when creating and implementing public health policy. Knowledge management on public health decisions. Gathering evidence to find the best data collection methods for evidence- based decision making. Creating the most effective health interventions.

Comparison of Registered and Published Intervention Fidelity Assessment in Cluster Randomized Trials of Public Health Interventions in LMIC

Cluster randomized trials (CRTs) evaluate public health interventions through fidelity assessments. This helps break down the interventions to evaluate if it was delivered the way it was planned and if the outcome of the intervention was due to the intervention or if there were confounding variables contributing to the outcome observed within LMIC. The study is evaluating the infidelity within the CRTs. Would help to change interventions and create more effective and efficient moving forward.

SVEUS National Collaboration for Value-Based Health Care

Sweden has a health care system that is paid for by taxation, but they have implemented a program for value-based monitoring and reimbursement when seeking specialized care (OECD, 2014). The organization discussed how the plan was organized around specific medical or therapeutic conditions and is to make the accessibility to care for these conditions more affordable (OECD, 2014). The way the program is implemented depended on the patient’s outcome following the treatment; a global assessment of pain before and after treatments along with a case-mix adjustment of actual pain (OECD, 2014). Those combined would add up to the patient’s reimbursement amount for the treatments. This treatment system engaged the patients and providers by allowing providers to offer the care necessary, but for the system to help the patient. It is a way to offer the best care while also helping patients to keep more of a financial stability.

Public Health Rationale for Investments in Emergency Medicine in Developing Countries- Ghana Case Study

Improving current primary care systems and outpatient clinical-based health care models. Deciding to add an emergency medicine infrastructure, opening Ghana’s health care as the country faces urbanization, population mobilizes and ages. The discussion is learning towards primary care, training levels, health care resources and how to allocate what they have, communication, transportation, and building new health facilities.

Public Values, Health Inequality, and Alternative Notions of a “Fair” Response

Identifying public health inequities and disparities in the United States. It focused on how values and priorities influence disparities. 3 main areas of priority, prioritize disadvantages, equalize health outcomes, and equalize health resources. WHO’s report on the social determinants of health evaluates how all socioeconomic leveled countries’ governments attempt to remedy the disparities within their specific countries. There is not as much emphasis on public health responses to these health disparities within the United States. This would be a major area of concern within the government to establish a public effort in improving the effectiveness of care and accessibility to care resources to limit these disparities moving forward.

The Structured Operational Research and Training Initiative for Strengthening Health Systems to Tackle Antimicrobial Resistance and Improve Public health in LMIC

Identifying problems within the health systems to work and actively working to improve the systems and increase the system resilience. Continuously researching health systems and keeping up to date with treatments, technology and evaluating the best way to allocate resources to benefit the most people as possible. Structured Operational Research and Training Initiative (SORT IT) is a global partnership that’s goal is to gather the most information possible and learn how to best support the public health field and active programs.

The Submissive Relationship of Public Health to Government, Politics, and Economics

Identifying how public health practitioners treat patients while navigating the different economic policies that might prevent care from being given to their treatments due to policies. The policies can be restrictive on the physicians for not being able to treat patients as they feel fit and prevent patients from receiving the best quality of care. Understanding what health practitioners feel they need to make the most informed decisions and impact the overall process of improving the government policies to help the population and improve public health strategies/interventions.

Universal health Coverage and Primary Health Care: the 30 by 2030 Campaign

Focusing on treating people in a holistic approach, starting by improving primary care systems. The first component is evaluating direct interventions into what can improve primary health care, secondly finding donors and supporters that understand what a holistic approach to healthcare could mean with improving quality and accessibility to care in the United States.

Which Public Health Interventions are Effective in Reducing Morbidity, Mortality, and Health Inequalities from Infectious Diseases Amongst Children in LMICs?

10 databases were searched in an umbrella review, identifying evidence on the effects of public health interventions on morbidity, mortality, and health inequities. Most of the systematic reviews focused on preventative studies and did not focus as much on promotion. The lack of communication and understanding from the public could be contributing to the health inequities and quality of care provided to patients nationwide.

Integration of Primary Care and Public Health

Understanding the individualism with primary care and public health, staying more care centered within primary care and on an acute level compared to a generalized approach that focuses on surveillance and planning/impact of health studies. Identifying also how public health and primary care complement one another and are needed to help one another in improving efficiency and quality of care for patients.

Strengthening Primary Care in Developing Countries

Revision of the Alma-Ata in 2008, continuing to widen the scope of primary care to incorporate multiple layers of care to establish the best form of care in developing countries. Protocols have been put in place for disease specific programs and care efforts such as tuberculosis, sexually transmitted diseases, and non-communicable diseases with some subcategories to these programs focusing on individual disease that fall into the categories listed. Along with improving care for specific programs they are looking at opening treatment options for diseases and different prognosis plans that can be put in place, following the development of the disease or necessary treatment for everyday health.

Spending by Primary Practices

Identifying health care spending and understanding how spending can affect health outcomes along with incentives that work or don’t in terms of promoting policies to improve health care in the United Kingdom. Is there an area that is taking too much funding that might be utilized differently to improve overall care? They did not see much of an association between emergency spending and health outcomes, national incentives also did not have much of an impact on overall healthcare outcomes.

Safer Care for All- a Global imperative

Identifying the WHO safer primary care report to identify how to improve healthcare. Former research showed medical errors being undertaken in hospital settings and focused on secondary settings rather than on a primary setting. Improving the primary care system could help alleviate morbidity problems within the secondary care system by looking into the preventative nature of primary care to determine the proper prognosis for any health concerns and how to fix them before they become dangerous.

Fostering Global Primary Care Research

Astana Declaration in improving primary health care, focusing on the environment of care that is being presented and new countries who are adapting and implementing a primary health care structure. Guyana adapted family medicine as a new specialty and were experienced in how to conduct and set up a strongly structured system to provide care to patients. Nigeria had a 4-year family medicine practice that included a research dissertation period to help evaluate and improve the program moving forward, they struggled with proper funding on the practice, it was hospital based. Malaysia was an upper-middle income country that had a family medicine program that had a masters and doctorate program to help build the research around their program and help their primary care improve over the years. Funding was something that varied between the different countries and had a major impact on the care they were able to provide.

The Assessment Quality Care of Primary Care with Facility Surveys

Primary care can address health needs, promote equity, and contain costs if providing quality health care. Through assessment surveys, it was determined that there are 3 quality domains that contribute to high quality health systems, competent systems, evidence-based care, and user experience. Based on these domains, quality scores for primary care in 10 different counties. From the surveys, it was determined that there were gaps in measurement of some outcomes, and scores for quality of care was low. There were a lot of gaps in the quality of care in Ethiopia, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda. The gaps observed in the quality of care indicated trouble in constructing a growing primary care system and put strain on the Sustainable Development Goals of the assessment.

Comparing the use of Direct Observation, Standardized Patients and Exit interviews in Low-and- Middle Income Countries: A Systematic Review of Methods of Assessing Quality of Primary Care

Understanding various measures of healthcare to determine what low and middle income (LMIC) countries lack regarding their quality-of-care patients receive has become one of the biggest problems in these countries’ healthcare systems passing accessibility. They found difficulties in assessing the quality of care due to the lack of clinical records or databases, but it was determined through the structures, processes, and outcomes. The reviews conducted compared a head-to-head interview to a data review of current systems and any current evidence they might have.

Organizational Effectiveness. Primary Care and the Congruence Model

Identifying framework for the strengths and weaknesses for primary care to identify what needs to be changed to increase the level of care. Applying and explaining the congruence model to help diagnose and organizational problems within the primary care system and help to predict any future problems that might arise.

The Role of Private Education in the Selection of Primary Care Careers in low- and middle-income countries. Findings from a representative survey of medical residents in Brazil

The numbers of Primary health physicians are dwindling in high- and low-income countries, there are many doctors moving into private education within middle income countries. The debate in Brazil is to determine if the increased number of physicians enrolling in private education will have an impact to increase the PHC physicians moving forward.

Pharmacists’ Contributions to Primary Care in the United States Collaborating to Address Unmet Patient Care Needs: The Emerging Role for Pharmacists to Address the Shortage of Primary Care Providers

Addressing concerns with primary care and the efficiency of care being provided to patients. Working to integrate care systems to build one strong primary care system for patients to access and work on moving forward with their treatments or wellness checks. The integration can help focus on accessibility to medications as well as finding the most cost effective and accessible way to receive the medications they need. Pharmacists can work with not only patients, but by communicating with the physicians, they can effectively find the correct medications that are also the most cost effective for the patients especially during medication shortages.

Organization of Primary Care in the United States

The United States has a larger number of specialists compared to the UK, while having similar primary care physicians. Physicians in the United States practice both privately and publicly insured patients. The primary care system has shifted to require a primary physician before being able to access the different specialists; they need a referral after receiving an initial appointment to see if the patients need more specific treatments.

Quality and Experience of Outpatient Care in the United States for Adults with or Without Primary Care

The US healthcare system is typically organized around hospitals and specialty care, with little emphasis on primary care. Through this article, the goal is to determine if there is an association between primary and specialized care and patient experiences with both.

The Effect of Local Primary Care Physician Supply on the Utilization of Preventative Health Services in the United States

Little research has examined the effect of physician supply on health-related measures at the individual and community level simultaneously. Using telephone survey data from six counties in upstate New York, a commuting radius was constructed between the zip codes of respondents and their primary care physicians. The evaluation of patients having a primary care physician or focusing on preventative health could be affected by the accessibility to care and the experiences with those physicians could have an impact on utilizing primary care.

Profiling Performance in Primary Care in the United States

Purchasers of healthcare in both the United States (governments, employers, health plans) and the United Kingdom (government) need to be able to measure the quality of services they are paying for. The public is concerned about the quality of the services they are receiving in both countries. Measuring primary care physicians and health providers on how they are treating patients is a challenge in itself, the profiling was being conducted in the United States. The goal is to understand the development of their approach and to identify main factors that are contributing to less efficient quality of care.

General Practice and Primary Care in Denmark

General practice is the cornerstone of Danish primary health care. General practitioners (GPs) are like family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP. General practice is characterized by 5 key components: (1) a list system, with an average of close to 1600 persons on the list of a typical GP; (2) the GP as gatekeeper and first-line provider in the sense that a referral from a GP is required for most office based specialists and always for in- and outpatient hospital treatment; (3) an after-hours system staffed by GPs on a rota basis; (4) a mixed capitation and fee-for-service system; and (5) GPs are self-employed, working on contract for the public funder based on a national agreement that details not only services and reimbursement but also opening hours and required postgraduate education. The contract is (re)negotiated every 2 years.

Primary Care and Why it Matters for U.S. Health System Reform

The term primary care is widely used as if it were consistently defined or well understood. In fact, neither is the case. This paper offers a definition of primary care derived from historical perspectives—from both the United States and abroad. We discuss the evidence for primary care’s important functions and international experiences with primary care. It’s also discussed how and why the United States has deviated from this fuller realization of primary care, as well as the steps needed to achieve primary care and health outcomes on a par with those of other developed countries. We can take other programs globally and determine what- from other developed countries- works and can adapt new practices into our health care system to help improve the overall quality of care.

Primary Care: An Increasingly Important Contributor to Effectiveness, Equity, and Efficiency of Health Services

There is more to the effectiveness of healthcare and quality than spending and the number of healthcare personnel, what counts is the existence of key features of health policy (Primary Health Care): universal financial coverage under government control or regulation, attempts to distribute resources equitably, comprehensiveness of services, and low or no copayments for primary care services. All of these, in combination, produce better primary care: greater first contact access and use, more person-focused care over time, greater range of services available and provided when needed, and coordination of care.

Primary Care, Income Inequality, and Self-Rated Health in the United States: A Mixed Level Analysis

The results from the 1996 household survey indicate that distributions of income and primary care within states are significantly associated with individuals’ self-rated health; that there is a gradient effect of income inequality on self-rated health; and those individuals living in states with a higher ratio of primary care physician to population are more likely to report good health than those living in states with a lower such ratio. From a policy perspective, improvement in individuals’ health is likely to require a multi-pronged approach that addresses individual socioeconomic determinants of health, social and economic policies that affect income distribution, and a strengthening of the primary care aspects of health services.

Primary Care: Current Problems and Proposed Solutions

In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.

Association of Primary Care Practice Location and Ownership with the Provisions of Low-Value in the United States

Physicians provide primary care within hospitals and community-based practices, the influence of the hospital location compared to a community centered office is being evaluated. The goal is to assess the association of hospital location and hospital location compared to different low-value health services.

Global Health and Primary Care Research

There is no direct link between better economic status and improved health in various countries. Research is needed to develop up to date practices and policies to better cater to the effectiveness of care for patients. They are focused on understanding the different caregivers perspectives of the situations especially in lower resource countries.

No Universal Health Coverage Without Primary Health Care

Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality.2 Strong orientation towards primary health care and its core principles (often outlined as first contact, continuous, comprehensive, and coordinated care)3 is shown to be stable over time 4 and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today.5 This observed stability makes the lack of focus on primary health care within the current universal health coverage debate an urgent issue.

Behavioral health as primary care: Beyond efficacy to effectiveness: A report of the Third Reno Conference on the Integration of Behavioral Health in Primary Care.

Integrated care is that it can reduce demand for health care by providing patients with the health care they need. There is significant clinical research and clinical experience all pointing to one fact: many patients (perhaps even a majority) receiving traditional primary care or specialty care medicine also need behavioral care. Integrated care can help to include multiple specialties and primary care to communicate and limit the number of tests that could be run and to understand all of the information when using new doctors to further help with existing medical concerns.

Advancing Integrated Behavioral Health and Primary Care: The Critical Importance of Behavioral Health in Health Care Policy

The increased recognition of the importance of mental health, behavioral health, and substance use in primary care creates opportunities for helping better achieve a more efficient and effective health care system. Redesigning primary care through the Patient-Centered Medical Home has opened new avenues for health care policy discussion; however, what remains unclear is the role behavioral health will play in this significant redesign. We can evaluate health policy and typical behaviors that can help to improve preventative care by evaluating the common behaviors that lead to different medical concerns.

Community-Oriented Primary Care and Primary Health Care

Primary care is the component of health services that addresses most of the health problems within a community, and when it is enhanced by a community orientation, it can be considered public health at the local level. By evaluating and focusing on primary care it can improve the outcomes of health on various levels and allocate resources differently to increase accessibility within communities. The communities can also find preventive measures through primary care that can improve overall health.

Primary Care, Self-Rated Health, and Reductions in Social Disparities in Health

Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. It will help to understand where resources could be best utilized to provide the most care regardless of income.

A Tool to Evaluate Primary Health Care from the Population Perspective

To evaluate the Primary Health Care system in Spain and to adapt it to better improve efficacy and efficiency of care. Gaining patients feedback through a 15-question survey to gauge the patients understanding of their care and the questionnaire. The goal is to help improve the evaluation of care to better provide for their patients.

Health Care Spending in the United States and High-Income Countries

The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely like those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. Evaluating spending efforts in healthcare can help to reallocate resources to help the physicians and patients receive effective and efficient care.

Contribution of Primary Care to Health Systems and Health

This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. Building a rapport with your physician can help to improve the quality of your care in the future. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies.

Quantifying the Health Benefits of Primary Care Physicians Supply in the United States

Increasing the number of primary care physicians will affect and increase the quality of care and health outcomes in the United States. Through increasing the number of physicians, it can increase accessibility to care and help to learn how to allocate resources to support not only patients, but the physician’s. Results showed that there was an increase in health outcomes regardless of what year the results were being analyzed.

The impact of Primary Care: A Focused Review

Primary care is the backbone of a strong health system that has often been overlooked in the United States. The review compiles research from PubMed and related articles focusing on primary care measures, care, equity, effectiveness, and cost that can be evaluated and contribute to healthcare reform in the future.

The Coming Primary Care Revolution

The United States has some of the most expensive and highest technological advances in the world in regards to health care. Along with some of those statistics, there has been a misuse of resources resulting in waste. Moving forward, to improve the quality of healthcare we need to focus on affordability, relationships between providers and patients, improve primary care settings with preventative care, and take a holistic approach to care. Healthcare reform should focus on the whole patient and how to make it as easily accessible and the most equitable as possible.

Characteristics of Americans with Primary Care and Changes over time 2002-2015

Identifying what can be contributing to the changes in utilization of primary care systems. The Medical Expenditure Panel Survey that focused on contact, comprehension, coordination, and continuity of care over 13 years. There was a 77% decrease over the 13 years utilizing primary care services in every age group besides those in their 80s. Trying to identify what are the largest contributing characteristics to the decrease in utilization of primary care.

Primary Care Visits Increase Utilization of Evidence-Based Preventative Health Measures

Questioning the link between the number of primary care physicians and the use of preventative health behaviors moving forward. Determining if there is a correlation for three evidence-based measures; vaccinations, colonoscopy, and mammography. There was an increased correlation between the physicians and the preventative health behaviors.

Primary Care (PC) and Primary Health Care (PHC)

Defining the differences between primary care and primary health care. Primary care being more individualized and narrow focused while primary health care is broader focusing on the World Health Organization’s main competencies. The narrow focus is with individual health care and the care that is given, while primary health care is more closely related to public health initiatives and interventions.

The Impact of Primary Health Care on Population Health in Low and Middle Income Countries

Primary healthcare in LMIC is normally focused on infant and child health, but there were associations found within the 36 articles reviewed, that primary healthcare has a positive effect on population health. There is a lack of research conducted to evaluate the reliability of the correlation, moving forward there would need to be more research conducted to determine the strength of the correlation. Moving forward the focus is conceptualizing and measuring primary health care, understanding advantages and future advancements of care, and further research and experimentation on primary care and its effect on health outcomes.

Systematic Reviews and Meta-Analysis: Understanding Best Evidence in Primary Health Care

Systematic reviews identifying the best evidence-based health care strategies to improve the quality of care provided to patients. Allowing the physicians to learn and understand the most up-to-date technology and strategies. This review allows for the assessment of research articles for physicians to be able to read and evaluate the current strategies and alter them if the research supports adapting the information.

Organization and Delivery of Primary Care Services in Petropolis, Brazil

Adapt and measure the performance of primary care services in Brazil. Evaluating the new Family Health Program to determine the performance on the methodology to separate the types of primary care, the clinic records, and the reliability of the data compared to other surveys. Regardless of the improvements, there is still a lot of improvement that needs to be done within the Petropolis health care system.

Patient Satisfaction with Primary Medical Care Evaluation of Sociodemographic and Predispositional Factors

Through healthcare, patient satisfaction and a patient-physician relationship can change health related behaviors. When increasing patient satisfaction there has been a correlation to an increase in health behaviors, the paper evaluated the main determinants of compliance to prognosis and other related health behaviors.