[Features and developments of Primary Care in a Public Health perspective]

In recent years, substantial changes of the population structure have occurred, both at the national and international levels, due to several factors, including demographic changes and technological progress. At the same time, an epidemiological transition is occurring, characterized by a shift from diseases with an acute onset and a rapid resolution, to chronic-degenerative conditions which require more long-term care solutions. This shift seems to contribute to an increased life expectancy of the population, and a larger proportion of elderly individuals having complex health needs. The above described changes of the population structure, in combination with the current economic and financial crisis, require a redefinition of health system priorities at different levels, and the identification of specific intervention approaches. Today Primary Care is generally considered to have a key role in the progress of health systems and governments and international agencies, including the World Bank and the World Health Organisation have already increased investments and introduced reforms of Primary Care. However, there still remains much to be done, particularly with regards to the definition of specific aspects related to Primary Care. In this article the characteristics and developments of two main concepts, Primary Care (PC), which describes the delivery of Primary Care services, and Primary Health Care (PHC), which is more broadly defined by a level of governance or stewardship, are described. The distinction between PC and PHC implies the need for a characterization of system governance or stewardship, and of governance for care delivery. The first entails decision-making mechanisms for protecting the health both of individuals and of communities, by setting health, appropriateness and economic sustainability goals. These decisionmaking mechanisms further take into account the consequent responsibilities and risks compared to the achieved results toward citizens. The second relates to decision-making mechanisms for the delivery of services. Some examples are given of the application of system governance for primary healthcare at the national level and of characteristics of aggregations of professionals and/or structures for PC delivery. Finally, ideas and proposals for the development of an integrated approach for the delivery of Primary Care and prevention services, in a Public Health perspective are presented.