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Comprehensiveness in Primary Care: A Scoping Review.
Agnes Grudniewicz1, Ellen Randall1, Lori Jones1
1University of Ottawa.
The Milbank Quarterly
|December 13, 2024
Summary
This scoping review clarifies the meaning of comprehensiveness in primary care by mapping its attributes. The findings provide a framework to improve research, practice, and policy for better primary care systems.
Area of Science:
- Primary Care Research
- Health Systems Science
- Healthcare Policy Analysis
Background:
- Comprehensiveness is vital for high-quality primary care, linked to efficiency and patient satisfaction.
- Concerns exist regarding a decline in primary care comprehensiveness and service breadth.
- Vague definitions hinder efforts to address perceived declines in primary care comprehensiveness.
Purpose of the Study:
- To explore and define comprehensiveness in primary care.
- To map the attributes of primary care comprehensiveness.
- To support clearer definitions for research, practice, and policy.
Main Methods:
- Conducted a scoping review following established methodologies (Arksey and O'Malley, Levac et al.).
- Searched Ovid MEDLINE, CINAHL, Embase, and gray literature for primary care and comprehensiveness terms.
- Employed a multistep review and detailed data extraction process.
Main Results:
- Identified nine attributes of primary care comprehensiveness across 360 sources.
- Mapped attributes into two domains: breadth of care (services, settings, needs, patients, availability) and approach to care (one-stop shop, whole-person, coordination, longitudinal).
- Discovered three key enablers: structures/resources, teams, and competency.
Conclusions:
- A conceptual map of primary care comprehensiveness offers enhanced clarity.
- Identified domains and attributes can inform definitions and measures for research, practice, and policy.
- Facilitates more precise interventions to improve primary care systems.
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