Previous studies have found better performance among health care systems based on solid PC systems [1224].

Scientific research, both international comparisons and within the United States, has shown that well
developed PC systems have better coordination and continuity of care and better opportunities to control
costs [2,12,21,25-27].
A recent review on the relationship between PC and health outcomes and costs reports that in PC
oriented countries the population experiences better outcomes and lower costs are incurred
Furthermore, research from the USA has shown that availability of GPs and Family Physicians and
first contact care are associated with reduced unnecessary care (avoidable hospitalisation) and
increased accessibility [32-35]. Avoidable hospital admissions can be used as an indicator of health
care performance. An admission is avoidable when a relatively expensive hospital admission for a
certain condition could have been prevented by effective and/or accessible primary health care. The
availability of GPs and insurance coverage for PC are related to lower rates of avoidable
hospitalisations . Several studies, predominantly from the USA, have shown positive effects of PC on
health outcomes [5,14]. Health policies aimed at strengthening PC are associated with better levels of
health [14]. Strong PC is associated with better health outcomes such as lower rates of all-cause,
heart disease, and cancer mortalities [QUALICOPC, a multi-country study evaluating quality, costs and
equity in primary care
Willemijn LA Schfer, 1 Wienke GW Boerma,1 Dionne S Kringos, BMC Fam Pract. 2011; 12: 115.)
dimentions of quality 9 PC:
Specific dimensions are typically applicable to PC systems:
- continuity of care (longitudinal care; episodic continuity)
- coordination and integration (with other professionals and levels of care)
- scope of services (broad range of curative and preventive services)
- community orientation

referral systems are ineffecient and weak , they are underdeveloped . to reduce
disabilities and fatalities due to injuries, PHC upgearding and integrating it with
emergency services is advocated for becuase preventive startegies can prevent the
loss of more than 45% of the DALYs resulting from injuries.( Implementing Health
Sector Reform in Central Asia: Papers from a Health Policy Seminar Held in Ashgabat,
Turkmenistan, in June 1996) edited by Zuzana Feachem, Martin Hensher, Laura
RoseWBI Learning Resources Series English; Paperback; 162 pages Published January 15, 1999 by
World Bank
development of pharmaceutical technology has premitted the effective management of a grwoing
range of conditions without recourese to hospitlization. PHC ply a major role in the management of
onditions such as asthma, constructive lung diseases, hypertension, diabetus, pnumona.
the innovative forms of provision organizating and financing could contribute to improved equity,
quality, efficeincy and accessibality to health services.
one of the forms of providing cost-effective services include the provision of intergtared primary of
secondary services. some effective interventions are not cost-effective because they are carried out
at hospital setting because the cost are high, but if they are developed in an ampulatory setting their
cost-effectiveness will oncrease dramatically.

delivering specialized and systematic chronic disease care requires time and skills not
necessarily within the capacity of the GP: Ostbye et al. estimated physicians required more

than 3 hours per day to practice evidence-based care for each well-controlled chronic
condition [Under

the same roof: co-location of practitioners within

primary care is associated with specialized chronic care management
Juliet Rumball-Smith1*, Walter P Wodchis12, Anna Kon1, Tim Kenealy3, Jan Barnsley12 andToni Ashton4
BMC Family Practice 2014, 15:149 ]
option 1:
the co-location of multiple disciplines within the primary care practice.

benifits:
Patient care teams may be an efficient means of providing systematic, safe and best practice
care for complex patients [8], and are widely encouraged by researchers [8,9] and
international bodies[10,11]. Their promotion reflects both the published evidence for their
effectiveness, as well as their place in theoretical models of chronic care [12,13]. While
introducing other providers may risk care fragmentation, proponents state that
interdisciplinary care is patient-centered and more comprehensive [9,14,15], improves
concordance with clinical guidelines [16], and has positive effects on both job satisfaction and
skill development for practitioners, and patient satisfaction and self-care skills [17].
Systematic reviews and meta-analyses have shown improved clinical outcomes in team-based
primary care for people with chronic conditions such as diabetes [18], depression [19], and
hypertension [Under

the same roof: co-location of practitioners within

primary care is associated with specialized chronic care management
Juliet Rumball-Smith1*, Walter P Wodchis12, Anna Kon1, Tim Kenealy3, Jan Barnsley12 andToni Ashton4
BMC Family Practice 2014, 15:149 )

issues:
training - retraining - adopting updtaed protocols and guidelines
in hospital:
issues to consider:
should be in a self-contained separeated facility no using the hospital facilities to reduce
disruption and limit the impact of unexpected emergencies
risks: it facilaites extra addmissions to hospitals - it lengthen hospital stay
Med Care. 1981 Feb;19(2):160-71.

Effect of hospital-based primary care setting on internists'

use of inpatient hospital resources.
Gold M, Greenlick M.

Abstract
Hospital-based primary care is expanding, yet the impact of the hospital setting on physician practice patterns and health
care costs is unknown. This project compared the use of inpatient hospital resources between internists practicing in
hospital-based and freestanding primary care clinics. All hospitalizations over a two-year period by internists in the KaiserPermanente Medical Care Program--Oregon Region were analyzed ( n = 5,623). Organizational and financial incentives
were uniform for all internists. Results indicate that hospital-based internists use inpatient resources differently from other
internists. The former are more likely to hospitalize, but their patients are likely to have a shorter length of stay and fewer
laboratory tests or consultations. On average, the hospital-based internists used 44 more hospital days for every 1,000
doctor office visits than did other internists, suggesting the policy makers need to consider the influence of the hospital
setting on the level of inpatient utilization. Further research on the causality of this relationship and its generalizability
appears a strong priorit

Acta Psychiatr Scand. 1995 Jul;92(1):30-4.

Cost comparison of psychiatric outpatient clinics based in

hospitals and in primary care (general practice health
center).
Shah A.
Author information
Abstract
The first study to compare the costs of hospital-based and primary care (general practice health center)-based psychiatric
outpatient clinics is reported. The operating costs of both clinic settings were estimated to be similar. There are many
advantages of primary care-based clinics compared with hospital-based clinics. However, as there are no evaluative
studies of the comparative efficacy of either clinic setting, before policy decisions to encourage primary care clinics are
made such evaluative studies should take place.

****************

Hospital-based versus free-standing primary care costs.

Gold M.
Abstract
A survey of the literature supports the broad generalization that primary care delivered in this
hospital outpatient department will be more expensive than care provided in a free-standing
setting. Among the reasons discussed by the author are: (1) reimbursement policies of third party
insurors which mask and inflate the distribution of the true costs of care within the hospital; (2)
lack of control by outpatient department directors over their own costs; (3) the degree to which
the availability of sophisticated and expensive technology within the hospital setting encourages
its utilization; and (4) the differences in case mix: "sicker" patients are seen in outpatient
departments. Gold recognizes that most studies to date contain serious limitations in their
generalizability; she concludes that additional studies are necessary to explain why the costs vary
to the extent they do. She also suggests studying other issues such as access, consumer
preferences, provider preferences and training requirements, and quality of care before reaching
any decisions about the future of hospital-based primary care.