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Letteratura scientifica selezionata sul tema "Primary"

Autore: Grafiati

Pubblicato: 4 giugno 2021

Ultima modifica: 31 luglio 2024

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Articoli di riviste sul tema "Primary"

1

Hampton, J. R. "The primacy of primary health care". BMJ 317, n. 7174 (19 dicembre 1998): 1724–25. http://dx.doi.org/10.1136/bmj.317.7174.1724.

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Erol, Mustafa, e Mustafa Başaran. "How Primary School Students Perceive Primary School Teacher Exchange?" Journal of Qualitative Research in Education 8, n. 4 (30 settembre 2020): 1–18. http://dx.doi.org/10.14689/issn.2148-2624.8c.4s.6m.

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Janaki, Amutha, Kavitha A. Kavitha A e Sindhura P. Sindhura P. "Primary Hepatic Osteosarcoma". Annals of Pathology and Laboratory Medicine 6, n. 4 (29 aprile 2019): C48–50. http://dx.doi.org/10.21276/apalm.2371.

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V.S, Haritha. "Primary Adrenal Lymphoma". Cancer Research and Cellular Therapeutics 6, n. 3 (16 maggio 2022): 01–03. http://dx.doi.org/10.31579/2640-1053/119.

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Primary adrenal lymphoma is a rare disease entity with only less than 200 cases reported till date. We have seen a single case among the 260 cases reported in our hospital in the last 5 years. Review of the English literature showed 65 such cases reported so far most of them being single case reports. The striking similarity in all of them were – median age of 68 years, bilateral involvement in 60% and predominantly diffuse large cell histology with B cell immunophenotype. adrenal insufficiency was seen in two – thirds of them at diagnosis. About one half respond to treatment with median survival of 4 months. A high index of suspicion is needed for early diagnosis and prompt treatment. We herein report a case of a 65-year-old male who was diagnosed with primary adrenal lymphoma.

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Noor, Ady Ferdian, A’am Rifaldi Khunaifi Supardi e Sukirno, Haryanto. "Multicultural Education Praxis for Primary Schools: Perspective of Muhammadiyah Primary Schools Indonesia". International Journal of Psychosocial Rehabilitation 23, n. 4 (20 dicembre 2019): 1039–52. http://dx.doi.org/10.37200/ijpr/v23i4/pr190432.

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SINGH, CHANDRA B. P., e PREETAM KUMAR. "Dynamics of Low Transition Rate from Primary to Upper Primary in Bihar". Issues and Ideas in Education 4, n. 2 (5 settembre 2016): 99–109. http://dx.doi.org/10.15415/iie.2016.42008.

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Khare, Manika, Ashish Airun e Umesh Babu Sharma. "Leiomyosarcoma with unknown primary". Annals of Pathology and Laboratory Medicine 4, n. 4 (25 agosto 2017): C106—C109. http://dx.doi.org/10.21276/apalm.1231.

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Johnson, E. W. "Primary factorization in semigroups". Czechoslovak Mathematical Journal 36, n. 2 (1986): 180–84. http://dx.doi.org/10.21136/cmj.1986.102082.

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Tashpulatova, Dilorom Mukimovna. "Primary School Teachers Professiogram". American Journal of Social Science and Education Innovations 03, n. 05 (7 maggio 2021): 11–15. http://dx.doi.org/10.37547/tajssei/volume03issue05-03.

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Carelli, Francesco. "On primary care leadership". Journal of Clinical Case Reports and Studies 2, n. 3 (19 luglio 2021): 01–02. http://dx.doi.org/10.31579/2690-8808/063.

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It is good to lead. It is axiomatic that it is good to lead. For differing reasons around Europe leadership is celebrated and actively promoted in primary care circles. It is apposite to consider why this might be so, what it might mean and whether it is of value. Initially the challenges facing European health care in general, and primary care in particular could be said to call for leadership – there is a perception of crisis in many countries health care systems for example. Crisis in funding and organisations to name but two, and good leadership among other factors can help address it by facilitating new ideas and practical responses.

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Tesi sul tema "Primary"

1

Bumgarner, D., K. Owens, J. Correll, W. T. Dalton e Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.

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Faulk, Janet, e Pamela Evanshen. "Primary Grades: Linking the Primary Classroom Environment to Learning". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/4462.

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Meade, Susie J. "Primary Metabolic Chemistry". Thesis, University of Canterbury. Chemistry, 1999. http://hdl.handle.net/10092/5794.

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Thioesters and acyl phosphates are important metabolites throughout the biosphere. This may imply that they were involved in prebiotic chemistry. The study of the reactivity of thioesters and acyl phosphates may therefore provide some insights into the possible roles for these molecules in prebiotic chemistry. The work described in this thesis demonstrates that acetyl phosphate and inorganic phosphate react to form pyrophosphate in the presence of salts of some divalent metals. Divalent metal ions and nitrogen containing compounds act in synergy to promote pyrophosphate formation in some cases. Ferrous salts were much more efficient at promoting the formation of pyrophosphate than similar reactions containing magnesium ions, Addition of pyridine, or a variety of other nitrogen containing compounds, did not enhance the pyrophosphate yield. The promotion of pyrophosphate formation at near neutral pH by ubiquitous metal salts is considered to be a feasible route for prebiotic production of pyrophosphate. One chemoautotrophic origin of life theory concentrates on the oxidative formation of pyrite (FeS2) from ferrous sulfide and hydrogen as a possible source of prebiotic reductive power. N-Phenyl acetamide can be prepared from mercaptoacetic acid and aniline in water using FeS/H2S as a reagent system. We have established that one possible intermediate, N-phenyl mercaptoacetamide does react to give the product, and that this reaction is fast. Ferrous ions were observed to promote the formation of N-acetyl alanine from alanine and thioacetic acid. Zinc and cadmium ions on the other hand, promote the hydrolysis of thioacetic acid to acetic acid in preference to the N-acylation reaction. Both ferrous ions and ferro cyanide ions were observed to promote the peptide bond formation between protected amino acid derivatives. The results described in this thesis are consistent with the proposal that iron chemistry may have been important in prebiotic chemistry.

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Dodd, Will. "Primary Care Cases". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8930.

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Lemmer, Eric Richard. "Primary sclerosing cholangitis". Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/25576.

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Thirty six consecutive patients with primary sclerosing cholangitis (PSC), 20 males median age 42 years, were studied in order to define prognostic variables and determine the influence of surgery on outcome. Presentation was usually with insidious cholestasis or recurrent cholangitis. Twenty six patients (72 per cent) had associated inflammatory bowel disease (ulcerative colitis 20, Crohn's disease 2, unclassified 4). Thirty two patients were followed prospectively for up to nine years. Twenty three remained either stable or had slowly progressive disease. Of the remaining nine patients, seven died (five from end-stage liver failure and two from cholangiocarcinoma) and two patients underwent liver transplantation. Actuarial survival at five years was 52 per cent. A raised serum bilirubin concentration was the only variable at presentation that independently predicted a poor outcome. Cholangiograms were available for detailed assessment in thirty PSC patients. Neither the extent of biliary involvement nor the presence of surgical correctable ("dominant") strictures in the extrahepatic ductal system were of prognostic importance. Six patients who developed obstructive jaundice associated with advanced liver disease underwent surgical drainage operations for dominant biliary strictures, but this did not seem to prevent progression of the disease. Two patients who progressed to end-stage liver disease went on to liver transplantation and were alive with functioning grafts at seven and fourteen months respectively. Nine patients with asymptomatic PSC were followed prospectively for up to twelve years. None of these patients developed overt liver disease but serum bilirubin levels became mildly elevated in two patients. It is concluded that symptomatic PSC is a progressive disease with a poor prognosis. Patients with advanced liver disease due to PSC should be considered directly for liver transplantation. In contrast, asymptomatic PSC patients may remain symptom-free for many years.

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Fellows, Matthew R. "Spatiotemporal tuning for position and velocity in primate primary motor cortex neurons /". View online version; access limited to Brown University users, 2005. http://wwwlib.umi.com/dissertations/fullcit/3174598.

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Button, Dianne. "Men and primary teaching". Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299729.

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Polaha, Jodi. "Primary Care Behavioral Health". Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6676.

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Polaha, Jodi. "ADHD in Primary Care". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6690.

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Dodd, Julia. "Trauma-Informed Primary Care". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7348.

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Libri sul tema "Primary"

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Church of Jesus Christ of Latter-Day Saints., a cura di. Primary ... Salt Lake City, Utah: Church of Jesus Christ of Latter-Day Saints, 1994.

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Peter, Griffin. Primary organiser: Proformas for primary schools. Birmingham: Questions, 1993.

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Bridge, Connie. Primary thoughts: Implementing Kentucky's primary program. Frankfort, Ky.]: Kentucky Dept. of Education, 1993.

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Singleton, Joanne K., Robert V. DiGregorio, Carol Green-Hernandez, Stephen Paul Holzemer, Eve S. Faber, Lucille R. Ferrara e Jason T. Slyer, a cura di. Primary Care. New York, NY: Springer Publishing Company, 2015. http://dx.doi.org/10.1891/9780826171481.

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Knight, Peter. Primary Geography Primary History. Routledge, 2013. http://dx.doi.org/10.4324/9781315067568.

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Knight, Peter. Primary Geography Primary History. Taylor & Francis Group, 2013.

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King, Maurice H. Primary Anesthesia (Primary Surgery). Oxford University Press, USA, 1986.

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Knight, Peter. Primary Geography Primary History. Taylor & Francis Group, 2013.

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Knight, Peter. Primary Geography Primary History. Taylor & Francis Group, 2013.

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Knight, Peter. Primary Geography Primary History. Taylor & Francis Group, 2013.

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Capitoli di libri sul tema "Primary"

1

Gooch, Jan W. "Primary". In Encyclopedic Dictionary of Polymers, 587. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-1-4419-6247-8_9431.

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Weik, Martin H. "primary". In Computer Science and Communications Dictionary, 1323. Boston, MA: Springer US, 2000. http://dx.doi.org/10.1007/1-4020-0613-6_14553.

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Drew, Robert. "Primary". In 100 Documentary Films, 177–78. London: British Film Institute, 2009. http://dx.doi.org/10.1007/978-1-84457-551-0_73.

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Large, A. R. G., G. Pautou e C. Amoros. "Primary production and primary producers". In The Fluvial Hydrosystems, 117–36. Dordrecht: Springer Netherlands, 1996. http://dx.doi.org/10.1007/978-94-009-1491-9_6.

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Jeulin, Dominique. "Primary Grains and Primary Functions". In Interdisciplinary Applied Mathematics, 509–30. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-75452-5_14.

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Bertocci, Peter A. "Can Primary Emotions Be Primary Motives?" In Recent Research in Psychology, 165–96. New York, NY: Springer New York, 1988. http://dx.doi.org/10.1007/978-1-4612-3914-7_6.

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Frank, J. Howard, J. Howard Frank, Michael C. Thomas, Allan A. Yousten, F. William Howard, Robin M. Giblin-davis, John B. Heppner et al. "Primary Parasitoid". In Encyclopedia of Entomology, 3046. Dordrecht: Springer Netherlands, 2008. http://dx.doi.org/10.1007/978-1-4020-6359-6_3125.

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Frank, J. Howard, J. Howard Frank, Michael C. Thomas, Allan A. Yousten, F. William Howard, Robin M. Giblin-davis, John B. Heppner et al. "Primary Production". In Encyclopedia of Entomology, 3046. Dordrecht: Springer Netherlands, 2008. http://dx.doi.org/10.1007/978-1-4020-6359-6_3126.

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Nanzyo, Masami, e Hitoshi Kanno. "Primary Minerals". In Inorganic Constituents in Soil, 11–35. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-13-1214-4_2.

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Bandeira, Francisco, Lívia Amaral e Paula Aragão. "Primary Hyperparathyroidism". In Endocrinology and Diabetes, 279–91. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-8684-8_22.

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Atti di convegni sul tema "Primary"

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Ionescu, Ancuta. "Creativity In Primary And Pre-Primary Children". In EduWorld 2018 - 8th International Conference. Cognitive-Crcs, 2019. http://dx.doi.org/10.15405/epsbs.2019.08.03.202.

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"DIGITAL PRIMARY SOURCES – RAUM FÜR PRIMÄR DIGITALE ANGELEGENHEITEN". In digital humanities austria 2018. Vienna: Austrian Academy of Sciences Press, 2020. http://dx.doi.org/10.1553/dha-proceedings2018s10.

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"Primary Authors". In Proceedings of the IEEE 2000 National Aerospace and Electronics Conference. NAECON 2000. Engineering Tomorrow. IEEE, 2000. http://dx.doi.org/10.1109/naecon.2000.894999.

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"Primary Reviewers". In 2006 17th International Symposium on Software Reliability Engineering. IEEE, 2006. http://dx.doi.org/10.1109/issre.2006.35.

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Amro, Raed, Yazan Qudimat, Rana Torman e Batoul Alzeghari. "Primary Results1". In 2017 International Conference on Electrical and Computing Technologies and Applications (ICECTA). IEEE, 2017. http://dx.doi.org/10.1109/icecta.2017.8251953.

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Stokes, Edward G., David J. Cowley, Charles P. Cavedoni e Tony T. Young. "Image improvement of CFHT's primary mirror: primary mirror autocollimation". In SPIE's 1995 Symposium on OE/Aerospace Sensing and Dual Use Photonics, a cura di Patrick T. Wallace. SPIE, 1995. http://dx.doi.org/10.1117/12.211456.

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Stokes, Edward G., Rohendra D. Atapattu e Rod Hendrix. "Image improvement of CFHT's primary mirror: primary mirror cooling". In SPIE's 1995 Symposium on OE/Aerospace Sensing and Dual Use Photonics, a cura di Patrick T. Wallace. SPIE, 1995. http://dx.doi.org/10.1117/12.211457.

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Leykin, Anton. "Numerical primary decomposition". In the twenty-first international symposium. New York, New York, USA: ACM Press, 2008. http://dx.doi.org/10.1145/1390768.1390793.

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Zaganiaris, Alcibiade, e E. Karmazsin. "Primary Coating Characterization". In 1985 International Technical Symposium/Europe, a cura di Remy Bouillie. SPIE, 1986. http://dx.doi.org/10.1117/12.950957.

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Hasan, Muntaha Abdul-Razaq. "Quasi-primary module". In PROCEEDINGS OF THE 1ST INTERNATIONAL CONFERENCE ON FRONTIER OF DIGITAL TECHNOLOGY TOWARDS A SUSTAINABLE SOCIETY. AIP Publishing, 2023. http://dx.doi.org/10.1063/5.0113953.

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Rapporti di organizzazioni sul tema "Primary"

1

Smit, Amelia, Kate Dunlop, Nehal Singh, Diona Damian, Kylie Vuong e Anne Cust. Primary prevention of skin cancer in primary care settings. The Sax Institute, agosto 2022. http://dx.doi.org/10.57022/qpsm1481.

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Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.

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Skone, Timothy J. Electricity Distribution (Primary). Office of Scientific and Technical Information (OSTI), aprile 2013. http://dx.doi.org/10.2172/1509156.

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Bunce G. M. 791 Primary beam. Office of Scientific and Technical Information (OSTI), luglio 1985. http://dx.doi.org/10.2172/1157437.

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Rumph, Jerald. Virtual Primary Care Clinic. Fort Belvoir, VA: Defense Technical Information Center, ottobre 2001. http://dx.doi.org/10.21236/ada396460.

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Bange, Marilyn S. Primary Hazard Screening 8701206. Office of Scientific and Technical Information (OSTI), settembre 2018. http://dx.doi.org/10.2172/1475509.

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Budhiraja, Navin, Keith Marzullo, Fred B. Schneider e Sam Toueg. Optimal Primary-Backup Protocols. Fort Belvoir, VA: Defense Technical Information Center, agosto 1992. http://dx.doi.org/10.21236/ada255494.

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Budhiraja, Navin, Keith Marzullo, Fred B. Schneider e Sam Toueg. Optimal Primary-Backup Protocols. Fort Belvoir, VA: Defense Technical Information Center, agosto 1992. http://dx.doi.org/10.21236/ada255568.

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Rumph, Jerald W. Virtual Primary Care Clinic. Fort Belvoir, VA: Defense Technical Information Center, maggio 2000. http://dx.doi.org/10.21236/ada392490.

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Cohen, Deborah J., Annette M. Totten, Robert L. Phillips, Jr., Yalda Jabbarpour, Anuradha Jetty, Jennifer DeVoe, Miranda Pappas, Jordan Byers e Erica Hart. Measuring Primary Healthcare Spending. Agency for Healthcare Research and Quality (AHRQ), maggio 2024. http://dx.doi.org/10.23970/ahrqepctb44.

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Abstract (sommario):

Background. Policy leaders and researchers have identified a range of primary care spending conceptualizations, developed frameworks and methods for measuring primary care spending, and documented the pros and cons of different approaches. However, these efforts have not been comprehensive, particularly as the number of estimates has grown. We continue this work by identifying the definitions, data sources, and approaches used to estimate primary care spending in the United States. Our objective was to identify where there is and is not consensus across methods, and how initial steps toward a standardized approach to estimating primary care spending might be achieved. We approached this comparison from a societal economic perspective. Methods. Searches were conducted in Ovid MEDLINE® and Cochrane CENTRAL databases (inception to May 2, 2023), and were supplemented by manual reviews of reference lists, Scopus searches of key articles, gray literature searches of State and organization websites, and responses to a Federal Register Notice, as well as recommendations from Key Informants. Websites of States and organizations that produced reports were reviewed in November 2023 to identify updates. Publicly available estimates and reports of methods were supplemented by discussions with experts who have supported States’ estimates. Findings. We identified 67 primary care spending estimates for 2010 to 2021: 42 of these were produced by 11 State Governments for their State, 2 were published by the Veterans Health Administration, and 23 were published by researchers or other organizations, which include foundations and policy organizations. Forty-four estimates reported on primary care spending for a single State, one estimate reported spending for the New England States, and 22 reported national spending. To date, 13 State Governments have developed and/or are implementing measurements of primary care spending. When State Governments measure primary care spending, they produce regular, often yearly, estimates. States have produced one to eight estimates, demonstrating some States have more experience with this task than others. Primary care spending estimates in our sample ranged from 3.1 to 10.3 percent. These estimates started with definitions of primary care, which are often labeled narrow or broad. Estimates may use these same labels to mean different things. Narrow definitions of primary care usually include fewer providers, locations, or service types, while broad definitions include more. State, regional, or national estimates are either reported as two estimates, one using a narrow and one using a broad definition of primary care, or as a single estimate labeled neither narrow nor broad. Variations in what providers, services, and locations are included in definitions of primary care are significant and likely contribute to variation in primary care spending estimates. However, it is difficult to distinguish differences in definitions and measurement from differences in actual primary care spending. Conclusions. While there are some core similarities in how primary care spending is measured across State, regional, and national estimates, there are more differences. While there may be rationale behind some of these variations, this variation limits comparisons and what could be understood about the impact of policies. Furthermore, lack of clear, detailed reporting of methods can obscure precisely how and why estimates differ. Research is needed that quantifies the impact different decisions and measurement methods have on spending estimates. To assure the validity and reliability of estimates of primary care spending, and facilitate comparisons and links to health outcomes, Federal, State, and policy leaders need to: (1) collaborate to create a primary care clinician database that can function as a public utility for States to allow for more precise identification of primary care clinics and clinicians, and reduce reliance on Current Procedural Terminology/Healthcare Common Procedure Coding System codes; (2) develop a template for transparent reporting of methods used to estimate primary care spending; (3) foster collaboration among Federal agencies and State leaders to develop a consensus definition of primary care and process for estimating primary care spending, with consideration of methods that are easy to understand and transparent; and (4) support the development and ongoing maintenance of State All-Payer Claims Databases, expand to include nonclaims payments, and supply Medicare and Medicaid estimates for every State.

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Shi, Leiyu, Diana M. Pinto e Frederico C. Guanais. Measurement of Primary Care: Report on the Johns Hopkins Primary Care Assessment Tool. Inter-American Development Bank, marzo 2013. http://dx.doi.org/10.18235/0009098.

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Renewed interest in the Primary Health Care-PHC agenda is a common element of the majority of recent health system reforms throughout Latin America and the Caribbean-LAC. Strengthening of PHC has been recognized as a promising solution to address the major challenges the Region's health systems face. As governments are making substantive long term investments in PHC oriented healthcare reforms, there is a requirement for accountability and increased transparency and reporting on the results of these initiatives. As a consequence, implementation of PHC strategies needs to be accompanied with mechanisms to collect data that will allow assessment of the extent to which primary care processes are being implemented and on their impact of quality, efficiency, cost, equity and consumer satisfaction. The Johns Hopkins Primary Care Assessment Tool or PCAT is amongst the instruments currently available to assess performance of PHC in several dimensions and from the perspective of users, practitioners, and systems. The purpose of this technical document is to provide a description of this instrument including its composition, measurement, functions, uses, and requirements to deploy the tool in practical applications and to discuss the challenges and opportunities to use the tool in the context of the LAC Region.

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