Primary care and the public’s health: evidence from service development initiatives

Abstract

The development of primary health care (PHC) has been a central concern of this Journal since it was launched in 2000: ‘Implementation of research and evaluation into PHC practice is also an area of significance to the journal and studies that directly address the challenges and successes of implementation arewelcomed by the editors. In all papers, authors should demonstrate how their research or development study relates to primary care both in the context of their own country and internationally’ (https://www.cambridge.org/core/journals/primaryhealth-care-research-and-development). In recognition of this concern, the papers in this issue of the journal focus on development and, in this editorial, an overview of the contribution of these papers to the development of PHC will be discussed. The papers included explore two main themes relevant to development: how PHC can best respond to the need to promote health through a recognition of the wider determinants of health and secondly how primary care is best organised to deliver a service which is acceptable and accessible to the population. The papers included in this issue are drawn from studies in Canada, the USA, Nigeria and the UK reflecting the international interest in questions of application and testing of evidence in practice. The papers by van Weel et al. (2017) and DeSantis et al. (2017) argue for the use of wider frameworks to be used in implementation and evaluation of PHC interventions. van Weel et al. (2017) suggest a focus on the context within which PHC is delivered and identify four dimensions which they advocate should be reported on in studies of PHC: the health system; the social welfare system; the population and society characteristics; and details of the objectives of an intervention. These authors note that most care is delivered in the community and the dimensions identified reflect the reality of the impact of multiple factors, apart from direct care, on people’s health. Awareness of these factors suggests the importance of the relationship between PHC, with its access to individuals, and public health, with its focus on the wider determinants (Laverack, 2015). DeSantis et al. (2017) explore a framework drawn from the behavioural sciences in a study testing the application of the Outcomes Rating Scale to adults attending primary care services. The scale asks people to rate themselves in terms of their individual personal wellbeing, their family and close relationships, their social and wider interpersonal relationships, and their overall sense of wellbeing. In this exploratory study, comparing findings with other scales used in primary care to measure depression, they argue that use of this framework has the potential to identify a larger group of people with situational and relationship distress than scales more specifically focussed on disease symptoms. The growing evidence concerning the impact of personal relationships on health supports the use of such a scale in PHC settings (Balfour et al., 2012; Meier, ND). Underlying this concern with wider factors impacting on health is the world-wide growth in people’s experience of living with long-term conditions and multimorbidity. The Cochrane review (Trivedi, 2017) in this issue considers the evidence of the effectiveness of health service and patient orientated interventions on outcomes for people with multimorbidity. Although the evidence suggests benefit from interventions aimed at comorbidity and depression, other findings are mixed and it is concluded that interventions that target problems across conditions are needed, as well as better measurement and research into effectiveness of interventions. Two papers address the intervention and measurement issues, making the case for different, non-medical, types of interventions to address some of the context, behavioural and relationship challenges impacting on health. Gandy et al. (2017) report on a detailed multimethod evaluation of a multifaceted secondary prevention programme in West Lancashire, UK. This three-year programme consisted of a range of interventions including education sessions, activities such as line dancing, lunch clubs, language Primary Health Care Research & Development 2017; 18: 105–108 EDITORIAL doi:10.1017/S1463423617000020