The integration of public health in European primary care systems.

Background: A strong primary care (PC) system provides accessible, comprehensive care in an ambulatory setting on a continuous basis and by coordinated care processes. These features give PC the opportunity to play a key role in providing public health (PH) services to their practice population. There is however a lack of up to date comparable information to evaluate the overall state of PC systems, and thus the degree in which PH is integrated in the structure and process level of PC systems. Methods: A comprehensive set of indicators has been developed to evaluate the functioning of PC systems based on a literature review and expert consultations. The integration of PH tasks in PC is a key focus point of the instrument. PH activities are featuring at both structure (e.g. governance), process (e.g. comprehensiveness of care) and outcome level (e.g. quality) of PC systems. In 2009–10, an international consortium implemented the Monitoring system by collecting PC data in 31 European countries by reviewing (inter)national literature, statistical databases and consulting national expert panels. Results: The current variation in the integration of PH in European PC systems will be shown. This will be illustrated by indicators such as type of preventive care and health promotion tasks performed by PC providers and utilization rates of these services. Furthermore, the efforts of European countries to improve the performance of PH services by appropriately structuring their PC system through policies and regulation, financial measures and workforce development will be presented. Conclusions: This study shows a variation in the degree in which PH activities are part of PC systems in Europe.