Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 10:22:e68.
doi: 10.1017/S1463423621000669.

Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities

Geronimo Jimenez  1   2 , David Matchar  3 , Gerald Choon Huat Koh  4 , Shilpa Tyagi  4 , Rianne M J J van der Kleij  2 , Niels H Chavannes  2 , Josip Car  1
Affiliations

Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities

Geronimo Jimenez et al. Prim Health Care Res Dev. .

Abstract

Background: The four primary care (PC) core functions (the '4Cs', ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better population health. However, their broad definitions have led to variations in their assessment, in the innovations implemented to improve these functions and ultimately in their performance.

Objectives: To update and operationalise the 4Cs' definitions by using a literature review and analysis of enhancement strategies, and to identify innovations that may lead to their enhancement.

Methods: Narrative, descriptive analysis of the 4Cs definitions, coming from PC international reports and organisations, to identify measurable features for each of these functions. Additionally, we performed an electronic search and analysis of enhancement strategies to improve these four Cs, to explore how the 4Cs inter-relate.

Results: Specific operational elements for first contact include modality of contact, and conditions for which PC should be approached; for comprehensiveness, scope of services and spectrum of population needs; for coordination, links between PC and higher levels of care and social/community-based services, and workforce managing transitions and for continuity, type, level and context of continuity. Several innovations like enrolment, digital health technologies and new or enhanced PC provider's roles, simultaneously influenced two or more of the 4Cs.

Conclusion: Providing clear, well-defined operational elements for these 4Cs to measure their achievement and improve the way they function, and identifying the complex network of interactions among them, should contribute to the field in a way that supports efforts at practice innovation to optimise the processes and outcomes in PC.

Keywords: basic concepts and models; continuity; coordination; core functions; health care organisation and management; primary care.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Illustration of (some of) the interrelations and complexities among the 4Cs.
See this image and copyright information in PMC

References

    1. Allen J, Gay B, Crebolder H, Heyrman J, Svab I, Ram P, Evans P et al. (2011) The European definition of General Practice/Family Medicine - 2011 Edition. Barcelona: WONCA Europe.
    1. American Hospital Association and Committee on Research (2010) AHA Research Synthesis Report: Patient-Centered Medical Home (PCMH). Chicago, IL: American Hospital Association.
    1. Annis AM, Harris M, Robinson CH and Krein SL (2016) Do Patient-Centered Medical Home Access and Care Coordination Measures Reflect the Contribution of All Team Members? A Systematic Review. J Nurs Care Qual 31, 357–366. - PubMed
    1. Baicker K and Chandra A (2004) Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Aff (Millwood), Suppl Web Exclusives, W4-184-97. - PubMed
    1. Baker R, Freeman GK, Haggerty JL, Bankart J and Nockels KH (2020) Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract 2020. 10.3399/bjgp20X712289. - DOI - PMC - PubMed

Publication types