Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence

Abstract

Background: Accessible and high-quality primary health care (PHC) is fundamental to countries moving towards universal health coverage. In order to improve the quality of patient-centered care provided in PHC, a comprehensive understanding of patients' values is crucial to address any gaps in the health care system. This systematic review aimed to identify patients' values relevant to PHC.

Methods: We searched primary qualitative and quantitative studies about patients' values related to primary care in PubMed and EMBASE (Ovid) from 2009 to 2020. The studies' quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for both quantitative and qualitative studies and Consolidated Criteria for Reporting Qualitative Studies (COREQ) for qualitative studies. A thematic approach was used in the data synthesis.

Outcome: The database search resulted in 1,817 articles. A total of 68 articles were full-text screened. Data were extracted from nine quantitative and nine qualitative studies that met the inclusion criteria. The participants of the studies were mainly the general population in high-income countries. Four themes emerged from the analysis: patients' values related to privacy and autonomy; values associated with the general practitioners including virtuous characteristics, knowledge and competence; values involving patient-doctor interactions such as shared decision-making and empowerment; and core values related to the primary care system such as continuity, referral, and accessibility.

Conclusions: This review reveals that the doctor's personal characteristics and their interactions with the patients are critical considerations concerning the primary care services from the patients' point of view. The inclusion of these values is essential to improve the quality of primary care.

Keywords: Healthcare access; Patient empowerment; Patient preference; Patient values; Primary health care; Universal health coverage.

Fig. 1

PRISMA flowchart for the included studies [21]

Fig. 2

Mapping results from the data extraction. First author and year: (1) Berkelmans et al. (2010) [28], (2) Ekawati et al. (2017) [31], (3) Marcinowicz et al. (2014) [26], (4) Bjorkman et al. (2009) [29], (5) Chauhan et al. (2018), (6) Papp et al. (2014) [35], (7) Naidoo et al. (2019), (8) Ross et al. (2015) [27], (9) Artuso et al. (2013) [33], (10) Aldosari et al. (2017) [38], (11) Croker et al. (2013) [36], (12) Droz et al. (2019) [12], (13) Ofei-Dodoo et al. (2019) [34], (14) Kenny et al. (2015), (15) Sebo et al. (2015) [39], (16) Lionis et al. (2017) [13], (17) Mercado et al. (2012) [40], (18) Hirsch et al. (2016) [37]

Fig. 3

Conceptual framework for patient values regarding primary care