Measurement and rural primary health care: a scoping review

Primary health care (PHC) is the foundation of health care systems around the world, recognized for its ability to deliver cost-effective, equitable, and high-quality care. Measuring and reporting on PHC performance allows decision-makers to ensure accountability and quality improvement. Rural areas, where residents are few and widely dispersed across vast areas, present special challenges for PHC delivery, and performance measurement systems need to acknowledge the ways rural PHC is unique. The objective of this scoping review is to establish the features of PHC that should be measured and reported in a rural versus a non-rural context. The electronic databasesPubMed, Scopus, and CINAHL, as well as grey literature in the form of government reports and research institute publications, were searched for relevant studies. Identified articles were eligible for inclusion if they reported or described: 1) rural primary health care; and 2) health care practice characteristics or structures, provider scope of practice, provider practice patterns, or patient patterns of health care use; and 3) one of four “pillars” of quality PHC outlined in the College of Family Physicians of Canada’s Patient’s Medical Home model: accessibility, continuity, comprehensiveness, or electronic health records. Articles were excluded if they reported or described: 1) specific patient populations, health concerns, or health outcomes; or 2) patient preferences or experiences with PHC. Data were extracted and analyzed to determine unique aspects of rural PHC. Twenty-six articles met inclusion criteria. Results suggest important differences in aspects of rural PHC, particularly in how rural patients access such care and the types of services they receive from providers compared to non-rural patients. These differences between rural and non-rural PHC will need to be considered in the design of performance measurement systems.