Making context work in primary health care

Health care in the community setting is one of the more challenging contexts for evidence-based practice. Community-based care comprises more than simply transplanting hospital care into people’s homes; in addition to the provision of supportive services, it also takes a range of approaches to health care practice that promotes optimal health and builds the capacity of individuals and communities to respond to their health needs.

Primary health care is comprised of the diverse activities that build sustainable community capacity to achieve health and well-being throughout all of life’s stages. The expansive nature of primary health care means that a map for practice is not feasible; however a framework which can be adapted to suit the variety of situations and practice settings can be identified. The focus of this chapter is to broadly define and explore the principles of primary health care and consider the contexts of primary health care in relation to evidence-based practice.

Not to be confused with primary health care, “primary care” refers to the activities of a health care provider who acts as a first point of consultation for patients and as such is an important form of health access in the community setting (Nesbitt & Hanna, 2008). It is the part of the health care system that, in many parts of the world, people interact with most of the time. Continuity of care is a key characteristic of primary care. Primary care involves the widest scope of health care and is inclusive of people across the life span, from all socioeconomic and geographic origins, including those seeking to maintain optimal health, people with multiple chronic diseases, and those at the end of their lives.

Despite these important definitional distinctions, both the published literature and in practice reflect poor understanding of the differences between the two.