Characteristics of population.

IntroductionForty years passed between the two most important definitions of primary health care from Alma Alta Conference in 1978 to WHO’s definition in 2018. Since then, reforms of healthcare systems, changes in ambulatory sector and COVID 19, have created a need for reinterpretations and redefinition of primary healthcare. The primary objective of the study was to precise the definitions and the representations of primary healthcare by healthcare professionals.MethodsWe conducted a descriptive cross-sectional study using a web-based anonymized questionnaire including opened-ended and closed-ended questions but also “real-life” case-vignettes to assess participant’s perception of primary healthcare, from September to December 2020. Five case-vignette, describing situations involving a specific primary health care professional in a particular place for a determined task were selected, before the study, by test/retest method.ResultsA total of 585 healthcare practitioners were included in the study, 29% were general practitioners and 32% were midwives. Amongst proposed healthcare professions, general practitioners (97.6%), nurses (85.3%), midwives (85.2%) and pharmacists (79.3%) were those most associated with primary healthcare. The functions most associated with primary healthcare, with over 90% of approval were “prevention, screening”, “education to good health”, “orientation in health system”. Two case-vignettes strongly emerged as describing a situation of primary healthcare: Midwife/Hospital/Pregnancy (74%) and Pharmacist/Pharmacy/Flu shot (90%). The profession and the modality of practice of the responders lead to diverging answers regarding their primary healthcare representations.ConclusionsPrimary healthcare is an ever-evolving part of the healthcare system, as is its definition. This study explored the perception of primary healthcare by French healthcare practitioners in two complementary ways: oriented way for the important functions and more practical way with the case-vignettes. Understanding their differences of representation, according to their profession and practice offered the authors a first step to a shared and operational version of the primary healthcare definition.引言：从1978年阿拉木图会议提出的初级卫生保健（primary health care）两大核心定义，到2018年世界卫生组织（WHO）的新版定义，前后间隔长达四十年。自此之后，医疗体系改革、门诊领域变革以及新冠疫情（COVID-19）的冲击，使得重新阐释、界定初级卫生保健的需求日益凸显。本研究的核心目标，在于明确医疗卫生从业者对初级卫生保健的定义与认知。 方法：本研究于2020年9月至12月期间开展描述性横断面研究，通过网络匿名问卷收集数据。问卷涵盖开放式问题、封闭式问题，以及用于评估参与者对初级卫生保健认知的“真实场景”案例 vignette（case-vignettes）。研究前期通过重测法（test/retest method）遴选了5个案例 vignette，每个案例均描述了特定初级卫生保健从业者在特定场景下执行特定任务的情境。 结果：本研究共纳入585名医疗卫生从业者，其中29%为全科医生，32%为助产士。在受访的医疗卫生职业中，与初级卫生保健关联度最高的四类职业依次为：全科医生（97.6%）、护士（85.3%）、助产士（85.2%）以及药剂师（79.3%）。超90%的受访者认可的初级卫生保健核心职能包括：疾病预防与筛查、健康宣教、医疗体系就诊指引。有两个案例 vignette被绝大多数受访者认定为契合初级卫生保健场景：助产士/医院/妊娠场景（74%）与药剂师/药房/流感疫苗接种场景（90%）。受访者的职业类别与执业模式，会导致其对初级卫生保健的认知产生显著分歧。 结论：初级卫生保健作为医疗体系中持续演进的组成部分，其定义同样处于动态更新之中。本研究通过两种互补路径探究了法国医疗卫生从业者对初级卫生保健的认知：其一为针对核心职能的定向调研，其二为借助案例 vignette开展的实践性场景评估。基于从业者职业与执业模式的差异厘清认知分歧，为本研究团队构建共识性、可落地的初级卫生保健定义奠定了初步基础。