Essential attributes and qualifiers of primary health care

Historically, the primary health care (PHC) has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country.Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1).A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicine in Europe), which describes 12 characteristics: general, accessible, integrated, continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2).Donabedian(3) systematized a group of important variables that can assess the quality of a system or health service and rated according to their characteristics in structure, process and outcome. The evaluation of the process includes the quality of services provided by health professionals individually or in groups and refer to professional qualifications, organization and coordination of the work process of teams. The evaluation of the structure includes environmental conditions and equipment in which the services are provided and the results are evaluated st