REMEDIUMREMEDIUM1561-59362658-3534Joint-Stock Company Chicot169310.32687/1561-5936-2024-28-1-39-46Original ArticleActual questions of ensuring accessibility of primary health care for the adult population (review)DzhurinskyMaxim O.max123tax1@gmail.comOgnevaEkaterina Yu.ogneva-e@mail.ruBurnasyan Federal Medical Biophysical Center, Moscow, RussiaDiagnostic Center No. 3 of the Moscow City Health Department, Moscow, RussiaState Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, RussiaMoscow Regional Research and Clinical Institute, Moscow, RussiaFederal Research Institute for Health Organization and Informatics, Moscow, Russia151220241394615102025Copyright © 2024,2024Annotation. Purpose: analysis of possible directions for increasing the accessibility of primary health care for the adult population in outpatient settings. Methodology for writing a review. This review was carried out according to the recommendations of PRISMA 2020. PubMed, eLibrary, Google Scholar databases were used as sources of information. Sources relevant to the research topic were analyzed for the period from January 2018 to September 2023. A total of 147 sources were found, of which 78 were selected after an initial analysis. For the final analysis, 49 publications were selected. Conclusion. According to the results of the completed theoretical study, the following areas seem relevant for solving the issues of providing high-quality primary health care to the population: 1) decision on human resources (both in relation to the number of medical specialists and regarding their qualifications); 2) organization of a system for the provision of primary health care (at the interstate, state, sectoral levels, as well as at the regional and local levels, taking into account socio-economic, nosological, climatic and geographical features); 3) the possibility of continuous monitoring and evaluation of the primary health care provided to the population.primary health careensuring accessibility of primary health carelean technologiesпервичная медико-санитарная помощьобеспечение доступности первичной медико-санитарной помощибережливые технологии[Kalininskaya A. A., Lazarev A. V., Allenov A. M. et al. Results and prospects for reforming primary health care in Moscow. Problems of social hygiene, health care and the history of medicine. 2022;(2):270—274.][WHO. News bulletin. November 2019. Primary health care. Social aspects of public health. 2019;(6):1—19.][Myasnikov A. O., Novikov A. Yu., Sadovskaya M. A. Primary health care as a basic element of the healthcare system at the present stage (basic principles and key tasks). The Scientific Heritage. 2020;(43—1):43—48.][Lazareva M. L., Fedyaev D. V., Melnikova L. S. Normative-legal regulation of the system of organization and payment of outpatient medical care in the Russian Federation. Medical technologies. Evaluation and choice. 2017;(3):31—40.][Sheiman I. M., Shevsky V. I., Sazhina S. V. Priority of primary health care — declaration or reality? Social aspects of population health. 2019;(1):3.][Akman M., Ayhan Başer D., Usanma Koban B. et al. Organization of primary care. Prim. Health Care Res. Dev. 2022;23:e49. DOI: 10.1017/S1463423622000275][Kazantseva A. V., Naboychenko E. S., Muratova A. A., Taskina E. K. Assessment of trends in changes in the personnel situation in primary health care in the Sverdlovsk region. Ural Medical Journal. 2021;20(6):4—13.][Vazquez Abanto H. E., Vazquez Abanto A. E. Primary health care and practical emergency medicine. Emergency Medicine. 2018;(7):70—83.][Mustafina G. T., Polunina V. V., Sharafutdinova N. Kh., Sharafutdinov M. A. Measures to improve primary health care for women. Medicine and healthcare organization. 2018;3(2):20—25.][Senn N., Breton M., Ebert S. T. et al. Assessing primary care organization and performance: Literature synthesis and proposition of a consolidated framework. Health Policy. 2021;125(2):160—167. DOI: 10.1016/j.healthpol.2020.10.004][Zadvornaya O. L. Problems and directions of development of primary health care. Modern problems of health care and medical statistics. 2021;(3):653—672. DOI: 10.24412/2312-2935-2021-3-653-672][Bogatova I. V., Shilnikova N. F. Assessment of the social effectiveness of primary health care. Healthcare of the Russian Federation. 2018;62(1):24—29.][Bekbolatova M. A., Dzhamedinova U. S., Shaltynov A. T. et al. Analysis of tools for assessing the performance of primary health care. Medicine and ecology. 2022;(3):22—32.][Bezymyanny A. S., Tyazhelnikov A. A., Yumukyan A. V. Projects to improve primary health care in Moscow, as a basis for choosing scientific directions for primary care specialists. Modern problems of health care and medical statistics. 2022;(2):23—39. DOI: 10.24412/2312-2935-2022-2-23-39][Pestushko N. A., Dorofeev A. L., Popova K. E. et al.. Criteria for the transition to a new model of a medical organization providing primary health care. Far Eastern Medical Journal. 2020;(3):152—157.][Smyshlyaev A. V., Melnikov Yu. Yu., Sadovskaya M. A. Results of the implementation of the project on the introduction of lean technologies and a process-oriented approach in the management of a medical organization providing primary health care in the Russian Federation. Chief Physician of the South of Russia. 2020;(5):45—48.][Breusov A. V., Pisklakov S. V., Breusov D. A. Lean healthcare — the philosophy of the activities of modern medical organizations. Modern problems of health care and medical statistics. 2022;(1):308—321. DOI: 10.24412/2312-2935-2022-1-308-321][Evdakov V. A., Allenov A. M., Artemyeva G. B. et al. Improving the activities of a city clinic based on lean technologies. Science of the young — Eruditio Juvenium. 2020;8(4):481—494.][Izmailova S. Kh., Sapakova M. M. Primary health care: Development prospects, marketing strategies (literature review). Bulletin of the Kazakh National Medical University. 2021;(2):329—335.][Senenko A. Sh., Son I. M., Dzyuba N. A. et al. Lean manufacturing technologies in reforming medical organizations providing primary health care. Analytical review. Social aspects of population health. 2020;66(4):6.][Kitanina K. Yu., Lastovetsky A. G. Lean management in healthcare. Bulletin of new medical technologies. Electronic edition. 2018;12(2):114—121. DOI: 10.24411/2075-4094-2018-16022][Metelskaya A. V. Problems of implementing the concept of «Lean polyclinic» in the practice of functioning of domestic polyclinic institutions. Problems of social hygiene, health care and the history of medicine. 2020;28(S2):1222—1226.][Kaspruk L. I. Some results of a study of the provision of primary health care to the population. Orenburg Medical Bulletin. 2018;6(1):41—45.][Zherebtsova T. A., Lyutsko V. V., Leontyev S. L. et al. Improving the organization of primary health care in the Sverdlovsk region. Modern problems of health care and medical statistics. 2022;(3):427—446. DOI: 10.24412/2312-2935-2022-3-427-446][Rugol L. V., Son I. M., Menshikova L. I. The influence of staffing of primary health care on the effectiveness of its activities. Social aspects of population health. 2020;66(3):10.][Prokhorenko N. F., Gaponova E. A., Petrachkov I. V., Ulumbekova G. E. Ensuring the accessibility and quality of primary health care. ORGZDRAV: News. Opinions. Education. VSHOUZ Bulletin. 2019;(4):20—42. DOI: 10.24411/2411-8621-2019-14002.][Perkhov V. I., Samorodskaya I. V., Tretyakov A. A., Gorin S. G. Integrated models of providing primary health care abroad. Modern problems of health care and medical statistics. 2020;(1):285—198. DOI: 10.24411/2312-2935-2020-00020][Senenko A.Sh., Dzyuba N. A. From a children's clinic to an adult clinic: organizational issues of ensuring continuity of primary health care. Healthcare manager. 2021;(6):21—26.][Ribeiro S. P., Cavalcanti M. L. T. Primary health care and coordination of care: device to increase access and improve quality. Cien. Saude Colet. 2020;25(5):1799—1808. DOI: 10.1590/1413—81232020255.34122019][Sellera P. E.G., Pedebos L. A., Harzheim E. et al. Monitoring and evaluation of Primary Health Care attributes at the national level: new challenges. Cien. Saude Colet. 2020;25(4):1401—1412. DOI: 10.1590/1413—81232020254.36942019][Wilson E. C., Pammett R., McKenzie F., Bourque H. Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study. CMAJ Open. 2021;9(1):E288—E294. DOI: 10.9778/cmajo.20200075][Levadnyaya M. O. Increasing the accessibility of primary health care for the population. Modern problems of health care and medical statistics. 2018;(1):26—35.][Karimi-Shahanjarini A., Shakibazadeh E., Rashidian A. et al. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst. Rev. 2019;4(4):CD010412. DOI: 10.1002/14651858.CD010412.pub2][Laurant M., van der Biezen M., Wijers N. et al. Nurses as substitutes for doctors in primary care. Cochrane Database Syst. Rev. 2018;7(7):CD001271. DOI: 10.1002/14651858.CD001271.pub3][Kalinskaya A. A., Lazarev A. V., Shlyafer S. I., Balzamova L. A. Staffing for primary health care in the Russian Federation. Healthcare manager. 2022;(6):62—68.][Zherebtsova T. A., Lyutsko V. V., Leontiev S. L. et al. Improving the organization of primary health care in the Sverdlovsk region. Modern problems of health care and medical statistics. 2022;(3):427—446. DOI: 10.24412/2312-2935-2022-3-427-446][Lechowski Ł., Jasion A. Spatial accessibility of primary health care in rural areas in Poland. Int. J. Environ. Res. Public Health. 2021;18(17):9282. DOI: 10.3390/ijerph18179282][Bekeshova E. N. Problems of organizing primary health care for the rural population at the present stage. Bulletin of Science and Practice. 2020;6(1):145—154.][Moskvicheva M. G., Polinov M. M. Analysis of the state of primary health care for the rural population at the regional level. Ural Medical Journal. 2021;20(1):50—57.][Polikarpov A. V., Ogryzko E. V., Kursekova I. V. Analysis of regulatory regulation of territorial planning in healthcare. Modern problems of health care and medical statistics. 2022;(4):610—628.DOI: 10.24412/2312-2935-2022-4-610-628][Malone N. C., Williams M. M., Smith Fawzi M. C. et al. Mobile health clinics in the United States. Int. J. Equity Health. 2020;19(1):40. DOI: 10.1186/s12939-020-1135-7][Nesterov R. A. Development of primary health care as the basis of the health care system in the Altai Territory. Scientific notes of the Altai branch of the Russian Academy of National Economy under the President of the Russian Federation. 2019;16:185—189.][Marques J. F., Áfioa A. C.E., de Carvalho L. V. et al. Physical accessibility in primary healthcare: a step towards the embracement. Rev. Gaúcha Enferm. 2018;39:e2017—0009. DOI: 10.1590/1983—1447.2018.2017—0009][Nischith K. R., Bhargava M., Akshaya K. M. An on-site assessment from Dakshina Kannada district in Southern India. J. Fam. Med. Primary Care. 2018;7(6):1300—1303. DOI: 10.4103/jfmpc.jfmp-c_177_18][Ferreira P. L., Raposo V., Tavares A. I. Primary health care patient satisfaction: Explanatory factors and geographic characteristics. Int. J. Qual. Health Care. 2020;32(2):93—98. DOI: 10.1093/intqhc/mzz134][Budardin S. S., Nikonov E. L., Elbek Yu. V. The relationship between the opinions of doctors and indicators characterizing the accessibility of primary health care to citizens in Moscow. Problems of social hygiene, health care and history of medicine. 2020;28(S2):1062—1067.][Odendaal W. A., Anstey Watkins J., Leon N. et al. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst. Rev. 2020;3(3):CD011942. DOI: 10.1002/14651858.CD011942.pub2]