Improving prevention in primary care: results of a review of reviews and a case study

BACKGROUND: For many reasons, such as the ageing of the population and the increase in chronic diseases, the organization of primary care (PC) systems is undergoing a major transformation in many European countries. Prevention policies are becoming more and more important but are still struggling to be implemented in the field. This study therefore aims to identify and analyse the obstacles and levers to the integration of prevention into PC. METHODS: This study mobilized: i) A systematic review of reviews of the literature who was conducted on PubMed, Web of Science, Embase and the Cochrane Database, ii) a case study who focused on three different cases of coordinated PC practice structures in France called communauté professionnelle territoriale de santé (CPTS). A qualitative method was used: 18 semi-structured interviews were conducted with health professionals, institutions and partners. RESULTS: In the review, among the 420 records identified, 35 reviews were included. This review identified many barriers (e.g. time and training) and levers (e.g. guidelines and motivation of the professionals) to the integration of prevention into PC. They were classified into 8 thematic categories according to their potential field of action. The case study complements the findings of the literature in the light of the French context. Specific obstacles and levers in the French context and in CPTS organizations were identified. For example, the construction of a network of professionals, the integration of PC into the health care system, its context and links with other policies (education, housing, transport, employment, etc.) were identified as major levers. CONCLUSIONS: This study highlights: 1) the need to consider all the factors that can influence the integration of prevention in PC in order to meet the challenge of the preventive shift faced by our health systems 2) the specific conditions linked to the coordinated practice by PC professionals, using the French example. KEY MESSAGES: • The practice of prevention in PC is very complex, depending on many factors. • It must be organized and integrated into the health system and local policies.