ArticlePrimary health care research & development2021
Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities.
Article in Primary health care research & development, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 3 of them syntheses that pooled it.
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Who cites it
45 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- [Emotional and social well-being in the indigenous population of Latin America: A systematic review].Atencion primaria · 2026Pooled it
- What Interventions Work to Reduce Cost Barriers to Primary Healthcare in High-Income Countries? A Systematic Review.International journal of environmental research and public health · 2024Pooled it
- The impact of remote care approaches on continuity in primary care: a mixed-studies systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Pooled it
- Addressing depression and comorbid health conditions through solution-focused brief therapy in an integrated care setting: a randomized clinical trial.BMC primary care · 2024Trial
- Mapping Quality Indicators in Primary Health Care: A Scoping Review of Contemporary Approaches and Persistent Measurement Gaps.Healthcare (Basel, Switzerland) · 2026Review
- Bridging primary care with artificial intelligence: toward a global 1.5-Tier Healthcare System.npj health systems · 2026Review
- Improving Primary Healthcare: Applying Grapevine (Healthcare (Basel, Switzerland) · 2026Article
- Governing the attention dividend: AI-reclaimed clinician capacity as a health policy resource.Health affairs scholar · 2026Article
- Perinatal interventions for parents with exposure to adverse childhood experiences: A narrative review of suitability for implementation in primary care.Infant mental health journal · 2026Review
- System changes to empower primary care in Alzheimer's disease detection and care.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- Implementation of Reference Framework for Preventive Care for Older Adults: Cross-sectional Qualitative Study.Journal of medical Internet research · 2026Article
- PRIMARY-AI: outcomes-based standards to safeguard primary care in the AI era.Nature medicine · 2026Article
- Engagement of primary care physicians in medication decision-making for patients with multimorbidity in China: A cross-sectional study.PloS one · 2026Article
- Factors associated with unmet healthcare needs in patients using Primary Care Access Points for unattached patients in Quebec (Canada).PloS one · 2026Article
- Income-related inequalities and decomposition of outpatient healthcare utilization in Saudi Arabia.Frontiers in public health · 2026Article
- Identifying social prescribing core outcomes using a Delphi approach: findings and future directions.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2026Article
- Effectiveness of an Internet-Based 4C Nursing Model on Pulmonary Rehabilitation Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Quasi-Experimental Study.Patient preference and adherence · 2026Article
- 'Fend for yourself': Nurses' experiences transitioning to Family Care Team practice settings in Newfoundland and Labrador.PloS one · 2026Article
- Article
- Implementation of the Person-Centered Primary Care Measure.Journal of the American Board of Family Medicine : JABFM · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe four primary care (PC) core functions (the '4Cs', ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better population health. However, their broad definitions have led to variations in their assessment, in the innovations implemented to improve these functions and ultimately in their performance.
objectivesTo update and operationalise the 4Cs' definitions by using a literature review and analysis of enhancement strategies, and to identify innovations that may lead to their enhancement.
methodsNarrative, descriptive analysis of the 4Cs definitions, coming from PC international reports and organisations, to identify measurable features for each of these functions. Additionally, we performed an electronic search and analysis of enhancement strategies to improve these four Cs, to explore how the 4Cs inter-relate.
resultsSpecific operational elements for first contact include modality of contact, and conditions for which PC should be approached; for comprehensiveness, scope of services and spectrum of population needs; for coordination, links between PC and higher levels of care and social/community-based services, and workforce managing transitions and for continuity, type, level and context of continuity. Several innovations like enrolment, digital health technologies and new or enhanced PC provider's roles, simultaneously influenced two or more of the 4Cs.
conclusionProviding clear, well-defined operational elements for these 4Cs to measure their achievement and improve the way they function, and identifying the complex network of interactions among them, should contribute to the field in a way that supports efforts at practice innovation to optimise the processes and outcomes in PC.
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