The Role of Family Physician-Based Models in Integrated Primary Care: A Systematic Review and Meta-Analysis of Patient-Experienced Primary Care Quality

Abstract

Background: Indonesia's Integrated Primary Care (ILP) reform relies on doctors to lead life-course clusters in community health centres, but the added value of family physician-based care is unknown.

Objective: To assess how family physician-based models relate to the primary care quality experienced by users.

Methods: PubMed and Scopus were searched from database inception for comparative studies of family physician-based models (contracted family doctors, Family Health Strategy teams, family medicine-trained physicians) versus conventional primary care reporting user-rated Primary Care Assessment Tool or equivalent scores. Hedges g was pooled with random-effects models (Hartung–Knapp); certainty was rated with GRADE.

Results: Fifteen cross-sectional studies from China and Brazil were included; twelve (13 comparisons, 25,101 users) contributed to the primary analysis. Family physician-based models were associated with higher overall quality (g=0.37, 95% CI 0.20 to 0.55; I²=95.3%; prediction interval −0.18 to 0.93), about 0.6 points on the 0–10 PCATool scale. Associations were strongest for longitudinality (g=0.42) and community orientation (g=0.32) and not significant for coordination (g=0.12) or comprehensiveness (g=0.17). The direction was consistent across countries and sensitivity analyses, but trim-and-fill attenuated the estimate to g=0.19 and certainty was very low.

Conclusion: Family physician-based primary care was associated with better experienced continuity and community orientation, but not with better coordination or comprehensiveness. ILP should link registered populations to physician-led teams while strengthening referral systems and service scope.