Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
This glossary has been created from several sources. It should not be construed to reflect the accepted definitions and policies of The College of Family Physicians of Canada. The glossary is neither inclusive of every term that can be applied to primary health care, nor are the definitions inclusive of all aspects of health care to which they could be applied.
This Glossary is provided in addition to the definitions of terms already included in the Primary Care Toolkit. For example, under Remuneration, please find detailed definitions for several methods of payment to family physicians.
Access - Extent to which an individual who needs care and services is able to receive them; more than having insurance coverage or the ability to pay for services; determined by the availability and acceptability of services, cultural appropriateness, location, hours of operation, transportation needs, costs and other factors.
Accountability - The ownership of conferred responsibilities combined with an obligation to report to a higher authority for the discharge of those responsibilities and the results obtained. (See Achieving Excellence, Treasury Board, Government of Newfoundland and Labrador [St. John's: 2000].)
Accreditation - Official decision made by a recognized organization that a health care plan, network, or other delivery system complies with applicable standards.
Administrative Costs - Costs not linked directly to the provision of medical care; includes staffing, billing, and medical record keeping, among others.
Adverse Event - An unintended injury or complication that results in disability or death and that is caused by health care management rather than the patient's underlying disease process. Health care management includes the actions of individual providers as well as broader systems and care processes, including both acts of omission and acts of commission. (Adapted from the Canadian Patient Safety Institute)
Appropriateness - Extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a patient's or client's needs. (Also see medically necessary.)
Behavioral Health Care - Continuum of services for individuals at risk of, or suffering from, mental, addictive, or other behavioral health disorders.
Benchmark - Measure of best performance for a particular indicator or performance goal. The benchmarking process identifies the best performance in health care (or non-healthcare) for a particular process or outcome; determines how that performance is achieved; applies the lessons learned to improve performance.
Best Practices - Approaches that have been shown to produce superior results, selected by a systematic process, and judged as "exemplary," "good," or "successfully demonstrated." (See Achieving Improved Measurement, Canadian Council on Health Services Accreditation [Ottawa: 2002], glossary.)
Capacity Building - Enhancing the ability of individuals and groups to mobilize and develop resources, skills and commitments needed to accomplish shared goals. (See Mental Health Promotion Tool Kit: A practical resource for community initiatives, Canadian Mental Health Association, 1999.)
Capitation - Fixed amount of money paid per person for covered services for a specific time; sometimes expressed in units of per patient/client per month.
Case Management - A system or process requiring an individual care provider or provider organization to be responsible for arranging, and/or approving all health care needs to ensure that individuals receive appropriate, timely and reasonable health care services.
Claim - A request by a health care professional (or the individual being care for) to a funder to pay for health services rendered.
Clinical Practice Guidelines - Systematically developed statements to standardize care and to assist in practitioner and patient decisions about the appropriate health care for specific circumstances; usually developed through a process that combines scientific evidence of effectiveness with expert opinion; also referred to as clinical criteria, protocols, algorithms, review criteria, and practice guidelines.
Community Capacity - The ability of community members to use the assets of their community, e.g. residents, associations and institutions, to improve the quality of life for those living in the community. Each community's collection of assets is unique and reflects the specific characteristics of its population, its political structures and geography. (See Mental Health Promotion Tool Kit: A practical resource for community initiatives, Canadian Mental Health Association, 1999.)
Community Development - A process involving community members or groups to build the community's strengths, self-sufficiency, wellbeing and problem solving. This process enables the community to make decisions, plan, design and implement strategies to achieve better health. (See B. Haen & R. Labonte, 1990.)
Comprehensiveness - The breadth of services that patients require and the knowledge base needed to treat multiple, complex medical conditions; linked with continuity. Family physicians provide continuous care when the care encompasses the many different conditions that a patient may develop in his or her lifetime, i.e. care is also comprehensive.
Continuity - The provision of unbroken services that is coordinated across a continuum of health care, over time within and across programs and organizations, as well as during the transition between levels of services. (See Achieving Improved Measurement, Canadian Council on Health Services Accreditation [Ottawa: 2002], Glossary.) Continuity includes three domains: informational continuity, longitudinal continuity and interpersonal continuity - distinguishing continuity provided by a group or organization from that within a physician-patient relationship. (See Saultz JW, Defining and Measuring Interpersonal Continuity of Care. Am Fam Med 2003;1:134-143.)
Continuous Quality Improvement (CQI) - An approach to health care quality management that builds on traditional quality assurance methods (see below) by putting in place a management structure that continuously gathers and assesses data that are then used to improve performance and design more efficient systems of care; also sometimes referred to as total quality management (TQM) or improvement (TQI).
Continuum of Care - A full range of flexible, effectively linked services, from institutional care to home-based/community-based care. (See 21st Century: A new vision for health care, McGill University Health Centre [Montreal: 1997].)
Continuum of Services - An integrated and seamless system of settings, services, service providers and service levels to meet the needs of patients/clients or defined populations over time. (See Achieving Improved Measurement, Canadian Council on Health Services Accreditation [Ottawa: 2002] Glossary.)
Cost-Sharing - A health policy provision that requires the involved parties to each pay a portion of the costs of services. Deductibles, co-insurance, and co-payment are types of cost sharing.
Determinants of Health - Factors that together contribute to the state of health and wellbeing of a population or individuals. These include: income and social status, social support network, education, health services, employment and working conditions, physical environment, biology and genetic endowment, personal health practices and coping skills, and child health and development. (See Federal, Provincial, and Territorial Advisory Committee on Population Health, 1994.)
Drug Formulary - The list of prescription drugs for which a particular pharmaceutical plan will pay (publicly funded through provincial / territorial / federal health plans or privately funded through insurance plans). Formularies are either "closed," including only certain drugs or "open," including all drugs.
Employee Assistance Plan (EAP) - Additional health care resources provided by employers either as part of or separate from publicly funded insurance health plans. EAPs often cover preventive care measures, various health care screenings, wellness activities or other aspects of health care not billable under the publicly funded system of health care.
Enrollee - A person eligible for health care services as a member of a defined population of patients receiving care, e.g. within a defined plan (as in insurance coverage), a registered population (as in a primary care group) or a geographically defined population (as in a regional approach to health care). In Canada, this is usually someone aligned with a specific family physician or practice, with or without specific financial responsibilities. (See Rostering.)
Enrollment - The total number of patients/clients in a defined population or group; also refers to the process by which a health system enrolls groups or individuals for membership or health benefits.
Evidence-based Decision Making - The explicit, conscientious and judicious consideration of the best available evidence in the provision of health care. (See Policy Statement on Evidence based Decision-making and Nursing Practice, Canadian Nurses Association, 1998.)
Facilitation - Providing leadership, advice and assistance; adapting to the constantly changing demands of a range of members belonging to a primary health care team; providing practical assistance and support to primary health care team members and to the communities that they serve; e.g. as in the role of a facilitator.
Fee for Service - A method of payment / remuneration in which individual health care providers are paid for individual medical services rendered.
Funder / Payer - The public or private organization that is responsible for payment of health care services.
Gatekeeper - A primary care provider (usually family physician) or a local health authority responsible for coordinating and managing the health care needs of patients belonging to the provider or the patient population defined by the health authority; often used to identify that access to specialty services in most regions requires a referral from the patient's family physician.
Health Promotion - Actively supporting and enabling people to increase control over and improve their health (World Health Organization, 1998); enabling people to reach a state of complete physical, mental and social well being. Health promotion is not just the responsibility of the health sector, but goes beyond wellbeing to healthy lifestyles. (See First International Conference on Health Promotion, Ottawa Charter for Health Promotion, 1986, and Mental Health Promotion Tool Kit: A practical resource for community initiatives, Canadian Mental Health Association, 1999.)
Horizontal Integration - A health care system where similar providers and/or groups of providers (as in organizations) work together at the same level of the system in providing care and service to patients, e.g. within the primary care system.
Intensive Case Management - Applies to intensive community services for patients with severe and persistent illnesses such as mental health illness or chronic debilitating disease; designed to improve planning for a wide variety of service needs requiring special skills; services may also include community outreach, monitoring / evaluation, and home support.
Inter-professional Primary Health Care Model - An approach to primary health care delivery which emphasizes universally accessible continuous, comprehensive, coordinated primary health care provision for a defined population through the shared responsibility and accountability of physicians and all other primary health care providers. (See Interdisciplinary Primary Care Models: Final Report - Working Group on Interdisciplinary Primary Care Models, Advisory Committee of Interpersonal Practitioners.) Note that "inter-professional" is sometimes substituted by "interdisciplinary" even though these words have different meanings for different stakeholders.
Inter-sectoral Collaboration - A recognized relationship between sectors of society which have been formed to take action on issues to achieve health outcomes in a way that is more effective, efficient or sustainable than might be achieved by the health sector acting alone. (See Health Promotion, World Health Organization, 1998, Glossary.)
Leadership - Characterized by meaningful direction given to collective effort; the ability to influence activities of an organized group toward goal achievement; demonstrated by an individual or group of individuals. (See Jacobs and Jacques, 1990, and Rauch and Behling, 1984.)
Management - The act, art or manner of controlling or conducting affairs; the skillful use of means to accomplish a defined purpose. (See Achieving Excellence, Treasury Board,
Government of Newfoundland and Labrador [St. John's: 2000].)
Managed Care - An organized system for delivering comprehensive health services that allows an entity managing care to determine what services will be provided to an individual within a prearranged care model that usually receives financial and administrative support; a term more popular in the USA where managed care is used to control contracted health care services and discourage unnecessary hospitalization and overuse of specialists.
Medical Group Practice - A number of physicians working in a systematic association with the joint use of equipment, technical and support personnel and within a centralized administrative and financial organization.
Medically Necessary - A treatment or drug without which, a patient's life and/or health would be jeopardized or at risk; in Canada, often but not always falls within the realm of publicly funded health care services under the Canada Health Act.
Medicare - Term used to refer to the government (federal, provincial and territorial - FPT) funded insurance program providing a defined range of health care services to Canadians; coverage and definition of services are usually legislated through the Canada Health Act and other FPT acts of relevance to health care delivery.
Network - A system of participating providers and/or institutions working together to deliver health care services; can be a formal or informal network.
Outcomes - The results of a specific health care service or care plan.
Outcome Measure - A tool to assess the impact of health services, e.g. improved quality and/or longevity of life and functioning.
Outcome Research - Studies that measure the effects of health care or service.
Patient / Client - The title given to an individual when she/he enters the health care system. The preferred title often depends on the health care provider: physicians generally prefer to refer to "patients" while others, e.g. social workers, may prefer to refer to "clients". In community health, families, groups or the community itself can be a client. Other terms could be customer, rostered member, care recipient, or consumer.
Patient-Physician Relationship - A relationship that describes the primacy of the person to family physicians; having the qualities of a covenant – a promise by physicians to be faithful to their commitment to patients' wellbeing, to provide continuing care, to promote the healing power of interactions, and to be advocates for their patients. (See The Four Principles of Family Medicine, CFPC.)
Performance Measurement - A systematic way to track, manage and report progress toward the attainment of goals and objectives; may relate, for example, to the provision of care or the management of an organization. Performance measurement focuses on the desired quantitative and qualitative outcomes and is a means of determining planned versus achieved results. (See Achieving Excellence, Treasury Board, Government of Newfoundland and Labrador [St. John's: 2000].)
Population Health Approach - A way to manage health care and health services; focuses on the needs of a given group as a whole and the factors that contribute and determine the health status of a defined group of people; facilitates the integration of services across a continuum of services. (See Achieving Improved Measurement, Canadian Council on Health Services Accreditation [Ottawa: 2002], Glossary.)
Primary Care - The first level of contact with the medical care system provided primarily by family doctors, (e.g. office visits, emergency room visits and house calls). Primary care operates inside the larger context of primary health care. (See Report of Primary Care Advisory Committee: The Family Physician's Role in a Continuum of Care Framework for Newfoundland and Labrador, [St. John's: 2001].)
Primary Care Physician - Usually refers to family physicians or general practitioners in Canada but in the USA, often includes other specialties, e.g. internal medicine, obstetrics/gynecology, and pediatrics. The primary care physician is usually responsible for investigating, diagnosing, treating and monitoring an individual's overall medical care and referring the individual to more highly specialized physicians if required for additional care.
Primary Health Care - The first level of contact with people taking action to improve health in a community. Primary health care is essential heath care made accessible at a cost that the country and community can afford, with methods that are practical, scientifically sound and socially acceptable. (See Health Promotion, World Health Organization, 1998, Glossary.)
Primary Health Care Team - A group of individuals who share common health goals and objectives determined by community needs, to which the achievement by each member of the team contributes, in a coordinated manner, in accordance with his/her competence and skills and respecting the functions of each. (See World Health Organization, 1985.)
Public Health - A social and political concept aimed at improving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention. (See Health Promotion,
World Health Organization, 1998.)
Quality Assurance - An approach to improving the appropriateness and effectiveness of medical and other health care services; includes a formal set of activities to review, assess, and monitor care to ensure that identified problems are addressed and that the best outcomes are achieved.
Regionalization - The defining of geographical regions and creation of health care services and organizations based on those boundaries.
Regional Health Authority - Organizational entity (usually publicly legislated and funded) that centrally maintains administrative, clinical, and fiscal authority for a geographically specific and organized system of health care being provided to a defined population.
Report Card - An accounting of the quality of services, compared among providers or systems over time; as in health report card; grades providers/systems on predetermined, measurable quality and outcome indicators; may be used by consumers and policy makers to determine overall program effectiveness, efficiency, and financial stability.
Risk - The chance or possibility of danger, loss, injury or adverse consequence; can be sometimes pre-determined and sometimes unexpected. (See Adverse Event.)
Rostering - Assigning patients to a family physician or practice; also called registering; facilitates the monitoring of patient care by the government or the practice; often accomplished by a formal agreement or contract between patients and their family physician. (See Enrollee.)
Scope of Practice - The range of activities that a qualified practitioner of an occupation may undertake; establishes the boundaries of an occupation, especially in relation to other occupations where similar activities may be performed; may be established through governing legislation or through internal regulations adopted by a regulatory body. (See Glossary of Terms, Human Resources Development Canada, 2002.)
Self-Care - The decisions and actions taken by someone, i.e. a patient or client, who is facing a health challenge or concern in order to cope and improve his/her health. (See Enhancing Health Services in Remote and Rural Communities of British Columbia, 1999.)
Secondary Care - First level specialized care requiring more complex diagnostic procedures and treatment than that provided at the primary care level, frequently delivered in hospitals. (See Health Services Review: Report of the Committee, New Brunswick Health and Community Services, 1998.)
Telehealth - Health telecommunication; involving information technology and health education to improve the efficiency and quality of healthcare. (See Health Canada, 2001, Glossary.)
Tertiary Care - Sub-specialty care usually requiring a high level of intensive hospital-based care. (See Health Services Review: Report of the Committee, New Brunswick Health and Community Services, 1998.)
Utilization - The level of use of a particular health service over time.
Utilization Management (UM) - A systematic process designed to evaluate health services provided to a specific patient or group of patients over a given time to ensure that they are cost-effective, appropriate, and accessible.
Utilization Review - Retrospective analysis of the patterns of health service used; an aid to determining how to optimize the value of the services provided (minimize cost and maximize effectiveness/appropriateness).
Vertical Integration - A health care system where different providers and/or organizations work together at different levels of the system in providing care to patients or groups of patients, i.e. the fit of primary with secondary with tertiary care. (See Horizontal Integration.)