Quality improvement in primary care: toward the provision of safe, high value, patient-centered, sustainable, and data-informed care.

In Switzerland, due to the growth and ageing of population, primary health care needs are increasing, especially for the management of chronic diseases and multimorbidity. Physicians are keen to improve the quality of care for their patients, and several inspiring initiatives have been conducted to monitor or improve the quality and safety of primary care in Switzerland. However, most of these initiatives were local and not funded on a sustained basis. Currently, there is no comprehensive approach of quality improvement (QI) in primary care and the culture of QI remains relatively weak, especially regarding monitoring and external accountability. There has never been a national QI program in primary care. Further, there is no national monitoring of quality and safety in primary care, including to track low value care and linked avoidable healthcare costs. We therefore recommend building a national strategy aiming to (1) set up a monitoring system for the quality and safety of primary care, (2) strengthen a culture of QI in primary care, (3) improve the quality of primary care through evidence-based and monitored interventions, (4) reduce low value care, and (5) support experiments to test QI initiatives. This strategy should be defined with citizens, patients, primary care physicians, allied health care providers (e.g., pharmacists), experts in health monitoring, health insurers, and health authorities, under the aegis of medico-scientific institutions with expertise in primary care as well as healthcare research and monitoring. Such a strategy would be key toward the provision of safe, high value, patient-centered, sustainable, and data-informed care