Consensus-based recommendations for strengthening emergency care atprimary health care level: a Delphi study

Abstract

Background: Emergency care at a primary health care (PHC) level must be strengthened toreduce overall mortality and morbidity in any country. Developing recommendations forimprovement in this area should take into consideration the context and nuances of thecurrent emergency care system and primary health care context. Contribution to policy fromthe experts in the cross-cutting fields of PHC and emergency care is lacking. Objectives: This study aims to evaluate the strengths and weaknesses of emergency care inprimary health settings and develop consensus-based recommendations for the strengthen-ing of emergency care at this level.Methods: Using a modified Delphi technique, data were collected from various data sourcesto evaluate the strengths and weaknesses of emergency care at PHC level, from whichrecommendation statements were developed. These recommendations were proposed toa panel of experts using a Delphi survey to build consensus on 14 recommendations tostrengthen emergency care at PHC level. Results: Ten experts were recruited to participate (n = 10) with a response rate of 90% inround II and 80% in round III of Delphi. Recommendations broadly addressed the areas ofeducation and training in emergency care, the role and placement of various actors, leader-ship in emergency care and the development of a national plan for emergency care.Consensus was reached in round II for 97.61% of the statements and after modificationbased on open-ended comments, 98.21% consensus was reached in round III. Conclusion: Strengthening emergency care at primary and subsequent levels of health carerequires a coordinated effort and mandate from authority in order to effect real change.