Revisiting the four core functions (4Cs) of primary care: Operational definitions and complexities
Abstract
Background: The 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. Objectives: To 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. Methods: Narrative, 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. Results: Specific 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. Conclusion:
Providing 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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https://hdl.handle.net/10161/24185Published Version (Please cite this version)
10.1017/S1463423621000669Publication Info
Jimenez, Geronimo; Matchar, David; Koh, Gerald Choon Huat; Tyagi, Shilpa; van der
Kleij, Rianne MJJ; Chavannes, Niels H; & Car, Josip (2021). Revisiting the four core functions (4Cs) of primary care: Operational definitions
and complexities. Primary Health Care Research and Development, 22. 10.1017/S1463423621000669. Retrieved from https://hdl.handle.net/10161/24185.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical
policies to their implementation in real world clinical settings. Most recently my
major content focus has been cerebrovascular disease. Other major clinical areas in
which I work include the range of disabling neurological conditions, cardiovascular
disease, and cancer prevention. Notable features of my work are: (1) reliance on
analytic strategies such as meta-analysis, simulation, decision analy

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