{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T04:02:35Z","timestamp":1768968155977,"version":"3.49.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2011,10,15]],"date-time":"2011-10-15T00:00:00Z","timestamp":1318636800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recent reforms in Portugal aimed at strengthening the role of the primary care system, in order to improve the quality of the health care system. Since 2006 new policies aiming to change the organization, incentive structures and funding of the primary health care sector were designed, promoting the evolution of traditional primary health care centres (PHCCs) into a new type of organizational unit - family health units (FHUs). This study aimed to compare performances of PHCC and FHU organizational models and to assess the potential gains from converting PHCCs into FHUs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Stochastic discrete event simulation models for the two types of organizational models were designed and implemented using Simul8 software. These models were applied to data from nineteen primary care units in three municipalities of the Greater Lisbon area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The conversion of PHCCs into FHUs seems to have the potential to generate substantial improvements in productivity and accessibility, while not having a significant impact on costs. This conversion might entail a 45% reduction in the average number of days required to obtain a medical appointment and a 7% and 9% increase in the average number of medical and nursing consultations, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Reorganization of PHCC into FHUs might increase accessibility of patients to services and efficiency in the provision of primary care services.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1472-6963-11-274","type":"journal-article","created":{"date-parts":[[2011,11,11]],"date-time":"2011-11-11T19:25:08Z","timestamp":1321039508000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Using discrete event simulation to compare the performance of family health unit and primary health care centre organizational models in Portugal"],"prefix":"10.1186","volume":"11","author":[{"given":"Andr\u00e9 S","family":"Fialho","sequence":"first","affiliation":[]},{"given":"M\u00f3nica D","family":"Oliveira","sequence":"additional","affiliation":[]},{"given":"Armando B","family":"S\u00e1","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2011,10,15]]},"reference":[{"issue":"3","key":"1823_CR1","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1111\/j.1468-0009.2005.00409.x","volume":"83","author":"B Starfield","year":"2005","unstructured":"Starfield B, Shi LY, Macinko J: Contribution of primary care to health systems and health. Milbank Q. 2005, 83 (3): 457-502. 10.1111\/j.1468-0009.2005.00409.x.","journal-title":"Milbank Q"},{"key":"1823_CR2","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.healthpol.2008.11.008","volume":"91","author":"CAEF Amado","year":"2009","unstructured":"Amado CAEF, Santos SP: Challenges for performance assessment and improvement in primary health care: The case of the Portuguese health centres. Health Policy. 2009, 91: 43-56. 10.1016\/j.healthpol.2008.11.008.","journal-title":"Health Policy"},{"issue":"6","key":"1823_CR3","first-page":"1","volume":"10","author":"DS Kringos","year":"2010","unstructured":"Kringos DS, Boerma WGW, Hutchinson A, van der Zee J, Groenewegen PP: The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Serv Res. 2010, 10 (6): 1-13.","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"1823_CR4","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1093\/intqhc\/mzm054","volume":"20","author":"W Hogg","year":"2008","unstructured":"Hogg W, Rowan M, Russell G, Geneau R, Muldoon L: Framework for primary care organizations: the importance of a structural domain. Int J Qual Health C. 2008, 20 (5): 308-313.","journal-title":"Int J Qual Health C"},{"key":"1823_CR5","doi-asserted-by":"publisher","first-page":"S203","DOI":"10.1002\/hec.1037","volume":"14","author":"MD Oliveira","year":"2005","unstructured":"Oliveira MD, Pinto CG: Health care reform in Portugal: An evaluation of the NHS experience. Health Econ. 2005, 14: S203-S220. 10.1002\/hec.1037.","journal-title":"Health Econ"},{"key":"1823_CR6","volume-title":"Health Systems in Transition","author":"PP Barros","year":"2007","unstructured":"Barros PP, Sim\u00f5es JA: Portugal - Health System Review. Health Systems in Transition. 2007, European Observatory Health Care Systems, 9."},{"key":"1823_CR7","volume-title":"Estat\u00edstica do Movimento Assistencial dos Centros de Sa\u00fade em 2005","author":"Instituto de Gest\u00e3o Inform\u00e1tica e Financeira de Sa\u00fade","year":"2006","unstructured":"Instituto de Gest\u00e3o Inform\u00e1tica e Financeira de Sa\u00fade: Estat\u00edstica do Movimento Assistencial dos Centros de Sa\u00fade em 2005. 2006, Lisboa: Minist\u00e9rio da Sa\u00fade"},{"key":"1823_CR8","volume-title":"Cuidados de Sa\u00fade Prim\u00e1rios em Portugal, Reformar para Novos Sucessos","author":"AR Biscaia","year":"2005","unstructured":"Biscaia AR, Martins JN, Carreira MFL, Gon\u00e7alves IF, Antunes AR, Ferrinho P: Cuidados de Sa\u00fade Prim\u00e1rios em Portugal, Reformar para Novos Sucessos. 2005, Lisbon: Padr\u00f5es Culturais Editora, 1","edition":"1"},{"key":"1823_CR9","volume-title":"Reformas da Sa\u00fade: o fio condutor","author":"AC Campos","year":"2008","unstructured":"Campos AC: Reformas da Sa\u00fade: o fio condutor. 2008, Almedina"},{"key":"1823_CR10","volume-title":"An\u00e1lise dos Custos e Sistema de Remunera\u00e7\u00f5es e Incentivos das Unidades de Sa\u00fade Familiar","author":"M Gouveia","year":"2007","unstructured":"Gouveia M, Silva SN, Oliveira P, Miguel LS: An\u00e1lise dos Custos e Sistema de Remunera\u00e7\u00f5es e Incentivos das Unidades de Sa\u00fade Familiar. 2007, Associa\u00e7\u00e3o Portuguesa de Economia da Sa\u00fade"},{"key":"1823_CR11","volume-title":"Reforma para os Cuidados de Sa\u00fade Prim\u00e1rios - Plano Estrat\u00e9gico 2007-2009","author":"Miss\u00e3o para os Cuidados de Sa\u00fade Prim\u00e1rios","year":"2007","unstructured":"Miss\u00e3o para os Cuidados de Sa\u00fade Prim\u00e1rios: Reforma para os Cuidados de Sa\u00fade Prim\u00e1rios - Plano Estrat\u00e9gico 2007-2009. 2007, Lisboa: Miss\u00e3o para os Cuidados de Sa\u00fade Prim\u00e1rios"},{"key":"1823_CR12","volume-title":"Implementing Primary Care Reform in Canada: Barriers and Facilitators","author":"C Fooks","year":"2004","unstructured":"Fooks C: Implementing Primary Care Reform in Canada: Barriers and Facilitators. 2004, McGill-Queen's University Press"},{"key":"1823_CR13","volume-title":"Decreto-Lei n.\u00b0 9\/2006","author":"Minist\u00e9rio da Sa\u00fade","year":"2006","unstructured":"Minist\u00e9rio da Sa\u00fade: Decreto-Lei n.\u00b0 9\/2006. 2006, Di\u00e1rio da Rep\u00fablica"},{"key":"1823_CR14","volume-title":"Decreto-Lei n.\u00b0 298\/2007","author":"Sa\u00fade Minist\u00e9rio da","year":"2007","unstructured":"Minist\u00e9rio da Sa\u00fade: Decreto-Lei n.\u00b0 298\/2007. 2007, Di\u00e1rio da Rep\u00fablica"},{"key":"1823_CR15","unstructured":"Estat\u00edstica das USF. [http:\/\/www.mcsp.min-saude.pt\/Imgs\/content\/page_32\/candnac_20111017.pdf]"},{"issue":"188","key":"1823_CR16","first-page":"1","volume":"8","author":"D D'Amour","year":"2008","unstructured":"D'Amour D, Goulet L, Labadie J-F, Mart\u00edn-Rodriguez LS, Pineault R: A model and typology of collaboration between professionals in healthcare organizations. BMC Health Serv Res. 2008, 8 (188): 1-14.","journal-title":"BMC Health Serv Res"},{"key":"1823_CR17","volume-title":"Contratualiza\u00e7\u00e3o com as Unidades de Sa\u00fade Familiares para 2007","author":"Ag\u00eancia de Contratualiza\u00e7\u00e3o dos Servi\u00e7os de Sa\u00fade","year":"2006","unstructured":"Ag\u00eancia de Contratualiza\u00e7\u00e3o dos Servi\u00e7os de Sa\u00fade: Contratualiza\u00e7\u00e3o com as Unidades de Sa\u00fade Familiares para 2007. 2006, Lisbon"},{"key":"1823_CR18","volume-title":"Proposta de Reconfigura\u00e7\u00e3o dos Centros de Sa\u00fade - Cria\u00e7\u00e3o de Agrupamentos de Centros de Sa\u00fade","author":"Miss\u00e3o para os Cuidados de Sa\u00fade Prim\u00e1rios","year":"2007","unstructured":"Miss\u00e3o para os Cuidados de Sa\u00fade Prim\u00e1rios: Proposta de Reconfigura\u00e7\u00e3o dos Centros de Sa\u00fade - Cria\u00e7\u00e3o de Agrupamentos de Centros de Sa\u00fade. 2007, Lisboa: Miss\u00e3o para os Cuidados de Sa\u00fade Prim\u00e1rios"},{"key":"1823_CR19","volume-title":"An\u00e1lise dos Custos dos Centros de Sa\u00fade e do Regime Remunerat\u00f3rio Experimental","author":"M Gouveia","year":"2007","unstructured":"Gouveia M, Silva SN, Oliveira P, Miguel LS: An\u00e1lise dos Custos dos Centros de Sa\u00fade e do Regime Remunerat\u00f3rio Experimental. 2007, Associa\u00e7\u00e3o Portuguesa de Economia da Sa\u00fade"},{"issue":"4","key":"1823_CR20","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1093\/pubmed\/fdg075","volume":"25","author":"D Fone","year":"2003","unstructured":"Fone D, Hollinghurst S, Temple M, Round A, Lester N, Weightman A, Roberts K, Coyle E, Bevan G, Palmer S: Systematic review of the use and value of computer simulation modelling in population health and health care delivery. J Public Health Med. 2003, 25 (4): 325-335. 10.1093\/pubmed\/fdg075.","journal-title":"J Public Health Med"},{"key":"1823_CR21","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1057\/palgrave.jors.2600669","volume":"50","author":"JB Jun","year":"1999","unstructured":"Jun JB, Jacobson SH, Swisher JR: Application of discrete-event simulation in health care clinics: A survey. J Oper Res Soc. 1999, 50: 109-123.","journal-title":"J Oper Res Soc"},{"key":"1823_CR22","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/978-0-387-33636-7_8","volume-title":"Patient Flow: Reducing Delay in Healthcare Delivery","author":"SH Jacobson","year":"2006","unstructured":"Jacobson SH, Hall SN, Swisher JR: Discrete-event simulation of health care systems. Patient Flow: Reducing Delay in Healthcare Delivery. Edited by: Hall RW. 2006, 211-252."},{"key":"1823_CR23","volume-title":"Tools for Thinking: Modelling in Management Science","author":"M Pidd","year":"2003","unstructured":"Pidd M: Tools for Thinking: Modelling in Management Science. 2003, Wiley, 2","edition":"2"},{"key":"1823_CR24","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.healthpol.2009.07.007","volume":"93","author":"S Ramwadhdoebe","year":"2009","unstructured":"Ramwadhdoebe S, Buskens E, Sakkers RJB, Stahl JE: A tutorial on discrete-event simulation for health policy design and decision making: Optimizing pediatric ultrasound screening for hip dysplasia as an illustration. Health Policy. 2009, 93: 143-150. 10.1016\/j.healthpol.2009.07.007.","journal-title":"Health Policy"},{"key":"1823_CR25","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1057\/jos.2009.25","volume":"4","author":"MM G\u00fcnal","year":"2010","unstructured":"G\u00fcnal MM, Pidd M: Discrete event simulation for performance modelling in health care: a review of the literature. Journal of Simulation. 2010, 4: 42-51. 10.1057\/jos.2009.25.","journal-title":"Journal of Simulation"},{"key":"1823_CR26","volume-title":"Simul8 2006 Standard Edition","author":"Simul8 Corporation","year":"2008","unstructured":"Simul8 Corporation: Simul8 2006 Standard Edition. 2008, Simul8 Corporation, 13.0","edition":"13.0"},{"key":"1823_CR27","volume-title":"Anu\u00e1rio Estat\u00edstico de Portugal","author":"Instituto Nacional de Estat\u00edstica","year":"2006","unstructured":"Instituto Nacional de Estat\u00edstica: Anu\u00e1rio Estat\u00edstico de Portugal. 2006, Instituto Nacional de Estat\u00edstica"},{"key":"1823_CR28","volume-title":"Population estimates","author":"Instituto Nacional de Estat\u00edstica","year":"2007","unstructured":"Instituto Nacional de Estat\u00edstica: Population estimates. 2007, Instituto Nacional de Estat\u00edstica"},{"key":"1823_CR29","volume-title":"Plano de Ac\u00e7\u00e3o Tri\u00e9nio 2008 - 2010","author":"USF Dafundo","year":"2007","unstructured":"USF Dafundo: Plano de Ac\u00e7\u00e3o Tri\u00e9nio 2008 - 2010. 2007"},{"key":"1823_CR30","volume-title":"Plano de Ac\u00e7\u00e3o 2008","author":"USF Delta","year":"2007","unstructured":"USF Delta: Plano de Ac\u00e7\u00e3o 2008. 2007"},{"key":"1823_CR31","volume-title":"Relat\u00f3rio de Actividades 2007","author":"USF Marginal","year":"2007","unstructured":"USF Marginal: Relat\u00f3rio de Actividades 2007. 2007"},{"key":"1823_CR32","volume-title":"Relat\u00f3rio de Actividades 2007","author":"USF Rodrigues Migueis","year":"2007","unstructured":"USF Rodrigues Migueis: Relat\u00f3rio de Actividades 2007. 2007"},{"key":"1823_CR33","volume-title":"Plano de Ac\u00e7\u00e3o 2007","author":"USF T\u00edlias","year":"2007","unstructured":"USF T\u00edlias: Plano de Ac\u00e7\u00e3o 2007. 2007"},{"key":"1823_CR34","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195158090.001.0001","volume-title":"An Introduction to Quality Assurance in Health Care","author":"A Donabedian","year":"2002","unstructured":"Donabedian A: An Introduction to Quality Assurance in Health Care. 2002, Oxford University Press"},{"key":"1823_CR35","volume-title":"Learning Simul8: The Complete Guide","author":"JW Hauge","year":"2004","unstructured":"Hauge JW, Paige KN: Learning Simul8: The Complete Guide. 2004, PlainVu, 2","edition":"2"},{"key":"1823_CR36","volume-title":"Di\u00e1rio da Rep\u00fablica","author":"Minist\u00e9rio da Sa\u00fade","year":"2005","unstructured":"Minist\u00e9rio da Sa\u00fade: Decreto-Lei n.\u00b0 88\/2005. Di\u00e1rio da Rep\u00fablica. 2005"},{"key":"1823_CR37","volume-title":"Di\u00e1rio da Rep\u00fablica","author":"Minist\u00e9rio da Sa\u00fade","year":"2008","unstructured":"Minist\u00e9rio da Sa\u00fade: Decreto-Lei n.\u00b0 28\/2008. Di\u00e1rio da Rep\u00fablica. 2008"},{"key":"1823_CR38","volume-title":"Policy on Rural Practice and Rural Health","author":"Wonca Working Party on Rural Practice","year":"2001","unstructured":"Wonca Working Party on Rural Practice: Policy on Rural Practice and Rural Health. 2001, Victoria: Monash University School of Rural Health"},{"issue":"15","key":"1823_CR39","first-page":"1","volume":"11","author":"C Rodr\u00edguez","year":"2010","unstructured":"Rodr\u00edguez C, Pozzebon M: The implementation evaluation of primary care groups of practice: a focus on organizational identity. BMC Family Practice. 2010, 11 (15): 1-10.","journal-title":"BMC Family Practice"},{"key":"1823_CR40","volume-title":"Physician Resource Questionnaire 2003","author":"Canadian Medical Association","year":"2003","unstructured":"Canadian Medical Association: Physician Resource Questionnaire 2003. 2003"},{"issue":"5","key":"1823_CR41","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1377\/hlthaff.2010.0069","volume":"29","author":"T Doran","year":"2010","unstructured":"Doran T, Roland M: Lessons from major initiatives to improve primary care in the United Kingdom. Health Affair. 2010, 29 (5): 1023-1029. 10.1377\/hlthaff.2010.0069.","journal-title":"Health Affair"},{"key":"1823_CR42","volume-title":"Simulation Modelling and Analysis","author":"AM Law","year":"2000","unstructured":"Law AM: Simulation Modelling and Analysis. 2000, McGraw Hill, 3","edition":"3"},{"issue":"6","key":"1823_CR43","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1057\/palgrave.jors.2601719","volume":"55","author":"PR Harper","year":"2004","unstructured":"Harper PR, Pitt MA: On the challenges of healthcare modelling and a proposed project life cycle for successful implementation. J Oper Res Soc. 2004, 55 (6): 657-661. 10.1057\/palgrave.jors.2601719.","journal-title":"J Oper Res Soc"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6963-11-274.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1472-6963-11-274\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6963-11-274","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6963-11-274.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,14]],"date-time":"2024-04-14T17:07:06Z","timestamp":1713114426000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/1472-6963-11-274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10,15]]},"references-count":43,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2011,12]]}},"alternative-id":["1823"],"URL":"https:\/\/doi.org\/10.1186\/1472-6963-11-274","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,10,15]]},"assertion":[{"value":"12 January 2011","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2011","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2011","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"274"}}