Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries.
However, optimal outcomes of IPP may be hampered by adherence to historically embedded cultural behaviours, together with persistence of models of care that perpetuate rigid professional boundaries.
The persistence of quality of care issues in resource poor settings suggests that similar underlying issues may be present.
11, 25, 40, 41 The higher prevalence in more deprived areas of mixed physical and mental multimorbidity highlights the need for holistic and integrated primary care services led by generalists, which if not met — because of the persistence of the inverse care law — is likely to widen inequalities in health.
For example, at baseline the prevalence of restricted self-care increased with age, whereas the persistence of restricted self-care was higher in the younger age-groups (50 59, 60 69, 70 79) than in those aged 80 and over.
Both the health authority's inability to guarantee the provision of adequate care in rural and poor urban areas, and the persistence of barriers to health care, suggest the need for an integral reform rather than the partial measures (based on the assumption that improved regulation would ensure access) already adopted.
More broadly, the findings reflect the lack of consistency in national standards defining antenatal care that all Australian women should expect to receive, which unless addressed, will see the persistence of inequalities in maternity care and outcomes.
In a more recent meta-analysis Ford et al. conclude that hypnotherapy leads to less persistence of complaints than usual care or control therapy [ 15].
Thus, the need to control for these factors in predictive models on the persistence of depression in primary care is clear [ 36].
Persistence of pain and health care utilization were not mentioned for each pain site separately due to the risk for recall bias.
