Abstract
OBJECTIVE: To analyze the evolution of the health policy framework regarding the deployment of community care services in primary care across different comunidades autónomas (CC. AA.) in Spain. DESIGN: A qualitative study. LOCATION: Comunidades autónomas, Spain. PARTICIPANTS: Regional representatives of the Programa de Actividades Comunitarias en Atención Primaria (PACAP). METHODS: A qualitative study was conducted in three phases: The first phase, document review of community health plans and strategies from the 17 Spain's CC. AA.. The second phase, semi-structured interviews with regional representatives of the PACAP. The third phase, focus group with community health experts. Content analysis was used to identify key patterns and implementation challenges. RESULTS: The 77.7% of CC. AA. Include community care in their health plans, but only 64.7% have formal PS. Aragon, Catalonia, and the Balearic Islands have integrated ABCD into electronic health records, while in other regions, recommendation and recording depend on individual professional interest. Barriers include lack of training, coordination with asset providers, and absence of impact evaluation indicators. CONCLUSIONS: Effective implementation of PS requires institutional support, standardization of indicators, and strengthening of intersectoral coordination spaces. Reducing regional inequalities in its application is key to ensuring a positive impact on community health at the national level.