-Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS) at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1). Hereby I would like to emphasize the importance of quality assessment (QA) especially in the era of newly established primary care implementations in our coun...
Armando Henrique Norman
Full Text Available A Revista Brasileira de Medicina de Família e Comunidade (RBMFC encerra o ano de 2013 com uma edição em comemoração ao nascimento da Dra. Barbara Starfield em 18 de dezembro (18/12/1932 - 10/6/2011. A foto da capa, intitulada “Desayuno en Buitrago de Lozoya” retrata a amizade entre Barbara Starfield, seu marido Neil “Tony” Holtzman e Juan Gérvas e Mercedes Pérez Fernández (autora da foto, na qual desfrutam e compartilham a vida à mesa. A mesa também faz referência a uma característica marcante de Starfield: a de nutriz (do latim nuctrix, que possui a capacidade de nutrir; que sustenta. Como afirmou seu marido Tony: - “Ela fez isso por meio de sua pesquisa, sua paixão altruísta e sua orientação àqueles que se preocupam com as pessoas, a justiça e a verdade”1.O editorial especial para esta edição foi escrito pelo Dr. Juan Gérvas e reflete a importância de se avaliar a qualidade da atenção primária à saúde (APS a fim de que ela possa, continuamente, se fortalecer. Em decorrência disso, todos os artigos desta edição versam sobre o Instrumento de Avaliação da Atenção Primária, em inglês Primary Care Assessment Tool (PCATool, sua validação, adaptação e aplicação para a APS2. Starfield e colaboradores desenvolveram, no The Johns Hopkins Populations Care Policy Center for the Underserved Populations, o PCATool, instrumento que permite mensurar a presença e a extensão dos atributos essenciais e derivados da APS3. Os quatro atributos essenciais da APS: a acesso de primeiro contato; b continuidade do cuidado; c abrangência (comprehensiveness; e d coordenação dos cuidados são subcomponentes do acesso e, portanto, a qualidade dos serviços passa pela melhoria de estruturas e processos (efetividade que garantam o acesso tanto no nível individual – atendendo os indivíduos e suas necessidades em saúde – como no nível populacional, em que o acesso volta-se à dimensão ética da
Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping
Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care. PMID:28210741
Full Text Available -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1. Hereby I would like to emphasize the importance of quality assessment (QA especially in the era of newly established primary care implementations in our country. Promotion of quality has been fundamental part of primary care health services. Nevertheless variations in quality of care exist even in the developed countries. Accomplishment of quality in the primary care has some barriers like administration and directorial factors, absence of evidence-based medicine practice lack of continuous medical education. Quality of health care is no doubt multifaceted model that covers all components of health structures and processes of care. Quality in the primary care set up includes patient physician relationship, immunization, maternal, adolescent, adult and geriatric health care, referral, non-communicable disease management and prescribing (2. Most countries are recently beginning the implementation of quality assessments in all walks of healthcare. Organizations like European society for quality and safety in family practice (EQuiP endeavor to accomplish quality by collaboration. There are reported developments and experiments related to the methodology, processes and outcomes of quality assessments of health care. Quality assessments will not only contribute the accomplishment of the program / project but also detect the areas where obstacles also exist. In order to speed up the adoption of QA and to circumvent the occurrence of mistakes, health policy makers and family physicians from different parts of the world should share their experiences. Consensus on quality in preventive medicine implementations can help to yield
Wound care is expensive and can cause immeasurable stress and inconvenience to patients and their significant others. It is therefore in the best interest of the patient, their significant others and the NHS as a whole that wounds are expertly assessed, managed and healed in the quickest timeframe possible. Nurses play a pivotal role in the process of accurate holistic wound assessment, evaluation and treatment. This article aims to help further develop and enhance both professional and clinical wound care assessment and evaluation skills. Pertinent wound care literature is critically reviewed and the crucial nature and important components of comprehensive wound assessment for facilitating the highest possible quality wound care to patients are presented alongside recommendations regarding how the enhanced knowledge and skills could be applied into everyday wound care practice.
Full Text Available Objective. To develop a primary care assessment tool in Tibetan area and assess the primary care quality among different healthcare settings. Methods. Primary care assessment tool-Tibetan version (PCAT-T was developed to measure seven primary care domains. Data from a cross-sectional survey of 1386 patients was used to conduct validity and reliability analysis of PCAT-T. Analysis of variance was used to conduct comparison of primary care quality among different healthcare settings. Results. A 28-item PCAT-T was constructed which included seven multi-item scales and two single-item scales. All of multi-item scales achieved good internal consistency and item-total correlations. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales, except first contact and continuity. Compared with prefecture hospital (77.42 and county hospital (82.01, township health center achieved highest primary care quality total score (86.64. Conclusions. PCAT-T is a valid and reliable tool to measure patients' experience of primary care in the Tibet Autonomous Region. Township health center has the best primary care performance compared with other healthcare settings, and township health center should play a key role in providing primary care in Tibet.
Stange, Kurt C; Etz, Rebecca S; Gullett, Heidi; Sweeney, Sarah A; Miller, William L; Jaén, Carlos Roberto; Crabtree, Benjamin F; Nutting, Paul A; Glasgow, Russell E
Metrics focus attention on what is important. Balanced metrics of primary health care inform purpose and aspiration as well as performance. Purpose in primary health care is about improving the health of people and populations in their community contexts. It is informed by metrics that include long-term, meaning- and relationship-focused perspectives. Aspirational uses of metrics inspire evolving insights and iterative improvement, using a collaborative, developmental perspective. Performance metrics assess the complex interactions among primary care tenets of accessibility, a whole-person focus, integration and coordination of care, and ongoing relationships with individuals, families, and communities; primary health care principles of inclusion and equity, a focus on people's needs, multilevel integration of health, collaborative policy dialogue, and stakeholder participation; basic and goal-directed health care, prioritization, development, and multilevel health outcomes. Environments that support reflection, development, and collaborative action are necessary for metrics to advance health and minimize unintended consequences.
Elwyn, G.; Rhydderch, M.; Edwards, A.; Hutchings, H.; Marshall, M.; Myres, P.; Grol, R.P.T.M.
OBJECTIVE: To design and develop an instrument to assess the degree of organisational development achieved in primary medical care organisations. DESIGN: An iterative development, feasibility and validation study of an organisational assessment instrument. SETTING: Primary medical care
Dizziness is a common reason for visits to primary health care, especially among elderly patients. From a physiotherapeutic perspective, this thesis aims to study the assessment and treatment of dizzy patients in primary health care. Interventions in papers I, III and IV comprised a vestibular rehabilitation programme. In paper I, patients with multisensory dizziness were randomized to intervention group or control group. At follow-up after six weeks and three months, the intervention ...
De Clercq, Etienne; van Casteren, Viviane; Bossuyt, Nathalie; Goderis, Geert; Moreels, Sarah
Starting in 2009, the first ever Belgian nationwide data collection network using routine data extracted from primary care EPR (upload method) has been built from scratch. The network also uses a manual web-based data collection method. This paper compares these two methods by analysing missing and most recent values for certain parameters. We collected data from 4954 practices, pertaining to 29,180 patients. Mean values for the most recent parameters were similar regardless of which data collection method was used. Many missing recent values (>46%) were found for all of the parameters when using the upload method. It seems that, in Belgium, uploading routine data from primary care EPR on a large scale is suitable and allows the collection of chronological retrospective data. However, the method still requires major, carefully controlled improvements.
Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.
Green Michael E
Full Text Available Abstract Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30 were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were
Green, Michael E; Hogg, William; Savage, Colleen; Johnston, Sharon; Russell, Grant; Jaakkimainen, R Liisa; Glazier, Richard H; Barnsley, Janet; Birtwhistle, Richard
To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices. This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and
Full Text Available Introduction. With Chinese health care reform increasingly emphasizing the importance of primary care, the need for a tool to evaluate primary care performance and service delivery is clear. This study presents a methodology for a rapid assessment of primary care organizations and service delivery in China. Methods. The study translated and adapted the Primary Care Assessment Tool-Adult Edition (PCAT-AE into a Chinese version to measure core dimensions of primary care, namely, first contact, continuity, comprehensiveness, and coordination. A cross-sectional survey was conducted to assess the validity and reliability of the Chinese Rapid Primary Care Assessment Tool (CR-PCAT. Eight community health centers in Guangdong province have been selected to participate in the survey. Results. A total of 1465 effective samples were included for data analysis. Eight items were eliminated following principal component analysis and reliability testing. The principal component analysis extracted five multiple-item scales (first contact utilization, first contact accessibility, ongoing care, comprehensiveness, and coordination. The tests of scaling assumptions were basically met. Conclusion. The standard psychometric evaluation indicates that the scales have achieved relatively good reliability and validity. The CR-PCAT provides a rapid and reliable measure of four core dimensions of primary care, which could be applied in various scenarios.
Gonzalez, G.Z.; Klazinga, N.; Asbroek, G. ten; Delnoij, D.M.
An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. OBJECTIVES: To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a hea
O'Kelly, C M
BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.
Full Text Available Abstract Background Primary Health Care (PHC is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed. Methods 284 students' case write-ups from the 6 primary care units (PCUs where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8 primary qualitative criteria. Results Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p Conclusion The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.
The portfolio consists of a variety of documentation of a learner's proof of learning. It has been promoted as one way to verify a learner's personal and professional development, especially for the more mature trainees and doctors at work. It has not been widely accepted as a summative tool because the amount of time imposed on the learners may be considerable. Ways to improve the reliability of assessments on unstandardised portfolios are needed for its wider application.
The portfolio consists of a variety of documentation of a learner’s proof of learning. It has been promoted as one way to verify a learner’s personal and professional development, especially for the more mature trainees and doctors at work. It has not been widely accepted as a summative tool because the amount of time imposed on the learners may be considerable. Ways to improve the reliability of assessments on unstandardised portfolios are needed for its wider application.
Simon de Lusignan
Full Text Available Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user’s preferences. The use of electronic patient record (EPR systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.
de Lusignan, Simon; Pearce, Christopher; Munro, Neil
Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.
Powell, Karen P; Christianson, Carol A; Hahn, Susan E; Dave, Gaurav; Evans, Leslie R; Blanton, Susan H; Hauser, Elizabeth; Agbaje, Astrid; Orlando, Lori A; Ginsburg, Geoffrey S; Henrich, Vincent C
Family health history can predict a patient's risk for common complex diseases. This project assessed the completeness of family health history data in medical charts and evaluated the utility of these data for performing risk assessments in primary care. Family health history data were collected and analyzed to determine the presence of quality indicators that are necessary for effective and accurate assessment of disease risk. More than 99% of the 390 paper charts analyzed contained information about family health history, which was usually scattered throughout the chart. Information on the health of the patient's parents was collected more often than information on the health of other relatives. Key information that was often not collected included age of disease onset, affected side of the family, and second-degree relatives affected. Less than 4% of patient charts included family health histories that were informative enough to accurately assess risk for common complex diseases. Limitations of this study include the small number of charts reviewed per provider, the fact that the sample consisted of primary care providers in a single geographic location, and the inability to assess ethnicity, consanguinity, and other indicators of the informativeness of family health history. The family health histories collected in primary care are usually not complete enough to assess the patient's risk for common complex diseases. This situation could be improved with use of tools that analyze the family health history information collected and provide risk-stratified decision support recommendations for primary care.
Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise
To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.
Maha Mohamed Ghobashi; Hanan Abdel Ghani El-ragehy; Hanan Mosleh Ibrahim; Fatma Abdullah Al-Doseri
Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of resp...
Cawley MJ; Pacitti R; Warning W
Objective: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians officeMethods: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceu...
Saust, Laura Trolle; Monrad, Rikke Nygaard; Hansen, Malene Plejdrup;
for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs......OBJECTIVE: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. DESIGN: A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs...
Full Text Available Objective: to translate and adapt the PCATool version for adult users to the Brazilian context and assess its validity and reliability. Methods: We conducted a cross-sectional study of 2404 adult users living in areas covered from public services Primary Care in Porto Alegre, and users of a self- management plan. We performed translation, reverse translation and adaptation of the instrument as well as its assessment in respect of content validity, factorial validity and reliability. Results: In the factor analysis were considered 12 factors that explained 50.83% of the total variation. In this way were recognized the attributes of Primary Care: access - accessibility and utilization; longitudinality; coordination - coordination of care and systems of information; comprehensiveness - services available and services provided; family orientation; and community orientation. In terms of internal consistency the values of Cronbach’s alpha ranged from 0.15 to 0.90. The stability over time was not observed for coordination of care (p<0.05, coordination information of system (p<0.05 and comprehensiveness of services provided (p<0.05. The scaling success rate was close to 100% for all attributes, except to coordination of information system. Conclusions: the results indicated that the PCATool-Brazil has adequate validity and reliability, and it can act as a national instrument for the assessment of Primary Care from the perspective of adult users.
Overbury, Rebecca; Murtaugh, Maureen A; Fischer, Aryeh; Frech, Tracy M
Raynaud's phenomenon is a clinical symptom that can commonly present to a primary care provider or generalist. Proper identification of an underlying connective tissue disease in a patient with Raynaud's could allow for the prevention of possible critical digital ischemia. Capillaroscopy is a tool which can identify abnormalities associated with connective tissue disease. Patients presenting with a complaint of Raynaud's phenomenon were assessed with capillaroscopy. In twenty consecutive Raynaud patients, 8 digits were assessed by a ×200 magnification dermatoscope and an image was obtained. Each image was assessed for the following abnormalities: drop-out (Raynaud's disease. However, formal training is needed to ensure accuracy and reproducibility. Furthermore, training and scoring systems should address time constraints of busy primary care practitioners.
Full Text Available Abstract Background The primary objectives of this study were to assess Wisconsin's primary care residents' attitudes toward international health training, the interest among faculty to provide IH training, and the preferred modality of IH training. Methods Surveys were administered using 505 residents and 413 medical faculty in primary care residencies in Wisconsin. Results from 128 residents and 118 medical school faculty members were collected during the spring of 2007 and analyzed. Results In total, 25% of residents (128/505 and 28% of faculty (118/413 responded to the survey. A majority of residents (58% and faculty (63% were interested in global health issues. Among residents, 63% planned on spending professional time working abroad. Few residents (9% and faculty (11% assess their residencies as preparing residents well to address topics relating to international health. The survey indicates that adequate faculty in Wisconsin could provide mentorship in international health as 47% (55 of faculty had experience working as a physician internationally, 49% (58 of faculty spend more than 25% clinical time caring for patient from underserved communities and 39% (46 would be willing to be involved with developing curriculum, lecturing and/or mentoring residents in international health. Conclusion Overall, the majority of the respondents expressed high interest in IH and few felt prepared to address IH issues indicating a need for increased training in this area. The findings of this survey are likely relevant as a prototype for other primary care residencies.
Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen
Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.
Woo, Jean; Mak, Benise; Yeung, Fannie
There has been no study evaluating whether primary care services are sufficiently oriented towards the older population in Hong Kong, particularly those with increasing frailty. Since primary care is a key first interface in promotion and maintenance of health in older people, an assessment of the age-friendliness of service provisions is of critical importance in optimizing the health of aging populations. The age-friendliness of primary care services for older people was assessed using focus groups of elderly people and also of service providers who care for them. Discussion content was based on the WHO guidelines for age-friendly primary care in the following areas: Information, education and training, community-based health care management systems, and the physical environment. Desirable improvements were identified in all domains. The findings underscore the need for wider dissemination of health care needs of older people in the primary care setting.
Krist, Alex H; Glasgow, Russell E; Heurtin-Roberts, Suzanne; Sabo, Roy T; Roby, Dylan H; Gorin, Sherri N Sheinfeld; Balasubramanian, Bijal A; Estabrooks, Paul A; Ory, Marcia G; Glenn, Beth A; Phillips, Siobhan M; Kessler, Rodger; Johnson, Sallie Beth; Rohweder, Catherine L; Fernandez, Maria E
Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p set goals for six risks (range of differences 3.8-16.6 %, p controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746.
François, P; Cardaci, C; Lopez-Ruiz, C; Boussat, B; Marchand, O
Multiprofessionnal teams in primary care are developing in many countries including France. These groups appear very heterogeneous regarding the level of integration and interprofessional cooperation. A systematic review of the literature was performed to screen the instruments which assess the organizational development of primary care groups. Scientific literature was searched in the Pubmed database, gray literature was searched for on the Internet. The documents were selected by two independent investigators. The collected data included information on assessment instruments: origin, content, method of use, and validation process. Sixty-five documents involving 16 assessment instruments were selected for the study. Twelve instruments have been developed in North America and 4 in Europe. Four instruments were evaluation questionnaires, 4 accreditation tools and 8 were maturity matrices. The maturity matrices were structured by levels of organizational development. Their use were effected by an individual self-assessment of each professional and then by consensus of the group in the presence of an external facilitator. The questionnaire and accreditation tools have organizations and use patterns variable. The number of questions ranged from 25 to 200 with a median of 80. The instruments were organized into 4 to 16 dimensions with a median of 7. Six common themes were identified: practice and staff management, quality development, data patient management, interprofessional cooperation, accessibility and continuity of care, and formation. The validation process of tools were variable and often incomplete. The set of assessment tools for primary care group is heterogeneous in purpose, content and mode of use. However, common themes were found for all tools. An evaluation questionnaire, in French, would be useful to monitor over time and evaluate the organizational development of centers and health houses in France. Copyright © 2016 Elsevier Masson SAS. All rights
Ana Paula Scoleze Ferrer
Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.
Geller, Alan C; Lash, Timothy L; Siegel, Benjamin; Annas, George David; Prout, Marianne N
American medical schools lack significant educational programs for teaching medical students about counseling parents and children on smoking prevention and cessation. Thus, the objectives of this study were to describe medical student's self-reported behaviors in the assessment of parents and children's use of tobacco and to compare these practices with well-accepted pediatric activities: injury prevention and developmental assessment. Third year medical students in a pediatric clerkship at Boston University, all of whom spend part of their clerkship with pediatricians in their offices, completed six weekly surveys (2001-2002) recording their clinical activities in counseling parents and children about smoking, injury prevention, and performing developmental assessments. Of the 150 third year students completing the pediatric orientation, 108 (72%) completed all six feedback surveys and the general cancer prevention survey. Of the 108 students, 77% completed smoking assessments with at least one family per week during their 6-week clerkship compared with performance of injury prevention (85%, P = 0.09) and developmental assessment (91%, P = 0.006). Among all smoking cessation and prevention recommendations, students were most likely to discourage parents from smoking in the house and least likely to offer tips for parents to counsel their children about smoking. All variables related to primary care pediatricians' role modeling and feedback for optimal tobacco counseling practices were significantly associated with student counseling practice. Third year medical students were less likely to complete smoking assessments than those for developmental assessment and injury prevention counseling. However, primary care pediatricians' strong expectations and modeling of smoking counseling were uniformly associated with improved self-perceived student performance. Future educational activities should engage the primary care pediatrician preceptors of students completing
Full Text Available Abstract Background The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1 improvement in the rational utilization of health-care services and 2 benefits reflected in improved health status and quality of life for patients. Methods/Design A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients and the other the control group (n = 32,114 patients. The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. Discussion The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of
Christianson, Carol A; Powell, Karen Potter; Hahn, Susan Estabrooks; Blanton, Susan H; Bogacik, Jessica; Henrich, Vincent C
Primary care providers (PCPs) offered input regarding the incorporation of a family health history (FHH) risk assessment tool into a community health care system (CHCS). Sixteen PCPs participated in one of three focus groups. Perceived impediments included the lack of standard screening guidelines, effective screening tests, genetic counseling resources, and services for high-risk patients. The PCPs were concerned about their level of expertise, the cost of preventive health care, and genetic discrimination. They also were concerned about the use of a FHH tool by oncologists within the CHCS because of communication gaps between oncologists and PCPs, lack of clarity regarding follow-up and legal liability, and reimbursement issues. To integrate a FHH tool into a CHCS, PCPs will need consultation and referral services, evidence-based recommendations, and "just-in-time" educational resources. Oncologists who use the tool will need to develop a streamlined communication system with PCPs, establish clearly defined roles, and ensure patient follow-up.
Chen, Alissa; Revere, Lee; Ramphul, Ryan
This article evaluates the spatial relationship between primary care provider clinics and walk-in clinics. Using ZIP code level data from Harris County, Texas, the results suggest that primary care physicians and walk-in clinics are similarly located at lower rates in geographic areas with populations of lower socioeconomic status. Although current clinic location choices effectively broaden the gap in primary care access for the lower income population, the growing number of newly insured individuals may make it increasingly attractive for walk-in clinics to locate in geographic areas with populations of lower socioeconomic status and less competition from primary care physicians.
Monteiro Grendene, Gabriela; Szczecinski Rodrigues, Átila; Katz, Natan; Harzheim, Erno
This paper presents results of an assessment of the quality research of endocrinology referrals in the public health system in the state of Rio Grande do Sul. From the analysis of 4,458 requests for endocrinology referrals, it was found that 15% of referrals had insufficient information for evaluation and 71% showed no clinical justification for authorization of referencing. The partial results of the study indicated that the lack of information makes it impossible to clinically regulate these requests. The use of referencing protocols associated with telemedicine tools can assist doctors in primary health care in the clinical management and make access to specialized services more equitable and timely.
Kavukcu, Ethem; Akdeniz, Melahat; Avci, Hasan Huseyin; Altuğ, Mehmet; Öner, Mehmet
The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Knowledge and competency of the family physicians in managing CNCP were improved as was
Pracilio, Valerie P; Keith, Scott W; McAna, John; Rossi, Giuseppina; Brianti, Ettore; Fabi, Massimo; Maio, Vittorio
This study investigates the organizational culture and associated characteristics of the newly established primary care units (PCUs)-collaborative teams of general practitioners (GPs) who provide patients with integrated health care services-in the Emilia-Romagna Region (RER), Italy. A survey instrument covering 6 cultural dimensions was administered to all 301 GPs in 21 PCUs in the Local Health Authority (LHA) of Parma, RER; the response rate was 79.1%. Management style, organizational trust, and collegiality proved to be more important aspects of PCU organizational culture than information sharing, quality, and cohesiveness. Cultural dimension scores were positively associated with certain characteristics of the PCUs including larger PCU size and greater proportion of older GPs. The presence of female GPs in the PCUs had a negative impact on collegiality, organizational trust, and quality. Feedback collected through this assessment will be useful to the RER and LHAs for evaluating and guiding improvements in the PCUs.
Junod Perron, Noelle; Cerutti, Bernard; Picchiottino, Patricia; Empeyta, Sebastien; Cinter, Francoise; van Gessel, Elisabeth
Despite the importance of appropriate interprofessional collaboration in health care, it is still insufficiently taught in health professions education. The aim of the study was to conduct a needs assessment among health professionals on the themes and skills to be taught during interprofessional education programs in the context of Swiss primary care. A three round Delphi electronic survey was carried out in order to identify priority themes and skills to be included in such a program. Participants comprised 12 categories of health professionals. Seventy-two participated in the first, 41 in the second and 43 in the third round. Patient communication, case management of chronic conditions, therapeutic patient education, health promotion and prevention, ethics and medication were the most important themes identified. The most important skill was regarded as "to define and then share tasks and responsibilities between professionals". Sub-analysis revealed that both priority themes and skills chosen differed between health professional categories.
Alper, Philip R.
Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, its…
Maha Mohamed Ghobashi
Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.
Full Text Available Background: Social dimensions of health are known to contribute to what is often termed “patient complexity”, which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs. Objectives: To examine: (i the Patient Centered Assessment Method (PCAM, a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii the impact of the PCAM on referral patterns and its perceived value; and (iii the PCAM’s perceived applicability for use in a complex patient population. Design: Two studies are described: (i a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population. Results: Use of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12% and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity. Conclusions: The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.
Development of primary care in Japan in still relatively unorganized and unstructured. As mentioned above, the author describes some strengths and weaknesses of the Japanese primary care system. In addressing the weaknesses the following suggestions are offered for the Japanese primary care delivery system: Increase the number of emergency rooms for all day, especially on holidays and at night. Introduce an appointment system. Introduce an open system of hospitals. Coordinate with public hospitals and primary care clinics. Organize the referral system between private practitioners and community hospitals. Increase the number of paramedical staff. Strengthen group practice among primary care physicians. Increase the establishment of departments of primary care practice with government financial incentives to medical schools and teaching hospitals. Develop a more active and direct teaching role for primary care practice or family practice at undergraduate, graduate, and postgraduate levels. Improve and maintain present health insurance payment method, shifting from quantity of care to quality and continuity of care. Introduce formal continuing education. Introduce formal training programs of primary care and strengthen ambulatory care teaching programs.
Elise Botteselle de Oliveira
Full Text Available Introduction: The aging population creates a greater demand creates a greater demand for health services and becomes a challenge for the health care system. Primary Health Care (PHC plays a fundamental role in promoting healthy aging and controlling multi-morbidity. Objective: To assess the quality of care provided to elderly patients in public PHC in Porto Alegre, Rio Grande do Sul state, Brazil. Methods: A cross-sectional population-based study carried out in 2007, with interviews conducted with 212 elderly patients from four types of municipal public services: Primary Health Centers, Family Health Strategy teams, the “Conceição” Hospital Community Health Service (CH/CHS, and the “Murialdo” School Health Center. Results: There were significant differences between the centers investigated regarding the following attributes: Access-utilization, Longitudinality, Care coordination and information systems, and Family and community orientation. The CH/CHS showed prevalence of 55.8% (p<0.001 for the overall PHC high score - higher figures in comparison with the other services. The overall score of preventive practices showed a significant association with the services to the overall PHC score, with an average of 3.9 (CI 95%=3.60-4.32 among the elderly who presented low scores and 5.9 (CI 95%=5.3-6.5 among those presenting high scores. Discussion: The results show low scores in all types of services. The services with a high overall PHC score present higher preventive practice prevalence. Conclusions: PHC-oriented services are more effective and offer greater quality of preventive care recommended for the elderly.
Birt, Linda; Emery, Jon D; Prevost, A Toby; Sutton, Stephen; Walter, Fiona M
Routine family history risk assessment for chronic diseases could enable primary care practitioners to efficiently identify at-risk patients and promote preventive management strategies. To investigate patients' understanding and responses to family history risk assessment in primary care. A mixed methods study set in 10 Eastern England general practices. Participants in a family history questionnaire validation study were triaged into population or increased risk for four chronic diseases (type 2 diabetes, cardiovascular disease, breast cancer, colorectal cancer). Questionnaires completed immediately prior to the family history consultation (baseline) and 4 weeks later (follow-up) assessed the psychological impact, including State-Trait Anxiety Inventory scores. Semi-structured interviews explored the meaning participants gave to their personal familial disease risk. Four hundred and fifty-three participants completed both baseline and follow-up questionnaires and 30 were interviewed. At follow-up, there was no increase in anxiety among either group, or differences between the groups [difference in mean change 0.02, 95% confidence interval -2.04, 2.08, P = 0.98]. There were no significant changes over time in self-rated health in either group. At follow-up, participants at increased risk (n = 153) were more likely to have recent changes to behaviour and they had stronger intentions to make changes to diet (P = 0.001), physical activity (P = 0.006) and to seek further information in the future than those at population risk (n = 300; P familial disease risk ('Being reassured', 'Controlling risk', 'Dealing with it later', 'Beyond my control', 'Disbelieving the risk'). The meanings they attributed to increased risk appeared to shape their intention to undertake behaviour change. Routine assessment for familial risk of chronic diseases may be undertaken in primary care without causing anxiety or reducing self-rated health. Patient responses to family history risk
Saust, Laura Trolle; Monrad, Rikke Nygaard; Hansen, Malene Plejdrup; Arpi, Magnus; Bjerrum, Lars
Objective To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. Design A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developi...
Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.
Loh, A.; Simon, D.; Hennig, K.; Hennig, B.; Harter, M.; Elwyn, G.
OBJECTIVE: In primary care of depression treatment options such as antidepressants, counseling and psychotherapy are reasonable. Patient involvement could foster adherence and clinical outcome. However, there is a lack of empirical information about the extent to which general practitioners involve
D.A.W.M. van der Windt (Daniëlle); B.W. Koes (Bart); M. van Aarst; M.A. Heemskerk; L.M. Bouter (Lex)
textabstractBACKGROUND: Conducting a pragmatic randomised trial in primary care is often accompanied by practical problems. Such problems are seldom reported and may constitute useful lessons for researchers planning future trials. AIM: To address the difficulties invol
Zenia Tamara Sánchez García
Full Text Available Primary Health Care is the strategy to organize the management of health system that ensures universal access to minimum health services through equitable distribution of resources, community participation and implication of policies from other sectors. Therefore, the development of assessment in Science and Technology System at this level becomes of vital importance. The policy and management of science and technology are crucial in the strategic development of each country. In this sense, considering the convergence of the activity of science and technology with social development becomes a necessity particularly important for developing countries. The purpose of this literature review is to summarize the development of this modality in Cuba and the world, in such a way that it will serve to help people who need information on the subject.
Full Text Available Abstract Background In Switzerland the extent to which patients with chronic illnesses receive care congruent with the Chronic Care Model (CCM is unknown. Methods According to guidelines we translated the Assessment of Chronic Illness Care (ACIC into German (G-ACIC. We tested the instrument in different primary care settings and compared subscales with the original testing. Results Difficulties encountered during the translation process consisted in the difference of health care settings in Switzerland and USA. However initial testing showed the G-ACIC to be a suitable instrument. The average ACIC subscale scores in Swiss managed care (MC-, group (GP- and single handed practices (SP were higher for MC practices than for group- and single handed practices: Organization of the healthcare delivery system: MC mean (m = 6.80 (SD 1.55, GP m = 5.42 (SD 0.99, SP m = 4.60 (SD 2.07; community linkages: MC m = 4.19 (SD 1.47, GP m = 4.83 (SD 1.81, SP m = 3.10 (SD 2.12; self-management support: MC m = 4.96 (SD 1.13, GP m = 4.73 (SD 1.40, SP m = 4.43 (SD 1.34; decision support: MC m = 4.75 (SD 1.06; GP m = 4.20 (SD 0.87, SP m = 3.25 (SD 1.59; delivery system design: MC m = 5.98 (SD 1.61, GP m = 5.05 (SD 2.05, SP m = 3.86 (SD 1.51 and clinical information systems: MC m = 4.34 (SD = 2.49, GP m = 2.06 (SD 1.35, SP m = 3.20 (SD 1.57. Conclusions The G-ACIC is applicable and useful for comparing different health care settings in German speaking countries. Managed care organizations seem to implement the different components of the CCM in a greater extend than group and single handed practices. However, much room exists for further improvement.
Souwer, I.H.; Bor, J.H.J.; Smits, P.; Lagro-Janssen, A.L.M.
BACKGROUND: GPs prescribe topical corticosteroids to patients with chronic chilblains despite poor evidence for their effectiveness. The authors of the current study therefore decided to assess the effectiveness of topical steroids in a primary care setting. AIM: To assess the effectiveness of
Qureshi, Nadeem; Armstrong, Sarah; Saukko, Paula; Sach, Tracey; Middlemass, Jo; Evans, Phil H; Kai, Joe; Farrimond, Hannah; Humphries, Steve E
Coronary heart disease (CHD) is the leading cause of death in the developed world, and its prevention a core activity in current UK general practice. Currently, family history is not systematically integrated into cardiovascular risk assessment in the UK, Europe or the US. Further, primary health care professionals' lack the confidence to interpret family history information and there is a low level of recording of family history information in General Practice (GP) records. Primary prevention of CHD through lifestyle advice has sometimes yielded modest results although, for example, behavioural interventions targeted at "at risk" patients have produced encouraging findings. A family history approach, targeted at those requesting CHD assessment, could motivate lifestyle change. The project will assess the clinical value of incorporating systematic family history information into CHD risk assessment in primary care, from the perspective of the users of this service, the health care practitioners providing this service, and the National Health Service. The study will include three distinct phases: (1) cross-sectional survey to ascertain baseline information on current recording of family information; (2) through an exploratory matched-pair cluster randomised study, with nested qualitative semi-structured interview and focus group study, to assess the impact of systematic family history recording on participants' and primary care professionals' experience; (3) develop an economic model of the costs and benefits of incorporating family history into CHD risk assessment. On completion of the project, users and primary care practitioners will be more informed of the value and utility of including family history in CHD risk assessment. Further, this approach will also act as a model of how familial risk information can be integrated within mainstream primary care preventive services for common chronic diseases. Current Controlled Trials ISRCTN17943542.
Marcus, Tessa; Memon, Shehla; Bam, Nomonde; Hugo, Jannie
Abstract Background Re-engineering primary health care is a cornerstone of the health sector reform initiated nationally in South Africa in 2009. Using the concept of ward based NGO-run health posts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011. Objectives This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district. Method Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health care providers’ understanding, perception and experience of COPC. Results Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities. Conclusion COPC touched a responsive nerve in the health care system, both nationally and locally. It was seen as an effective way to respond to South Africa's crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.
Green, James Ij
The Peer Assessment Rating (PAR) index is a valid and reliable measure of orthodontic treatment outcome and is the most widely accepted such index. Assessing outcomes with the PAR index requires the examination of pre-treatment and post-treatment orthodontic study models. Beginning with the pre-treatment models, a score is given to each feature that deviates from an ideal occlusion (all anatomical contact points adjacent, good interdigitation between posterior teeth and non-excessive overjet/overbite), the scores are then added together to give a total that represents the severity of the malocclusion. The process is then repeated with the post-treatment models. The difference between the pre-treatment and the post-treatment scores reflects the improvement that has taken place during treatment. A score of zero represents an ideal occlusion and in general the higher the score, the more extensive the malocclusion. It is currently a condition of the NHS orthodontic contract for providers to monitor a proportion of their cases using the PAR index. This paper aims to provide primary dental care practitioners with an overview of the PAR index and should provide a useful guide for those wishing to seek calibration in the use of the index.
Koppula, Sudha; Brown, Judith B.; Jordan, John M.
Abstract Objective To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics. Design Qualitative study using in-depth interviews. Setting Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta. Participants Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton. Methods Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner. Main findings Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics. Conclusion Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics. PMID:24627402
The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available Karen Grimmer-Somers1, Saravana Kumar1, Nic Vipond2, Gillian Hall21Centre for Allied Health Evidence, University of South Australia, Australia; 2Accident Compensation Corporation, Wellington, New ZealandBackground: Early identification in primary care settings of individuals with, or at-risk of, developing persistent pain, is important to limit development of disability. There is little information to assist primary care providers to choose or deliver relevant, efficient, and soundly constructed assessment instruments for this purpose.Objective: We recently published the findings of a literature review, which produced a compendium of assessment instruments to identify adults with, or at-risk of developing, persistent pain of noncancer origin. This paper reports on instruments opportunistically identified during this review which may be appropriate to primary health care settings for early identification of such patients.Results: One hundred sixteen potentially useful instruments were initially identified in the review, measuring pain severity, psychological distress, functional capacity, quality of life or multidimensional constructs of persistent pain. Following a series of steps, 45 instruments were shortlisted, with sound clinical utility and strong psychometric properties. Of these, 16 instruments were appropriate to primary health care settings because of simple wording, brief items, short administration time, and ease of scoring.Conclusion: No one assessment instrument captured all constructs of persistent pain. The 16 instruments provide a broad choice for primary care clinicians to assist with early identification of adults at risk of, or with persistent pain.Keywords: adults with persistent pain, primary health care assessment, early identification
Smith, Philip H; Homish, Gregory G; Barrick, Christopher; Grier, Nancy L
This pilot study examined the use of a touch-screen tablet personal computer to assess smoking and alcohol use among low-income primary care patients (N = 100) and tested cross-method consistency with a paper assessment. Data were collected in 2009. A touch-screen survey assessed smoking, alcohol use, partner smoking, and acceptability. A separate paper survey assessed smoking, partner smoking, and acceptability. The touch-screen assessment was highly acceptable and reliable. Implications and limitations are noted. Future research should explore the use of touch-screen technology for clinical endeavors requiring a quick assessment of substance use. There was no outside funding for this study.
Wagemakers, H.P.; Luijsterburg, P.A.; Boks, S.S.; Heintjes, E.M.; Berger, M.Y.; Verhaar, J.A.; Koes, B.W.; Bierma-Zeinstra, S.M.
Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 2010;91:1452-9. Objective: To a
Paula, Weslla Karla Albuquerque Silva de; Samico, Isabella Chagas; Caminha, Maria de Fátima Costa; Filho, Malaquias Batista; Silva, Suzana Lins da
Analyze the evaluation of the attributes of primary care made by users of basic units of Brazilian health by using PCATool instrument adapted to Brazil. A systematic literature review conducted in the PubMed database, IBECS, LILACS, SciELO and BDTD. 4,405 documents were found, selected 23 full texts. After Full reading and application of eligibility criteria, 14 articles were evaluated. The studies showed that primary care performs well in longitudinality attributes, completeness and coordination and worse performance on attributes access first contact, family counseling and community orientation, even in the basic units with the Family Health. The users of basic health units assessed as unsatisfactory attributes considered essential for a health care more equitable and competing for user autonomy and social control. It is inferred that there are still obstacles hindering user access to basic health services and care actions are still being developed without favoring user participation and the community context in which they live. Analisar a avaliação dos atributos da Atenção Básica feita por usuários de unidades básicas de saúde brasileiras, mediante utilização de adaptações do instrumento PCATool para o Brasil. Revisão sistemática da literatura realizada nas bases de dados Medline/PubMed, LILACS, IBECS, SciELO e BDTD. Foram encontrados 4.405 documentos, sendo selecionados 23 textos completos. Após leitura integral e aplicação dos critérios de elegibilidade, 14 artigos foram avaliados. Os estudos apontaram que a Atenção Básica tem bom desempenho nos atributos longitudinalidade, integralidade e coordenação e pior desempenho nos atributos acesso de primeiro contato, orientação familiar e a orientação comunitária, mesmo nas unidades básicas com Saúde da Família. Os usuários das unidades básicas de saúde avaliaram como insatisfatórios atributos considerados fundamentais para uma atenção à saúde mais equânime e concorrente para
Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.
Numans Mattijs E
Full Text Available Abstract Background Pre-eclampsia is associated with an increased risk of development of cardiovascular disease later in life. It is not known how general practitioners in the Netherlands care for these women after delivery with respect to cardiovascular risk factor management. Methods Review of medical records of 1196 women in four primary health care centres, who were registered from January 2000 until July 2007 with an International Classification of Primary Care (ICPC code indicating pregnancy. Records were searched for indicators of pre-eclampsia. Of those who experienced pre-eclampsia and of a random sample of 150 women who did not, the following information on cardiovascular risk factor management after pregnancy was extracted from the records: frequency and timing of blood pressure, cholesterol and glucose measurements - and vascular diagnoses. Additionally the sensitivity and specificity of ICPC coding for pre-eclampsia were determined. Results 35 women experienced pre-eclampsia. Blood pressure was more often checked after pregnancy in these women than in controls (57.1% vs. 12.0%, p Conclusion Despite the evidence of increased risk of future cardiovascular disease in women with a history of pre-eclampsia, follow-up of these women is insufficient and undeveloped in primary care in the Netherlands.
Robert C. Abrams
Full Text Available Introduction. We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. Methods and Materials. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner, and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. Results. Subjects (N=1505 comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% (N=555 screened positive for depression, 26.9% (N=405 for anxiety, and 322 (21.4% screened positive for both. Any positive score was associated with age (P<0.033, female gender (P<0.006, and a nonsignificant trend toward living alone (P<0.095. 8.87% had suicidal thoughts. Conclusions. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.
Full Text Available Background: Re-engineering primary health care is a cornerstone of the health sector reforminitiated nationally in South Africa in 2009. Using the concept of ward based NGO-run healthposts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC through ward based outreach teams (WBOT in seven wards during 2011.Objectives: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district.Method: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health careproviders’ understanding, perception and experience of COPC.Results: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities.Conclusion: COPC touched a responsive nerve in the health care system, both nationallyand locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.
Background Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health informatio...
Brandão, Maria Piedade; Martins, Laura; Philp, Ian; Cardoso, Margarida Fonseca
The EASYCare is a multidimensional assessment tool for older people, which corresponds to the concerns and priorities of older people in relation to their needs, health, and quality of life. The EASYCare instrument has been used in many countries worldwide. Lack of reliability evidence has recently been raised by researchers. This study aimed to test the validity and reliability of the EASYCare-2010 instrument in community-dwelling Portuguese older people attended in Primary Health Care centres. The sample for this transversal study (N=244) was collected from Portuguese Primary Health Care Centers. Categorical Principal Component Analysis was used to assess the underlying dimensions of EASYCare-2010. Construct validity was evaluated through correlation with the World Health Organization Quality of Life Assessment Instrument-Short Form. A two-factor model (labelled "mobility and activities of daily life", and "general well-being and safety") was found. The EASYCare-2010 instrument showed acceptable levels for internal consistency (≥0.70). The EASYCare-2010 factors were correlated with measures of quality of life. Results showed that in most polytomous items, some of the more extreme categories were not considered at all or only by a residual number of participants. EASY Care -2010 version is a valid and reliable instrument for holistic assessment of the older people attended in Primary Health Care centres in Portugal. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de
BACKGROUND: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with t
Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de
Background: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with t
OBJECTIVE: to assess the actual workload of primary-care midwives in the Netherlands. BACKGROUND: In 2000, a strike and large demonstration before parliament convinced everyone of the shortage of midwives and their excessive workload. The government reacted by increasing the capacity of the midwifer
Poote, Aimee E; French, David P; Dale, Jeremy; Powell, John
We evaluated the advice given by a prototype self-assessment triage system in a university student health centre. Students attending the health centre with a new problem used the automated self-assessment system prior to a face-to-face consultation with the general practitioner (GP). The system's rating of urgency was available to the GP, and following the consultation, the GP recorded their own rating of the urgency of the patient's presentation. Full data were available for 154 of the 207 consultations. Perfect agreement, where both the GP and the self-assessment system selected the same category of advice, occurred in 39% of consultations. The association between the GP assessment and the self-assessment rankings of urgency was low but significant (rho = 0.19, P = 0.016). The self-assessment system tended to be risk averse compared to the GP assessments, with advice for more urgent level of care seeking being recommended in 86 consultations (56%) and less urgent advice in only 8 (5%). This difference in assessment of urgency was significant (P self-assessed and GP-assessed urgency was not associated with symptom site or socio-demographic characteristics of the user. Although the self-assessment system was more risk averse than the GPs, which resulted in a high proportion of patients being triaged as needing emergency or immediate care, the self-assessment system successfully identified a proportion of patients who were felt by the GP to have a self-limiting condition that did not need a consultation. In its prototype form, the self-assessment system was not a replacement for clinician assessment and further refinement is necessary.
Mao, Jun J; Kapur, Rahul
Acupuncture, an ancient traditional Chinese medical therapy, is used widely around the world. When practiced by a certified provider, it is safe and patients often find it calming and relaxing. Animal and human studies have found a physiologic basis for acupuncture needling in that it affects the complex central and peripheral neurohormonal network. Although it is unclear whether acupuncture is beneficial over sham/placebo acupuncture, acupuncture care yields clinically relevant short- and long-term benefits for low back pain, knee osteoarthritis, chronic neck pain, and headache. The integration of acupuncture into a primary care setting also appears to be cost-effective. The practice of acupuncture in primary care requires rigorous training, financial discipline, and good communication skills. When done correctly, acupuncture is beneficial for both patients and providers.
Arndt, Brian; Tuan, Wen-Jan; White, Jennifer; Schumacher, Jessica
An understanding of primary care provider (PCP) workload is an important consideration in establishing optimal PCP panel size. However, no widely acceptable measure of PCP workload exists that incorporates the effort involved with both non-face-to-face patient care activities and face-to-face encounters. Accounting for this gap is critical given the increase in non-face-to-face PCP activities that has accompanied electronic health records (EHRs) (eg, electronic messaging). Our goal was to provide a comprehensive assessment of perceived PCP workload, accounting for aspects of both face-to-face and non-face-to-face encounters. Internal medicine, family medicine, and pediatric PCPs completed a self-administered survey about the perceived workload involved with face-to-face and non-face-to-face panel management activities as well as the perceived challenge associated with caring for patients with particular biomedical, demographic, and psychosocial characteristics (n = 185). Survey results were combined with EHR data at the individual patient and PCP service levels to assess PCP panel workload, accounting for face-to-face and non-face-to-face utilization. Of the multiple face-to-face and non-face-to-face activities associated with routine primary care, PCPs considered hospital admissions, obstetric care, hospital discharges, and new patient preventive health visits to be greater workload than non-face-to-face activities such as telephone calls, electronic communication, generating letters, and medication refills. Total workload within PCP panels at the individual patient level varied by overall health status, and the total workload of non-face-to-face panel management activities associated with routine primary care was greater than the total workload associated with face-to-face encounters regardless of health status. We used PCP survey results coupled with EHR data to assess PCP workload associated with both face-to-face as well as non-face-to-face panel management
Full Text Available Abstract Objective To assess the gender related impact of osteoarthritis (OA on quality of life (QoL and health service utilization (HSU of primary care patients in Germany. Methods Cross sectional study with 1250 OA patients attending 75 primary care practices from March to May 2005. QoL was assessed using the GERMAN-AIMS2-SF. Data about comorbidities, prescriptions, health service utilization, and physical activity were obtained by questioning patients or from the patients' medical files. Depression was assessed by means of the Patient Health Questionnaire (PHQ-9. Results 1021 (81.7% questionnaires were returned. 347 (34% patients were male. Impact of OA on QoL was different between gender: women achieved significantly higher scores in the AIMS 2-SF dimensions lower body (p Conclusion The extent to which OA impacts men and women differs in primary care patients. This might have resulted in the revealed differences in the pharmacological treatment and the HSU. Further research is needed to confirm our findings and to assess causality.
Rollow, William; Cucchiara, Peter
The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation.
Kai Joe; Evans Phil H; Middlemass Jo; Sach Tracey; Saukko Paula; Armstrong Sarah; Qureshi Nadeem; Farrimond Hannah; Humphries Steve E
Abstract Background Coronary heart disease (CHD) is the leading cause of death in the developed world, and its prevention a core activity in current UK general practice. Currently, family history is not systematically integrated into cardiovascular risk assessment in the UK, Europe or the US. Further, primary health care professionals' lack the confidence to interpret family history information and there is a low level of recording of family history information in General Practice (GP) record...
Laura Figueroa-Martín; Gonzalo Duarte-Clíments; María Begoña Sánchez-Gómez; Pedro Ruyman Brito-Brito
This study analyzes the content validity and criterion of different parts of the interview relationed with the sexuality pattern and studies the clinimetric and psychometric characteristics of the selected instruments in the review of literature -scoping review-.. By the inclusions criteria, 28 items have been selected; of which seven questionnaires assess sexuality in women and men. The contribution of this study to nursing care is to provide suitable tools for valuation of sexuality, raisin...
Full Text Available This study analyzes the content validity and criterion of different parts of the interview relationed with the sexuality pattern and studies the clinimetric and psychometric characteristics of the selected instruments in the review of literature -scoping review-.. By the inclusions criteria, 28 items have been selected; of which seven questionnaires assess sexuality in women and men. The contribution of this study to nursing care is to provide suitable tools for valuation of sexuality, raising awareness on the need to conclude in important areas of exploration and develop effective tools for the assessment of this pattern in children, adolescents and elderly.
Todd M. Maja; Susanna C.D. Wright; Zelda Wasserman
Low literacy can be described as the inability to read, write or use numbers effectively. The limited ability to read and understand health care instructions directly translates into poor health outcomes.The aim of this study was to assess the English literacy levels of primary health care patients using the Learning Ability Battery (LAB) and the adapted Rapid Estimate of Adult Literacy, Revised(REALM-R) and to determine how the results of the adapted REALM-R correlate with those of the LAB. ...
Christine E. Gould, PhD
Full Text Available Anxiety disorders are common and debilitating in older individuals, yet anxiety is often not formally assessed in primary care. We conducted a quality improvement project to examine the feasibility of implementing a brief anxiety assessment, the Geriatric Anxiety Inventory (GAI, in a Department of Veterans Affairs geriatric primary care clinic. We compared the GAI with a depression assessment, the 15-item Geriatric Depression Scale (GDS-15. Fifty older Veterans (mean age = 78.5 +/– 7.4 yr completed the GAI and GDS-15. Mean completion time and feedback to patients was brief (6.20 min; n = 10. Good internal consistency (alpha = 0.82 was found for GAI scores. Patients with psychiatric diagnoses obtained significantly higher GAI scores (mean = 4.73 +/– 1.15 compared with patients without psychiatric diagnoses (mean = 1.15 +/– 1.86, t(11.46 = –3.10, p = 0.01. Findings suggest that the GAI is acceptable to patients but may not be suitable for differentiating anxiety symptoms or disorders from depression. Interdisciplinary team members continued to implement the GAI after project completion to screen for and track anxiety symptoms in our geriatric primary care patients. Detecting anxiety with the GAI had the benefit of allowing providers to initiate conversations about available treatments and track symptoms as part of noting treatment progress.
Full Text Available BACKGROUND: The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD. However the quality of family health information in primary care records is unclear. AIM: To assess the availability and quality of family history of CHD documented in electronic primary care records. DESIGN: Cross-sectional study. SETTING: 537 UK family practices contributing to The Health Improvement Network database. METHOD: Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st January 1998 and 31(st December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively. RESULTS: In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25, however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88. Of the 140,058 patients with a positive family history recorded (9% of total cohort, age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration. CONCLUSION: Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from
Dhiman, Paula; Kai, Joe; Horsfall, Laura; Walters, Kate; Qureshi, Nadeem
The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD). However the quality of family health information in primary care records is unclear. To assess the availability and quality of family history of CHD documented in electronic primary care records. Cross-sectional study. 537 UK family practices contributing to The Health Improvement Network database. Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st) January 1998 and 31(st) December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively. In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25)), however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88)). Of the 140,058 patients with a positive family history recorded (9% of total cohort), age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration. Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.
Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient's home. The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions. Methods/design A primary care-based randomised controlled trial will be carried out to assess the impact of a telemonitoring intervention aimed at home care patients with heart failure (HF) and/or chronic lung disease (CLD). The results will be compared with those obtained with standard health care practice. The duration of the study will be of one year. Sixty patients will be recruited for the study. In-home patients, diagnosed with HF and/or CLD, aged 14 or above and with two or more hospital admissions in the previous year will be eligible. For the intervention group, telemonitoring will consist of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight and body temperature. Additionally, the patients will complete a qualitative symptom questionnaire daily using the telemonitoring system. Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits. The control group will receive usual care. The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-randomisation. The secondary outcome measures are: duration of hospital stay, hospital admissions due to HF or CLD, mortality rate, use of health care resources, quality of life, cost-effectiveness, compliance and patient and health care professional satisfaction with the new technology. Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting. The study may
Full Text Available Abstract Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient's home. The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions. Methods/design A primary care-based randomised controlled trial will be carried out to assess the impact of a telemonitoring intervention aimed at home care patients with heart failure (HF and/or chronic lung disease (CLD. The results will be compared with those obtained with standard health care practice. The duration of the study will be of one year. Sixty patients will be recruited for the study. In-home patients, diagnosed with HF and/or CLD, aged 14 or above and with two or more hospital admissions in the previous year will be eligible. For the intervention group, telemonitoring will consist of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight and body temperature. Additionally, the patients will complete a qualitative symptom questionnaire daily using the telemonitoring system. Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits. The control group will receive usual care. The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-randomisation. The secondary outcome measures are: duration of hospital stay, hospital admissions due to HF or CLD, mortality rate, use of health care resources, quality of life, cost-effectiveness, compliance and patient and health care professional satisfaction with the new technology. Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care
Sebek, Kimberly; Jacobson, Laura; Wang, Jason; Newton-Dame, Remle; Singer, Jesse
Urban contexts introduce unique challenges that must be addressed to ensure that areas of high population density can function when disasters occur. The ability to generate useful data to guide decision-making is critical in this context. Widespread adoption of electronic health record (EHR) systems in recent years has created electronic data sources and networks that may play an important role in public health surveillance efforts, including in post-disaster situations. The Primary Care Information Project (PCIP) at the New York City Department of Health and Mental Hygiene has partnered with local clinicians to establish an electronic data system, and this network provides infrastructure to support primary care surveillance activities in New York City. After Hurricane Sandy, PCIP generated several sets of data to contribute to the city's efforts to assess the impact of the storm, including daily connectivity data to establish practice operations, data to examine patterns of primary care utilization in severely affected and less affected areas, and data on the frequency of respiratory infection diagnosis in the primary care setting. Daily patient visit data from three heavily affected neighborhoods showed the health department where primary care capacity was most affected in the weeks following Sandy. Overall transmission data showed that practices in less affected areas were quicker to return to normal reporting patterns, while those in more affected areas did not resume normal data transmissions for a few months. Rates of bronchitis increased after Sandy compared to the two prior years; while this was most likely attributable to a more severe flu season, it demonstrates the capacity of primary care networks to pick up on these types of post-emergency trends. Hurricane Sandy was the first disaster situation where PCIP was asked to assess public health impact, generating information that could contribute to aid and recovery efforts. This experience allowed us to
Gorman, Rosemary D
Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.
Aakre, K.M.; Thue, G.; Subramaniam-Haavik, S.;
BACKGROUND: Microalbuminuria (MA) is recognized as an important risk factor for cardiovascular and renal complications in diabetes. We sought to evaluate how screening for MA is conducted and how urine albumin (UA) results are interpreted in primary care internationally. METHODS: General...... changes in UA results were considered clinically important [critical difference (CD)]. Participants received national benchmarking feedback reports. RESULTS: We included 2078 GPs from 9 European countries. Spot urine samples were used most commonly for first time office-based testing, whereas timed...... MA are followed only partially, and should be made more practicable, addressing issues such as type of samples, measurement units, and repeat tests. (c) 2008 American Association for Clinical Chemistry Udgivelsesdato: 2008/10...
Yawn, Barbara P; Rank, Matthew A; Cabana, Michael D; Wollan, Peter C; Juhn, Young J
To assess primary care adherence to 2007 US asthma guidelines. Patients with persistent asthma aged 5 to 65 years from 22 primary care participating practices provided the data for this analysis of baseline information from the pragmatic randomized clinical trial the Asthma Tools Study. Using a combination of abstracted medical record data and patient-reported demographic information, we assessed the medical record documentation for elements of the 2007 US asthma guidelines. Elements assessed included documentation of (1) assessment of control, (2) factors that affect control (medication adherence evaluation, inhaler technique education, and evaluation for triggers), (3) self-management support (action plan), and (4) asthma medications prescribed (short-acting β-agonists and daily maintenance therapy). The baseline data was collected from March 16, 2009, to May 1, 2014. In 1176 patients (285 children, 211 tweens, and 680 adults) from 16 family medicine and 6 pediatric practices across the United States, documented guideline adherence was highest for prescription of medications (88.0% for short-acting β-agonists and 70.4% for maintenance medications) and lowest for an asthma action plan (3.1%). Documentation of control (15.0%) and factors that affect control (inhaler technique education, 7.6%; medication adherence assessment, 32.5%; and allergy evaluation, 32.5%) was not common and even less common for adults compared with children. A total of 22.2% of the enrolled patients had no asthma-related visit in the year before enrollment. Adherence to the nonmedication elements were higher in practices located in cities of more than 250,000 people and cities that used electronic medical records. Older patient age was negatively associated with guideline adherence. Adherence to asthma guidelines is poor in primary care practices, leaving many opportunities for improvement. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc
Muntingh, Anna D. T.; van der Feltz-Cornelis, Christina M.; van Marwijk, Harm W. J.; Spinhoven, Philip; Penninx, Brenda W. J. H.; van Balkom, Anton J. L. M.
Background: Appropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (so
Muntingh, Anna D. T.; van der Feltz-Cornelis, Christina M.; van Marwijk, Harm W. J.; Spinhoven, Philip; Penninx, Brenda W. J. H.; van Balkom, Anton J. L. M.
Background: Appropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (so
Wright, Robert; Saul, Robert A
Epigenetics, the study of functionally relevant chemical modifications to DNA that do not involve a change in the DNA nucleotide sequence, is at the interface between research and clinical medicine. Research on epigenetic marks, which regulate gene expression independently of the underlying genetic code, has dramatically changed our understanding of the interplay between genes and the environment. This interplay alters human biology and developmental trajectories, and can lead to programmed human disease years after the environmental exposure. In addition, epigenetic marks are potentially heritable. In this article, we discuss the underlying concepts of epigenetics and address its current and potential applicability for primary care providers.
Vedsted, Peter; Kallestrup, Per
International Perspectives on Primary Care Research examines how the evidence base from primary care research can strengthen health care services and delivery, tackle the growing burden of disease, improve quality and safety, and increase a person-centred focus to health care. Demonstrating the i...
Boerma, Wienke GW; Murante, Anna M; Sixma, Herman JM; Schellevis, François G; Groenewegen, Peter P
Abstract Objective To investigate patients’ perceptions of improvement potential in primary care in 34 countries. Methods We did a cross-sectional survey of 69 201 patients who had just visited general practitioners at primary-care facilities. Patients rated five features of person-focused primary care – accessibility/availability, continuity, comprehensiveness, patient involvement and doctor–patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. We calculated the potential for improvement by multiplying the proportion of negative patient experiences with the mean importance score in each country. Scores were divided into low, medium and high improvement potential. Pair-wise correlations were made between improvement scores and three dimensions of the structure of primary care – governance, economic conditions and workforce development. Findings In 26 countries, one or more features of primary care had medium or high improvement potentials. Comprehensiveness of care had medium to high improvement potential in 23 of 34 countries. In all countries, doctor–patient communication had low improvement potential. An overall stronger structure of primary care was correlated with a lower potential for improvement of continuity and comprehensiveness of care. In countries with stronger primary care governance patients perceived less potential to improve the continuity of care. Countries with better economic conditions for primary care had less potential for improvement of all features of person-focused care. Conclusion In countries with a stronger primary care structure, patients perceived that primary care had less potential for improvement. PMID:25883409
Wiborg, J.F.; Gieseler, D.; Lowe, B.
OBJECTIVE: To examine suicidal ideation in a sample of German primary care patients. METHODS: We conducted a cross-sectional study and included 1455 primary care patients who visited 1 of 41 general practitioners (GPs) working at 19 different sites. Suicidal ideation and psychopathology were assesse
Ijäs, Jarja; Alanen, Seija; Kaila, Minna
-sectional telephone survey. SETTING: All municipal health centres in Finland. SUBJECTS: Health centres where both the head physician and the senior nursing officer responded. MAIN OUTCOME MEASURES: Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension......OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p
Voros, Viktor; Osvath, Peter; Fekete, Sandor
Although suicide rates are decreasing in most countries, suicide is still a major health concern. Our aim was to introduce a complex, integrative, regional suicide prevention strategy. Based on reviewing the literature and on our previous studies we developed a suicide prevention model, which includes recognition, risk assessment and intervention. The main steps of the model are the recognition of warning signs (communicative or behavioural), exploration of crisis situation and/or psychopathologic symptoms, assessment of protective and risk factors, estimation of suicide risk and a plan for management of suicidal patients through different levels of interventions. In the management of suicidal behaviour, the complex stress-diathesis model has to be adjusted by considering biological markers and psycho-social factors. Only after the assessment of these factors can primary care professionals, as gatekeepers, manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic interventions in the recognition, treatment and prevention of suicidal behaviour.
Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini
There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately
Alameddine, Mohamad; Saleh, Shadi; Natafgi, Nabil
Successful endorsement of quality indicators hinges on the readiness and acceptability of care providers for those measures. This paper aims to assess the readiness of care providers in the primary health-care sector in Lebanon for the implementation of quality and patient safety indicators. A cross-sectional survey methodology was utilized to gather information from 943 clinical care providers working at 123 primary health-care centres in Lebanon. The questionnaire included two sections: the first assessed four readiness dimensions (appropriateness, management support, efficacy, and personal valence) of clinical providers to use quality and safety indicators using the Readiness for Organization Change (ROC) scale, and the second section assessed the safety attitude at the primary care centre utilizing the Agency of Health Research and Quality (AHRQ) Safety Attitude Questionnaire (SAQ)-Ambulatory version. Although two thirds (66%) of respondents indicated readiness for implementation of quality and patient safety indicators in their centres, there appear to be differences by professional group. Physicians displayed the lowest scores on all readiness dimensions except for personal valence which was the lowest among nurses (60%). In contrast, allied health professionals displayed the highest scores across all readiness dimensions. Generally, respondents reflected a positive safety attitude climate in the centres. Yet, there remain a few areas of concern related to punitive culture (only 12.8% agree that staff should not be punished for reported errors/incidents), continuity of care (41.1% believe in the negative consequences of lack in continuity of care process), and resources (48.1% believe that the medical equipment they have are adequate). Providers with the highest SAQ score had 2.7, 1.7, 7 and 2.4 times the odds to report a higher readiness on the appropriateness, efficacy, management and personal valence ROC subscales, respectively (P value quality and patient
Woods, Cindy; Carlisle, Karen; Larkins, Sarah; Thompson, Sandra Claire; Tsey, Komla; Matthews, Veronica; Bailie, Ross
Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns. Learning from the processes and strengths of high-improving services may be useful
Scarpaci, Joseph L.
Primary medical care in Chile: accessibility under military rule [Front Cover] [Front Matter] [Title Page] Contents Tables Figures Preface Chapter 1: Introduction Chapter 2: The Restructuring of Medical Care Financing in Chile Chapter 3: Inflation and Medical Care Accessibility Chapter 4: Help......-Seeking Behavior of the Urban Poor Chapter 5: Spatial Organization and Medical Care Accessibility Chapter 6: Conclusion...
Rosendal, Marianne; Olesen, Frede; Fink, Per
OBJECTIVE: Our aim was to evaluate the effect of an educational program designed to improve care for somatizing patients in primary care. METHOD: Evaluation was performed during routine clinical care in a cluster randomized controlled trial. Patients were included consecutively, and those...
Luize Barbosa Antunes
Full Text Available Objective: to investigate the evaluation of the user with respiratory symptoms of tuberculosis in Primary Health Care services according to the norms of the National Program for Tuberculosis Control. Methods: cross-sectional study with application of a form to 99 people with pulmonary tuberculosis. Results: a total of 87.9% participants reported cough as the symptom that motivated the search for Primary Care; from these, 27.3% sought Primary Care units, 96.3% received care in this service, of which 46.2% reported that sputum smear was requested by professionals in the units. Conclusion: more than half of participants sought secondary or tertiary services due to the symptoms of tuberculosis, and also less than half of patients assisted in Primary Care had diagnostic tests requested by professionals of that service.
Su, Meng; Zhang, Qiuli; Lu, Jiapeng; Li, Xi; Tian, Na; Wang, Yun; Yip, Winnie; Cheng, Kar Keung; Mensah, George A; Horwitz, Ralph I; Mossialos, Elias; Krumholz, Harlan M; Jiang, Lixin
China has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC. This paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers. The central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China. NCT02953926. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Sherif A. Essa
Conclusion: In Gharbia Governorate, PHC physicians lack proper knowledge about TB and their units lack proper equipments (Lab and CXR. The PHC system needs to be empowered by the health care authorities through training and equipments for better performance in NTP.
Sep 2, 2012 ... (13%) of the 8.8 million new TB cases globally were among people living with ... TB patients, activities included HIV counselling and testing. (HCT) ... progress has been made in implementation, targets of the ... diagnosis and treatment services, HCT, pre- ..... point-of-care – such as the Xpert MTB/RIF10 test ...
Seth, Puneet; Abu-Abed, Mohamed Ismail; Kapoor, Vikram; Nicholson, Kathryn; Agarwal, Gina
Email between patients and their health care providers can serve as a continuous and collaborative forum to improve access to care, enhance convenience of communication, reduce administrative costs and missed appointments, and improve satisfaction with the patient-provider relationship. The main objective of this study was to investigate the attitudes of patients aged 16 years and older toward receiving email communication for health-related purposes from an academic inner-city family health team in Southern Ontario. In addition to exploring the proportion of patients with a functioning email address and interest in email communication with their health care provider, we also examined patient-level predictors of interest in email communication. A cross-sectional study was conducted using a self-administered, 1-page survey of attitudes toward electronic communication for health purposes. Participants were recruited from attending patients at the McMaster Family Practice in Hamilton, Ontario, Canada. These patients were aged 16 years and older and were approached consecutively to complete the self-administered survey (N=624). Descriptive analyses were conducted using the Pearson chi-square test to examine correlations between variables. A logistic regression analysis was conducted to determine statistically significant predictors of interest in email communication (yes or no). The majority of respondents (73.2%, 457/624) reported that they would be willing to have their health care provider (from the McMaster Family Practice) contact them via email to communicate health-related information. Those respondents who checked their personal email more frequently were less likely to want to engage in this electronic communication. Among respondents who check their email less frequently (fewer than every 3 days), 46% (37/81) preferred to communicate with the McMaster Family Practice via email. Online applications, including email, are emerging as a viable avenue for patient
Gawaine Powell Davies
Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.
Scarpaci, Joseph L.
Primary medical care in Chile: accessibility under military rule [Front Cover] [Front Matter] [Title Page] Contents Tables Figures Preface Chapter 1: Introduction Chapter 2: The Restructuring of Medical Care Financing in Chile Chapter 3: Inflation and Medical Care Accessibility Chapter 4: Help...
Todd M. Maja
Full Text Available Low literacy can be described as the inability to read, write or use numbers effectively. The limited ability to read and understand health care instructions directly translates into poor health outcomes.The aim of this study was to assess the English literacy levels of primary health care patients using the Learning Ability Battery (LAB and the adapted Rapid Estimate of Adult Literacy, Revised(REALM-R and to determine how the results of the adapted REALM-R correlate with those of the LAB. Data were collected by means of a self-report whereby the participants had to answer the questions that were posed in the LAB and read the words out loud for the adapted REALM-R.The data analysis was performed by means of descriptive and inferential statistics, including the chi-square test and Spearman’s rho.The result of the study indicated that in South Africa, school grades achieved and the reading levels of primary health care patients differ with four grades.In terms of the correlation between the results of the adapted REALM-R and those of the LAB, a correlation of r = 0.43 (p < 0.001 could be established. Depending on the cut-off point used for the adapted REALM-R, 67% of the participants had low literacy levels. The study provides evidence of the importance of a validated, quick and easy-to-administer literacy screening tool. The effective assessment of patients’ literacy levels will assist registered professional nurses to provide health education on an appropriate level to improve patients’ health literacy.
Lae geletterdheidsvlakke kan beskryf word as ’n persoon se onvermoë om doeltreffend te lees, te skryf of syfers te gebruik. Die beperkte vermoë om te lees en gesondheidsorgvoorskrifte te verstaan,gee direk tot swak gesondheidsuitkomste aanleiding. Die doel van hierdie studie was om die Engelse geletterdheidsvlakke van primêregesondheidsorg-pasiënte deur middel van twee instrumente
Makaula, Peter; Bloch, Paul; Banda, Hastings T.;
Primary Health Care (PHC) is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions is...
Roberts, Kirsty; Macleod, John; Metcalfe, Chris; Simon, Joanne; Horwood, Jeremy; Hollingworth, William; Marlowe, Sharon; Gordon, Fiona H; Muir, Peter; Coleman, Barbara; Vickerman, Peter; Harrison, Graham I; Waldron, Cherry-Ann; Irving, William; Hickman, Matthew
Public Health England (PHE) estimates that there are upwards of 160,000 individuals in England and Wales with chronic hepatitis C virus (HCV) infection, but until now only around 100,000 laboratory diagnoses have been reported to PHE and of these 28,000 have been treated. Targeted case-finding in primary care is estimated to be cost-effective; however, there has been no robust randomised controlled trial evidence available of specific interventions. Therefore, this study aims to develop and conduct a complex intervention within primary care and to evaluate this approach using a cluster randomised controlled trial. A total of 46 general practices in South West England will be randomised in a 1:1 ratio to receive either a complex intervention comprising: educational training on HCV for the practice; poster and leaflet display in the practice waiting rooms to raise awareness and encourage opportunistic testing; a HCV risk prediction algorithm based on information on possible risk markers in the electronic patient record run using Audit + software (BMJ Informatica). The audit will then be used to recall and offer patients a HCV test. Control practices will follow usual care. The effectiveness of the intervention will be measured by comparing number and rates of HCV testing, the number and proportion of patients testing positive, onward referral, rates of specialist assessment and treatment in control and intervention practices. Intervention costs and health service utilisation will be recorded to estimate the NHS cost per new HCV diagnosis and new HCV patient initiating treatment. Longer-term cost-effectiveness of the intervention in improving quality-adjusted life years (QALYs) will be extrapolated using a pre-existing dynamic health economic model. Patients' and health care workers' experiences and acceptability of the intervention will be explored through semi-structured qualitative interviews. This trial has the potential to make an important impact on patient
Sep 2, 2012 ... standardised recording tools and incomplete documentation impeded assessment at facility .... and posters on cough hygiene were displayed in all 3 facilities. .... sent, resulting in poor service quality and a waste of resources.
The Staffordshire Arthritis, Musculoskeletal, and Back Assessment (SAMBA Study: a prospective observational study of patient outcome following referral to a primary-secondary care musculoskeletal interface service
Jordan Kelvin P
Full Text Available Abstract Background Recent healthcare policy has shifted the management of musculoskeletal conditions in the UK away from secondary care towards Clinical Assessment and Treatment Services at the primary-secondary care interface. However, little is known about the outcome of patients with musculoskeletal conditions referred from primary care to Clinical Assessment and Treatment Services or how best to identify those patients at high risk of poor outcome in this setting. We describe the protocol for a twelve-month prospective observational study which aims to describe the outcome of patients referred to musculoskeletal and back pain services at the primary-secondary care interface and to develop simple prognostic measures to guide clinical prioritisation and triage. Methods/Design All patients referred over a twelve-month period from primary care to musculoskeletal and back pain clinics in the primary-secondary care interface Clinical Assessment and Treatment Service in North Staffordshire will be mailed a postal questionnaire prior to their consultation. This will collect information on quality of life, general health, anxiety and depression, pain, healthcare utilisation including medication use, occupational characteristics, and socio-demographics. At the consultation in the interface clinic, the clinical diagnosis, investigations requested, and clinical interventions will be recorded. Follow-up data for the twelve-month period subsequent to recruitment will be collected via mailed follow-up questionnaires at 6 and 12 months, and review of medical records. Discussion This twelve-month prospective observational study of patients referred to a musculoskeletal Clinical Assessment and Treatment Service will assess the management and outcome of musculoskeletal care at the primary-secondary care interface as proposed in the Musculoskeletal Services Framework.
McGill, M; Molyneaux, L M; Yue, D K; Turtle, J R
Modern diabetes management emphasizes the early detection and prompt treatment of diabetic complications. However it is difficult to organize comprehensive screening at the primary care level. To address this problem we established a complication assessment service whereby all the major diabetes-specific complications were assessed in a single 3 h visit. A report with results and recommendations was sent to the general practitioner (GP). Being philosophically a complication-specific service, no attempt was made to intervene with metabolic management. This paper describes our experience with the first 743 patients of whom 92% had been referred from GPs. Of the diabetes-specific complications, 22% of patients had one, 5% had two, and 1% had three major complications. Many of the patients were unaware of the presence of these complications. One hundred and three people had attended the service on more than one occasion with an average time between visits of 1.7 years. The results demonstrated that GPs were very good at following a recommendation to refer a patient for ophthalmic assessment (85% of cases) and improving hypertension but were less successful in treating hyperlipidaemia. This service has proven to be an excellent forum for the collection of data and the teaching of health professionals. It is a move away from the traditional format of hospital-based clinics providing comprehensive diabetes management.
Vogler, Carrie N; Sattovia, Stacy; Salazar, Laura Y; Leung, Tiffany I; Botchway, Albert
This study evaluates the impact of pain education group visits on patients with chronic non-cancer pain (CNCP). The primary outcome of the study was to evaluate patients' functional status and secondary outcomes included knowledge, behavior, and satisfaction, before and after participation in the pain education group visits. Locally produced patient educational videos on chronic non-cancer pain were delivered during patient group visits led by a healthcare provider. Study participants included patients with CNCP pain in an academic general medicine practice. The primary outcome was functional status, measured by the Pain Intensity, Enjoyment of life, and General Activity (PEG) score and the Oswestry Disability Index. Secondary outcomes were evaluated through a pre- and post-intervention knowledge assessment and chart review of opioid use and utilization of emergency and urgent care services. A satisfaction survey was administered after each group visit. Thirty-five patient-group visits were analyzed and 14 patient charts reviewed. A moderately positive correlation was observed between PEG and Oswestry Disability Index (r = 0.47, p high. Group visits providing patient education about CNCP may benefit patients' knowledge about this clinical condition, and was received with high patient satisfaction. Further investigation is needed to evaluate longer-term knowledge retention, sustainability of improvements resulting from the intervention, and longer-term effects of the intervention on functional status.
Koka, Eric; Aboagye, Samuel Yaw; Kpeli, Grace; Pluschke, Gerd; Yeboah-Manu, Dorothy; Junghanss, Thomas
Background Beyond Mycobacterium ulcerans—specific therapy, sound general wound management is required for successful management of Buruli ulcer (BU) patients which places them among the large and diverse group of patients in poor countries with a broken skin barrier. Methods Clinically BU suspicious patients were enrolled between October 2013 and August 2015 at a primary health care (PHC) center and a municipal hospital, secondary health care (SHC) center in Ghana. All patients were IS2404 PCR tested and divided into IS2404 PCR positive and negative groups. The course of wound healing was prospectively investigated including predictors of wound closure and assessment of infrastructure, supply and health staff performance. Results 53 IS2404 PCR positive patients—31 at the PHC center and 22 at the SHC center were enrolled—and additionally, 80 clinically BU suspicious, IS2404 PCR negative patients at the PHC center. The majority of the skin ulcers at the PHC center closed, without the need for surgical intervention (86.7%) compared to 40% at the SHC center, where the majority required split-skin grafting (75%) or excision (12.5%). Only 9% of wounds at the PHC center, but 50% at the SHC center were complicated by bacterial infection. The majority of patients, 54.8% at the PHC center and 68.4% at the SHC center, experienced wound pain, mostly severe and associated with wound dressing. Failure of ulcers to heal was reliably predicted by wound area reduction between week 2 and 4 after initiation of treatment in 75% at the PHC center, and 90% at the SHC center. Obvious reasons for arrested wound healing or deterioration of wound were missed additional severe pathology; at the PHC center (chronic osteomyelitis, chronic lymphedema, squamous cell carcinoma) and at the SHC center (malignant ulceration, chronic lymphedema) in addition to hygiene and wound care deficiencies. When clinically suspicious, but IS2404 PCR negative patients were recaptured in the community, 76
antiretroviral therapy (HAART) [which] lead[ s ] to improved health outcomes….” (17). They also noted that routine risk assessment allows physicians to...Lesbian Medical Association and LGBT health experts. Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual, and Transgender ( LGBT ) Health. 2001...HIV prevention: what works? Am J Nurs. 2001 Jun;101(6):45-50. 41. U. S . Preventive Services Task Force. Screening for HIV. In: Services HaH, editor
Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, P.M.B. ... the child's health, culturally based beliefs and ..... immunization safety as this was a rural ... Charles SW, Olalekan AU, Peter MN,.
Journal of Community Medicine and Primary Health Care. ... This is one of the factors that determine whether or ..... Expired vaccines found in fridge / cold box .... date vaccine temperature monitoring charts. were stored on refrigerator door ...
Puura, Kaija; Mäntymaa, Mirjami; Luoma, Ilona; Kaukonen, Pälvi; Guedeney, Antoine; Salmelin, Raili; Tamminen, Tuula
Distressed infants may withdraw from social interaction, but recognising infants' social withdrawal is difficult. The aims of the study were to see whether an infant observation method can be reliably used by front line workers, and to examine the prevalence of infants' social withdrawal symptoms. A random sample of 363 families with four, eight or 18-month-old infants participated in the study. The infants were examined by general practitioners (GPs) in well-baby clinics with the Alarm Distress BaBy Scale (ADBB), an observation method developed for clinical settings. A score of five or more on the ADBB Scale in two subsequent assessments at a two-week interval was regarded as a sign of clinically significant infant social withdrawal. Kappas were calculated for the GPs' correct rating of withdrawn/not withdrawn against a set of videotapes rated by developer of the method, Professor Guedeney and his research group. The kappas for their ratings ranged from 0.5 to 1. The frequency of infants scoring above the cut off in two subsequent assessments was 3%. The ADBB Scale is a promising method for detecting infant social withdrawal in front line services. Three percents of infants were showing sustained social withdrawal as a sign of distress in this normal population sample.
Full Text Available Abstract Background To identify clinical questions and assessments regarded by health care practitioners as important when assessing undifferentiated hand pain or problems in adults aged 50 years and over presenting to primary care. Methods A purposively selected panel of 26 UK-based Health Care Practitioners comprising occupational therapists, physiotherapists, rheumatologists and general practitioners, were invited to take part in a consensus study involving three postal rounds of a Delphi questionnaire with accompanying case scenarios. Participants were asked to generate questions and assessments (round 1, rate their importance (round 2, and vote on which items were most important (round 3. Results Sixteen Health Care Practitioners agreed to participate with 11 completing all three rounds. The first round of the Delphi study generated 156 questions and 143 assessments. After three rounds agreement was reached on the importance of 25 questions and 19 assessments. Questions were weighted towards current symptoms, but also included the history of previous hand problems, self-reported hand function, co-morbidity and general health. Observation and palpation of features predominated in the choice of assessment, but specific tests, grip strength, evaluation of sensation and hand function were also included. Conclusions A pool of clinical questions and assessments were generated by Health Care Practitioners, and those considered most important for assessing older adults presenting with undifferentiated hand pain and hand problems in primary care were identified. Further evaluation is required to establish the reliability and feasibility of using these questions and assessments in primary care. In particular, the relative contribution of these questions and assessments in evaluating the nature and severity of hand problems, assisting diagnosis, indicating appropriate management, and predicting future course requires further investigation.
Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.
McGrail Matthew R
Full Text Available Abstract Background The two step floating catchment area (2SFCA method has emerged in the last decade as a key measure of spatial accessibility, particularly in its application to primary health care access. Many recent ‘improvements’ to the original 2SFCA method have been developed, which generally either account for distance-decay within a catchment or enable the usage of variable catchment sizes. This paper evaluates the effectiveness of various proposed methods within these two improvement groups. Moreover, its assessment focuses on how well these improvements operate within and between rural and metropolitan populations over large geographical regions. Results Demonstrating these improvements to the whole state of Victoria, Australia, this paper presents the first comparison between continuous and zonal (step decay functions and specifically their effect within both rural and metropolitan populations. Especially in metropolitan populations, the application of either type of distance-decay function is shown to be problematic by itself. Its inclusion necessitates the addition of a variable catchment size function which can enable the 2SFCA method to dynamically define more appropriate catchments which align with actual health service supply and utilisation. Conclusion This study assesses recent ‘improvements’ to the 2SFCA when applied over large geographic regions of both large and small populations. Its findings demonstrate the necessary combination of both a distance-decay function and variable catchment size function in order for the 2SFCA to appropriately measure healthcare access across all geographical regions.
McGrail, Matthew R
The two step floating catchment area (2SFCA) method has emerged in the last decade as a key measure of spatial accessibility, particularly in its application to primary health care access. Many recent 'improvements' to the original 2SFCA method have been developed, which generally either account for distance-decay within a catchment or enable the usage of variable catchment sizes. This paper evaluates the effectiveness of various proposed methods within these two improvement groups. Moreover, its assessment focuses on how well these improvements operate within and between rural and metropolitan populations over large geographical regions. Demonstrating these improvements to the whole state of Victoria, Australia, this paper presents the first comparison between continuous and zonal (step) decay functions and specifically their effect within both rural and metropolitan populations. Especially in metropolitan populations, the application of either type of distance-decay function is shown to be problematic by itself. Its inclusion necessitates the addition of a variable catchment size function which can enable the 2SFCA method to dynamically define more appropriate catchments which align with actual health service supply and utilisation. This study assesses recent 'improvements' to the 2SFCA when applied over large geographic regions of both large and small populations. Its findings demonstrate the necessary combination of both a distance-decay function and variable catchment size function in order for the 2SFCA to appropriately measure healthcare access across all geographical regions.
Acupuncture is an ancient traditional Chinese medical therapy that is used widely around the world. When practiced by a certified provider, it is safe and often perceived as calming and relaxing for patients. Animal and human studies have found a physiological basis for acupuncture needling in that it affects the complex central and peripheral neuro-hormonal network. Although it is unclear whether acupuncture is beneficial over sham/placebo acupuncture, acupuncture care yields clinically rele...
Celia Maria Sivalli Campos
Full Text Available Objective Identify nurses’ emancipatory practices in primary care, to contribute to the improvement of health care. Method A case study type social research of qualitative nature, in which nurses of a primary health care service unit in São Paulo were interviewed. Results The home visit was identified as a nursing practice possible to be expanded in order to identify social determinants of health, triggering emancipatory practices in the service. This expansion occurred because the design of health care labour intended by the service team changed its focus from the traditional object of health services, the disease. Conclusion First, it is advocated that social policies lead projects with the purpose of improving health needs. On the other hand, the daily labour needs to provide opportunities for reflection and discussion of healthcare projects, leading workers to propose labour-processes targeted to both the social determinants of health and people’s illness.
Alpert, J J
Primary care is about the intimate contact that takes place when a patient comes to the physician because that individual is concerned that he or she, son or daughter, parent or grandparent is sick, or is well and wants to stay well. Our history has been that we have paid attention to important problems but we have missed so far on primary care as a megatrend. As noted, one of our most important societal megatrends is proverty and how poverty places children at risk. Poverty and primary care are linked. The reality that all of our citizens do not have access to primary care is not just our failure but it is society's as well. We pediatricians face many problems. In developing solutions, historically our profession has never lost sight of the fact that we are a helping and caring discipline. We are an advocate for the poor, advocates for children, advocates for community, and that is a large job. But the challenge is real, and we do not have much time. Now is not the time to be timid. We need to achieve consensus, accepting and acting on the megatrend of securing the future for primary care.
Scott, Joan; Trotter, Tracy
With the recent expansion of genetic science, its evolving translation to clinical medicine, and the growing number of available resources for genomics in primary care, the primary care provider must increasingly integrate genetics and genomics into daily practice. Because primary care medicine combines the treatment of acute illness with disease prevention and anticipatory guidance, the primary care provider is in an ideal position to evaluate and treat patients for genetic disease. The notion that genetic knowledge is only rarely needed will have to be replaced with a comprehensive approach that integrates "genetic thinking" into every patient encounter. Genomic competencies will need to be added to the primary care provider's repertoire; such competencies include prevention, assessment, evaluation, and diagnosis of genetic conditions; the ordering and interpreting of genetic tests; communication with families; appropriate referrals; and the management or comanagement of care. The process of deciding when to order genetic tests, what tests to order, and how to interpret the results is complex, and the tests and their results have specific risks and benefits, especially for pediatric patients. The longitudinal nature of primary pediatric care provides the opportunity to obtain and continually update the family history, which is the most powerful initial genetic "test." The ongoing provider-family relationship, coupled with the astounding number of advances in genetic and genomic testing, also necessitates a constant re-evaluation of past diagnosis or nondiagnosis.
Full Text Available Abstract Background Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation. Methods A integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access. Results 19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals. Conclusions Primary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence
Full Text Available Abstract Objectives Major depressive disorder (MDD is a prevalent psychiatric disorder associated with impaired patient functioning and reductions in health-related quality of life (HRQL. The present study describes the impact of MDD on patients' HRQL and examines preference-based health state differences by patient features and clinical characteristics. Methods 95 French primary care practitioners recruited 250 patients with a DSM-IV diagnosis of MDD for inclusion in an eight-week follow-up cohort. Patient assessments included the Montgomery Asberg Depression Rating Scale (MADRS, the Clinical Global Impression of Severity (CGI, the Short Form-36 Item scale (SF-36, the Quality of Life Depression Scale (QLDS and the EuroQoL (EQ-5D. Results The mean EQ-5D utility at baseline was 0.33, and 8% of patients rated their health state as worse than death. There were no statistically significant differences in utilities by demographic features. Significant differences were found in mean utilities by level of disease severity assessed by CGI. The different clinical response profiles, assessed by MADRS, were also revealed by EQ-5D at endpoint: 0.85 for responders remitters, 0.72 for responders non-remitter, and 0.58 for non-responders. Even if HRQL and EQ-5D were moderately correlated, they shared only 40% of variance between baseline and endpoint. Conclusions Self-reported patient valuations for depression are important patient-reported outcomes for cost-effectiveness evaluations of new antidepressant compounds and help in further understanding patient compliance with antidepressant treatment.
Design and setting: Aggregated nationwide data in Singapore from 1991 to1998 were analysed for hospitalisations for chronic diseases that are avoidable by timely, appropriate, and effective primary care: asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (avoidable hospitalisations).
Matthews, Veronica; Burgess, Christopher P; Connors, Christine; Moore, Elizabeth; Peiris, David; Scrimgeour, David; Thompson, Sandra C; Larkins, Sarah; Bailie, Ross
Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded. We undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012-2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded. Approximately 23% (n = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0-86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4-82.4; p risk, of whom almost one-third were under 35 years (n = 16). Documentation of follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood lipid or glucose levels had follow-up management plans recorded. There was wide variation
Full Text Available BackgroundAboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD. Despite the importance of absolute cardiovascular risk assessment (CVRA as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded.MethodsWe undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012–2014. Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded.ResultsApproximately 23% (n = 478 of eligible clients had documented CVRA. Almost all assessments (99% were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0–86%. Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4–82.4; p < 0.001. Eleven percent (n = 53 of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years (n = 16. Documentation of follow-up varied with respect to the targeted risk factor
Maria Cristina Barbaro
Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Hanbury, Andria; Farley, Katherine; Thompson, Carl; Wilson, Paul M
Educational workshops are a commonly used quality improvement intervention. Often delivered by credible local health professionals who do not necessarily have skills in pedagogy, it can be challenging to achieve high intervention fidelity. This paper summarizes the fidelity assessment of a workshop designed to increase the uptake of a primary care alcohol screening recommendation. Delivered in a single health region, the workshop comprised separate sessions delivered by three local health professionals, plus two role plays delivered by a commercial company. Sessions were tailored to local barriers. Meetings were held with presenters and an outline of the barriers was provided. Two researchers attended the workshop, rating the number of specified barriers targeted by presenters and their quality of delivery. Participant responsiveness was measured through attendees' feedback and intervention dose was calculated as the proportion of health professionals who attended and proportion of general practices represented. Exposure was low, with 62 of 545 health professionals from 30 of a possible 80 practices attending. Sixty-five per cent of the specified barriers were targeted. There was variability in quality of delivery and participant responsiveness; challenges included potential mixed messages, overreliance on didactic methods and certain barriers appearing easier to target than others. The framework provided a rounded assessment of intervention fidelity: intervention coverage was low, adherence was moderate and there was variability in the quality of delivery across presenters. Future studies testing the effectiveness of interventions delivered by local experts with and without brief training in pedagogy/behaviour change would be beneficial. © 2015 John Wiley & Sons, Ltd.
Noël Polly H
Full Text Available Abstract Background Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in the health care literature, but may be related to the ability of primary care practices to improve the care they deliver. To better understand learning in primary care settings by developing a scale of learning in primary care clinics based on the literature related to learning across disciplines, and to examine the association between scale responses and chronic care model implementation as measured by the Assessment of Chronic Illness Care (ACIC scale. Methods Development of a scale of learning in primary care setting and administration of the learning and ACIC scales to primary care clinic members as part of the baseline assessment in the ABC Intervention Study. All clinic clinicians and staff in forty small primary care clinics in South Texas participated in the survey. Results We developed a twenty-two item learning scale, and identified a five-item subscale measuring the construct of reciprocal learning (Cronbach alpha 0.79. Reciprocal learning was significantly associated with ACIC total and sub-scale scores, even after adjustment for clustering effects. Conclusions Reciprocal learning appears to be an important attribute of learning in primary care clinics, and its presence relates to the degree of chronic care model implementation. Interventions to improve reciprocal learning among clinic members may lead to improved care of patients with chronic disease and may be relevant to improving overall clinic performance.
Vanderlip, Erik R; Williams, Nancy A; Fiedorowicz, Jess G; Katon, Wayne
People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.
Stacey B Trooskin; Victor J Navarro; Robert J Winn; David J Axelrod; A Scott McNeal; Maricruz Velez; Steven K Herrine; Simona Rossi
AIM:To determine rates of hepatitis C(HCV)risk factor ascertainment,testing,and referral in urban primary care practices,with particular attention to the effect of race and ethnicity.METHODS:Retrospective chart review from four primary care sites in Philadelphia;two academic primary care practices and two community clinics was performed.Demographics,HCV risk factors,and other risk exposure information were collected.RESULTS:Four thousand four hundred and seven charts were reviewed.Providers documented histories of injection drug use(IDU)and transfusion for less than 20% and 5% of patients,respectively.Only 55% of patients who admitted IDU were tested for HCV.Overall,minorities were more likely to have information regarding a risk factor documented than their white counterparts (79% vs 68%,P ＜ 0.0001).Hispanics were less likely to have a risk factor history documented,compared to blacks and whites(P ＜ 0.0001).Overall,minorities were less likely to be tested for HCV than whites in the presence of a known risk factor(23% vs 35%,P = 0.004).Among patients without documentation of risk factors,blacks and Hispanics were more likely to be tested than whites(20% and 24%,vs 13%,P ＜ 0.005,respectively).CONCLUSION:(1)Documentation of an HCV risk factor history in urban primary care is uncommon,(2)Racial differences exist with respect to HCV risk factor ascertainment and testing,(3)Minority patients,positive for HCV,are less likely to be referred for subspecialty care and treatment.Overall,minorities are less likely to be tested for HCV than whites in the presence of a known risk factor.
Gisele Damian Antonio
Full Text Available OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949
catastrophic health expenditures (CHE) and risk of being impoverished as a result of cost of care were assessed. Statistical ... Impact and contributors to cost of managing long term conditions in a ... sectors is ongoing, it has become clear that.
Isaac, Kathleen S; Hay, Jennifer L; Lubetkin, Erica I
Addressing cultural competency in health care involves recognizing the diverse characteristics of the patient population and understanding how they impact patient care. Spirituality is an aspect of cultural identity that has become increasingly recognized for its potential to impact health behaviors and healthcare decision-making. We consider the complex relationship between spirituality and health, exploring the role of spirituality in primary care, and consider the inclusion of spirituality in existing models of health promotion. We discuss the feasibility of incorporating spirituality into clinical practice, offering suggestions for physicians.
Davis, Melinda M; Bond, Lynne A.; Howard, Alan; Sarkisian, Catherine A.
Purpose: Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians’ age expectations likely influence patients’ expectations and care delivery patterns; yet, limited research has explored clinicians’ age expectations. The Expectations Regarding Aging Survey (ERA-12) was used to assess (a) age expectations in a sample of primary care clinicians practicing in the United States and (b) clinician chara...
Conclusion The MoleMateTM training program is a potentially effective and acceptable informatics tool to teach practitioners to recognise the features of SPLs identified by the MoleMateTM system. It will be used as part of the intervention in a randomised controlled trial to compare the diagnostic accuracy and appropriate referral rates of practitioners using the MoleMateTM system with best practice in primary care.
Groenewegen, P.; Heinemann, S.; Gress, S.; Schäfer, W.
Background: There is a large variation in the organization of primary care in Europe. In some health care systems, primary care is the gatekeeper to more specialized care, whilst in others patients have the choice between a wide range of providers. Primary care has increasingly become teamwork.
Groenewegen, P.; Heinemann, S.; Gress, S.; Schäfer, W.
Background: There is a large variation in the organization of primary care in Europe. In some health care systems, primary care is the gatekeeper to more specialized care, whilst in others patients have the choice between a wide range of providers. Primary care has increasingly become teamwork. Meth
Jul 31, 2014 ... Key Words: Primary Health Care, Strategies for implementation, Constraints, Alma Ata Declaration, Nigeria. 4th June, 2014. Accepted: ... including family planning; immunization against the ... evolved to meet the challenges associated with these diversities. .... and urban areas in Nigeria with the intention of.
Impetigo is a superficial, but contagious, bacterial infection of the skin that predominantly affects children and is common in primary care. In UK general practice, around half of the people with impetigo are treated with topical fusidic acid. However, bacterial resistance to this antibacterial drug is increasing. Here we discuss how patients with impetigo should be treated.
Journal of Community Medicine and Primary Health Care. 26 (1) 96-107 ... obesity. Specific criteria for MetS developed by. 19 of hypertension. .... Triglycerides 150 mg/dL or more or on Christians 329 (96.2%); and lower grade income.
4 and optimal use. In Nigeria, despite the The main objective of this study is therefore to .... Islam. Others. 185. 205. 5. 46.8. 51.9. 1.3. Utilization (use) of PHC Services and educational qualifications and of low socio-economic .... other zones except in the south-east region. .... primary health care interventions, the evidence is.
The aim of this thesis is to assess diagnostic strategies in patients suspected of heart failure (defined as a syndrome in which patients suffer from the inability of the heart to supply sufficient blood flow to meet the needs of the body) in primary care. B-type Natriuretic Peptide (BNP or NT-proBN
Gibson, Odette R; Segal, Leonie
To describe reported studies of the impact on HbA1C levels, diabetes-related hospitalisations, and other primary care health endpoints of initiatives aimed at improving the management of diabetes in Indigenous adult populations of Australia, Canada, New Zealand and the United States. Systematic literature review using data sources of MEDLINE, Embase, the Cochrane Library, CINHAL and PsycInfo from January 1985 to March 2012. Inclusion criteria were a clearly described primary care intervention, model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on at least one quantitative diabetes-related health outcome, and where results were reported separately for Indigenous persons. Joanna Briggs Institute critical appraisal tools were used to assess the study quality. PRISMA guidelines were used for reporting. The search strategy retrieved 2714 articles. Of these, 13 studies met the review inclusion criteria. Three levels of primary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-level improvement processes to enhance the quality of diabetes care, 3) change in primary health funding to support better access to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care, specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studies reported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation. The methodological quality of the four comparable cohort and seven observational studies was good, and moderate for the two randomised control trials. The current literature provides an inadequate evidence base for making important policy and practice decisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very small number of published studies, the general
Ramona S DeJesus
Full Text Available Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4% patient responders and 28 (66% provider responders. The majority of patients (>70% and providers (89% expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes care
Lader, Malcolm; Tylee, Andre; Donoghue, John
The use of benzodiazepine anxiolytics and hypnotics continues to excite controversy. Views differ from expert to expert and from country to country as to the extent of the problem, or even whether long-term benzodiazepine use actually constitutes a problem. The adverse effects of these drugs have been extensively documented and their effectiveness is being increasingly questioned. Discontinuation is usually beneficial as it is followed by improved psychomotor and cognitive functioning, particularly in the elderly. The potential for dependence and addiction have also become more apparent. The licensing of SSRIs for anxiety disorders has widened the prescribers' therapeutic choices (although this group of medications also have their own adverse effects). Melatonin agonists show promise in some forms of insomnia. Accordingly, it is now even more imperative that long-term benzodiazepine users be reviewed with respect to possible discontinuation. Strategies for discontinuation start with primary-care practitioners, who are still the main prescribers.This review sets out the stratagems that have been evaluated, concentrating on those of a pharmacological nature. Simple interventions include basic monitoring of repeat prescriptions and assessment by the doctor. Even a letter from the primary-care practitioner pointing out the continuing usage of benzodiazepines and questioning their need can result in reduction or cessation of use. Pharmacists also have a role to play in monitoring the use of benzodiazepines, although mobilizing their assistance is not yet routine. Such stratagems can avoid the use of specialist back-up services such as psychiatrists, home care, and addiction and alcohol misuse treatment facilities.Pharmacological interventions for benzodiazepine dependence have been reviewed in detail in a recent Cochrane review, but only eight studies proved adequate for analysis. Carbamazepine was the only drug that appeared to have any useful adjunctive properties for
Beyer, Martin; Gerlach, Ferdinand M; Erler, Antje
In its 2009 report the Federal Advisory Council on the Assessment of Developments in the Health Care System developed a model of Primary Care Practices for future general practice-based primary care. This article presents the theoretical background of the model. Primary care practices are seen as developed organisations requiring changes at all system levels (interaction, organisation, and health system) to ensure sustainability of primary care functions in the future. Developments of the elements comprising the health care system may be compared to the developments and proposals observed in other countries. In Germany, however, the pace of these developments is relatively slow.
Maarsingh, O.R.; Dros, J.; Schellevis, F.G.; Weert, H.C. van; Windt, D.A. van der; Riet, G. ter; Horst, H.E. van der
PURPOSE: Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of
Maarsingh, O.R.; Dros, J.; Schellevis, F.G.; van Weert, H.C.; van der Windt, D.A.; ter Riet, G.; van der Horst, H.E.
PURPOSE Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of
Lee, Linda; Hillier, Loretta M; Molnar, Frank; Borrie, Michael J
Increasingly, primary care collaborative memory clinics (PCCMCs) are being established to build capacity for person-centred dementia care. This paper reflects on the significance of PCCMCs within the system of care for older adults, supported with data from ongoing evaluation studies. Results highlight timelier access to assessment with a high proportion of patients being managed in primary care within a person-centred approach to care. Enhancing primary care capacity for dementia care with interprofessional and collaborative care will strengthen the system's ability to respond to increasing demands for service and mitigate the growth of wait times to access geriatric specialist assessment.
Torner, Nuria; Baricot, Maretva; Martínez, Ana; Toledo, Diana; Godoy, Pere; Dominguez, Ángela
The aim of this study was to evaluate the outcome of a collaborative action between Public Health services and Primary Care in the context of a case-control study on effectiveness of pharmaceutical and non-pharmaceutical measures to prevent hospitalization in a pandemic situation. To carry out this research the collaborative action of the primary care physicians members of the Influenza surveillance network was needed, they had to recall clinical information from influenza A(H1N1)pmd09 confirmed outpatient cases and negative outpatient controls matching their corresponding hospitalized confirmed case. A survey questionnaire to assess involvement of Influenza Sentinel Surveillance Primary care physicians' Network of Catalonia (PIDIRAC) regarding the outpatient case and control outreach during the pandemic influenza season was performed. A total of 71,1% of completed surveys were received. Perception of pandemic activity was considered to be similar to seasonal influenza activity in 43.8% or higher but not unbearable in 37.5% of the replies. There was no nuisance reported from patients regarding neither the questions nor the surveyor. Collaborative research between Public Health services and Primary Care physicians enhances Public Health actions and research.
Wharton, Tracy C.; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E.
Objectives Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Design Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. Participants The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Results Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P <.001), Chronic obstructive pulmonary disease (z = 3.9; P < .001), and cancer (z = 8.5; P < .001). There was no statistically significant difference between the 2 groups in terms of the prevalence of geriatric syndromes. Scores on subscales of the interRAI-home care indicated a lower risk of serious health decline and adverse outcomes for MWP compared with HBPC clients (1.4 ± 1.1 vs 0.9 ± 0.1; z = 2.5; P = .012). Veterans receiving home-based care through the Veterans Affairs Medical
2Department of Health Policy and Management, Faculty of Public Health, College of Medicine and University ... 86 (21%) had primary school education, 210 (51.3%) were married, and 357 (87.3%) were employed. ...... patient satisfaction and behavioral intentions in. 5. .... Psychological Assessment 1995; 7 (3):309-319.
Judith Ortiz PhD
Full Text Available Background: The Accountable Care Organization (ACO is one of the new models of health care delivery in the United States. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so. Methods: A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs in 9 states. Two dependent variables—participation in ACOs and willingness to join ACOs—were created and analyzed using a generalized estimating equation approach. Results: A total of 257 RHCs responded to the survey. A small percentage (5.2% of the respondent clinics reported that they were participating in ACOs. Rural Health Clinics in isolated areas were 78% less likely to be in ACOs (odds ratio = 0.22, P = .059. Nonprofit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B = 1.271, P = .054. There is a positive relationship between RHC size and willingness to join an ACO (B = 0.402, P = .010. Conclusion: At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers’ limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs.
Reid, Sophie C; Kauer, Sylvia D; Hearps, Stephen J C; Crooke, Alexander H D; Khor, Angela S; Sanci, Lena A; Patton, George C
GPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people's reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care. We conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project's Exit Interview. Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no
... and the Internet What's a Primary Care Physician (PCP)? KidsHealth > For Parents > What's a Primary Care Physician ( ... getting the right amount of exercise. Types of PCPs Different types of PCPs treat kids and teens. ...
Cho, Kyung-Hwan; Roh, Yong-Kyun
A mismatch in the demand and supply of primary care physicians could give rise to a disorganization of the health care system and public confusion about health care access. There is much evidence in Korea of the existence of a primary care physician shortage. The appropriate required ratio of primary care physicians to the total number of physicians is estimated by analyzing data for primary care insurance consumption in Korea. Sums of primary care expenditure and claims were calculated to estimate the need for primary care physicians by analyzing the nationwide health insurance claims data of the Korean National Medical Insurance Management Corporation (KNMIMC) between the years 1989-1998. The total number of physicians increased 183% from 1989 to 1998. However, the number of primary care physicians including general physicians, family physicians, general internists, and general pediatricians showed an increase of only 169% in those 10 years. The demand for primary care physicians reaches at least 58.6%, and up to 83.7%, of the total number of physicians in Korea. However, the number of primary care physicians comprises up to 22.0% of the total number of active physicians during the same research period, which showed a large gap between demand and supply of primary care physicians in Korea. To provide high quality care overall, a balanced supply of primary care physicians and specialists is required, based on the nation's demand for health services.
Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul
This paper proposes a new methodology to assess demand and price-elasticity for health care, based on patients' stated willingness to pay (WTP) values for certain aspects of health care quality improvements. A conceptual analysis of how respondents consider contingent valuation (CV) questions allowed us to specify a probability density function of stated WTP values, and consequently, to model a demand function for quality-improved health care, using a parametric survival approach. The model was empirically estimated using a CV study intended to assess patients' values for improving the quality of primary health care (PHC) services in Palestine. A random sample of 499 individuals was interviewed following medical consultation in four PHC centers. Quality was assessed using a multi-attribute approach; and respondents valued seven specific quality improvements using a decomposed valuation scenario and a payment card elicitation technique. Our results suggest an inelastic demand at low user fees levels, and when the price-increase is accompanied with substantial quality-improvements. Nevertheless, demand becomes more and more elastic if user fees continue to rise. On the other hand, patients' reactions to price-increase turn out to depend on their level of income. Our results can be used to design successful health care financing strategies that include a consideration of patients' preferences and financial capacities.
Degen, C; Möller, D; Schlechter, C
The following study examines the influencing factors on the satisfaction of oncological patients with their primary care physician, specialist physician, hospital and health insurance provider. Individual patient satisfaction with cross-sectoral collaboration is examined based on the satisfaction with these sectors. 12 specialist practices from 8 federal states participated in the patient survey. Altogether, 516 patients took part during the investigation period 2011-2012. The results were evaluated by multiple regression analysis. The results show that patients are content with cross-sectoral collaboration if they are satisfied with their health insurance and the specialist physician. With regard to satisfaction with the primary care physician and the specialist physician, trust is perceived to be the most important influencing factor. For hospitals, the most significant influencing factor is interest in and time for patients. Regarding health insurance, providing the patients with information leads to a greater degree of satisfaction. Psychosocial factors are of key importance for the patient's perceptions of satisfaction with the different sectors. This contains for instance factors like to 'putting confidence in physicians' or 'talking about patients' fears'. The sectors considered in this study should therefore give more consideration to these factors during patient care. A health insurance provider can take on the role of a competent point of contact, providing quality-assured information in the context of oncological diseases. © Georg Thieme Verlag KG Stuttgart · New York.
Makaula, Peter; Bloch, Paul; Banda, Hastings T.
is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi) and community-directed interventions (CDI) are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated...... with PHC. The CDI approach has successfully been used to improve the delivery of interventions in areas that have previously used CDTi. However, little is known about the added value of community participation in areas without prior experience with CDTi. This study aimed at assessing PHC in two rural...
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Primary care. 96.47 Section 96.47 Public Welfare... and Tribal Organizations § 96.47 Primary care. Applications for direct funding of Indian tribes and tribal organizations under the primary care block grant must comply with 42 CFR Part 51c (Grants...
Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system Evaluación de la atención primaria de salud: Primary Care Assessment Tools - Facility version para el sistema de salud español
M. Isabel Pasarín
Full Text Available Objective: To obtain versions of the Primary Care Assessment Tools (PCAT-Facility version to evaluate primary care (PC in the Spanish context, and to analyze its feasibility, reliability and validity. Methods: Cultural adaptation was performed through the use of forward and backward translations into Spanish and Catalan, observations and opinions of a panel of experts, and cognitive interviews with target users (PC team managers. A pilot phase was carried out in a sample of 130 managers of PC teams in Catalonia. A post-test questionnaire was sent 4-5 months later to all 194 managers of PC teams in the Barcelona health region. Analysis of metric properties included: 1 description of items and verification of Likert assumptions, since domain scores are obtained by summing item scores; 2 reliability analysis (Cronbach's alpha coefficient, Pearson's correlation coefficient, test-retest analysis; and 3 validity analysis (expert panel, cognitive interviews, and convergent and discriminant validity. Results: Substantial adaptation was required for the accessory section of the questionnaire, but less was required in PC domain measurements. Items were added to the comprehensiveness domain to reflect services usually available in Spain. The lowest Cronbach's alpha scores were found for Access (0.62 and Coordination (0.59 and 0.65, while values were >0.70 for the remaining domains. Conclusion: The Spanish version of the PCAT-Facility questionnaire is now available and shows adequate reliability and validity. The Spanish PCAT version will facilitate national and international comparisons of PC and analysis of the determinants of quality of service provision.Objetivo: Obtener versiones del Primary Care Assessment Tools-Facility version como herramienta de evaluación de la atención primaria (AP para la aplicación en el contexto español, y analizar su fiabilidad y validez. Métodos: Se realizó una adaptación cultural con traducciones y retrotraducciones
Prytherch, Helen; Leshabari, Melkidezek T.; Wiskow, Christiane; Aninanya, Gifty A.; Kakoko, Deodatus C.V.; Kagoné, Moubassira; Burghardt, Juliane; Kynast-Wolf, Gisela; Marx, Michael; Sauerborn, Rainer
Background The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated. PMID
van Lieshout Jan
Full Text Available Abstract Background Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others factors. Objectives This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs. Design and methods An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most indicators are based on medical records, and some on a structured interview with a contact person of the practice. Lifestyle (smoking, physical exercise, diet will be measured with previously validated questionnaires that are completed by patients. Additional measures include practice characteristics and exposure to programs to improve cardiovascular care.
Ian J. Nelligan
Full Text Available Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1 making a community diagnosis, (2 understanding social determinants of health and (3 training in participatory research. Three community-based enablers for sustainability of COPC were (1 partnerships with community health workers, (2 community empowerment and engagement and (3 institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.
Full Text Available Abstract Background Whether the primary care physician's assessment of patient compliance is a valuable prognostic marker to identify patients who are at increased risk of death, or merely reflects measurement of various treatment parameters such as HbA1C or other laboratory markers is unclear. The objective of this prospective cohort study was to investigate the prognostic value of the physicians' assessment of patient compliance and other factors with respect to all-cause mortality during a one year follow-up period. Methods A prospective cohort study was conducted among 1014 patients with type 2 diabetes aged 40 and over (mean age 69 years, SD 10.4, 45% male who were under medical treatment in 11 participating practices of family physicians and internists working in primary care in a defined region in South Germany between April and June 2000. Baseline data were gathered from patients and physicians by standardized questionnaire. The physician's assessment of patient compliance was assessed by means of a 4-point Likert scale (very good, rather good, rather bad, very bad. In addition, we carried out a survey among physicians by means of a questionnaire to find out which aspects for the assessment of patient compliance were of importance to make this assessment. Active follow-up of patients was conducted after one year to determine mortality. Results During the one year follow-up 48 (4.7% of the 1014 patients died. Among other factors such as patient type (patients presenting at office, nursing home or visited patients, gender, age and a history of macrovascular disease, the physician's assessment of patient compliance was an important predictor of all-cause mortality. Patients whose compliance was assessed by the physician as "very bad" (6% were significantly more likely to die during follow-up (OR = 2.67, 95% CI 1.02–6.97 after multivariable adjustment compared to patients whose compliance was assessed as "rather good" (45% or "very good
Brown, Jonathan D.
Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…
Houston, John P; Kroenke, Kurt; Davidson, Jonathan R; Adler, Lenard A; Faries, Douglas E; Ahl, Jonna; Swindle, Ralph; Trzepacz, Paula T
Patients with nonpsychotic mental health and emotional problems are commonly seen by primary care physicians. The objective of this study was to expand the Provisional Diagnostic Instrument-4 (PDI-4) to include a short self-report screen for 5 common anxiety-related diagnoses: panic attack (PA), social phobia (SP), obsessive-compulsive disorder (OCD), hypochondriasis, and post-traumatic stress disorder (PTSD). Primary care patients (N = 343) were originally evaluated with a self-report screen comprised of 85 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom-based candidate questions, then interviewed by a trained rater for Structured Clinical Interview Research Version (SCID)/Adult ADHD Clinician Diagnostic Scale version 1.2 (ACDS) assessment and diagnosis. Responses to screening questions were used to calculate sensitivity and specificity for an SCID diagnosis, and to select the optimal cutoffs in symptom frequency for 1 or 2 questions for each additional anxiety-related diagnosis. The PDI-4 Anxiety (PDI-4A) contains 6 items for provisional differential diagnosis of PA, SP, OCD, hypochondriasis, and PTSD in addition to items for the PDI-4. Sensitivities/specificities were: PA, 88%/68%; SP, 57%/70%; OCD, 88%/61%; hypochondriasis, 67%/85%; and PTSD, 71%/72%. Screening for multiple common anxiety diagnoses may be desirable, although limitations may include reduced sensitivity and specificity for selected diagnoses. The PDI-4A may additionally help primary care physicians identify patients with PA, SP, OCD, hypochondriasis, and PTSD.
Cássia Regina de Paula Paz
Full Text Available Objective.Assess the need for incorporation of palliative care in primary health care (PHC through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Methods. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS to identify the indication of palliative care. Results. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141 had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%, followed by disorders related to quality of care during pregnancy and childbirth (24.38%. Conclusion. It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.
de Paula Paz, Cássia Regina; Reis Pessalacia, Juliana Dias; Campos Pavone Zoboli, Elma Lourdes; Ludugério de Souza, Hieda; Ferreira Granja, Gabriela; Cabral Schveitzer, Mariana
Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.
Goldberg, D. P.; Reed, G. M.; Robles, R.
Objective A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11. BSS requires multiple somatic symptoms not caused by known physical pathology and associated...... with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co...... without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care. © 2016 Elsevier Inc....
Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A
Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.
Juan Manuel Sánchez Soto
Full Text Available Introduction: Overweight and obesity are considered a disease - a public health problem that has becomes one of the main factors related to deaths from cardiovascular disease in Mexico. Methods: We conducted a cross-sectional descriptive study in search of inference between obesity and overweight among health caregivers and the general population in six primary care clinics that belong to the Ministry of Health of the municipality of Nezahualcoyotl. We recruited 124 participants from the different work areas of the centers, including those responsible for nutritional programs. Diagnostic parameters for obesity and overweight were body mass index, waist hip ratio and percentage of body fat (% BF. Results: Body mass index: 0.22 normal; 0.53 overweight; 0.23 obesity I; 0.03 obesity II; 0.00 obesity III. Waist circumference: normal 0.28 and above normal 0.72. Fat percentage: normal 0.20 and 0.80% higher. We found that 77% of participants were obese or overweight. Discussion: Those in charge of controlling obesity and overweight also suffer from it and can contribute to the failure of programs in the community. It is essential to develop programs in healthy lifestyle based on nutrition and physical activity. These should be applied primarily to healthcare professionals who are in charge of community lifestyle programs.
Full Text Available We explored primary care physicians’ (PCPs’ beliefs and practices about e-cigarettes. Cross-sectional, semi-structured interviews with PCPs in 2014 were conducted and audio-recorded. Participants were 15 general internal and family medicine physicians practicing in two settings in Virginia, USA. Interview recordings were transcribed, and the content analyzed using the Constant Comparative Method to identify key themes regarding PCPs’ reported current practices and beliefs. Five themes were identified: (1 existing clinic processes do not include mechanisms to screen for noncombustible tobacco products (such as e-cigarettes; (2 e-cigarette discussions are becoming commonplace with patients initiating the discussions and seeking physician guidance regarding e-cigarette use; (3 a lack of knowledge regarding the potential harms and benefits of e-cigarettes, yet a willingness to support their patients’ desire to use e-cigarettes (4 believing e-cigarettes are a safer alternative to smoking combustible tobacco products; and (5 abandoning concerns regarding the potential harms of e-cigarettes in the context of highly addicted patients and those with extensive comorbidities. Despite acknowledging limited knowledge regarding e-cigarettes, findings suggest that some PCPs are currently recommending e-cigarettes to their patients for smoking cessation and relative harm reduction, often personalizing recommendations based on the patient’s perceived addiction level and current health status. Physicians need to be informed about the evolving evidence regarding the risks and benefits of e-cigarettes.
Conclusion: Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.
Acharya, D; Paudel, R
Background Despite greater emphasis on maternal and neonatal health through policy and programming in Nepal, maternal and neonatal health is still not impressive. Health care providers' knowledge assessment on maternal and neonatal care has been well documented elsewhere, but it is very little understood in Nepal. Objective The primary objective of this study was to assess the critical knowledge of primary level nurse- midwives on maternal and newborn care in Kapilvastu District of Nepal. Method This was an Institution based cross-sectional study, conducted in Kapilvastu district, Nepal among sixty eight nurse-midwives. The participants were selected using simple random sampling technique. For collecting the data, health institutions were visited by enumerators for a month from 1st October to 1st November 2012. Data were entered into Microsoft Excel, cleaned and analyzed using SPSS version 17.0. Result More than 3/4th of the nurse-midwives had 10-20 years of experience. Majority of them (89.7%) had poor knowledge in taking action to prevent mother to child transmission for HIV positive women. More than half of them (54.4%) had some knowledge in performing the active management of third stage of labor whereas almost half (51.5%) had poor knowledge to actions needed on post-partum haemorrhage (PPH). Similarly, more than two third (69.1%) had poor knowledge in newborn care. Conclusion Majority of the nurse-midwives were found to have either poor or some level of knowledge in most of the components of maternal and newborn care services. So, greater emphasis should be given to upgrade the knowledge of nurse mid-wives.
Phalkey, Revati; Dash, Shisir R; Mukhopadhyay, Alok; Runge-Ranzinger, Silvia; Marx, Michael
Early detection of an impending flood and the availability of countermeasures to deal with it can significantly reduce its health impacts. In developing countries like India, public primary health care facilities are frontline organizations that deal with disasters particularly in rural settings. For developing robust counter reacting systems evaluating preparedness capacities within existing systems becomes necessary. The objective of the study is to assess the functional capacity of the primary health care system in Jagatsinghpur district of rural Orissa in India to respond to the devastating flood of September 2008. An onsite survey was conducted in all 29 primary and secondary facilities in five rural blocks (administrative units) of Jagatsinghpur district in Orissa state. A pre-tested structured questionnaire was administered face to face in the facilities. The data was entered, processed and analyzed using STATA(®) 10. Data from our primary survey clearly shows that the healthcare facilities are ill prepared to handle the flood despite being faced by them annually. Basic utilities like electricity backup and essential medical supplies are lacking during floods. Lack of human resources along with missing standard operating procedures; pre-identified communication and incident command systems; effective leadership; and weak financial structures are the main hindering factors in mounting an adequate response to the floods. The 2008 flood challenged the primary curative and preventive health care services in Jagatsinghpur. Simple steps like developing facility specific preparedness plans which detail out standard operating procedures during floods and identify clear lines of command will go a long way in strengthening the response to future floods. Performance critiques provided by the grass roots workers, like this one, should be used for institutional learning and effective preparedness planning. Additionally each facility should maintain contingency funds for
Full Text Available Background: Early detection of an impending flood and the availability of countermeasures to deal with it can significantly reduce its health impacts. In developing countries like India, public primary health care facilities are frontline organizations that deal with disasters particularly in rural settings. For developing robust counter reacting systems evaluating preparedness capacities within existing systems becomes necessary. Objective: The objective of the study is to assess the functional capacity of the primary health care system in Jagatsinghpur district of rural Orissa in India to respond to the devastating flood of September 2008. Methods: An onsite survey was conducted in all 29 primary and secondary facilities in five rural blocks (administrative units of Jagatsinghpur district in Orissa state. A pre-tested structured questionnaire was administered face to face in the facilities. The data was entered, processed and analyzed using STATA® 10. Results: Data from our primary survey clearly shows that the healthcare facilities are ill prepared to handle the flood despite being faced by them annually. Basic utilities like electricity backup and essential medical supplies are lacking during floods. Lack of human resources along with missing standard operating procedures; pre-identified communication and incident command systems; effective leadership; and weak financial structures are the main hindering factors in mounting an adequate response to the floods. Conclusion: The 2008 flood challenged the primary curative and preventive health care services in Jagatsinghpur. Simple steps like developing facility specific preparedness plans which detail out standard operating procedures during floods and identify clear lines of command will go a long way in strengthening the response to future floods. Performance critiques provided by the grass roots workers, like this one, should be used for institutional learning and effective preparedness
Anandarajah, Gowri; Gupta, Priya; Jain, Nupur; El Rayess, Fadya; Goldman, Roberta
Development, evaluation and dissemination of primary care innovations are essential for the future of health care; however, primary care physicians including family physician, lag behind hospital-based physicians in research productivity. Family medicine residencies struggle to implement scholarly skills training programmes for busy family physicians. The Primary Care Scholarly Development Program (PC-SDP) aimed to empower residents to incorporate innovation with scholarship into future practice, by facilitating successful resident scholarly projects and reducing perceived barriers. Educational intervention. The required PC-SDP was piloted through a family medicine residency programme in the USA. Key elements included: rigorous but achievable requirements; emphasis on Boyer's scholarship of application, teaching and discovery; resident engagement, through the support of their 'professional passions'; basic research training; multilevel mentoring; and modest curriculum time. A mixed-methods longitudinal evaluation included: (1) a qualitative study of intervention class; (2) assessing the scholarly output of the intervention class versus the comparison class; and (3) a follow-up survey of both groups after 3 or 4 years. Data were analysed from all 25 residents in the classes of 2008 and 2009 (12 intervention; 13 comparison). Qualitative interviews of residents from the intervention group revealed that their initial feelings of trepidation about scholarly work gave way to feelings of accomplishment and confidence in their ability to integrate scholarship into busy careers. Residents in the intervention group had a greater volume of scholarly output at graduation, and follow-up surveys suggest that they value incorporating scholarship into their careers more so than physicians from the comparison group. The PC-SDP seems to foster enthusiasm for scholarship by supporting residents' professional passions and facilitating successful projects. This may foster improved
Okoli Ugo; Eze-Ajoku Ezinne; Oludipe Modupe; Spieker Nicole; Ekezie Winifred; Ohiri Kelechi
Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...
Groenewegen, P.; Heinemann, S.; Greß, S.; Schäfer, W.
Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices
Groenewegen, P.P.; Heinemann, Stephanie; Greß, Stefan; Schäfer, Willemijn
Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices
Lember, M.; Cartier, T.; Bourgueil, Y.; Dedeu, T.; Hutchinson, A.; Kringos, D.
The way primary care is structured establishes important conditions for both the process of care and its outcomes. In this chapter, the structure of primary care will be discussed according to three dimensions: governance, economic conditions and workforce development. Governance refers to the visi
Lember, M.; Cartier, T.; Bourgueil, Y.; Dedeu, T.; Hutchinson, A.; Kringos, D.
The way primary care is structured establishes important conditions for both the process of care and its outcomes. In this chapter, the structure of primary care will be discussed according to three dimensions: governance, economic conditions and workforce development. Governance refers to the
Kringos, D.; Boerma, W.; Bourgueil, Y.; Cartier, T.; Dedeu, T.; Hasvold, T.; Hutchinson, A.; Lember, M.; Oleszczyk, M.; Pavlick, D.R.
This chapter analyses differences between countries and explains why countries differ regarding the structure and process of primary care. The components of primary care strength that are used in the analyses are health policy-making, workforce development and in the care process itself (see Fig.
Rotar Pavlič, Danica; Zelko, Erika; Vintges, Marga; Willems, Sara; Hanssens, Lise
Abstract Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations. At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people. PMID:27703542
Groenewegen, P.P.; Hutten, J.B.F.
As a result of policy changes and developments on the demand side, the importance of technology in primary health care will grow fast. An approach to the implementation of new technologies in primary health care is presented in this article. First we describe the main problems in Dutch primary healt
Swartwout, Kathryn D
A 2012 Institute of Medicine report calls primary and public healthcare workers to action, tasking them with working together to improve population health outcomes. A Practical Playbook released in 2014 enables this public health/primary care integration. Primary care NPs are in an excellent position to lead the charge and make this integration happen.
Cinza-Sanjurjo, Sergio; Rey-Aldana, Daniel; Gestal-Pereira, Enrique; Calvo-Gómez, Carlos
To determine the degree of control of patients on anticoagulants in follow-up in primary care in Galicia and investigate whether time in therapeutic range as estimated using the number of acceptable controls is comparable with the estimation using the Rosendaal method. Transversal study that included patients older than 65 years, diagnosed with nonvalvular atrial fibrillation, on anticoagulants for at least 1 year. Control was considered good when the time in therapeutic range was greater than 65%, estimated by the Rosendaal method, or 60% estimated by the number of acceptable controls. We enrolled 511 patients (53.0% women; mean [standard deviation] age, 77.8 [0.6] years). Overall, 41.5% of the patients were in therapeutic range at fewer than 60% of the controls and 42.7% spent less than 65% of follow-up in therapeutic range, as estimated with the Rosendaal method. In the group of patients with poor control, we observed more drugs (6.8 [0.4] vs 5.7 [0.3]; P<.0001), greater presence of kidney disease (24.3% vs 17.0%; P=.05), and higher HAS-BLED scores (3.8 [0.1] vs 2.5 [0.1]; P<.0001). The cutoff of 60% for number of acceptable controls had a sensitivity and specificity of 79.4% and 86.7%, respectively, with an area under the curve of 0.92 (95%CI, 0.87-0.97). More than 40% of patients on anticoagulants do not reach the minimum time in therapeutic range to benefit from anticoagulation. The factors associated with worse control were kidney disease and high risk of cerebral hemorrhage. The 2 methods of estimation are comparable. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Dybowska, Małgorzata; Tomkowski, Witold Z; Kuca, Paweł; Ubysz, Rafał; Jóźwik, Adam; Chmielewski, Dariusz
The clinical picture of deep vein thrombosis (DVT) is nonspecific. Therefore assessment of the probability of occurrence of DVT plays a very important part in making a correct diagnosis of DVT. The aim of our prospective study was to assess the accuracy of the Wells scale in primary care setting in diagnostic procedure of suspected deep vein thrombosis. In the period of 20 - months (from 2007 to 2009) a group of residents from one of the urban districts of Warsaw, who reported to family doctors (22 primary care physicians were involved in the study) with symptoms of DVT were assessed on the probability of occurrence of deep vein thrombosis using the Wells scale. Family doctors were aware of symptoms of DVT and inclusion patients to this study was based on clinical suspicion of DVT. Patients were divided into three groups, reflecting probability of DVT of the lower limbs. To confirm DVT a compression ultrasound (CUS) test was established. We analyzed the relationship between a qualitative variable and a variable defined on an original scale (incidence of DVT versus Wells scale count) using the Mann-Whitney test. Chi-square test compared rates of DVT events in all clinical probability groups. Patient were follow up during 3 months in primary care setting. In the period of 20 months (from 2007 to 2009) a total number of 1048 patients (male: 250 , female: 798 mean age: 61.4) with symptoms suggestive of DVT of the lower extremities entered the study. Among the 100 patients classified in the group with a high probability of DVT of the lower extremities, 40 (40%) patients (proximal DVT - 13; distal DVT - 27) were diagnosed with it (95% CI [30.94% -49.80%]). In the group with a moderate probability consisting of 302 patients, DVT of the lower extremities was diagnosed in 19 (6.29%) patients (95% CI [4.06% -9.62%]), (proximal DVT - 1; distal DVT - 18). Of the 646 patients with a low probability of DVT of the lower extremities distal DVT was diagnosed in 1 (0.15%) patient
Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact
Department of Veterans Affairs — The Primary Care Management Module (PCMM) was developed to assist VA facilities in implementing Primary Care. PCMM supports both Primary Care and non-Primary Care...
Halley, Marc D; Anderson, Peter
Primary care physicians today can be expected to capture between 2,000 and 5,000 active patients who consider that physician to be "my physician." The geographic location of primary care physicians affects the payer mix of the hospital and its affiliated subspecialists. Hospital and health system CFOs would be wise to advocate investment in primary care physicians to secure market share. They should also develop compensation plans with a value-volume balance and establish ways to actively manage referrals.
Hyman, D J; Maibach, E W; Flora, J A; Fortmann, S.P.
The active involvement of primary care physicians is necessary in the diagnosis and treatment of elevated blood cholesterol. Empirical evidence suggests that primary care physicians generally initiate dietary and pharmacological treatment at threshold values higher than is currently recommended. To determine current treatment thresholds and establish factors that distinguish physicians who are more likely to initiate therapy at lower cholesterol values, 119 primary care physicians in four nor...
U.S. Department of Health & Human Services — The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen...
Hoedeman, Rob; Blankenstein, Annette H.; van der Feltz-Cornelis, Christina M.; Krol, Boudien; Stewart, Roy; Groothoff, Johan W.; van der Feltz-Cornelis, CM
Background In primary care between 10% and 35% of all visits concern patients with medically unexplained physical symptoms (MUPS). MUPS are associated with high medical consumption, significant disabilities and psychiatricmorbidity. Objectives To assess the effectiveness of consultation letters (CLs
Holtrop, Jodi Summers; Luo, Zhehui; Alexanders, Lynn
Care management in primary care can be effective in helping patients with chronic disease improve their health; however, primary care practices are often challenged to identify revenue to pay for it. This study explored the impact of direct reimbursement on the provision of care management in a primary care physician organization. Using data on expenses and health plan reimbursement during the initial 16 months of care management implementation at 5 practices, we calculated the percentage of related costs that were covered by payments. Qualitative data from interviews with practice members were used to identify their perceived barriers to care management reimbursement and the impact of current reimbursement strategies on service delivery. Direct reimbursement for care management covered only 21% of the costs. Reimbursement varied by care manager background, patient diagnoses, insurer, and indication for the visit. Barriers to gaining reimbursement included patient resistance to copay, clinician hesitation to bill for care management visits (for fear the patient may receive a bill), differential reimbursement policies of insurers, and general lack of reimbursement for care management in many cases. Although practice-level quality improvement incentives were an alternative means of supporting care management, because these incentives were not directly tied to the service of care management, they were used for other activities ultimately supporting patient care. This study highlights the need for sufficient reimbursement to initiate and maintain care management for patients in primary care as proposed for service reforms under the Affordable Care Act. © Copyright 2015 by the American Board of Family Medicine.
Druss, Benjamin G; Mauer, Barbara J
The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.
Armando Henrique Norman
ferramenta metodológica prática para o desenvolvimento de pesquisa usando a CIAP e formulários de papel e o artigo Assessment of pre-test probability in Primary Health Care using International Classification of Primary Care 2 (ICPC -2 refere-se à aplicação dessa metodologia em um serviço da APS brasileira. Convém ressaltar que a maioria das pesquisas realizadas na APS foram produzidas em uma era em que a coleta de dados era feita em papel, mesmo assim, pioneiros como William Pickles – em sua descrição das doenças infecciosas – são exemplos de como a pesquisa em APS auxiliou a modificar a face da medicina8. Desse modo, esses artigos visam possibilitar, mesmo em serviços de APS sem o uso de prontuários eletrônicos, o desenvolvimento de pesquisas que possam contribuir para o entendimento da realidade local de saúde. Como afirmou Bentsen9, [...] na prática médica, um diagnóstico é um rótulo que anexamos às pessoas enfermas. Usamos esses rótulos como a base prática para o tratamento e, se possível, para o diagnóstico. Se as terminologias diagnósticas estão relacionadas com a necessidade de pesquisa, então elas adquirem uma outra dimensão. Elas passam a ser ferramentas necessárias para a análise dos problemas, ou seja, para a pesquisa em epidemiologia, na clínica, nos processos operacionais ou na medicina social. De acordo com Starfield1, no intervalo de um ano, 75% a 85% da população necessitam apenas de cuidados primários de saúde, sendo que, do remanescente, 10% a 12% precisam de cuidados secundários e 5% a 10% requerem cuidados terciários, ou seja, a grande maioria dos pacientes recebe atendimento médico em ambulatório ou clínicas da atenção primária à saúde. Entretanto, a maior parte das pesquisas ocorre fora desses cenários de prática, criando uma distorção que dificulta a boa prática em medicina de modo geral e na medicina de família em particular4. Por fim, espera-se que a leitura do conteúdo da presente edi
Marloes Amantia van Bokhoven; Stephanie Anna Lenzen; Jerôme Jean Jacques van Dongen; Ramon Daniëls; Anna Beurskens; Trudy van der Weijden
Background: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding
de Villiers, M
A symposium on Learning in Primary Care was held in Cape Town, South Africa, as a pre-conference workshop to the 9th International Ottawa Conference on Medical Education. The aim of this report is to inform medical educationalists of important issues in learning in primary care and to stimulate further debate. Four international speakers gave presentations on their experiences in teaching and learning in primary care. Objective positive outcome measures include acquiring clinical skills equally well in general practice as in hospital, and improved history taking, physical examination and communication skills learning. Students regard the course as an essential requirement for learning and are appreciative of the wider aspect to learning provided by the community, giving a more holistic view of health. A SWOT analysis (strengths, weaknesses, opportunities and threats) of teaching and learning in primary care identified that learning in primary care is of a generalist nature and reality based, but is hampered by a lack of resources. The increased professionalization of teaching in primary care results in better training, cost containment, and improved quality of health care at community level. It is important to focus on turning threats into opportunities. Academic credibility needs to be established by conducting research on learning in primary care and developing the conceptual basis of primary care.
Maddams, Jessica; Miller, Kathryn; Rushforth, Bruno
In the UK, undergraduate curricula have evolved to include a greater proportion of community-based teaching. However, for most students it still remains predominantly a hospital-based training experience. With 50 per cent of all medical graduates in the UK now expected to work in the community, students need to be fully informed about career pathways and opportunities within primary care. A key driver for curriculum change in the UK has been the General Medical Council's guidance in Tomorrow's Doctors, which advocates experience in a variety of health care settings together with career advice at undergraduate level. However, the existing career guidance provision may be inadequate for the current needs of students. We explore what students are doing to combat the lack of primary care focused career guidance: from taking a year out to intercalate in primary care to setting up and running student-led primary care groups. We report on a new UK venture that we hope to launch in consultation with national primary care bodies to provide support and guidance for students considering a career in primary care. Primary care-focused career advice should be incorporated into the undergraduate curriculum. Student-led primary care groups can offer an alternative source of support and guidance. © Blackwell Publishing Ltd 2012.
Qureshi, Nadeem; Armstrong, Sarah; Dhiman, Paula; Saukko, Paula; Middlemass, Joan; Evans, Philip H; Kai, Joe
Evidence of the value of systematically collecting family history in primary care is limited. To evaluate the feasibility of systematically collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment. Pragmatic, matched-pair, cluster randomized, controlled trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 17943542). 24 family practices in the United Kingdom. 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk, seen between July 2007 and March 2009. Participants in control practices had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records. Participants in intervention practices also completed a questionnaire to systematically collect their family history. All participants were informed of their risk status. Participants with high cardiovascular risk were invited for a consultation. The primary outcome was the proportion of participants with high cardiovascular risk (10-year risk ≥ 20%). Other measures included questionnaire completion rate and anxiety score. 98% of participants completed the family history questionnaire. The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practices, compared with 0.3 percentage point in control practices when family history from patient records was incorporated. The 4.5-percentage point difference between groups (95% CI, 1.7 to 7.2 percentage points) remained significant after adjustment for participant and practice characteristics (P = 0.007). Anxiety scores were similar between groups. Relatively few participants were from ethnic minority or less-educated groups. The potential to explore behavioral change and clinical outcomes was limited. Many data were missing for anxiety scores. Systematically
payment for health care services; a widely used strategy to supplement ... and opportunities for sustainable health care financing for low income communities in sub-. Saharan ..... funding and rising costs for health care services, More so, evidence from research studies have ... provider payment method has the potential to.
Reid Sophie C
Full Text Available Abstract Background Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs via a secure website in summary format for medical review. Methods We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored or the attention comparison group (where only daily activities were monitored. Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA Scale. Results Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46. Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post
Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial
Full Text Available Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and
Thomas, K J; Fitter, M; Brazier, J; MacPherson, H; Campbell, M; Nicholl, J P; Roman, M
This paper presents the research protocol for a pragmatic study of the benefits of providing an acupuncture service to patients in primary care with chronic low back pain. The proposal was written in response to a call for bids from the NHS Executive's centrally funded research programme for Health Technology Assessment (HTA). The research question posed was 'Does acupuncture have long-term effectiveness in the management of pain in primary care?' The present study was designed as a collaboration between an interdisciplinary team drawn from health services researchers at the University of Sheffield, acupuncture researchers from the Foundation for Traditional Chinese Medicine in York, and practitioners from general practice and acupuncture in York. The proposal presented here was submitted in response to an invitation from the Commissioning Board following a successful outline bid. It is reproduced here, largely as submitted in January 1998, using the headings under which information was requested. We also present an appendix describing methodological alterations made to the design in response the Commissioning Board's comments on the proposal. We present it in this format to give an idea of the evolution of the design and the process by which the research proposal was shaped. The final working protocol comprises a combination of these two elements.
Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.
The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have
Skolarus, Ted A; Holmes-Rovner, Margaret; Northouse, Laurel L; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond Y; Rovner, David R; Darwish-Yassine, May; Wei, John T
Although the effectiveness of prostate cancer screening is controversial, screening rates have risen dramatically among primary care providers in the United States. The authors' findings suggest more collaboration among primary care and specialty organizations, especially with respect to decision aid endorsement, is needed to achieve more discriminatory and patient-centered prostate cancer screening.
Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.
The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have bee
Walley, John; Lawn, Joy E; Tinker, Anne; de Francisco, Andres; Chopra, Mickey; Rudan, Igor; Bhutta, Zulfiqar A; Black, Robert E
The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and community health workers linked to strengthened primary-care facilities and first-referral services are needed. Furthermore, intersectoral action linking health and development is necessary, including that for better water, sanitation, nutrition, food security, and HIV control. Chronic diseases, mental health, and child development should be addressed. Progress should be measured and accountability assured. We prioritise research questions and suggest actions and measures for stakeholders both locally and globally, which are required to revitalise primary health care.
Punchik, Boris; Shapovalov, Avital; Dwolatzky, Tzvi; Press, Yan
Background The development of screening instruments will help the primary care team to determine when further comprehensive cognitive assessment is necessary. Design A retrospective analysis based on medical records. Patients and setting Patients referred to a comprehensive geriatric assessment unit. Analysis Cognitive screening and assessment included visual-spatial components: the Mini Mental State Examination, the Clock Drawing Test, the Montreal Cognitive Assessment Test, and the Neurotrax (Mindstreams) computerized cognitive assessment battery. Results The average age of the 190 eligible patients was 81.09±5.42 years. Comparing the individual tests with that of the visual-spatial index of Neurotrax, we found the Trail Making B test to be most sensitive (72.4%) and the Cube Test to have the highest specificity (72.8%). A combination of tests resulted in higher sensitivity and lower specificity. Conclusion The use of a combination of visual-spatial tests for screening in neurocognitive disorders should be evaluated in further prospective studies. PMID:26648704
de Graaf Pim; Rotar Pavlič Danica; Zelko Erika; Vintges Marga; Willems Sara; Hanssens Lise
Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations.
de Graaf Pim
Full Text Available Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations.
Full Text Available Background: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority.Objective: This study sought to establish the amount of time that clinical nurse practitioners (CNPs in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care.Methods: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified.Results: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs.Conclusions: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified – task shifting and adjustments in health workerd eployment – as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.
Claire Van Deventer
Full Text Available Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.
van Deventer, Claire; Mash, Bob
Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.
Kathryn M. Magruder
Full Text Available Background and Objectives: Research in the last decade has acknowledged that primary care plays a pivotal role in the delivery of mental health services. The aim of this paper is to review major accomplishments, emerging trends, and continuing gaps concerning mental health problems in primary care in North America. Methods: Literature from North America was reviewed and synthesized. Results: Major accomplishments include: the development and adoption of a number of clinical guidelines specifically for mental health conditions in primary care, the acceptance of the chronic care model as a framework for treating depression in primary care, and the clear adoption of pharmacologic approaches as the predominant mode for treating depression and anxiety. Emerging trends include: the use of non-physician facilitators as care managers in the treatment of depression in primary care, increasing use of technology in the assessment and treatment of mental health conditions in primary care, and dissemination and implementation of integrated mental health treatment approaches. Lingering issues include: the difficulty in moving beyond problem identification and initiation of treatment to sustaining evidence-based treatments, agreement on a common metric to evaluate outcomes, and the stigma still associated with mental illness. Conclusion: Though there now exists a solid and growing evidence base for the delivery of mental health services in primary care, there are still significant challenges which must be overcome in order to make further advances.
Maeseneer, J. De; Driel, M.L. van; Green, L.A.; Weel, C. van
Making evidence from scientific studies available to clinical practice has been expected to directly improve quality of care, but this expectation has not been realised. The notion of quality of care is complex, and quality improvement needs medical, contextual, and policy evidence. In primary care,
Brakel, T. M.; de Flokstra-Blok, B. M. J.; Elberink, J. N. G.; Schuttelaar, M. L. A.; Christoffers, W. A.; Roerdink, E. M.; van der Molen, T.; Dubois, A. E. J.
Background: For many patients suspected of allergy, management is initially and often ultimately the responsibility of general practitioners (GPs). However, previous studies have shown that GPs find that providing such care is difficult, especially when anaphylactic symptoms occur. An area of concer
Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial.
Perry, M.; Draskovic, I.; Achterberg, T. van; Borm, G.F.; Eijken, M.I.J. van; Lucassen, P.; Vernooij-Dassen, M.J.F.J.; Olde Rikkert, M.G.M.
BACKGROUND: Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and
King, James R.
The caring and nurturing of children, which characterize primary education culture, have tended to shape a public perception of primary teaching as "women's work." Several social factors influence men's underrepresentation in the profession of primary education, such as parents not wanting their children exposed to "soft"…
Weijs, Cynthia A; Coe, Jason B; Hecker, Kent G
Final-year veterinary students must meet baseline clinical competency upon completion of their training for entry to practice. Workplace-based assessments (WBAs), widely used in human medical training to assess post-graduate students' professionalism and clinical performance, have recently been adopted in undergraduate veterinary clinical teaching environments. WBAs should support veterinary trainees' learning in a clinical teaching environment, though utility of WBAs within veterinary education may differ from that in medical training due to differences in context and in learners' stage of clinical development. We conducted focus groups with final-year veterinary students and clinical instructors following the implementation of three WBAs (Direct Observation of Procedural Skills [DOPS], the Mini-Clinical evaluation exercise [Mini-CEX], and the In-Training Evaluation Report [ITER]) during a small-animal primary-veterinary-care rotation. Students and clinical instructors viewed the DOPS and Mini-CEX as feasible and valuable learning and assessment tools that offered an overall opportunity for timely in-the-moment feedback. Instructors viewed the ITER as less feasible in the context of a service-oriented veterinary clinical teaching environment. Students believed the ITER had potential to be informative, although in its existing application the ITER had limited utility due to time constraints on instructors that prevented them from providing students with individualized and specific feedback. In service-oriented veterinary clinical teaching environments, successful implementation of WBAs requires balancing provision of feedback to students, time demands on clinical instructors, and flexibility of assessment tools.
Odencrants, Sigrid; Theander, Kersti
To describe nutritional status, meal related situations, food habits and food preferences of patients with chronic obstructive pulmonary disease (COPD) in a Primary health care (PHC) setting. To date, guidelines have mainly focused on underweight patients with COPD, as a low body mass index (BMI) is a risk factor for mortality. However, in recent years there has been an increase in the number of overweight patients with COPD, and therefore nutritional management must be developed to cover problems related to both under and overweight. Descriptive. One hundred and three patients from PHC centres representing COPD stages 2 and 3 were included. The Mini Nutritional Assessment (MNA) was used to collect nutritional status data while semi-structured interviews provided information on food and meal related situations. Mean age was 69 (± 5)years and 45% were women. Among all patients mean BMI was 27 and 14% had a BMI ≤ 21 kg/m(2) . More women (31%) than men (26%) had a BMI ≥ 30 kg/m(2) . According to the MNA screening score, 86% of the patients were assessed as normal or not at risk of malnutrition. The total MNA assessment score revealed that 10 patients were at risk of malnutrition or malnourishment. Problems with meal related situations were mostly associated with eating, and only a small number reported difficulties with shopping or preparing food. In PHC, more patients with COPD were obese than malnourished and their self-reported nutritional status was not always accurate. It is challenging to identify the patient's nutritional status, individualize nutritional care and educate obese patients with COPD at PHC centres. It is necessary to develop screening instruments to assess the risk of both obesity and malnutrition. © 2012 Blackwell Publishing Ltd.
Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial
Lucassen PL; van Eijken MIJ; Borm GF; van Achterberg T; Drašković I; Perry M; Vernooij-Dassen MJFJ; Olde Rikkert MGM
Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-bas...
Haldrup, Steffen; Thomsen, Reimar W; Bro, Flemming
BACKGROUND: Point-of-care testing (POCT) in primary care may improve rational antibiotic prescribing. We examined use of POCT in Denmark, including patient- and general practitioner (GP)-related predictors. METHODS: We linked nationwide health care databases to assess POCT use (C-reactive protein...
Snyder, Barbara K; Burack, Gail D; Petrova, Anna
Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth's experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns.
infection prevention and control programmes for the protection of patients, patient care givers and healthcare ... laundry, pharmacy etc where there is exposure to a .... unused sterile swabs (10) and culture media plates ..... patient safety.
birth attendants, and if there is a proper division of labour amongst the three tiers of the health system. 3 ... Obstetric. Care,. Traditional. Birth. Attendants,. Maternal. Mortality,. Neonatal ..... interview believed that sudden onset of labor and.
This was a cross-sectional, multi clinic study involving 265 mothers whose children had erupted at least a tooth and attending the ... parents, health care workers and personal experiences were the sources of beliefs ..... Ethiopians abroad.
Rosendal, Marianne; Jarbøl, Dorte Ejg; Pedersen, Anette Fischer;
BACKGROUND: Assessment and management of symptoms is a main task in primary care. Symptoms may be defined as 'any subjective evidence of a health problem as perceived by the patient'. In other words, symptoms do not appear as such; symptoms are rather the result of an interpretation process. We a......, including medicalisation of normal phenomena and devaluation of medically unexplained symptoms. Future research in primary care could gain from exploring symptoms as a generic phenomenon and raised awareness of symptom complexity....
Cervical cancer remains a major public health challenge in developing countries ... relation to knowledge on cervical cancer, primary level of education ... Latin America and Southeast Asia. ... practices such as level of awareness, educational.
Smithson, Sarah; Pignone, Michael P
The burden of depression in the United States is substantial. Evidence supports the benefits of screening for depression in all adults, including older patients and pregnant and postpartum women, when coupled with appropriate resources for management of disease. Developing, implementing, and sustaining a high-fidelity screening process is an important first step for improving the care of patients with depression in primary care. Initial treatment for depression should include psychotherapy, pharmacotherapy, or a combination of both. Collaborative care models are evidence-based approaches to depression treatment and follow-up that can be feasibly initiated in the primary care setting. Copyright © 2017 Elsevier Inc. All rights reserved.
Ruymán Brito-Brito, Pedro; Rodríguez-Ramos, Mercedes; Pérez-García-Talavera, Carlos
This is the case of a 61-year-old patient woman that visits her nurse in Primary Health Care to get the control of blood pressure and glycemia. In the last two years has suffered the loss of her husband and of two brothers beside having lived through other vital stressful events that have taken her to a situation of complicated grief. The care plan is realized using the M. Gordon assessment system and standardized languages NANDA, NOC and NIC. The principal aims were the improvement of the depression level and the improvement in the affliction resolution. As suggested interventions were proposed to facilitate the grief and the derivation to a mental health unit. A follow-up of the patient was realized in nursing consultation at Primary health care to weekly intervals, in the beginning, and monthly, later. The evaluation of the care plan reflects an improvement in the criteria of Prigerson's complicated grief; an increase of the recreative activities; the retreat of the mourning that still she was guarding; as well as an improvement in the control of the blood pressure numbers. The attention of nurses before a case of complicated grief turns out to be complex. Nevertheless the suitable accomplishment of certain interventions orientated to facilitating the grief, with a follow-up in consultation, shows the efficiency. The difficulty in the boarding of the psychosocial problems meets increased at the moment of are necessary the nursing diagnostics adapted for every individual case. The work in group between nurses could improves the consensus.
Castillo-Arenas, E; Garrido, V; Serrano-Ortega, S
Skin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate. Data were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement. The most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high. According to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions-especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.
Crampton, Peter; Davis, Peter; Lay-Yee, Roy
Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.
Samuelson, M.; Tedeschi, P.; Aarendonk, D.; Cuesta, C. de la; Groenewegen, P.
Primary care is the central pillar of health care. The increasingly complex health needs of the population and individual patients in a changing society can only be met by promoting interprofessional collaboration (IpC) within primary care teams. The aim of this Position Paper of the European Forum
Dunham, Daniel P; Marcelo, Karen; Baker, David W
Increasing clinical workload with dwindling compensation has challenged primary care medical practices over the past decade. This has led to more physicians leaving and fewer medical trainees entering primary care. In an effort to make primary care practices viable, many groups routinely charge for providing care that was uncompensated in the past. We initiated a program in our practice that charged for certain after-hour and electronic communications, completion of forms outside of office visits, and failure to show for appointments. We assessed the effect on workload, patient adherence to appointments, and financial outcomes. This initiative decreased our physicians' workload, increased physicians' satisfaction, and produced a modest increase in revenues.
Swoboda, W; Hermens, T
Internal medicine specialists involved in primary care will have a leading part in the treatment of geriatric patients with complex healthcare needs in the future. Approved models like specialized geriatric practices, ambulant or mobile geriatric rehabilitation and special geriatric services for nursing homes are available. Essential is a geriatric qualification that fits with the tasks of an internist in primary care. An incentive payment system has to be created for this purpose to improve the treatment of elderly patients.
Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication...
Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt
OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...... most commonly involved in inappropriate prescribing were medications for treatment of peptic ulcer, cardiovascular medications, anti-inflammatory medications, antidepressants, hypnotics and anti-asthmatics. CONCLUSION: The overall prescribing quality in primary care in Copenhagen County, Denmark...
Background Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access. Objective The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceive...
Lifestyle Changes and the Risk of Colorectal Cancer among. Immigrants in the United .... food rich in red meat, animal fat, sugars and refined of CRC in Africa .... region to improve health care delivery and secure the is obtainable in the UK, ...
availability and affordability of ACTs in Secondary Health Care (SHC) facilities in Lagos State and ... percent (37.5%) of the hospitals did not have the drug in stock at the time of visit and drugs had been out of .... Only one in the community pharmacies as single dose .... funding and international competitive bidding for.
proir permission to their pregnant wives to seek care studies, a husband ... two or three male CHOs, while a female CHO getting safe blood, given prior permission for comes once a week .... and note taker, both of whom were native speakers.
Collins, Kerry A.; Wolfe, Vicky V.; Fisman, Sandra; DePace, JoAnne; Steele, Margaret
OBJECTIVE To investigate family physicians’ practice patterns for managing depression and mental health concerns among adolescent and adult patients. DESIGN Cross-sectional survey. SETTING London, Ont, a mid-sized Canadian city. PARTICIPANTS One hundred sixty-three family physicians identified through the London and District Academy of Medicine. MAIN OUTCOME MEASURES Practice patterns for managing depression, including screening, pharmacotherapy, psychotherapy, shared care, and training needs. RESULTS Response rate was 63%. Family physicians reported spending a substantial portion of their time during patient visits (26% to 50%) addressing mental health issues, with depression being the most common issue (51% to 75% of patients with mental health issues). About 40% of respondents did routine mental health screening, and 60% screened patients with risk factors for depression. Shared care with mental health professionals was common (care was shared for 26% to 50% of patients). Physicians and patients were moderately satisfied with shared care, but were frustrated by long waiting lists and communication barriers. Most physicians provided psychotherapy to patients in the form of general advice. Differences in practice patterns were observed; physicians treated more adults than adolescents with depression, and they reported greater comfort in treating adults. Although 33% of physicians described using cognitive behavioural therapy (CBT), they reported having little training in CBT. Moderate interest was expressed in CBT training, with a preference for a workshop format. CONCLUSION Although 40% of family physicians routinely screen patients for mental health issues, depression is often not detected. Satisfaction with shared care can be increased through better communication with mental health professionals. Physicians’ management of adolescent patients can be improved by further medical training, consultation, and collaboration with mental health professionals
Pawełczyk, Agnieszka; Pawełczyk, Tomasz; Bielecki, Jan
This paper analyzes and synthesizes the literature on primary care specialty choice. Motivation for choosing medicine and its impact on recruitment to different types of medical work has been presented. Factors that influence medical students and young doctors to change specialty preference have also been explored. Variables, such as gender, martial status, age, income expectations and prestige, that affect medical students' specialty selection decisions for primary care, have been examined. Personality profiles of primary care physician have been evaluated and the influence of communication skills and knowledge of social psychology on his/her work have been analyzed. It is presented that other traits, such as patient-centeredness, needs to serve society and value orientation, is also associated with increases in numbers of students choosing primary care. The analyze shows that the preference for primary care is connected with being interested in diverse patients and health problems and also with being people-orientated. A survey conducted into Polish medical students' attitudes to primary care and family medicine is presented. There is a negative perception of family medicine among Polish students and doctors because of its long work hours and less time for family, insufficient diagnostic possibilities and monotony It is chosen because of lack of other possibilities, difficulties in employment and opportunity to become 'a specialist' in short time.
Nasser, Mariana Arantes; Nemes, Maria Ines Battistella; Andrade, Marta Campagnoni; Prado, Rogério Ruscitto do; Castanheira, Elen Rose Lodeiro
The objective of this study is to assess performance in sexual and reproductive health of primary health care services of the Brazilian Unified Health System, in the State of São Paulo, Brazil. An evaluative framework was built for sexual and reproductive health with the categorization of 99 indicators in three domains: sexual and reproductive health promotion (25), sexually transmitted infections/AIDS prevention and care (43), and reproductive health care (31). This framework was applied to assess the services responses to the questionnaire of Quality Evaluation of Primary Health Care in the Municipalities of São Paulo State (QualiAB), in 2010. Percentages were calculated for positive responses to indicators and performance in the sexual and reproductive health dimension, according to domains, and their contribution to the overall score in sexual and reproductive health (Friedman), relative participation (Dunn), and correlation (Spearman) was verified. Overall, 2,735 services participated in the study. They were located in 586 municipalities (distributed throughout the 17 regional health departments of São Paulo), of which 70.6% had fewer than 100,000 inhabitants. The overall average performance of these services for sexual and reproductive health is 56.8%. The actions are characterized by: prenatal with adequate beginning and exams, better organization for immediate rather than for late postnatal care, and selective reproductive planning for some contraceptives; prevention based on specific protection, limitations in the prevention of congenital syphilis, in the treatment of sexually transmitted infections, and in the screening of cervical and breast cancer; specific educational activities, with a restricted vulnerability approach, focus on sexuality over reproduction. The domain of reproductive health has greater participation in the overall score, followed by prevention/care and promotion. The three domains are correlated; the domain of prevention/care has
Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.
diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action planning......Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...
Full Text Available Abstract Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87% felt that the monitoring of quality was important and two-thirds (66% felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71% supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners. At the same time, support for the
Background A constructive patient safety culture is a main prerequisite for patient safety and improvement initiatives. Until now, patient safety culture (PSC) research was mainly focused on hospital care, however, it is of equal importance in primary care. Measuring PSC informs practices on their s
Beasley, John W.; Starfield, Barbara; van Weel, Chris; Rosser, Walter W.; Haq, Cynthia L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in pr
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in pr
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in
Stevanović, Ranko; Stanić, Arsen; Varga, Sinisa
The Croatian Ministry of Health started a health care system computerization project aimed at strengthening the collaboration among health care institutions, expert groups and individual health care providers. A tender for informatic system for Primary Health Care (PHC) general practice, pediatrics and gynecology, a vital prerequisite for project realization, has now been closed. Some important reasons for undertaking the project include rationalization of drug utilization, savings through a reduced use of specialists, consultants and hospitalization, then achievement of better cooperation, work distribution, result linking, data quality improvement (by standardization), and ensuring proper information-based decision making. Keeping non-standardized and thus difficult to process data takes too much time of the PHC team time. Since, however, a vast amount of data are collected on only a few indicators, some important information may remain uncovered. Although decisions made by health authorities should rely on evidence and processed information, the authorities spend most of the time working with raw data from which their decisions ultimately derive. The Informatic Technology (IT) in PHC is expected to enable a different approach. PHC teams should be relieved from the tedious task of data gathering and the authorities enabled to work with the information rather than data. The Informatics Communication Technology (ICT) system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. At the national level (National Public Health Informatics System), a software platform will be built for data collection, analysis and distribution. This data collection will be based on the International Classification of Primary Care (ICPC-2) standard to ensure the utilization of medical records and quality assessment. The system permits bi-directional data exchange between
We do not need a crystal ball to see the future. Our web-based future has already arrived in all other aspects of our lives--even our mobile phones. The tools for progress--Personal Health Records, Social Networks, and Online medical information--are widely available. The demand is at hand--Millennials are flexing consumer muscles as they enter the healthcare market. Real "Health Care Reform" requires fundamental changes in practice--which in turn requires effective use of information technologies and adaption to changing consumer expectations. The VHA and the MHS are uniquely capable of leveraging political, academic and technological forces to help move American health care through this millennial transformation. Federal health systems are positioned to demonstrate the value of innovation as America seeks healthcare reform.
Gutiérrez Pérez, M Isabel; Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez
Wounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care -up to 48 hours- and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended. In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate. Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique. Copyright © 2014 Elsevier España, S.L. All rights reserved.
Full Text Available BACKGROUND: Although most people with Type 2 diabetes receive their diabetes care in primary care, only a limited amount is known about the quality of diabetes care in this setting. We investigated the provision and receipt of diabetes care delivered in UK primary care. METHODS: Postal surveys with all healthcare professionals and a random sample of 100 patients with Type 2 diabetes from 99 UK primary care practices. RESULTS: 326/361 (90.3% doctors, 163/186 (87.6% nurses and 3591 patients (41.8% returned a questionnaire. Clinicians reported giving advice about lifestyle behaviours (e.g. 88% would routinely advise about calorie restriction; 99.6% about increasing exercise more often than patients reported having received it (43% and 42% and correlations between clinician and patient report were low. Patients' reported levels of confidence about managing their diabetes were moderately high; a median (range of 21% (3% to 39% of patients reporting being not confident about various areas of diabetes self-management. CONCLUSIONS: Primary care practices have organisational structures in place and are, as judged by routine quality indicators, delivering high quality care. There remain evidence-practice gaps in the care provided and in the self confidence that patients have for key aspects of self management and further research is needed to address these issues. Future research should use robust designs and appropriately designed studies to investigate how best to improve this situation.
Thomas, Paul; Graffy, Jonathan; Wallace, Paul; Kirby, Mike
PURPOSE Theory of effective network operation in primary care is underdeveloped. This study aimed to identify how primary care networks can best integrate academic and service initiatives. METHODS We performed a comparative case study of 4 primary care research networks in North London, England, for the years 1998–2002. Indicators were selected to assess changes in (1) research capacity, (2) multidisciplinary collaboration, and (3) research productivity. We compared the profiles of network outcome with descriptions of their contexts and organizational types from a previous evaluation. RESULTS Together, the networks supported 133 viable projects and 30 others; 399 practitioners, managers, and academics participated in the research teams. How the networks organized themselves was influenced by the circumstances in which they were formed. Different ways of organizing were associated with different outcome profiles. Shared projects and learning spaces helped participants to develop trusted relationships. A top-down, hierarchical approach based on institutional alliances and academic expertise attracted more funding and appeared to be stable. The bottom-up, individualistic network with research practices was good at reflecting on practical primary care concerns. Whole-system methods brought together stakeholder contributions from all parts of the system. CONCLUSIONS Networks can help integrate academic research and service development initiatives by facilitating interorganizational interactions and in shared leadership of projects. Researchers and practitioners stand to gain considerably from an integrated approach in both the short and the long term. Success requires agreement about a set of pathways, learning spaces, and feedback mechanisms to harness the insights and efforts of stakeholders throughout the whole system. PMID:16735525
Email- email@example.com ... households do not use any method for malaria prevention. ... study was conducted to assess the barriers to obtained from Ahmadu Bello University Teaching ..... Environmental Study Team (NEST).2007; p 1-57.
Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen
Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue
Siersma, Volkert; Kousgaard, Marius Brostrøm; Reventlow, Susanne
Rationale, aims and objectives: This study aimed to evaluate the relative effectiveness of electronic and postal reminders for increasing adherence to the quality assurance programme for the international normalized ratio (INR) point-of-care testing (POCT) device inprimary care. Methods: All 213...... family practices that use the Elective Laboratory of the Capital Region, Denmark, and regularly conduct INR POCT were randomly allocated into two similarly sized groups. During the 4-month intervention, these practices were sent either computer reminders (ComRem) or computer generated postal reminders....... Results: Both interventions were associated with an increase in adherence to the split test procedure – a factor 6.00 [95% confidence interval (CI) 4.46–7.72] and 8.22 [95% CI5.87–11.52] for ComRem and Postal, respectively – but there is no evidence that one of the interventions was more effective than...
da Silva, Andréa Tenório Correia; Lopes, Claudia de Souza; Susser, Ezra; Menezes, Paulo Rossi
To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.
Stephanie Giulianne Silva Morelli
Full Text Available Objectives: to analyze the associations between burnout syndrome and individual and work-related characteristics among primary care physicians. Methods: a systematic review was performed using the Medline (PubMed, SciELO, Lilacs and Cochrane databases. In November, 2013, we ran a search based on the descriptors: “professional burnout”, “health personnel”, and “primary care”. We assessed 2,416 titles and 18 studies were selected. Results: the prevalence of burnout was high among primary care physicians. Burnout was associated with physical illnesses, mental disorders, and alcohol and substance abuse. Physicians who had higher levels of emotional exhaustion were more likely to be absent from work, and to change their job. Physicians suffering from burnout were also more likely to increase pharmaceutical expenditure per patient. The work-related characteristics associated with burnout were: length of employment in primary care, number of working hours per week, number of patients attended, type of employment contract, teaching activity, holiday period, and difficulties in dealing with other staff. Conclusion: the high prevalence of burnout among primary care physicians is a major concern for policy makers, since primary care is the cornerstone of health systems, and burnout syndrome can jeopardize the quality of care provided to populations, and the effectiveness of the entire health care system. Understanding the factors associated with burnout allows the development of strategies for intervention and prevention.
Hernández Josep M
Full Text Available Abstract Background Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. Methods/Design Design: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression. Setting: 20 primary care centres in the province of Tarragona (Spain Sample: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV and who need to initiate antidepressant treatment Intervention: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface. Measurements: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial. These interviews will be given at 0, 3, 6 and 12 months. Main variables: Severity of the depressive symptoms, response rate and remission rate. Analysis: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster. Discussion The effectiveness of caring for depression in primary care can be
March Cerdá, Joan Carles; Oviedo-Joekes, Eugenia; Romero Vallecillos, Manuel; Prieto Rodríguez, María Angeles; Danet, Alina
To evaluate the dynamics and establish the emotional map of 8 primary care teams. Descriptive, cross-sectional and multi-site study. Primary care centers in Granada, Cádiz and Málaga, Spain. Simple random sampling of 8 health centers and 272 primary care professionals. A self administered questionnaire with 10 Likert-type questions. Answers were classified by items, media and mode. Leadership is not integrated (0.42 points). Relationships between workers show rivalry, burnout and little sensation of being part of a team, but they are united by support and trust. There is a moderate enthusiasm of team objectives (1.36 points). Professional self esteem is generally positive (1.89 points). Emotional climate of the teams recorded medium values. Aspects as regards integrating leadership and increased enthusiasm towards the common work project need to be improved, following the inter-professional collaborative care model.
I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.
Kayingo, Gerald; Deon Kidd, Vasco; Gilani, Owais; Warner, Mary L
The goal of t his study was to describe the characteristics of primary care teams, activities, and ro les of physician assistant (PA) students as they encounter various primary care sites. An electronic survey was distributed to second year PA students in 12 programs who had completed at least 4 weeks in a primary care rotation. Of the 179 students who responded (response rate 41 %), 88% had completed their primary care rotations in urban settings, mostly in private practices (53%). Physician assistant students reported encountering many types of health care providers on their teams, and the 2 most favored features of the rotations were the interactions with their supervising clinicians and clinical responsibilities. About 68% interacted with other health profession students during their rotation(interprofessional experiential learning). Almost all students completed histories, physical examinations, and treatment plans, but less than 30% reported involvement in billing or care coordination and less than 10% participated in quality improvement projects. More than 60% were satisfied with team-based and interprofessional practices encountered during their primary care rotations, and 39% were more than likely to pursue primary care careers. Team-based prima ry ca re had a positive impact on students, but more exposure to underserved clinical settings, care coordination, quality improvement, and billing is needed to prepare PA students for the practice of the future. This study is t he first of its kind to explore the relationship between primary care sites and PA training in the era of health care reform.
The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's.
study assessed the knowledge and practice of disease surveillance and notification ... for active surveillance especially if an outbreak Health workers play a key role in .... ethical clearance was obtained from the ethics and Eighty one percent of .... Salami S. Knowledge of disease notification among New York: John Wiley ...
Kronfly Rubiano, Eduardo; Rivilla Frias, Daniel; Ortega Abarca, Isabel; Villanueva Villanueva, Montserrat; Beltrán Martínez, Eva; Comellas Villalba, Montserrat; Almeda Ortega, Jesús; Casals Fransi, Jordi; Rico García, Yolanda; Martínez Carmona, Sonia; Carrasco Coria, Rosa; Bonfill Gavaldà, Montserrat; Calderón Loren, Belén; Fernández Fernández, Mercedes; Barranco Oliver, Laura
To determine the prevalence of the risk of depression, major defining characteristics and factors associated with. Sub-study of comprehensive geriatric assessment cross-study. Primary health center. For an estimated 14% prevalence we need a sample of 288 people. From 3854, 290 people ≥75 years were selected. Excluding terminals, chemotherapy, recent surgery, temporary residence, mental retardation, serious psychiatric illness, or under home care. risk of depression (≥2 points on the Goldberg depression subscale. Sociodemographic and five study areas of the Comprehensive Geriatric Assessment: medical -comorbidity, polypharmacy, falls and hospital admissions-, functional -Up&Go Test, Lawton-Brody and Barthel Index-, nutritional -Mini Nutritional Assessment (MNA)-, mental-affective -Pfeiffer Questionnaire and Goldberg scale-, and social. Descriptive analysis and logistic regression. We obtained 290 interviews, with 102 (35.1%) male and mean age of 79.4 years (SD:3.2). The prevalence of the risk of depression was 37.2%, 26.5% in men and 43.1% in women (p=0.005). Association of risk of depression is observed with arterial hypertension (OR:3.87 95% CI:1.61-9.34), cancer (OR:4.12 95%, CI:1.58-10.76), lack of leisure activity (OR:2.75 95%, CI:1.33-5.67), increase of anxiety scale (OR:1.87 95%, CI:1.57-2.22) and decrease in MNA (OR:0.78 95%, CI:0.68-0.9). The prevalence of risk of depression is higher than expected, although overestimated until being confirmed with a diagnostic test. We appreciate new associations of comorbidity variables with risk of depression and corroborate other known. The studied factors that were associated with the risk of depression should be included in future studies of geriatric depression. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Grumbach, Kevin; Bodenheimer, Thomas
In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.
Riley, Anthony J; Harding, Geoffrey; Underwood, Martin R; Carter, Yvonne H
Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness.
Full Text Available BACKGROUND: Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. METHODS: We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. RESULTS: Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%. CONCLUSIONS: In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.
Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia
Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.
The purpose of this literature review is to critically evaluate published protocols on polypharmacy in adults ages 65 and older that are currently used in primary care settings that may potentially lead to fewer adverse drug events. A review of OVID, CINAHL, EBSCO, Cochrane Library, Medline, and PubMed databases was completed using the following key words: protocol, guideline, geriatrics, elderly, older adult, polypharmacy, and primary care. Inclusion criteria were: articles in medical, nursing, and pharmacology journals with an intervention, protocol, or guideline addressing polypharmacy that lead to fewer adverse drug events. Qualitative and quantitative studies were included. Exclusion criteria were: publications prior to the year 1992. A gap exists in the literature. No standardized protocol for addressing polypharmacy in the primary care setting was found. Mnemonics, algorithms, clinical practice guidelines, and clinical strategies for addressing polypharmacy in a variety of health care settings were found throughout the literature. Several screening instruments for use in primary care to assess potentially inappropriate prescription of medications in the elderly, such as the Beers Criteria and the STOPP screening tool, were identified. However, these screening instruments were not included in a standardized protocol to manage polypharmacy in primary care. Polypharmacy in the elderly is a critical problem that may result in adverse drug events such as falls, hospitalizations, and increased expenditures for both the patient and the health care system. No standardized protocols to address polypharmacy specific to the primary care setting were identified in this review of the literature. Given the growing population of elderly in this country and the high number of medications they consume, it is critical to focus on the utilization of a standardized protocol to address the potential harm of polypharmacy in the primary care setting and evaluate its effects on
A.J. ten Cate-Hoek; D.B. Toll; H.R. Büller; A.W. Hoes; K.G. Moons; R. Oudega; H.E. Stoffers; E.F. van der Velde; H.C. van Weert; M.H. Prins; M.A. Joore
Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT. Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test com
Effective communication requires direct interaction between the hospitalist and the primary care provider using a standardized method of information exchange with the opportunity to ask questions and assign accountability for follow-up roles. The discharge summary is part of the process but does not provide the important aspects of handoff, such as closed loop communication and role assignments. Hospital discharge is a significant safety risk for patients, with more than half of discharged patients experiencing at least one error. Hospitalist and primary care providers need to collaborate to develop a standardized system to communicate about shared patients that meets handoff requirements. Copyright © 2014 Elsevier Inc. All rights reserved.
Jan L. Losby
Full Text Available Objectives: Increasing demands on primary care providers have created a need for systems-level initiatives to improve primary care delivery. The purpose of this article is to describe and present outcomes for 2 such initiatives: the Pennsylvania Academy of Family Physicians’ Residency Program Collaborative (RPC and the St Johnsbury Vermont Community Health Team (CHT. Methods: Researchers conducted case studies of the initiatives using mixed methods, including secondary analysis of program and electronic health record data, systematic document review, and interviews. Results: The RPC is a learning collaborative that teaches quality improvement and patient centeredness to primary care providers, residents, clinical support staff, and administrative staff in residency programs. Results show that participation in a higher number of live learning sessions resulted in a significant increase in patient-centered medical home recognition attainment and significant improvements in performance in diabetic process measures including eye examinations (14.3%, P = .004, eye referrals (13.82%, P = .013, foot examinations (15.73%, P = .003, smoking cessation (15.83%, P = .012, and self-management goals (25.45%, P = .001. As a community-clinical linkages model, CHT involves primary care practices, community health workers (CHWs, and community partners. Results suggest that CHT members successfully work together to coordinate comprehensive care for the individuals they serve. Further, individuals exposed to CHWs experienced increased stability in access to health insurance (P = .001 and prescription drugs (P = .000 and the need for health education counseling (P = .000. Conclusion: Findings from this study indicate that these 2 system-level strategies have the promise to improve primary care delivery. Additional research can determine the extent to which these strategies can improve other health outcomes.
Olivera Cañadas, G; Cañada Dorado, A; Drake Canela, M; Fernández-Martínez, B; Ordóñez León, G; Cimas Ballesteros, M
To identify and describe a list of sentinel events (SEs) for Primary Care (PC). A structured experts' consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of "yes", "no", or "yes but with modification". In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses ("yes", "yes with modification"), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs. The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%. Having a list of SEs available in PC will help to improve the management of health care risks. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
Meijler, F.L.; Tweel, I. van der
A better understanding of the pathophysiologic mechanisms that determine the random pattem of ventricular rhythm may assist the primary care physician in treating and guiding atrial fibrillation patients. These mechanisms also form the basis for our understanding of drug action and effect on ventric
Wilson, A.; Windak, A.; Oleszczyk, M.; Wilm, S.; Hasvold, T.; Kringos, D.
This chapter will be devoted to the dimensions which have been grouped in the framework as “process” and that focus on essential features of service delivery in primary care. In addition to the breadth of services delivered, a comparative overview will be provided of variation in access to services,
Honkoop, Pieter Jacob
Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of ‘Controlled asthma’, which means patients experience hardly any symptom
B.W.V. Schouten (Boris); A.M. Bohnen (Arthur); B.W. Koes (Bart); J.A.N. Verhaar (Jan); S.M. Bierma-Zeinstra (Sita); A.M. Lievense (Annet)
markdownabstractBACKGROUND: Trochanteric pain is the second most important diagnosis of hip problems presenting in primary care, but its incidence and prognosis in this context is largely unknown. AIM: To determine the 1- and 5-year prognoses of trochanteric pain and the
In patients suspected of deep venous thrombosis (DVT) in primary care, it is a challenge to discriminate the patients with DVT from those without DVT. The risk of missing the diagnosis and the risk of unnecessary referral and treatment with a potential harmful therapy has to be balanced by the prima
Gindner, L.; Tilemann, L.; Schermer, T.R.J.; Dinant, G.J.; Meyer, F.J.; Szecsenyi, J.; Schneider, A.
BACKGROUND: To evaluate the sensitivity, specificity and predictive values of spirometry for the diagnosis of chronic obstructive pulmonary disease (COPD) and asthma in patients suspected of suffering from an obstructive airway disease (OAD) in primary care. METHODS: Cross sectional diagnostic study
Beasley, J W; Hahn, D L; Wiesen, P; Plane, M B; Manwell, L
A significant portion of research project costs is incurred before the receipt of grant funds. This poses a problem for the initiation of primary care research, especially in community practice settings. Potential investigators need financial support for staff time, training, pilot work, and grant proposal writing if primary care researchers are to compete successfully for grant funds. To find this support, we need to understand and eventually quantify the actual costs of research with attention to those that are incurred before the receipt of grant funds. We outline 10 phases of the research process and provide a model for understanding where costs are incurred and by whom. Costs include those associated with maintaining practice interest in research, supporting practice participation, and disseminating research findings. They may be incurred by either an academic center or a research network, by the practices and physicians themselves, or by an extramural funding source. The needed investment for initiating primary care research can be itemized and, with further research, quantified. This will enhance the arguments for capital investments in the primary care research enterprise.
B.W.V. Schouten (Boris); A.M. Bohnen (Arthur); B.W. Koes (Bart); J.A.N. Verhaar (Jan); S.M. Bierma-Zeinstra (Sita); A.M. Lievense (Annet)
markdownabstractBACKGROUND: Trochanteric pain is the second most important diagnosis of hip problems presenting in primary care, but its incidence and prognosis in this context is largely unknown. AIM: To determine the 1- and 5-year prognoses of trochanteric pain and the predictive
Honkoop, Pieter Jacob
Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of ‘Controlled asthma’, which means patients experience hardly any symptom
Michael K. Gusmano
Full Text Available
Background: The main purpose of this essay is to review the role of primary care in the U.S. health care system and assess the probability that health reform will lead to greater emphasis on primary care.
Methods: The author conducted a literature review to present an historical analysis of policies designed to increase the availability and use of primary care in the U.S.
Results: Despite widespread agreement that the use of primary care should be expanded, U.S. policies have
encouraged the growth of a system that relies predominantly on specialty care. The 2010 health reform
law includes several provisions designed to increase the availability and use of primary care, but the new Congress has threatened to delay the law’s implementation.
Conclusions: As concepts, primary care and prevention enjoy nearly universal support in the U.S., but the reality does not match the rhetoric.
Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen
Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…
Groenewegen, P.P.; Jurgutis, A.
Background: Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care an
Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen
Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…
Full Text Available Stephen Gillam Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK Abstract: Pay-for-performance (P4P schemes have become increasingly common in primary care, and this article reviews their impact. It is based primarily on existing systematic reviews. The evidence suggests that P4P schemes can change health professionals' behavior and improve recorded disease management of those clinical processes that are incentivized. P4P may narrow inequalities in performance comparing deprived with nondeprived areas. However, such schemes have unintended consequences. Whether P4P improves the patient experience, the outcomes of care or population health is less clear. These practical uncertainties mirror the ethical concerns of many clinicians that a reductionist approach to managing markers of chronic disease runs counter to the humanitarian values of family practice. The variation in P4P schemes between countries reflects different historical and organizational contexts. With so much uncertainty regarding the effects of P4P, policy makers are well advised to proceed carefully with the implementation of such schemes until and unless clearer evidence for their cost–benefit emerges. Keywords: financial incentives, pay for performance, quality improvement, primary care
Lymbery, M; Millward, A
This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.
Pressure sore prevention in palliative care is recognized as being an essential element of holistic care, with the primary goal of promoting quality of life for patient and family. Little is known about the incidence of pressure sore development and the use of pressure sore risk assessment tools in palliative care settings. The development of a risk assessment tool specifically for palliative care patients in a 41-bedded specialist palliative care unit is described. The risk assessment tool was developed as part of a tissue viability practice development initiative. The approach adopted in the validation of the Hunters Hill Marie Curie Centre pressure sore risk assessment tool was the comparative analysis of professional judgment of experienced palliative care nurses with the numerical scores achieved during the assessment of risk on 291 patients (529 risk assessment events). This comparative analysis identified the threshold for different degrees of risk for the patient group involved: low risk, medium risk, high risk and very high risk. Further work is being undertaken to evaluate the inter-rater reliability of the new tool. A number of issues are explored in this paper in relation to pressure sore prevention in palliative care: the role of risk assessment tools, the sometimes conflicting aims of trying to ensure comfort and prevent pressure sore damage, and the uncertainties faced by palliative care nurses when they are trying to maintain quality of life for the dying.
Martins, Leonardo Fernandes; Laport, Tamires Jordão; Menezes, Vinicius de Paula; Medeiros, Priscila Bonfante; Ronzani, Telmo Mota
Burnout is characterized by emotional exhaustion, depersonalization and low occupational performance, which may occur among health professionals. This article evaluates burnout among workers in Primary Health Care (PHC) in three small towns in the Zona da Mata Mineira. The study analyzes associations by logistic regression between burnout, socioeconomic, and demographic aspects of work. A total of 149 professionals were selected, 107 of these responded to all questionnaires. To measure burnout, the Maslach Burnout Inventory (MBI) was used and to characterize the professional, a questionnaire assessing three different issues - namely individual and sociodemographic aspects and team area coverage - was used. 101 professionals were classified with positive indication for burnout. The variables present in the backward stepwise logistic regression model positively associated with indicative of burnout were: being younger than the population average (> 29.5 years) and use of drugs, including sedatives, tranquilizers and sleeping pills. The results contribute to the identification of factors associated with burnout and therefore highlight the need for more detailed investigation.
Dowrick, Christopher; Kokanovic, Renata; Hegarty, Kelsey; Griffiths, Frances; Gunn, Jane
Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience - ordinary magic and personal medicine - which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 people, drawn from a longitudinal study of the management of depression in primary care in Victoria, Australia. We also assess how respondents rate personal resilience in comparison with help received from professional sources. Our data are obtained from semi-structured telephone interviews, and analysed inductively through refinement of our theoretical framework. We find substantial evidence of resilience both in terms of ordinary magic - drawing on existing social support and affectional bonds; and in terms of personal medicine - building on personal strengths and expanding positive emotions. There is a strong preference for personal over professional approaches to dealing with mental health problems. We conclude that personal resilience is important in the minds of our respondents, and that these elements should be actively considered in future research involving people with experience of mental health problems.
Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Vanessa Bertoglio Comassetto Antunes de Oliveira
Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.
Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa
At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.
Schmidt, Karen L; Lingler, Jennifer H; Schulz, Richard
Primary care visits of patients with Alzheimer's disease (AD) often involve communication among patients, family caregivers, and primary care physicians (PCPs). The objective of this study was to understand the nature of each individual's verbal participation in these triadic interactions. To define the verbal communication dynamics of AD care triads, we compared verbal participation (percent of total visit speech) by each participant in patient/caregiver/PCP triads. Twenty-three triads were audio taped during a routine primary care visit. Rates of verbal participation were described and effects of patient cognitive status (MMSE score, verbal fluency) on verbal participation were assessed. PCP verbal participation was highest at 53% of total visit speech, followed by caregivers (31%) and patients (16%). Patient cognitive measures were related to patient and caregiver verbal participation, but not to PCP participation. Caregiver satisfaction with interpersonal treatment by PCP was positively related to caregiver's own verbal participation. Caregivers of AD patients and PCPs maintain active, coordinated verbal participation in primary care visits while patients participate less. Encouraging verbal participation by AD patients and their caregivers may increase the AD patient's active role and caregiver satisfaction with primary care visits.
Alghanim, Saad Abdullah
Little is known about the implementation of the patient bill of rights (PBR) in Saudi Arabia. Therefore, this study was conducted to explore to what extent health care recipients and providers know about the bill and its implementation. A cross-sectional survey conducted on health care professionals and patients at Primary Health Care Centers in Riyadh, Saudi Arabia, during July 2010. The study employed a self-administered questionnaire to collect data from 500 patients (aged 18 years or older) and 500 health care providers (physicians and nurses) in primary health care (PHC) centers in Riyadh. Data was collected on the respondents' knowledge of the existence and contents of the bill, the extent to which the bill is implemented, and the obstacles that may hinder bill implementation. The data was analyzed and presented in a descriptive fashion. More than three quarters of patients and one third of PHC providers did not know about the existence of the bill. Among those who knew about its existence, about three quarters of patients and almost half of PHC providers had little (or very little) knowledge about the bill contents. In general, patients scored lower means of perception than PHC staff about the implementation of the bill's aspects. PHC staff reported several obstacles that may hinder the implementation of the PBR in Saudi Arabia. Patients and health care providers lack necessary knowledge about the PBR. More dissemination of information about the bill, taking into account the particularities of the Saudi population is needed. Future research is required to establish measures that are effective in ensuring that patients rights are ensured.
Sheaff, R; Rogers, A; Pickard, S; Marshall, M; Campbell, S; Sibbald, B; Halliwell, S; Roland, M
In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisation of these changes. Clinical governance in PCGs and PCTs displays important parallels with governance in soft bureaucracies, but the concept of soft bureaucracy requires modification to make it more applicable to general practice. In English primary care, governance over rank-and-file doctors is exercised by local professional leaders rather than general managers, harnessing their colleagues' perception of threats to professional autonomy and self-regulation rather than fears of competition as the means of 'soft coercion'.
Milena Soriano Marcolino
Full Text Available Objective: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. Methods: all digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. Results: during the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years, 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001 and lower in patients with hypertension (45.8% vs 63.2%, p <0.001 or diabetes (43.3% vs 63.2%, p <0.001. A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. Conclusion: the prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality.
Baldor, R A; Quirk, M E; Dohan, D
Magnetic resonance imaging (MRI) has recently been introduced in the United States as an imaging technique for clinical use. Initially used by neurologists to view the brain stem, its indications have rapidly expanded to include spine, pelvis, bone marrow, and joints. This has raised concerns over the appropriate, cost-effective use of such an expensive technology. This paper examines MRI scanning patterns that have developed over time in central Massachusetts and surveys primary care knowledge, attitudes, and patterns of utilization. The two MRI centers in central Massachusetts were surveyed for information about the number and types of scans ordered and the specialties of the physicians who ordered the scans. Questionnaires were sent to primary care physicians in Worcester County to assess knowledge and attitudes about MRI and utilization. The data demonstrate changing patterns of MRI utilization over time. Orthopedics has been the specialty with the greatest increase in use, now slightly surpassing neurology in the total number of scans ordered. Primary care physician use has doubled over this same period. Not all primary care physicians utilize MRI, but those who have used the technology have familiarized themselves with its indications and problems and have a better knowledge about its costs. Utilization patterns of MRI have changed considerably in a short time, with primary care physicians requesting use of this new technology much more frequently than when it was first introduced.
In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.
Stephanie K. Young
Full Text Available Background: Primary care in remote communities in northern Canada is delivered primarily by nurses who receive clinical support from physicians in regional centres and the patient transportation system. To improve continuity, quality and access to care in remote northern communities, it is important to understand the perspectives of front-line providers and the complex challenges they face. Objective: To design and implement a survey of primary care providers to identify issues relating to inter-professional communication, clinical support and patient evacuation. Methods: In collaboration with the territorial government and regional health authority partners, we developed a 21-item self-administered questionnaire survey, which could be completed online. The survey was sent to 218 physicians and nurses who were employed in the Northwest Territories (NWT at the time of the survey and were involved in sending patients out of the community and/or receiving patients. The survey also contained an open-ended question at the end seeking comments regarding primary health care. Results: The overall low response rate of 39% among nurses and 19% among physicians threatens the validity of the quantitative results. The majority of providers were satisfied with their ability to communicate with other providers in a timely manner, their freedom to make clinical decisions and their overall experience practicing in the NWT. The patient transfer system appears to work from both the sender and receiver perspectives. However, a common theme reported by nurses was that physicians providing clinical advice, especially short-term locums, were not familiar with the local situation, whilst physicians at the receiving end remarked that the clinical information provided to them often lacked clarity. Conclusions: Important lessons were learnt from the pilot study, especially in better engagement of providers in planning and dissemination. The questionnaire design and the
Rogan, Lisa; Boaden, Ruth
Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.
Full Text Available This paper describes a framework for implementing fuzzy classifications in primary dental care services. Dental practices aim to provide the highest quality services for their patients. To achieve this, it is important that dentists are able to obtain patients' opinions about their experiences in the dental practice and are able to accurately evaluate this. We propose the use of fuzzy classification to combine various assessment criteria into one general measure to assess patients' satisfaction with primary dental care services. The proposed framework can be used in conventional dental practice information systems and easily integrated with those already used. The benefits of using the proposed fuzzy classification approach include more flexible and accurate analysis of patients' feedback, combining verbal and numeric data. To confirm our theory, a prototype was developed based on the Microsoft TM SQL Server database management system for two criteria used in dental practices, namely making an appointment with a dentist and waiting time for dental care services.
Full Text Available Eliza Lai Yi Wong1, Jean Woo2, Elsie Hui3, Carrie Chan2, Wayne LS Chan2, Annie Wai Ling Cheung11School of Public Health and Primary Care, The Chinese University of Hong Kong, 2School of Public Health and Primary Care, Division of Geriatrics, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 3Medical and Geriatric Unit, Shatin Hospital, HK SAR, Hong Kong, People’s Republic of ChinaBackground: Care of diabetes mellitus in the elderly requires an additional perspective to take into account impaired cognitive function, physical function, low level of education, and difficulty making lifestyle changes. Existing services tend to be driven by the views of tertiary and secondary care staff, rather than those of primary care staff and elderly patients. This study aimed to explore the attitudes and preferences of elderly patients with diabetes mellitus towards primary care (clinical care and community program.Method: Elderly patients with diabetes mellitus aged 60 years or above were recruited from governmental diabetes mellitus clinics and diabetes mellitus specific community centers. Three focus group discussions of 14 diabetic elderly patients were conducted and their perspectives on the new service model were assessed. Participants were interviewed according to an open-ended discussion guide which includes the following items: comments on existing clinic follow up and community program, motivation for joining the community program, and suggestions on further clinical services and community service program development.Results: Incapability of the current health service to address their special needs was a common concern in three focus group discussions. The majority highlighted the benefits of the new service program, that is, self-care knowledge and skill, attitudes to living with diabetes mellitus, and supportive network. Key facilitators included experiential learning, a group discussion platform
Álvarez-Cordovés, M M; Mirpuri-Mirpuri, P G; Gonzalez-Losada, J; Chávez-Díaz, B
We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary option...
Bitar, George W; Springer, Paul; Gee, Robert; Graff, Chad; Schydlower, Manuel
Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary care providers are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been described in the literature, few studies have investigated these issues from the first-person perspective of front-line providers. The purpose of this study, therefore, is to provide an in-depth description of primary care providers' attitudes and perceptions of adolescent behavioral health care across a diversity of primary care settings (i.e., Federally Qualified Health Center [FQHC], FQHC-Look Alike, school-based, military). Sixteen focus groups were conducted at 5 primary care clinics. Thematic analysis was used to analyze the focus group data. Obstacles to integration are presented as well as strategies to overcome these challenges, using training and education, working groups, and community collaboratives.
Hestbæk, Lise; Munck, Anders; Hartvigsen, Lisbeth;
Study Design. Baseline description of a multicenter cohort study. Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark. Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations...... in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice. Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented...... separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson's chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out...
Fleming, Sara A; Gutknecht, Nancy C
Naturopathy is a distinct type of primary care medicine that blends age-old healing traditions with scientific advances and current research. Naturopathy is guided by a unique set of principles that recognize the body's innate healing capacity, emphasize disease prevention, and encourage individual responsibility to obtain optimal health. Naturopathic treatment modalities include diet and clinical nutrition, behavioral change, hydrotherapy, homeopathy, botanical medicine, physical medicine, pharmaceuticals, and minor surgery. Naturopathic physicians (NDs) are trained as primary care physicians in 4-year, accredited doctoral-level naturopathic medical schools. At present, there are 15 US states, 2 US territories, and several provinces in Canada, Australia, and New Zealand that recognize licensure for NDs. Published by Elsevier Inc.
Bowie, Paul; Jeffcott, Shelly
In the second paper of this series, we provide a brief overview of the scientific discipline of human factors and ergonomics (HFE). Traditionally the HFE focus in healthcare has been in acute hospital settings which are perceived to exhibit characteristics more similar to other high-risk industries already applying related principles and methods. This paper argues that primary care is an area which could benefit extensively from an HFE approach, specifically in improving the performance and well-being of people and organisations. To this end, we define the purpose of HFE, outline its three specialist sub-domains (physical, cognitive and organisational HFE) and provide examples of guiding HFE principles and practices. Additionally, we describe HFE issues of significance to primary care education, improvement and research and outline early plans for building capacity and capability in this setting.
Rindfleisch, J Adam
Energy medicine modalities, also known as biofield therapies, are perhaps the most mysterious and controversial complementary alternative medicine therapies. Although many of these approaches have existed for millennia, scientific investigation of these techniques is in its early stages; much remains to be learned about mechanisms of action and efficacy. These techniques are increasingly used in clinical and hospital settings and can be incorporated into an integrative primary care practice. This article describes several energy medicine and biofield therapies and outlines key elements they hold in common. Several specific approaches are described. Research findings related to the efficacy of energy medicine are summarized, and proposed mechanisms of action and safety issues are discussed. Guidelines are offered for primary care providers wishing to advise patients about energy medicine or to integrate it into their practices, and Internet and other resources for obtaining additional information are provided.
Sayed Mahdi Madani
Full Text Available the primary health cares are among the individuals’ primary rights and their outsourcing can pave the way to more suitable use of resources for the field inside and outside of the organization and in this way make possible the better cares. The aim of this study was to determine the type of primary health cares that can be outsourced in Iran; this study embarked upon specifying which one, among the primary health cares, has ability of being outsourced by contractors outside the organization. This applied study has been done by a descriptive and cross-sectional method. According to the other studies at first a general framework was founded; hence the main framework with respect to the opinions of 30 experts. Thereafter a questionnaire was compiled for ensuring its correctness and gathering other experts’ opinions. The method of experts’ judgment was used for validity and for its reliability with distribution of 30 copies the method of calculating Cronbach’ salpha, which was 0.925. Then it was distributed among experts and 786 questionnaires were completed and collected; by using the method of factor of factor and confirmatory analysis as well as the descriptive statistics we embarked upon investigating and deducing the results. For statistical investigation the software SPSS21 and AMOS20 were used. In the factor of outsourcing activities one factor only covering 55.25% of variables variance was discovered. The results suggest that the item q10, “possibility of outsourcing the concrete activities”, with factor load of 0.791 and the item q6, "outsourcing and standardization", with factor load of 0.668 have respectively the highest load and the lowest one in the definition of the factor of cares of outsourcing. The more the primary health cares are more concrete, more simple, more standardized and have the further differentiability, their successful outsourcing is highly possible; in addition only those activities are able to be
Breathlessness is a high-volume problem with 10% of adults experiencing the symptom daily placing a heavy burden on the health and wider economy. As it worsens, they enter the specialist and hospital-based symptom services where costs quickly escalate and people may find themselves in a place not of their choosing. For many, their care will be delivered by a disease or organ specialist and can find themselves passing between physicians without coordination for symptom support. General practitioners (GPs) will be familiar with this scenario and can often feel out of their depth. Recent advances in our thinking about breathlessness symptom management can offer opportunities and a sense of hope when the GP is faced with this situation. Original research, reviews and other findings over the last 12-18 months that pertain to the value that general practice and the wider primary care system can add, include opportunities to help people recognize they have a problem that can be treated. We present systems that support decisions made by primary healthcare professionals and an increasingly strong case that a solution is required in primary care for an ageing and frail population where breathlessness will be common. Primary care practitioners and leaders must start to realize the importance of recognizing and acting early in the life course of the person with breathlessness because its impact is enormous. They will need to work closely with public health colleagues and learn from specialists who have been doing this work usually with people near to the end of life translating the skills and knowledge further upstream to allow people to live well and remain near home and in their communities.
Full Text Available This article is part of the series on African primary care research and focuses on participatory action research. The article gives an overview of the emancipatory-critical research paradigm, the key characteristics and different types of participatory action research. Following this it describes in detail the methodological issues involved in professional participatory action research and running a cooperative inquiry group. The article is intended to help students with writing their research proposal.
Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede
sectors.METHOD. A number of focus group interviews were conducted with three types of subgroups: 1) Bereaved relatives, 2) GPs and 3) Various health-care-professionals, namely community nurses, hospital physicians and GPs. The interviews were transcribed and analysed according to a phenomenological......BACKGROUND. Palliative care for cancer patients is an important part of a GP's work. Although every GP is frequently involved in care for terminally ill cancer patients, only little is known about how these palliative efforts are perceived by the patients and their families, a knowledge...... that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care...
Pereboom, M.T.R.; Manniën, J.; Spelten, E.R.; Hutton, E.K.; Schellevis, F.G.
Objective: to assess the knowledge of cytomegalovirus (CMV) infection among Dutch primary care midwives, and clinical approaches to informing women about CMV. Design: cross-sectional study, using self-administered questionnaires. Participants: 330 Dutch primary care midwives. Setting: primary midwif
Full Text Available Paolo Mannelli,1 Li-Tzy Wu1–41Department of Psychiatry and Behavioral Sciences, 2Department of Medicine, 3Duke Clinical Research Institute, Duke University Medical Center, 4Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USARecent reports on prescription opioid misuse and abuse have described unprecedented peaks of a national crisis and the only answer is to expand prevention and treatment, including different levels of care.1 Nonetheless, concerns remain about the ability of busy primary care settings to manage problem opioid users along with other patients. In particular, proposed extensions of buprenorphine treatment, a critically effective intervention for opioid use disorder (OUD, are cautiously considered due to the potential risk of misuse or abuse.2 General practitioners are already facing this burden daily in the treatment of chronic pain, and expert supervision and treatment model adjustment are needed to help improve outcomes. Approximately 20% of patients in primary care have noncancer pain symptoms, with most of them receiving opioid prescriptions by their physicians, and their number is increasing.3 Pain diagnoses are comparable in severity to those of tertiary centers and are complicated by significant psychiatric comorbidity, with a measurable lifetime risk of developing OUD.4,5 Some primary care physicians report frustration about opioid abuse and diversion by their patients; support from pain specialists would improve their competence, the quality f their performance, and the ability to identify patients at risk of opioid misuse.6 Thus, buprenorphine treatment should not be adding to a complex clinical scenario. To this end, the promising models of care emphasize the integration of medical with psychological and pharmacological expertise for the management of OUD.
Eshet, I; Van Relta, R; Margalit, A; Baharir, Z
This department of family medicine has been challenged with helping a group of Russian immigrant physicians find places in primary care clinics, quickly and at minimal expense. A 3-month course was set up based on the Family Practice Residency Syllabus and the SFATAM approach, led by teachers and tutors from our department. 30 newly immigrated Russian physicians participated. The course included: lectures and exercises in treatment and communication with patients with a variety of common medical problems in the primary care setting; improvement of fluency in Hebrew relevant to the work setting; and information on the function of primary care and professional clinics. Before-and-after questionnaires evaluating optimal use of a 10- minute meeting with a client presenting with headache were administered. The data showed that the physicians had learned to use more psychosocial diagnostic question and more psychosocial interventions. There was a cleared trend toward greater awareness of the patient's environment, his family, social connections and work. There was no change in biomedical inquiry and interventions but a clear trend to a decrease in recommendations for tests and in referrals. The authors recommend the following didactic tools: adopting a biopsychosocial attitude, active participation of students in the learning situation, working in small groups, use of simulations and video clips, and acquiring basic communication experience.
Bhui, Kamaldeep; Bhugra, Dinesh; Goldberg, David; Sauer, Justin; Tylee, Andre
Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.
Full Text Available Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004 and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.
Healthcare system intervention for safer use of medicines in elderly patients in primary care-a qualitative study of the participants' perceptions of self-assessment, peer review, feedback and agreement for change.
Lenander, Cecilia; Bondesson, Åsa; Midlöv, Patrik; Viberg, Nina
The elderly population is increasing and with advanced age comes a higher risk for contracting diseases and excessive medicine use. Polypharmacy can lead to drug-related problems and an increased need of health care. More needs to be done to help overcome these problems. In order for new models to be successful and possible to implement in health care they have to be accepted by caregivers. The aim of this study was to evaluate participants' perceptions of the SÄKLÄK project, which aims to enhance medication safety, especially for elderly patients, in primary care. This is a qualitative study within the SÄKLÄK project. The SÄKLÄK project is a multi-professional intervention in primary care consisting of self-assessment, peer review, feedback and written agreements for change. A total of 17 participants from the intervention's primary care units were interviewed. Most of the interviews were done on a one-to-one basis. The interviews were recorded and transcribed verbatim. A survey was also sent to the primary care unit heads. Qualitative content analysis was used to explore the participants' perceptions. The analysis of the interviews yielded six categories: multi-professional co-operation, a focus on areas of improvement, the joy of sharing knowledge, disappointment with the focus of the feedback, spend time to save time and impact on work. From these categories a theme developed: "Medication safety is a large area. In order to make improvements time needs to be invested and different professions must contribute." This study shows that our studied intervention method is feasible to use in primary care and that the multi-professional approach was perceived as being very positive by the participants. Multi-professional co-operation was time consuming, but was also deemed as an investment and an opportunity to share knowledge. Some points of improvement of the method were identified such as simplification of the self-assessment form and clearer instructions for
Anna Bryndis Blondal
Full Text Available Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient’s medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher’s notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125 before and between general practitioners’ interviews. The study setting was a primary care clinic in the Reykjavik area and the patients’ homes. Results showed that the GPs’ knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space
Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick
In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.
As part of the primary care strategy, the Governments of the Americas have included the agricultural and animal health sectors among the public health activities of the Plan of Action. This means that both sectors--agricultural and veterinary--must be guided in their work by a multidisciplinary and multisectoral approach, with full community participation. Hence, it is certain that both the study of veterinary medicine and the practice of the profession in the Region will have to be reoriented so that they may be more fully integrated with the primary care strategy. The reorientation of animal health activities is the subject of this paper. There can be no doubt that animal health has a vital part to play in improving the quality of human life and that veterinary practice itself offers excellent opportunities for building a sense of personal and community responsibility for the promotion, care, and restoration of health. Through their contact with the rural population while caring for their livestock (an integral part of the rural socioeconomic structures), the veterinarian and animal health assistant establish close bonds of trust not only with farmers, but with their families and the entire community as well; they are thus well placed to enlist community participation in a variety of veterinary public health activities such as zoonoses control, hygiene programs, and so forth. While the goal of the Plan of action is to extend primary care to the entire population, the lack of material and human resources requires that priority attention be given to the needs of the more vulnerable groups, including the extremely poor living in rural and urban areas. These are the groups at greatest risk from the zoonoses still present in the Americas. In the face of these facts, it is clear that primary care in the animal health field should be based on the application in each country of proven, effective, appropriate technology by personnel who, whether new or retrained, are well
Lin, Ching-Pin; Guirguis-Blake, Janelle; Keppel, Gina A; Dobie, Sharon; Osborn, Justin; Cole, Allison M; Baldwin, Laura-Mae
Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings. To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework. Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure. Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.
Antônio Thomaz Gonzaga da Matta-Machado
Full Text Available Objective. To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ. Materials and methods. A cross-sectional study was conducted through interviews with 16 960 profes- sionals in Brazil in 2012. To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. Results. A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health. The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. Conclusion. Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.
Full Text Available BACKGROUND: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. METHODOLOGY/PRINCIPAL FINDINGS: We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe. After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort. Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV and 97.8% negative predictive value of (NPV for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort the PPV for AD was 39.1% (52% for any dementia in the test cohort. CONCLUSIONS: The prediction score has useful prediction accuracy. It can define individuals (1 sensitively for low cost-low risk interventions, or (2 more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs.
Trotter, Tracy L; Martin, Helen M
The family history is a critical element in pediatric medicine and represents the gateway to the molecular age of medicine for both pediatric clinicians and their patients. The pediatric clinician has several opportunities to obtain a family history and multiple clinical and educational uses for that information. Available methods include paper and digital forms, classical pedigrees, online programs, and focused family history at the time of a new diagnosis or problem. Numerous barriers impede the application of family history information to primary pediatric practice. The most common barrier is the limited amount of time the typical primary care encounter allows for its collection. The family history can be used in many facets of pediatric practice: (1) as a diagnostic tool and guide to testing and evaluation; (2) to identify patterns of inheritance; and (3) as a patient-education tool. The most exciting future use of family history is as a tool for public health and preventive medicine. More accurately identifying children at risk for common chronic conditions such as diabetes, asthma, and cardiovascular disease could change the primary care clinician's approach to pediatric medicine.
Noël, Polly Hitchcock; Lanham, Holly J; Palmer, Ray F; Leykum, Luci K; Parchman, Michael L
Recent research from a complexity theory perspective suggests that implementation of complex models of care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams. Our primary aim was to assess the extent to which practice member perceptions of relational coordination and reciprocal learning were associated with the presence of CCM elements in community-based primary care practices. We used baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM and improve risk factor control for patients with Type 2 diabetes in small primary care practices. Practice members (i.e., physicians, nonphysician providers, and staff) completed baseline assessments, which included the Relational Coordination Scale, Reciprocal Learning Scale, and the Assessment of Chronic Illness Care (ACIC) survey, along with items assessing individual and clinic characteristics. To assess the association between Relational Coordination, Reciprocal Learning, and ACIC, we used a series of hierarchical linear regression models accounting for clustering of individual practice members within clinics and controlling for individual- and practice-level characteristics and tested for mediation effects. A total of 283 practice members from 39 clinics completed baseline measures. Relational Coordination scores were significantly and positively associated with ACIC scores (Model 1). When Reciprocal Learning was added, Relational Coordination remained a significant yet notably attenuated predictor of ACIC (Model 2). The mediation effect was significant (z = 9.3, p < .01); 24% of the association between Relational Coordination and ACIC scores was explained by Reciprocal Learning. Of the individual- and practice-level covariates included in Model 3, only the presence of an electronic medical record was significant; Relational Coordination and Reciprocal Learning remained significant
Aline do Amaral Zils
Full Text Available Users' satisfaction is an important end-point to evaluate health services. This study has to do with an assessment of the level of user's satisfaction with relation to the last visit held in the primary health care network of Porto Alegre — RS, whose objective is to compare satisfaction of the users that assess the quality of the care process received as being of high APS score with that of the users who evaluate it as low APS score. A cross-sectional study based on the population, using the Primary Care Assessment Tool - PCATool, which enables the classification of the health services at the level of guidance to APS by means of the general score of primary care, defining it as high or low, in accordance with the users' experience. The satisfaction of the user was measured by a questionnaire consisting of twelve questions relative to the last visit, being measured by a 5-item Likert scale: "very good", "good", "regular", "bad" and "very bad". For the analysis, the results were grouped into two classifications, i.e. "satisfied", when referred as "veg good" or "good", and "dissatisfied" when referred to any of the other items. A significant difference was noticed in the 12 variables reflecting satisfaction in several aspects of the visit, showing higher satisfaction in users that classified the service as being of high score. The .general evaluation of the service presented 95.6% and 73.5% of "satisfied" in the services with high and low APS score, respectively (p<0.001. Users of services with high level of guidance to primary care obtain higher satisfaction in their visits. This higher satisfaction can benefit the decision-making process of the patient in face of the medical recommendations made.
Brant, Jeannine M; Blaseg, Karyl; Aders, Kathy; Oliver, Dona; Gray, Evan; Dudley, William N
To examine symptom and quality-of-life (QOL) trajectories in breast cancer and lymphoma survivors enrolled in a survivorship navigation intervention and to explore patient, caregiver, and primary care provider (PCP) satisfaction with receipt of a survivorship care plan (SCP). . Prospective, cohort, longitudinal. . The Billings Clinic, an integrated cancer center in Montana. . 67 patients with breast cancer or lymphoma who recently completed cancer treatment, along with 39 of their caregivers and 23 PCPs. . Data collection at one, three, and six months by the Functional Assessment of Cancer Therapy-General and satisfaction surveys. . Symptoms, QOL, and satisfaction with the survivorship navigator and the SCP. . Symptoms persisted six months following treatment. Symptoms and QOL indicators with worst intensity were energy, sleep, coping, and satisfaction with sex life. Patients with more comorbidities reported worse QOL, telephoned the survivorship navigator more often, and were more satisfied with the SCP. Patients with lymphoma reported higher QOL, but it was not significantly different from patients with breast cancer. Patients were significantly more satisfied than caregivers with the SCP at time 1. PCPs were highly satisfied with the SCP. . Some symptoms persist, even when cancer treatment has ended. Patients with comorbidities are at higher risk for more severe symptoms and worse QOL and may benefit from ongoing support. SCPs can facilitate patients' transition to primary care following cancer treatment. . Healthcare professionals who care for breast cancer survivors need to routinely assess them for the presence of comorbid conditions. Obese breast cancer survivors may benefit from weight reduction interventions to possibly decrease their risk of developing lymphedema and improve their overall health status.
Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth
This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior.
Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Kay Johnson, N.; Shanette Granstaff, U.; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.
Objectives. We compared homeless patients’ experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the “Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient–clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient–clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Conclusions. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness. PMID:24148052
Even though most countries have committed to primary health care (PHC), South Africa, a middle-income country, has an inadequate PHC system. The poor system has roots in the colonial period and apartheid reinforces this system. Race, class, and place of residence determine the type of health care individuals receive. South Africa falls far short of all 5 principles of PHC. Just 12% of the health budget goes to 40% of the population who live in the homelands which shows the inequitable distribution of health care resources and inadequate quality health care for all. Similarly, South Africa has not altered its communication and education techniques to improve preventive and promotive health services. It has not implemented any successful national campaigns such as a campaign against diarrhea deaths. South Africa does not make good use of available appropriate technology such as breast feeding, oral rehydration, refrigeration, and the ventilated improved pit latrine which lead to health for all. People in South Africa discuss community participation but it is not likely to occur without general political democracy. Some people have made local attempts at community participation but they tend to use inflexible means and request either cash or contributions in kind from people who have little. The elite in South Africa has not recognized the need to correct socioeconomic inequalities. The Population Development Plan Programme among white farmer-owners has showed some support for a multisectoral approach to improve health care, however. For example, it acknowledges that non-health-care interventions such as better salaries, literacy, and living conditions, lead to better health. The Department of National Health has discussed improved coordination of the budget to allow priority determination of national PHD and manpower plans. Nongovernmental organizations are beginning to use the PHC approach instead of the charitable approach.
García-Molina Sáez, Celia; Urbieta Sanz, Elena; Madrigal de Torres, Manuel; Piñera Salmerón, Pascual; Pérez Cárceles, María D
To quantify and to evaluate the reliability of Primary Care (PC) computerised medication records of as an information source of patient chronic medications, and to identify associated factors with the presence of discrepancies. A descriptive cross-sectional study. General Referral Hospital in Murcia. Patients admitted to the cardiology-chest diseases unit, during the months of February to April 2013, on home treatment, who agreed to participate in the study. Evaluation of the reliability of Primary Care computerised medication records by analysing the concordance, by identifying discrepancies, between the active medication in these records and that recorded in pharmacist interview with the patient/caregiver. Identification of associated factors with the presence of discrepancies was analysed using a multivariate logistic regression. The study included a total of 308 patients with a mean of 70.9 years (13.0 SD). The concordance of active ingredients was 83.7%, and this decreased to 34.7% when taking the dosage into account. Discrepancies were found in 97.1% of patients. The most frequent discrepancy was omission of frequency (35.6%), commission (drug added unjustifiably) (14.6%), and drug omission (12.7%). Age older than 65 years (1.98 [1.08 to 3.64]), multiple chronic diseases (1.89 [1.04 to 3.42]), and have a narcotic or psychotropic drug prescribed (2.22 [1.16 to 4.24]), were the factors associated with the presence of discrepancies. Primary Care computerised medication records, although of undoubted interest, are not be reliable enough to be used as the sole source of information on patient chronic medications when admitted to hospital. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Hall, Charles B; Brazil, Kevin; Wakefield, Dorothy; Lerer, Trudy; Tennen, Howard
The purpose of this study is to examine how organizational culture and job satisfaction affect clinician turnover in primary care pediatric practices. One hundred thirty clinicians from 36 primary care pediatric practices completed the Primary Care Organizational Questionnaire (PCOQ), which evaluates interactions among members of the practice and job-related attributes measuring 8 organizational factors, along with a separate 3-item instrument measuring job satisfaction. Random effects logistic models were used to assess the associations between job satisfaction, the organizational factors from the PCOQ, and clinician turnover over the subsequent year. All 8 measured organizational factors from the PCOQ, particularly perceived effectiveness, were associated with job satisfaction. Five of the 8 organizational factors were also associated with clinician turnover. The effects of the organizational factors on turnover were substantially reduced in a model that included job satisfaction; only 1 organizational factor, communication between clinicians and nonclinicians, remained significant (P = .05). This suggests that organizational culture affects subsequent clinician turnover primarily through its effect on job satisfaction. Organizational culture, in particular perceived effectiveness and communication, affects job satisfaction, which in turn affects clinician turnover in primary care pediatric practices. Strategies to improve job satisfaction through changes in organizational culture could potentially reduce clinician turnover.
Sabando Carranza, J A; Cortés Martinez, M; Calvo Carrasco, D
Several cases of mucocele have been treated in our Primary Health Care centre. These are benign lesions, relatively frequent (2.5/1000), which is caused by a retention of mucous from the minor salivary glands into the oral cavity, mainly at the level of the lower lip. The experience in their treatment in this centre is presented, along with a review of the literature to see if our treatment was correct. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Ross, Andrew; Mash, Bob
This is the second article in the series on African primary care research. The article focuses on how to search for relevant evidence in the published literature that can be used in the development of a research proposal. The article addresses the style of writing required and the nature of the arguments for the social and scientific value of the proposed study, as well as the use of literature in conceptual frameworks and in the methods. Finally, the article looks at how to keep track of the literature used and to reference it appropriately.
Full Text Available This is the second article in the series on African primary care research. The article focuses on how to search for relevant evidence in the published literature that can be used in the development of a research proposal. The article addresses the style of writing required and the nature of the arguments for the social and scientific value of the proposed study, as well as the use of literature in conceptual frameworks and in the methods. Finally, the article looks athow to keep track of the literature used and to reference it appropriately.
Leung, Marcia A; Flaherty, Anna; Zhang, Julia A; Hara, Jared; Barber, Wayne; Burgess, Lawrence
The primary care physician's role in recognizing sudden sensorineural hearing (SSNHL) loss and delivering initial treatment is critical in the management of the syndrome. This role involves recognizing its clinical symptoms, distinguishing it from conductive hearing loss with the Weber tuning fork or the Rauch hum test, and urgent administration of high dose oral corticosteroids. Diagnosis and treatment should not be delayed for audiometric testing or referral to otolaryngology. This paper provides an update on the initial evaluation and treatment of this syndrome based on the literature and clinical guideline recommendations.
Kurtz, Kenneth J.
The recent establishment of primary care residencies at the University of Nevada School of Medicine has raised important questions about local priorities in the training of physicians to provide primary care for adults. Because the amount of money available for health care training is decreasing, these questions also have national importance. Primary care internal medicine, not synonymous with general internal medicine, offers distinct advantages to patients over family practice adult care and primary care offered by internist subspecialists. The University of Nevada has a singular opportunity to organize a strong primary care internal medicine residency, but national problems of internal medicine emphasis exist. Nationwide changes in internal medicine residency programs (ongoing) and American Board of Internal Medicine nationalization of the fledgling primary care internal medicine fellowship movement are suggested. Specifically proposed is an extra year for primary care training with a single examination after four years, producing general internists with a primary care “minor.” Alternately, and ideally, there would be a full two-year primary care fellowship with a separate internal medicine primary care subspecialty board examination. Either of the above options would provide necessary training and academic credibility for primary care internists, and would redirect internal medicine certification and training. PMID:7072246
Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface
Hart, Huberta E.; Rutten, Guy E H M
In the Netherlands so-called Diabetes Care Groups organize the primary diabetes care centrally with delegation to different health care providers. A training course for general practitioners who would like to become experts in diabetology in the primary care setting meets the need to guide the quali
Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style
Wasson, J; Keller, A; Rubenstein, L; Hays, R; Nelson, E; Johnson, D
In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice is difficult because the necessary steps require time, thought, recording, and follow-up. Attention to the office ecosystem is very important before any patient care management method is introduced. The clinician must transform the results of health status screening into a specific functional diagnosis. The clinician has to understand the sensitivity, specificity, and predictive value of the measure for a preliminary diagnosis to be made. Often, additional measurements must be taken to establish a specific diagnosis. These steps encompass assessment linkage. Once the specific cause for the dysfunction is recognized, the clinician then has to determine the need for special resources. This is called the resource linkage. By following the steps outlined in this paper, the clinician should be able to overcome many obstacles for functional health status assessment in busy ambulatory settings.
Kastner, Theodore A.; Walsh, Kevin K.
Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…
Almeida, Patty Fidelis de; Santos, Adriano Maia Dos
To analyze the breadth of care coordination by Primary Health Care in three health regions. This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde. Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia. A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de servi
Vilà Falgueras, Maite; Cruzate Muñoz, Carlota; Orfila Pernas, Francesc; Creixell Sureda, Joan; González López, María Pilar; Davins Miralles, Josep
To estimate the prevalence of burnout and the perception of teamwork in Primary Care teams from Barcelona. Multicenter cross-sectional. Primary Health Care Teams from Barcelona. Institut Català de la Salut. All permanent employees or temporary professionals of all categories from 51 teams (N=2398). A total of 879 responses (36.7%) were obtained. The Maslach Burnout Inventory questionnaire, with 3 dimensions, was sent by emotional exhaustion (AE), depersonalization (DP), and personal accomplishment (RP). Burnout is considered present when two or more dimensions scored high marks. Perception of teamwork and evaluation of leaders was evaluated using an ad hoc questionnaire. The prevalence of burnout was17.2% (two or more dimensions affected), and 46.2% had at least one of the three dimensions with a high level. A high level of AE was found in 38.2%, of DP in 23.8%, and 7.7% had low RP. Almost half (49.2%) believe that teamwork is encouraged in their workplace. Social workers overall, have a higher average of dimensions affected at a high level, followed by administrative personnel, dentists, doctors and nurses (pteamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (pTeamwork and appreciating their leaders protect from burnout. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.
Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M
Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.
Catalán, Arantxa; Borrell, Francesc; Pons, Angels; Amado, Ester; Baena, José Miguel; Morales, Vicente
The Institut Català de la Salut (ICS) has designed and integrated in electronic clinical station of primary care a new software tool to support the prescription of drugs, which can detect on-line certain medication errors. The software called PREFASEG (stands for Secure drug prescriptions) aims to prevent adverse events related to medication use in the field of primary health care (PHC). This study was made on the computerized medical record called CPT, which is used by all PHC physicians in our institution -3,750- and prescribing physicians through it. PREFASEG integrated in eCAP in July 2010 and six months later we performed a cross-sectional study to evaluate their usefulness and refine their design. The software alerts on-line in 5 dimensions: drug interactions, redundant treatments, allergies, contraindications of drugs with disease, and advises against drugs in over 75 years. PREFASEG generated 1,162,765 alerts (1 per 10 high treatment), with the detection of therapeutic duplication (62%) the most alerted. The overall acceptance rate is 35%, redundancies pharmacological (43%) and allergies (26%) are the most accepted. A total of 10,808 professionals (doctors and nurses) have accepted some of the recommendations of the program. PREFASEG is a feasible and highly efficient strategy to achieve an objective of Quality Plan for the NHS.
Gutiérrez Angulo, María Luisa; Amenabar Azurmendi, Miren Dolores; Cuesta Solé, María Lourdes; Prieto Esteban, Irene; Mancebo Martínez, Sara; Iglesias Alonso, Amparo
To ascertain the prevalence of obesity and overweight recording in primary care (PC) clinical records. A descriptive, cross-sectional study. The study was conducted in three urban, primary care centers in Gipuzkoa. 620 computerized clinical records randomly selected from a population of 63,820. Patient age older than 14 years was the only inclusion criterion. Recording of the clinical episode referring to obesity and/or overweight. Other variables included age, sex, body mass index (BMI), waist circumference, comorbidity (diabetes, hypertension, heart failure, among others), and variability of the record made by healthcre professionals at each center. Statistical analysis included a Chi-square test or a Fisher's test for low frequencies. A value of P<.05 was considered significant. Analysis was performed using SPSS(®) v.21 software. Prevalence of recorded obesity was 6%, and 78.4% of those with recorded obesity were women. Overweight was recorded in 3% of subjects, of which 33.2% were women. BMI was recorded in 170 cases (27%). At least one comorbidity was found in 241 subjects (39%). Association of BMI with presence of comorbidity was statistically significant (P=.0001). Recording of obesity was associated to presence of comorbidity (P =.0002). This study confirmed that prevalence of obesity is underestimated, mainly because it is inadequately recorded in clinical histories; that prevalence increases in the presence of other risk factors; and that there is a significant variability in data collection between healthcare professionals. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.
Ricketts, T C
Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.
Pang, Junxiong; Hildon, Zoe Jane-Lara; Thein, Tun Linn; Jin, Jing; Leo, Yee Sin
Dengue results in high morbidity and mortality globally. The knowledge, attitude and practices (KAP) of dengue management, including diagnosis, among primary care physicians (PCPs) are important to reduce dengue transmission and burden. However, there is a lack of understanding on the impact of dengue epidemic on dengue management. Hence, the aim of this study is to examine the changes in KAP on dengue management among PCPs before and after the largest dengue epidemic in 2013 in Singapore. Surveys were mailed to 2000 and 1514 PCPs registered under the Singapore Medical Council in March of year 2011 and 2014, respectively. Survey data were then collected between April and June of that year. Chi-square or Fisher's exact test was used for comparing categorical variables. A multivariate logistic regression model was implemented to determine independent factors for frequent use of dengue diagnostic tests (DDTs). All tests were conducted at 5% level of significance. Adjusted odds ratio and corresponding 95% confidence intervals were reported, where applicable. Qualitative data were descriptively coded for themes and analysis. Among PCPs surveyed in 2011 and 2014, 89.9% and 86% had good knowledge on dengue management respectively. The usage of DDTs had increased significantly in 2014 (N = 164;56%) as compared to 2011 (N = 107;29.5%) in both private and public clinics (p Dengue Duo point-of-care test (POCT) kits was independently associated with frequent use of DDTs (adjusted odds ratio = 2.15; 95% confidence interval = 1.25-3.69). There was a significant reduction in referral of dengue patients to hospital (31.4% in 2011; 13.3% in 2014; p dengue management can be improved with availability of POCT kit, better awareness of the disease and any revised clinical guidelines. The knowledge on dengue management remained high, while the attitude and practices, particularly on the usage of DDTs improved significantly after a large epidemic. Furthermore, PCPs had more
Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H
With the advent of antiretroviral therapy and improved access to care, the average life expectancy of patients with HIV infection receiving optimal treatment approaches that of patients in the general population. AIDS-related opportunistic infections and malignancies are no longer the primary issues; instead, traditional age- and lifestyle-related conditions are a growing concern. Patients with HIV infection are at higher risk of cardiovascular disease, diabetes, hypertension, and some non-AIDS-related cancers than patients in the general population. Family physicians need to be knowledgeable about screening for and managing chronic comorbid conditions as this population ages. Health maintenance, including appropriate vaccinations, prophylaxis against opportunistic infections, and routine screening for sexually transmitted infections, remains an important part of care. As HIV infection becomes a chronic condition, emerging strategies in prevention, including preexposure prophylaxis, fall within the scope of practice of the family physician.
Shearer, David S
The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.
Kuo Christina L
Full Text Available Abstract Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.
Allwright Shane PA
Full Text Available Abstract Background An industrial dispute between prison doctors and the Irish Prison Service (IPS took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. Methods This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. Results There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available. Conclusions People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons.
Davis, G L; Boulger, J G; Hovland, J C; Hoven, N T
Mental health care shortages in rural areas have resulted in the majority of services being offered through primary medical care settings. The authors argue that a paradigm shift must occur so that those in need of mental health care have reasonable, timely access to these services. Changes proposed include integrating mental health services into primary medical care settings, moving away from the traditional view of mental health care services (one therapist, one hour, and one client), and increasing the consultative role of psychologists and other mental health care providers in primary medical care. Characteristics of mental health providers that facilitate effective integration into primary medical care are presented. The results of a needs assessment survey and an example of a telemental health project are described. This project involved brief consultations with patients and their physicians from a shared care model using a broadband internet telecommunications link between a rural clinic and mental health service providers in an urban area.
Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators
Pollyanna Kássia de Oliveira Borges
Full Text Available Objective: to check the profile of sensitive causes hospitalizations for primary care. Methods: this is an ecological, epidemiological study. Data was collected in the Hospital Information System at the Department of Health System Information, grouped according to the admissions list for Sensitive to Primary Causes of Health System. Results: there were 227,014 hospitalizations, 25.8% of them were sensitive to Primary care. The illnesses which caused sensitive admissions were pneumonia (n=19,832; 33.7%, heart failure (n=6,688, 11.3%, and gastroenteritis (n=6,287, 10.7%. Conclusion: sensitive hospitalizations for primary care have decreasing historical trend in the study area. Primary care services, with guidelines and principles, well conducted could minimize the risk of exacerbation of chronic conditions and also endorse lower rates of infection transmitted diseases.
Frigola-Capell, Eva; Pareja-Rossell, Clara; Gens-Barber, Montse; Oliva-Oliva, Glòria; Alava-Cano, Fernando; Wensing, Michel; Davins-Miralles, Josep
ABSTRACT Background: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. Objective: To present an international framework for patient safety indicators in primary care. Methods: Literature review and online Delphi-survey, starting from the Catalan model. Results: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. Conclusion: The framework can be used to organize indicator development and guide further work in the field. PMID:26339833
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
Kriegel, J; Rebhandl, E; Reckwitz, N; Hockl, W
Current and projected general practitioner (GP) and primary care in Austria shows structural and process inadequacies in the quality as well as assurance of healthcare supply. The aim is therefore to develop solution- and patient-oriented measures that take patient-related requirements and medical perspectives into account. Using an effect matrix, subjective expert and user priorities were ascertained, cause and effect relationships were examined, and an expanded circle of success for the optimization of GP and primary care in Upper Austria was developed. Through this, the relevant levers for target-oriented development and optimization of the complex system of GP and primary care in Upper Austria were identified; these are training to become general practitioners, entrepreneurs as well as management and coordination. It is necessary to further adapt the identified levers conceptually and operationally in a targeted approach. This is to be achieved by means of the primary health care (PHC) concept as well as management tools and information and communication technologies (ICT) associated with it. © Georg Thieme Verlag KG Stuttgart · New York.
Cabeza, Elena; March, Sebastià; Cabezas, Carmen; Segura, Andreu
This article argues for the need to implement community healthcare promotion initiatives in medical practice. Some of the community initiatives introduced in primary care, as well as scientific evidence and associated implementation factors are described. The need for effective coordination between primary care and public health services, working with the community, is underlined. Two specific coordination initiatives are explained by way of example. The first is a project to develop healthcare plans in health centres in the Balearic Islands, by means of a participatory process with the collaboration of citizens, local organisations and the town council (urban planning, mobility, social services, etc.). The second is the Interdepartmental Public Health Plan of Catalonia, which was established to coordinate cross-sectoral healthcare. A specific part of this plan is the COMSalud project, the purpose of which is to introduce a community perspective to health centres and which is currently being piloted in 16 health areas. We review the proposals of a 2008 research study to implement healthcare promotion in primary care, assessing its achievements and shortfalls. The Disease Prevention and Health Promotion Strategy of the Spanish Ministry of Health is recognised as an opportunity to coordinate primary and public health. It is concluded that this change of mentality will require both financial and human resources to come to fruition. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Muthyala Pavana Sandhya
Full Text Available Background: Primary dental care can be a way of achieving good oral health for the community. This can be achieved by integration of oral health care with the existing primary health care activities through training of primary health care workers on aspects of oral health. Objective: To assess the effectiveness of oral health education among primary health care workers at the primary health center (PHC in Nellore district, Andhra Pradesh. Materials and Methods: Descriptive longitudinal study was conducted from June 2010 to August 2010 at a PHC. Knowledge about oral health among primary health care workers was pretested using a self-administered questionnaire prepared in local language (Telugu. Later after a month health education was provided to the health workers, and pamphlets with information on oral health were distributed. Posttest assessment was done 1-month after providing health education using the same questionnaire. Statistical analysis was performed using the SPSS 12.0 software, Student′s t-test was used to compare knowledge scores between pre and posttests. Results: A total of 118 Primary Health Care Workers with the majority in the 20-30 years age group participated in the study. Posttest assessment showed a change in knowledge level with an overall increase in knowledge level of primary health care workers with a mean difference of 12.56 ± 3.23, which was highly significant (P < 0.001. Conclusion: The knowledge about oral health was poor, and it improved after providing health education to primary health care workers. Change in knowledge was appreciable and may play a key role in oral health promotion of the vast majority of the rural population.
Performance assessment through pre- and post-training evaluation of continuing medical education courses in prevention and management of cardio-vascular diseases in primary health care facilities of Armenia.
Khachatryan, Lilit; Balalian, Arin
To assess the difference of pre- and post-training performance evaluation of continuing medical education (CME) courses in cardio-vascular diseases (CVD) management among physicians at primary health care facilities of Armenian regions we conducted an evaluation survey. 212 medical records were surveyed on assessment of performance before and after the training courses through a self-employed structured questionnaire. Analysis of survey revealed statistically significant differences (p evaluation of performance assessment may be explained by improved and interactive training modes, more advanced methods of demonstration of modeling. Current findings may serve a basis for future planning of CME courses for physicians of remote areas facing challenges in upgrading their knowledge, as well as expand the experience of performance assessment along with evaluation of knowledge scores.
Full Text Available Background: The primary health care workers of a district in northern India were trained in the year 2006 for Integrated Management of Neonatal and Childhood Illness (IMNCI using two different training methods: conventional 8-day training and new interrupted 5-day training. Knowledge and skills may decline over a period of time. Rate of decline may be associated with the type of training. A study was thus conducted to see the retention of knowledge and skills in the two training groups, 3 years after the initial training. Materials and Methods: This study was done in the Panchkula district of Haryana state in northern India. In the year 2006, 50 primary health care workers were given new interrupted 5-day training and another 35 workers were given conventional 8-day training on IMNCI. Knowledge and skills of the same workers were evaluated in the year 2009, using the same methodology and tools as were used in the year 2006. Data analysis was done to see the extent of decline in knowledge and skills in these 3 years and whether decline was more in any particular training group. Results: Compared to post-training score in the year 2006, composite knowledge and skill scores for Auxilliary Nurse Midwives (ANMs and Anganwari workers (AWWs together declined significantly in the year 2009 from 74.6 to 58.0 in 8-day training group and from 73.2 to 57.0 in 5-day training group (P < 0.001. Follow-up composite scores in the two training groups were similar. Whereas the decline was more for knowledge scores in 8-day training group and for skill score in 5-day training group, the pattern of decline was inconsistent for different health conditions and among ANMs and AWWs. Conclusion: Long-term retention of knowledge and skills in 5-day group was equivalent to that in 8-day training group. Refresher trainings may boost up the decline in the knowledge and skills.
Roseira, Camila Eugenia; da Silva, Darlyani Mariano; Passos, Isis Pienta Batista Dias; Orlandi, Fabiana Souza; Padoveze, Maria Clara; de Figueiredo, Rosely Moralez
ABSTRACT Objective: identify the compliance of health care product processing in Primary Health Care and assess possible differences in the compliance among the services characterized as Primary Health Care Service and Family Health Service. Method: quantitative, observational, descriptive and inferential study with the application of structure, process and outcome indicators of the health care product processing at ten services in an interior city of the State of São Paulo - Brazil. Results: for all indicators, the compliance indices were inferior to the ideal levels. No statistically significant difference was found in the indicators between the two types of services investigated. The health care product cleaning indicators obtained the lowest compliance index, while the indicator technical-operational resources for the preparation, conditioning, disinfection/sterilization, storage and distribution of health care products obtained the best index. Conclusion: the diagnosis of compliance of health care product processing at the services assessed indicates that the quality of the process is jeopardized, as no results close to ideal levels were obtained at any service. In addition, no statistically significant difference in these indicators was found between the two types of services studied. PMID:27878220
Camila Eugenia Roseira
Full Text Available ABSTRACT Objective: identify the compliance of health care product processing in Primary Health Care and assess possible differences in the compliance among the services characterized as Primary Health Care Service and Family Health Service. Method: quantitative, observational, descriptive and inferential study with the application of structure, process and outcome indicators of the health care product processing at ten services in an interior city of the State of São Paulo - Brazil. Results: for all indicators, the compliance indices were inferior to the ideal levels. No statistically significant difference was found in the indicators between the two types of services investigated. The health care product cleaning indicators obtained the lowest compliance index, while the indicator technical-operational resources for the preparation, conditioning, disinfection/sterilization, storage and distribution of health care products obtained the best index. Conclusion: the diagnosis of compliance of health care product processing at the services assessed indicates that the quality of the process is jeopardized, as no results close to ideal levels were obtained at any service. In addition, no statistically significant difference in these indicators was found between the two types of services studied.
Goodwin, Elizabeth; Frew, Emma J
In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment
Kristensen, Troels; Rose Olsen, Kim
Aim: We analyze total operating costs and activities in Danish General Practice units to assess whether there are unexploited economies of scope in the production of primary care services. Methods: We apply stochastic frontier analysis to derive cost functions and associated cost complementarities...... between GP services and overall economies of scope. Data: Cross-section data for a sample of 331 primary care practices with 1-8 GPs from the year 2006. This is a unique combined dataset consisting of survey and register data. Results: We find a trend towards cost complementarities between the production...... economies of scope in the production of GP services. Conclusions: Our preliminary results show that there were overall economies of scope associated with the joint production of a) standard consultations, b) email/phone consultations and c) home visits. Cost complementarities between standard consultations...
Dienye, Paul O; Gbeneol, Precious K
Domestic violence against men is rare in Nigeria. This study was aimed at assessing the prevalence of domestic violence against men, the sociodemographic characteristics of victims, and the pattern of injury sustained in a primary care setting. This was a retrospective study over a period of 5 years in which all the medical records of patients were retrieved and information on domestic violence extracted from them and transferred to a data sheet. Those whose records were grossly deficient were excluded from the study. A total of 220,000 patients were seen of which 48 (22 per 100,000) were victims of domestic violence. There were only five married male victims with a prevalence of 0.0023%. The injuries observed were scratches, bruises, welts, and scalds. The primary care physician needs a high index of suspicion to be able to detect it.
Offerhaus, P; Fleuren, M; Wensing, M
Objective: to assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. Design: cross-sectional survey study. Setting: primary-care midwifery in The Netherlands. Pa
Offerhaus, P.M.; Fleuren, M.; Wensing, M.J.P.
OBJECTIVE: To assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. DESIGN: Cross-sectional survey study. SETTING: Primary-care midwifery in The Netherlands. PA
Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc
AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general p
Alonso Porcel, C; Martínez Ibán, M; Arboleya Álvarez, L; Suárez Gil, P; Sánchez Rodríguez, L M
To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage. Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated. The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor. The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Martin-Misener, Ruth; Kilpatrick, Kelley; Donald, Faith; Bryant-Lukosius, Denise; Rayner, Jennifer; Valaitis, Ruta; Carter, Nancy; Miller, Patricia A; Landry, Véronique; Harbman, Patricia; Charbonneau-Smith, Renee; McKinlay, R James; Ziegler, Erin; Boesveld, Sarah; Lamb, Alyson
activities relevant to community-based primary health care nurse practitioners. Tools to measure all the components of these role are needed when determining panel/caseload size. Outcomes research is absent in the determination of panel/caseload size. There are few systems in place to track and measure community-based primary health care nurse practitioner activities. The development of such mechanisms is an important next step to assess community-based primary health care nurse practitioner productivity and determine patient panel/caseload size. Decisions about panel/caseload size must take into account the effects of nurse practitioner activities on outcomes of care. Copyright © 2016 Elsevier Ltd. All rights reserved.
Letícia Fernandez Frigo
Full Text Available Rationale and Objectives: Currently Diabetes Mellitus (DM is confi gured as a major public health problems in Brazil, making it one of the most common chronic disorders in the world. Thus, this study focused strategies made by health professionals in primary care, education of patients with type 2 diabetes in primary care in order to contribute to the promotion of health. Methods: This is a literature on the application of scientifi c strategies, which aims to gather and synthesize publications and conduct a critical assessment of them. Data collection was conducted between March and May 2012, the following electronic databases: CAPES (Coordination of Improvement of Higher Education Personnel, Brazil, Scientifi c Electronic Library Online - SciELO, LILACS, Google Scholar andSBD (Brazilian Society Diabetes, where 14 articles were selected. Results: The present study showed advances knowledge regarding diabetes and changes in educational strategies used that aimed to understand their effects on disease control and management of self-care. Also, lets discuss the possible limits and options for improving the process of health education, interdisciplinary care related to diabetes. Conclusion: The educational practice presents itself as the best way to educate people with diabetes about the importance of improving dietary habits and their own care. It is a time when individuals and health professionals discussing all the information about the disease and treatment. KEYWORDS: Health education. Strategies. Diabetes Mellitus Type2.
Knight, Emily; Stuckey, Melanie I; Petrella, Robert J
Physical activity guidelines recommend engaging in moderate- and vigorous-intensity physical activity to elicit health benefits. Similarly, these higher intensity ranges for activity are typically targeted in healthy living interventions (ie, exercise prescription). Comparatively less attention has been focused on changing lower intensity physical activity (ie, sedentary activity) behaviors. The purpose of this study was to explore the effects of prescribing changes to physical activity of various intensities (ie, sedentary through exercise) through the primary care setting. Sixty older adults (aged 55-75 years; mean age 63 = 5 years) volunteered to participate, and were randomly assigned to 4 groups: 3 receiving an activity prescription intervention targeting a specific intensity of physical activity (exercise, sedentary, or both), and 1 control group. During the 12-week intervention period participants followed personalized activity programs at home. Basic clinical measures (anthropometrics, blood pressure, aerobic fitness) and blood panel for assessing cardiometabolic risk (glucose, lipid profile) were conducted at baseline (week 0) and follow-up (week 12) in a primary care office. There were no differences between groups at baseline (P > 0.05). The intervention changed clinical (F₅,₅₀ = 20.458, P = 0.000, ηP² = 0.672) and blood panel measures (F₅,₅₀ = 4.576, P = 0.002, ηP² = 0.314) of cardiometabolic health. Post hoc analyses indicted no differences between groups (P > 0.05). Physical activity prescription of various intensities through the primary care setting improved cardiometabolic health status. To our knowledge, this is the first report of sedentary behavior prescription (alone, or combined with exercise) in primary care. The findings support the ongoing practice of fitness assessment and physical activity prescription for chronic disease management and prevention.
van Straten Annemieke
Full Text Available Abstract Background Depressive and anxiety disorders are common in general practice but not always treated adequately. Introducing stepped care might improve this. In this randomized trial we examined the effectiveness of such a stepped care model. Methods The study population consisted of primary care attendees aged 18-65 years with minor or major DSM-IV depressive and/or anxiety disorders, recruited through screening. We randomized 120 patients to either stepped care or care as usual. The stepped care program consisted of (1 watchful waiting, (2 guided self-help, (3 short face-to-face Problem Solving Treatment and (4 pharmacotherapy and/or specialized mental health care. Patients were assessed at baseline and after 8, 16 and 24 weeks. Results Symptoms of depression and anxiety decreased significantly over time for both groups. However, there was no statistically significant difference between the two groups (IDS: P = 0.35 and HADS: P = 0.64. The largest, but not significant, effect (d = -0.21 was found for anxiety on T3. In both groups approximately 48% of the patients were recovered from their DSM-IV diagnosis at the final 6 months assessment. Conclusions In summary we could not demonstrate that stepped care for depression and anxiety in general practice was more effective than care as usual. Possible reasons are discussed. Trial Registration Current Controlled Trails: ISRCTN17831610.
Mark, Annabelle L; Shepherd, Ifan D H
This paper considers how NHS Direct is affecting demand for primary care in particular out-of-hours services from GPs. This is reviewed through a 3-year study of NHS Direct and HARMONI, the integrated telephone health helpline based in West London. It describes the policy background and development of the services on the site, and some of the outcomes of the HARMONI commissioned research to answer the question 'Has NHS Direct increased the workload for HARMONI doctors?'. The research adopted both a qualitative and quantitative approach using cross-sectional and longitudinal analysis of the data collected. The analysis of the data reveals the issues as both complex and dynamic in nature. The research shows that while there has been no significant change to the total volume of activity, changes within patient groups notably the elderly and children, and in individual GP practices may be significant. In addition, the changes in organizational arrangements may influence significant changes in referral patterns such as GP out-of-hours visits. This was confirmed in the interview data indicating a link between the change in nurses' role from gatekeeper to patient advocate, which happened when they ceased to be employees of the part-time co-op and began to work instead for the 24 hours, 7 days a week NHS Direct service. The conclusions drawn are that behavioural and organizational changes are at least as significant as the evidence-based computerized decision support software in changing the demand for primary care. Further evidence cited is that a different demand pattern of calls was experienced by those local GPs not integrated into out-of-hours provision at NHS Direct West London at the time of the study.
Full Text Available Iran is a large country with a total area of 1,645,000 square kilometers. The country’s population is estimated at about 31 millions. There is an uneven distribution of the population, varying from 2 to 50 per square kilometer. Sixty per cent of the total population (18 millions is living in nearly 66,000 small and large village’s scattered throughout the country. A total of 10,000 physicians provide the main source of medical manpower, however more than 40% of these physicians are located in the capital city of Teheran. The physician to population ratio for the country is about 1 per 3,000 and the figure reaches 100,000 in some rural areas. Each year a total of 600 graduates is added to the health manpower , but technical and socio-economic handicapping factors make the rural and low-income areas less attractive to the new graduates. In this paper the reconstruction of health services around the concept of Primary Medical Care has been reposed for the country’s health development. Taking into consideration the country’s special geographical and demographic features, two levels of primary care workers have been suggested; the first group with 4 year’s training in curative and preventive services, and the second group at grade 9 level in education. It is foreseen that the two afore-mentioned groups will form a network of auxiliaries to the physicians in extending health services to the remote areas of the country.
Flokstra - de Blok, Bertine MJ; van der Molen, Thys; Christoffers, Wianda A; Kocks, Janwillem WH; Oei, Richard L; Oude Elberink, Joanne NG; Roerdink, Emmy M; Schuttelaar, Marie Louise; van der Velde, Jantina L; Brakel, Thecla M; Dubois, Anthony EJ
Background Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. Methods Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. Results The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2). Conclusion Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients. PMID:28352197
Goyal, Neera K; Hall, Eric S; Kahn, Robert S; Wexelblatt, Scott L; Greenberg, James M; Samaan, Zeina M; Brown, Courtney M
Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as ≤ or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization.
This is a retrospective report on the importance of Kark and Cassel's 1952 paper on community-oriented primary care (COPC). In 1978, WHO and UNICEF endorsed COPC. However, the ideas girding and framing this approach had first been given full expression in practice some four decades earlier. In Depression-Era South Africa, Sidney Kark, a leader of the National Department of Health, converted the emergent discipline of social medicine into a unique form of comprehensive practice and established the Pholela Health Center, which was the explicit model for COPC. COPC as founded and practiced by Kark was a community, family and personal practice; it also was a multidisciplinary and team practice. Furthermore, the innovations of COPC entailed monitoring, evaluation, and research. Evaluation is the essence of Kark and Kassel's paper, which offers a convincing demonstration of the effects of COPC. Its key findings include the following: 1) that there was a decline in the incidence of syphilis in the area served by the health center; 2) that diet and nutrition improved; and 3) that the crude mortality rate as well as the infant mortality rate--the standard marker--declined in Pholela. In the succeeding decades, OPC had an international legacy (through WHO and H. Jack Geiger's influence in the US Office of Economic Opportunity), which came full circle in the 1980s, when a young generation of South Africans began to search their history for models for their health care programs at the dawn of the post-Apartheid Era.
Young, Melodie; Aldredge, Lakshi; Parker, Patti
Primary care practitioners (PCPs) are playing an increasingly important role in the management and care of psoriasis. Thus, it is important for PCPs to be knowledgeable about the disease and to be able to differentiate between common myths and facts related to diagnosis and treatment. By building relationships with their patients and working collaboratively with dermatology health professionals and other specialists, PCPs can facilitate communication about the patient's treatment preferences and expectations for symptom relief, and they may be better able to work with the patient to optimize treatment adherence. This review aims to provide PCPs with a primer on psoriasis, its associated comorbidities, and its impact on patients' quality of life. Discussion topics include psoriasis epidemiology, triggering factors, clinical presentation, differential diagnosis, comorbidities, and approaches to treatment. This review also highlights the importance of staying abreast of advances in the understanding of psoriasis pathogenesis as well as emerging therapeutic treatment options, because these advances may change the treatment landscape and increase patients' expectations for skin clearance. ©2017 American Association of Nurse Practitioners.
Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher
Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Kringos, D.S.; Boerma, W.G.W.
Background: The investment in primary care (PC) reforms to improve the overall performance of health care systems has been substantial in Europe. There is however a lack of up to date comparable information to evaluate the development and strength of PC systems. This EU-funded Primary Health Care A
Eisenberg, John M.
The organization and curricula of internal medicine residencies programs that emphasize primary care are described and compared with traditional residencies in internal medicine. It is noted that primary care residents spend more time in ambulatory care and are allowed more electives in specialties outside of internal medicine. Out-of-hospital…
Dinny H. de Bakker
Full Text Available
Background: Primary care in the Netherlands has a strong international reputation. However, this picture may be qualified in two respects. First of all, the Dutch primary care system is less cohesive than is sometimes suggested. Secondly, there are major challenges in the Dutch system (as is the case with other European health care systems, which have to be resolved in order to maintain and improve primary care. Methods: Description of primary care in the Netherlands based on nationally and internationally published sources. Identification of challenges and trends. Narrative review of the literature.
Results: GPs have a strong position in the Netherlands. Their numbers are relatively low; they have a gatekeeping position, and there is no cost-sharing for GP care (unlike other forms of care. The primary care system as a whole, however, is characterised by weak coherence. Individual primary care disciplines have their own separate modes of funding. Challenges include a growing and changing demand for primary care services, and changes in manpower and organisation, that affect the balance between demand and supply regarding primary care services.
Conclusions: Among the threats to strong primary care are the risk of increasing fragmentation of care, negative side effects of a transformation process from cottage industry to service industry, and reluctance to invest in integrated primary care. An opportunity lies in the consensus among stakeholders that integrated primary care has a future. Technological developments support this, especially the development of electronic patient records.
Mary E W Dankbaar
Full Text Available Each year over 1.5 million health care professionals attend emergency care courses. Despite high stakes for patients and extensive resources involved, little evidence exists on the quality of assessment. The aim of this study was to evaluate the validity and reliability of commonly used formats in assessing emergency care skills.Residents were assessed at the end of a 2-week emergency course; a subgroup was videotaped. Psychometric analyses were conducted to assess the validity and inter-rater reliability of the assessment instrument, which included a checklist, a 9-item competency scale and a global performance scale.A group of 144 residents and 12 raters participated in the study; 22 residents were videotaped and re-assessed by 8 raters. The checklists showed limited validity and poor inter-rater reliability for the dimensions "correct" and "timely" (ICC = .30 and.39 resp.. The competency scale had good construct validity, consisting of a clinical and a communication subscale. The internal consistency of the (subscales was high (α = .93/.91/.86. The inter-rater reliability was moderate for the clinical competency subscale (.49 and the global performance scale (.50, but poor for the communication subscale (.27. A generalizability study showed that for a reliable assessment 5-13 raters are needed when using checklists, and four when using the clinical competency scale or the global performance scale.This study shows poor validity and reliability for assessing emergency skills with checklists but good validity and moderate reliability with clinical competency or global performance scales. Involving more raters can improve the reliability substantially. Recommendations are made to improve this high stakes skill assessment.
Isabel Cristina Ramos Vieira Santos
Full Text Available This study aimed to describe the treatment of patients with wounds in the Primary Health Care. A descriptive research with quantitative approach. Ninety-three Family Health Units of the city of Recife-PE, Brazil, were selected, and 112 nurses were interviewed from July to December 2011. The record book of bandages and procedures and the dressing form were used as an additional source of data. Frequencies, measures of central tendency and dispersion, prevalence and, for continuous variables, the analysis of variance were estimated. The prevalence of patients with wounds was 1.9% of the estimated covered population. Vascular ulcers accounted for 74.1% of the treated wounds. The dressing was predominantly performed by Nursing technicians, and the products available for this procedure did not match the current technological development.
Assessment and prevention of behavioural and social risk factors associated with oral cancer: protocol for a systematic review of clinical guidelines and systematic reviews to inform Primary Care dental professionals.
Mathur, Sweta; Conway, David I; Worlledge-Andrew, Heather; Macpherson, Lorna M D; Ross, Alastair J
Tobacco and alcohol are recognised as the major risk factors for both oral cavity (mouth) and oropharyngeal (throat) cancers, with increasing acceptance of the role of human papillomavirus (HPV) in the aetiology of oropharyngeal cancers. In addition, there is a significant increased risk for oral cancer among lower socioeconomic groups, males and older age groups. There is a growing evidence for the potential role of primary care professionals in smoking cessation and reducing alcohol-related harm. However, there are uncertainties about the best approaches/strategies to assess risk factors associated with oral cancer, effective components of preventive interventions for behaviour change and implementation strategies in primary care dental settings. Thus, in order to contribute to the prevention of oral cancer effectively, dental professionals need to assess patients on the major risk factors (tobacco, alcohol and HPV/sexual behaviours) and deliver appropriate prevention, taking into account the patient's sociodemographic context. The study aims to synthesise evidence on the best practice for undertaking an assessment of major behavioural risk factors associated with oral cancer and delivering effective behaviour change preventive interventions (e.g. advice, counselling, patient recall, signposting/referral to preventive services) by dental professionals in primary care dental settings. The study involves a systematic review and evidence appraisal. We will search for clinical guidelines and systematic reviews from the following databases: Cochrane Library, Ovid MEDLINE, EMBASE, Web of Science, PsychINFO, PubMed, TRIP and Google Scholar. We will also search websites of professional organisations/agencies and bibliographies/reference lists of selected papers. Quality will be assessed with the AGREE II (Appraisal of Guidelines for Research & Evaluation II) instrument for included clinical guidelines and the AMSTAR (A Measurement Tool to Assess Systematic Reviews) and
Torner, Nuria; Godoy, Pere; Soldevila, Núria; Toledo, Diana; Rius, Cristina; Domínguez, Angela
Health personnel are at risk of acquiring influenza infection and of nosocomial influenza transmission. The objective of this study was to assess the relationship between the knowledge and attitudes of primary care health personnel in Catalonia as regards influenza vaccine and the factors related to the uptake of this vaccine. A cross-sectional study using a web survey. Primary care health personnel of the Catalan Health Institute. A total of 1212 primary health care personnel were included in the survey. Those who had medical reasons for being or not being vaccinated were excluded. A total of 423 replies were valid, with a 46.6% overall vaccination coverage. Vaccination rate was higher among 45 to 54 year-olds, paediatricians, those vaccinated in preceding seasons, and those living with chronic patients. There was an association between having received the vaccine and considering vaccination the best preventive action, advocating vaccination to at risk population, concern about acquiring influenza, and considering health personnel vaccination important. Actions taken to increase vaccination rate among health personnel should aim at correcting lack of knowledge and misconceptions about influenza vaccination of health personnel. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Silberman, Jordan; Tentler, Aleksey; Ramgopal, Rajeev; Epstein, Ronald M
Effective treatments can be rendered useless by poor patient recall of treatment instructions. Studies suggest that patients forget a great deal of important information and that recall can be increased through recall-promoting behaviors (RPBs) like repetition or summarization. To assess how frequently RPBs are used in primary care, and to reveal how they might be applied more effectively. Recordings of 49 unannounced standardized patient (SP) visits were obtained using hidden audiorecorders. All SPs presented with typical gastroesophageal reflux disease symptoms. Transcripts were coded for treatment recommendations and RPBs. Forty-nine primary care physicians. Of 1,140 RPBs, 53.7% were repetitions, 28.2% were communication of the rationale for a treatment, 11.7% were categorizations of treatments (i.e., stating that a treatment could be placed into a treatment category, such as medication-related or lifestyle-related categories), and 3.8% were emphasis of a recommendation's importance. Physicians varied substantially in their use of most RPBs, although no physicians summarized or asked patients to restate recommendations. The number of RPBs was positively correlated with visit length. Primary care physicians apply most RPBs inconsistently, do not utilize several RPBs that are particularly helpful, and may use RPBs inefficiently. Simple principles guiding RPB use may help physicians apply these communication tools more effectively.
Banasiak, Nancy Cantey
Spirometry is an essential part of diagnosing a child with asthma. The National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) expert panels recommend spirometry to be performed on children five years of age and older as an objective assessment of lung function, to diagnosis asthma, and for ongoing yearly management of asthma (GINA, 2012; NAEPP, 2007). According to the NAEPP expert panel, history and physical examination alone are not reliable to accurately diagnose asthma, exclude alternative diagnosis, or determine lung impairment (NAEPP, 2007 Dombkowski, Hassan, Wasilevich, and Clark (2010) found 52% of physicians who provide primary care to children used spirometry, but only 21% used spirometry according to the national guidelines, and only 35% of physicians surveyed were comfortable interpreting the test results. Zanconato, Meneghelli, Braga, Zacchello, and Baraldi (2005) found that 21% of spirometry readings were interpreted incorrectly, concluding that proper training and quality control were important to provide if spirometry in the primary care office setting is to be used. The purpose of this article is to review the appropriate use of spirometry in pediatric primary care.
A primary health care approach is essential to contemporary nursing roles such as practice nursing. This paper examines the evolution of primary health care as a global strategy for responding to the social determinants of health. Primary health care roles require knowledge of, and a focus on social determinants of health, particularly the societal factors that allow and perpetuate inequities and disadvantage. They also require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context, and visionary in balancing both workforce and client needs. The key to succeeding in working with communities and groups under a primary health care umbrella is to balance the big picture of comprehensive primary health care with operational strategies for selective primary health care. The other essential element involves using leadership skills to promote inclusiveness, empowerment and health literacy, and ultimately, better health.
Smith, Michele S
Reviews the book, Integrated Psychological Services in Primary Care edited by William Scott Craig (see record 2016-01850-000). This book opens with an article by the editor, in which he outlines the behavioral health needs of primary care patients and the rationale behind integrating mental health services in primary care settings. Subsequent chapters address basic and practical information for a variety of practice locations, such as Patient Centered Medical Home clinics, the Veteran's Administration medical centers, and primary care settings where the concept of integrated health is new. This is an excellent primer for anyone planning to implement an integrated care program or for those considering moving from an independent practice, agency, or traditional health care/hospital environment into an integrated primary care environment. The authors' writing styles made difficult concepts easy to understand and their knowledge of the utility of integration was evident. (PsycINFO Database Record
Pinnock, Hilary; Ostrem, Anders; Roman Rodriguez, Miguel; Ryan, Dermot; Stallberg, Bjorn; Thomas, Mike; Tsiligianni, Ioanna; Williams, Sian; Yusuf, Osman
Background: Community-based care, underpinned by relevant primary care research, is an important component of the global fight against non-communicable diseases. The International Primary Care Research Group's (IPCRG's) Research Needs Statement identified 145 research questions within five domains (
Hu, Amanda; Sardesai, Maya G.; Meyer, Tanya K.
Objective Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs. PMID:22754276
Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte;
to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...
Healthcare professionals in primary care are gatekeepers to specialist services and are important in terms of ensuring access to community support and appropriate referral for the sizable number of older people with mental health problems. This literature review explores the role of primary care professionals, particularly GPs and practice nurses, in diagnosing and managing patients with dementia. It recommends that education and training are required to raise awareness of the importance of accurate diagnosis and management in primary care.
O'Flynn, Norma; Ridsdale, Leone
Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evid...
Managing chronic conditions in a South African primary care context: ... is an approach to motivating behaviour change in general health care settings. ... They had mixed experiences with skills for agenda setting and reducing resistance.
Journal of Community Medicine and Primary Health Care. ... of research findings, reviews, theories and information on all aspects of public health. ... health planning and management, health policy, health care financing, public health nutrition, ...
Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa
In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.
Rifkin, S B; Walt, G
What is the impact of technology on improving the life situations of people, especially the poor? How is this impact analyzed in terms of health improvements? These questions are paramount in the minds of health planners as they pursue national policies of primary health care, a policy popularized by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and accepted by over 150 governments at Alma Ata in 1978. The purpose of this paper is to explore these questions in depth. It begins by giving the background to the debate, then examines the origins of two concepts which have dominated the field, those of 'primary health care' and 'selective primary health care.' On this basis it suggests areas of differences in the two concepts and discusses the policy and practical implications of confusing the two approaches. The paper suggests that the differences are firstly who controls the outcome of technological interventions and the perceived time frame in which plans can be carried out.
Nair, M K C; Chacko, D S; Indira, M S; Siju, K E; George, Babu; Russell, P S
Adolescents can have mental, emotional, and behavior problems that are a source of stress for the child as well as the family, school and community. These may disrupt the adolescent's ability to function normally. Adolescents also have reproductive concerns especially at menarche. Considering the extent of problems of adolescents and the lack of adolescent care and counseling services, it was felt that community adolescent care counseling services should be made available. This article describes the steps involved in the setting up of Taluk model of adolescent care and counseling services. Following steps were involved in setting up a Taluk model of adolescent care counseling service delivery system. Step I: Focus Group Discussions (FGDs) among Stakeholders. Step II: Conceptualization and Strategy planning for service delivery. III: Finalization of service delivery model Step IV: Workshops for finalization of TSQ-T 2008 version the tool to be used for assessing the adolescents in the ARSH clinics. Step V: Training Programme for Medical/Paramedical health staff. Step VI: Awareness programs for mothers of adolescents. Step VII: Setting up of ACS/ARSH clinics at Taluk hospitals. Step VIII: Evaluation of the utilization of services at Taluk hospitals. The clinic has been well utilized with 1,588 adolescents being seen in 2 years. Medical and Reproductive problems among adolescent girls were anemia, underweight, dysmenorrhoea, menstrual irregularities and symptoms of Polycystic Ovarian Syndrome, whereas among boys problems were mostly related to concerns about masturbation and its perceived ill effects. The psychosocial problems ranged from minor anxieties, sadness and adjustment problems to psychiatric disorders. Scholastic problems included poor concentration, poor study habits and low intelligence quotient. The success of the clinics in these five hospitals can be replicated in other parts of the state as well as the country. These will go a long way to ameliorate
Ana Gladys Aráuz Hernández
based on the increase of both theory (knowledge and practice (skills. Results: Participants were 177 health workers from 44 EBAIS (31% ATAP, 26, 6% physicians and, 22,6% nurse assistants.The assessment showed that participants obtained excellent grades in the practical area, although the score of the urban zone of the Central Valley, was inferior. In the written test (knowledge, the final general score increased significantly in all disciplines and geographic areas. By discipline, knowledge increased in almost all themes. The multiple comparison test (ANOVA showed some differences in the knowledge change in several themes and disciplines. Conclusions: This course based on a the multiprofessional methodology was appropriate to increase both knowledge and skill of professionals, technicians and administrative health workers from the primary level of health attention. The test organization by thematic areas, allowed the evaluation of every theme among the different disciplines. Diabetes education using this methodology on the site of work improved the primary health attention teams.
Hersh, Lauren; Salzman, Brooke; Snyderman, Danielle
Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information.
Aubert, Carole E; Streit, Sven; Da Costa, Bruno R; Collet, Tinh-Hai; Cornuz, Jacques; Gaspoz, Jean-Michel; Bauer, Doug; Aujesky, Drahomir; Rodondi, Nicolas
Polypharmacy is associated with adverse events and multimorbidity, but data are limited on its association with specific comorbidities in primary care settings. We measured the prevalence of polypharmacy and inappropriate prescribing, and assessed the association of polypharmacy with specific comorbidities. We did a cross-sectional analysis of 1002 patients aged 50-80years followed in Swiss university primary care settings. We defined polypharmacy as ≥5 long-term prescribed drugs and multimorbidity as ≥2 comorbidities. We used logistic mixed-effects regression to assess the association of polypharmacy with the number of comorbidities, multimorbidity, specific sets of comorbidities, potentially inappropriate prescribing (PIP) and potential prescribing omission (PPO). We used multilevel mixed-effects Poisson regression to assess the association of the number of drugs with the same parameters. Patients (mean age 63.5years, 67.5% ≥2 comorbidities, 37.0% ≥5 drugs) had a mean of 3.9 (range 0-17) drugs. Age, BMI, multimorbidity, hypertension, diabetes mellitus, chronic kidney disease, and cardiovascular diseases were independently associated with polypharmacy. The association was particularly strong for hypertension (OR 8.49, 95%CI 5.25-13.73), multimorbidity (OR 6.14, 95%CI 4.16-9.08), and oldest age (75-80years: OR 4.73, 95%CI 2.46-9.10 vs.50-54years). The prevalence of PPO was 32.2% and PIP was more frequent among participants with polypharmacy (9.3% vs. 3.2%, pPolypharmacy is common in university primary care settings, is strongly associated with hypertension, diabetes mellitus, chronic kidney disease and cardiovascular diseases, and increases potentially inappropriate prescribing. Multimorbid patients should be included in further trials for developing adapted guidelines and avoiding inappropriate prescribing. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Perry, M.; Draskovic, I.; Lucassen, P.L.B.J.; Vernooij-Dassen, M.J.F.J.; Achterberg, T. van; Olde Rikkert, M.G.M.
OBJECTIVE: To determine the effects of educational interventions about dementia, directed at primary care providers (PCPs). DESIGN: We searched Medline, Embase, PsycInfo, Cinahl and the Cochrane library for relevant articles. Two researchers independently assessed the citations identified against
In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.
Pim P. Valentijn
Full Text Available Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care.Methods: The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework.Results: The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration, meso (professional and organisational integration and macro (system integration level. Functional and normative integration ensure connectivity between the levels.Discussion: The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.
Over the last decade, I have put together a new theory of leadership. This paper describes its four propositions, which are consistent with the research literature but which lead to conclusions that are not commonly held and seldom put into practice. The first proposition is a model describing the territory of leadership that is different from either the Leadership Qualities Framework, 2006 or the Medical Leadership Competency Framework, 2010, both of which have been devised specifically for the NHS (National Health Service). The second proposition concerns the ill-advised attempt of individuals to become expert in all aspects of leadership: complete in themselves. The third suggests how personality and capability are related. The fourth embraces and recommends the notion of complementary differences among leaders. As the NHS seeks increasing leadership effectiveness, these propositions may need to be considered and their implications woven into the fabric of NHS leader selection and development. Primary Health Care research, like all fields of collective human endeavour, is eminently in need of sound leadership and the same principles that facilitate sound leadership in other fields is likely to be relevant to research teams.
Chapel, Helen; Prevot, Johan; Gaspar, Hubert Bobby; Español, Teresa; Bonilla, Francisco A.; Solis, Leire; Drabwell, Josina
Primary immune deficiencies (PIDs) are a growing group of over 230 different disorders caused by ineffective, absent or an increasing number of gain of function mutations in immune components, mainly cells and proteins. Once recognized, these rare disorders are treatable and in some cases curable. Otherwise untreated PIDs are often chronic, serious, or even fatal. The diagnosis of PIDs can be difficult due to lack of awareness or facilities for diagnosis, and management of PIDs is complex. This document was prepared by a worldwide multi-disciplinary team of specialists; it aims to set out comprehensive principles of care for PIDs. These include the role of specialized centers, the importance of registries, the need for multinational research, the role of patient organizations, management and treatment options, the requirement for sustained access to all treatments including immunoglobulin therapies and hematopoietic stem cell transplantation, important considerations for developing countries and suggestions for implementation. A range of healthcare policies and services have to be put into place by government agencies and healthcare providers, to ensure that PID patients worldwide have access to appropriate and sustainable medical and support services. PMID:25566243
Full Text Available Primary Immune Deficiencies (PIDs are a growing group of over 230 different disorders caused by ineffective, absent or an increasing number of gain of function mutations in immune components (mainly cells and proteins. Once recognised, these rare disorders are treatable and in some cases curable. Otherwise untreated PIDs are often chronic, serious or even fatal. The diagnosis of PIDs can be difficult due to lack of awareness and facilities for diagnosis, and management of PIDs is complex. This document was prepared by a worldwide multi-disciplinary team of specialists; it aims to set out comprehensive principles of care for PIDs. These include the role of specialised centres, the importance of registries, the need for multinational research, the role of patient organisations, management and treatment options, the requirement for sustained access to all treatments including immunoglobulin (Ig therapies and HSCT, important considerations for developing countries and suggestions for implementation. A range of healthcare policies and services have to be put into place by government agencies and healthcare providers, to ensure that PID patients world-wide have access to appropriate and sustainable medical and support services.
The concept of primary care in the Kupat Holim Health Insurance Institution encompasses all the stages of health: the promotion of health, personal preventive care, curative care, and rehabilitation in the community. Primary care is, thus, the foundation of this nationwide comprehensive health insurance and health care delivery system; Kupat Holim covers 3.2 million people, close to 80 percent of Israel's total population in 1983. Primary care clinics in the community are the main focus of care and have undergone changes in the types of health care providers and functions as population characteristics change. In this system, the planning process allows constant review of changing needs and demands and the introduction of new functions. The main approaches to planning primary care that are presented deal with team members and the division of work in the community clinic, manpower training at undergraduate and postgraduate levels, and the content of primary care. Current trends include the extension of services provided to the patient in his home as well as the clinic and greater emphasis on preventive care. The interrelationship between policy and planning for primary care is strengthened by the linkage between financer, provider, and consumer in Kupat Holim. The planning process must make optimal use of this linkage to guide those responsible for health policy in implementing effective change.
Hochman, Michael; Asch, Steven M
...; and coordinated care when it must be sought elsewhere.” As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives...
Katerndahl, David; Parchman, Michael; Wood, Robert
The purpose of this study was to examine relationships of both perceived autonomy and perceived complexity of care with career satisfaction. This secondary analysis used 3 consecutive surveys of family physicians, internists, and pediatricians from the Community Tracking Survey. Two-way analysis of variance assessed interaction effects of perceived complexity of care and perceived autonomy on satisfaction. Logistic regression analysis identified physician characteristics, practice characteristics, practice improvement strategies, perceived complexity, and perceived autonomy that accounted for variance in career satisfaction among physicians. Although 24% to 27% of physicians felt perceived complexity of care expected was greater than it should be, 83% to 86% felt free to make clinical decisions. Approximately 80% of physicians were satisfied with their careers. Differences in probability of career satisfaction were highly significant (P satisfaction. Higher perceived autonomy and lower perceived patient complexity as higher than desirable were associated with high career satisfaction among primary care physicians.
Mold, James W
This seventh annual practice-based research theme issue of the Journal of the American Board of Family Medicine highlights primary care research conducted in practice-based research networks (PBRNs). The issue includes discussion of (1) theoretical and methodological research, (2) health care research (studies addressing primary care processes), (3) clinical research (studies addressing the impact of primary care on patients), and (4) health systems research (studies of health system issues impacting primary care including the quality improvement process). We had a noticeable increase in submissions from PBRN collaborations, that is, studies that involved multiple networks. As PBRNs cooperate to recruit larger and more diverse patient samples, greater generalizability and applicability of findings lead to improved primary care processes.
Epstein, Andrew J; Barry, Colleen L; Fiellin, David A; Busch, Susan H
Most individuals with substance use disorders and with mental disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. The advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented. However, less is known about consumers' valuation of these options. The authors assessed monetary valuation of these treatment types compared with usual care in a specialty treatment setting. Contingent valuation methods were used in a Web-based randomized vignette experiment that involved 2,146 individuals who screened positive for a drug or alcohol use disorder or a mental disorder. Participants valued a primary care-based treatment visit over usual care in a specialty treatment setting by $9.00 and a collaborative care visit over usual care in a specialty treatment setting by $5.85.
The main goal of this PhD research was to provide insight into primary school teachers’ classroom assessment practice in mathematics in the Netherlands. Classroom assessment is assessment that teachers can use to get access to their students’ skills and understanding, in an effort to tailor their in
The main goal of this PhD research was to provide insight into primary school teachers’ classroom assessment practice in mathematics in the Netherlands. Classroom assessment is assessment that teachers can use to get access to their students’ skills and understanding, in an effort to tailor their in
Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys
Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.
Sorocco, Kristen H; Bratkovich, Kristi L; Wingo, Rita; Qureshi, Saleem M; Mason, Patrick J
The purpose of this program was to evaluate the benefits of integrating VA Care Coordination Home Telehealth and Telemental health within HBPC. A case study design was used to determine quality assurance and quality improvement of incorporating additional home telehealth equipment within Home Based Primary Care (HBPC). Veterans with complex medical conditions and their caregivers living in rural Oklahoma were enrolled. Veterans received the same care other HBPC patients received with the addition of home telehealth equipment. Members from the interdisciplinary treatment team were certified to use the telehealth equipment. Veterans and their caregivers were trained on use of the equipment in their homes. Standard HBPC program measures were used to assess the program success. Assessments from all disciplines on the HBPC team were at baseline, 3, and 6 months, and participants provided satisfaction and interview data to assess the benefits of integrating technology into standard care delivery within an HBPC program. Six veterans were enrolled (mean age = 72 yrs) with a range of physical health conditions including: chronic obstructive pulmonary disease, cerebrovascular accident, spinal cord injury, diabetes, hypertension, and syncope. Primary mental health conditions included depression, dementia, anxiety, and PTSD. Scores on the Mini-Mental State Examination ranged from 18 to 30. Over a 6-month period, case studies indicated improvements in strength, social functioning, decreased caregiver burden, and compliance with treatment plan. This integration of CCHT and HBPC served previously underserved rural veterans having complex medical conditions and appears both feasible and clinically beneficial to veterans and their caregivers.
Full Text Available Abstract Background A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods Review of recent developments supporting primary care clinical research. Results Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some countries. Emerging from this has been innovation in research design and focus, although less is known of the effect on research output. Conclusion Primary care research is now well placed to lead a broad re-vitalisation of academic medicine, answering questions of relevance to practitioners, patients, communities and Government. Key areas for future primary care research leaders to focus on include exposing undergraduates early to primary care research, integrating this early exposure with doctoral and postdoctoral research career support, further expanding cross disciplinary approaches, and developing useful measures of output for future primary care research investment.
Gordon, Jason; McEwan, Phil; Evans, Marc; Puelles, Jorge; Sinclair, Alan
To describe the relative health and economic outcomes associated with different second-line therapeutic approaches to manage glycaemia in older type 2 diabetes patients requiring escalation from metformin monotherapy. The Clinical Practice Research Datalink database was used to inform a retrospective observational cohort study of patients with type 2 diabetes treated with metformin monotherapy requiring escalation (addition or switch) to a second-line oral regimen from January 1, 2008 to December 31, 2014. Primary outcomes included time to first event (any event, myocardial infarction [MI], stroke, or composite of MI/stroke [major adverse cardiovascular event; MACE]) and total event rate. The health economic consequences associated with the choice of second-line treatment in older patients were assessed using the CORE Diabetes Model. A total of 10 484 patients were included; the majority escalated to second-line treatment with metformin + sulphonylurea (SU; 42%) or switched to SU monotherapy (28%). In multivariate adjusted analyses, total event rates for MACE with metformin + dipeptidyl peptidase-4 (DPP-4) inhibitor were significantly lower than with metformin + SU (0.61, 95% confidence interval [CI] 0.39-0.98), driven by a lower MI rate in the metformin + DPP-4 inhibitor group (0.52, 95% CI 0.27-0.99). Economic analyses estimated that metformin + DPP-4 inhibitor treatment was associated with the largest gain in health benefit, and cost-effectiveness ratios were favourable (<£30 000 per quality-adjusted life-year) for all second-line treatment scenarios. With respect to treatment choice, data from the present study support the notion of prescribing beyond metformin + SU, as alternative regimens have been shown to be associated with reduced outcomes risk and value for money. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Saravu, Kavitha; Kumar, Rishikesh; Ashok, Herikudru; Kundapura, Premananda; Kamath, Veena; Kamath, Asha; Mukhopadhyay, Chiranjay
Background Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India. Method Five PHCs were selected within Udupi taluk based on probability proportional to size. In-vivo therapeutic efficacy assessment of CQ (1500 mg over three days) plus PQ (210 mg over 14 days) regimen was carried out in accordance with the World Health Organization’s protocol of 28 days follow-up among microscopically diagnosed monoinfection P. vivax cohort. Results In total, 161 participants were recruited in the study of which, 155 (96.3%) participants completed till day 28 follow-up, fully complied with the treatment regimen and showed adequate clinical and parasitological response. Loss to follow up was noted with 5 (3.1%) participants and non-compliance with treatment regimen occurred with one participant (0.6%). Glucose-6-phosphate dehydrogenase deficiency (G6PDd, <30% of normal mean activity) was noted among 5 (3.1%) participants and one of them did develop PQ induced dark-brown urination which subsided after PQ discontinuation. G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with G6PD 1.4 U/g Hb due to complaint of reddish-brown coloured urine by 48 hours of PQ initiation. Nested polymerase chain reaction test revealed 45 (28%) cases as mixed (vivax and falciparum) malaria. Conclusions The CQ-PQ combined regimen remains outstandingly effective to treat uncomplicated P. vivax malaria in Udupi taluk and thus it should continue as first line regimen. For all P. vivax cases, G6PD screening before PQ administration must be mandatory and made available in all PHCs. PMID:27315280
Full Text Available Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs of Udupi taluk, Udupi district, Karnataka, India.Five PHCs were selected within Udupi taluk based on probability proportional to size. In-vivo therapeutic efficacy assessment of CQ (1500 mg over three days plus PQ (210 mg over 14 days regimen was carried out in accordance with the World Health Organization's protocol of 28 days follow-up among microscopically diagnosed monoinfection P. vivax cohort.In total, 161 participants were recruited in the study of which, 155 (96.3% participants completed till day 28 follow-up, fully complied with the treatment regimen and showed adequate clinical and parasitological response. Loss to follow up was noted with 5 (3.1% participants and non-compliance with treatment regimen occurred with one participant (0.6%. Glucose-6-phosphate dehydrogenase deficiency (G6PDd, <30% of normal mean activity was noted among 5 (3.1% participants and one of them did develop PQ induced dark-brown urination which subsided after PQ discontinuation. G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with G6PD 1.4 U/g Hb due to complaint of reddish-brown coloured urine by 48 hours of PQ initiation. Nested polymerase chain reaction test revealed 45 (28% cases as mixed (vivax and falciparum malaria.The CQ-PQ combined regimen remains outstandingly effective to treat uncomplicated P. vivax malaria in Udupi taluk and thus it should continue as first line regimen. For all P. vivax cases, G6PD screening before PQ administration must be mandatory and made available in all PHCs.
Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte
abstracts were independently reviewed by two investigators. RESULTS: We identified 23 measurement instruments and, within these, eight organisational elements were found. No measurement instrument covered all organisational elements, but almost all studies include well-defined structural and process aspects......INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how...... to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...
Nadeau, Katie; Pinner, Kerri; Murphy, Katie; Belderson, Kristin M
The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.
Maarsingh, Otto R.; Dros, Jacquelien; Schellevis, François G.; van Weert, Henk C.; van der Windt, Danielle A.; Riet, Gerben ter; van der Horst, Henriette E.
PURPOSE Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of dizziness. METHODS We performed a cross-sectional diagnostic study among elderly patients in the Netherlands consulting their family physician for persistent dizziness. All patients underwent a comprehensive evaluation according to a set of diagnostic tests that were developed during an international Delphi procedure. Data for each patient were independently reviewed by a panel consisting of a family physician, a geriatrician, and a nursing home physician, which resulted in major and minor contributory causes of dizziness. RESULTS From June 2006 to January 2008, we included 417 patients aged 65 to 95 years. Presyncope was the most common dizziness subtype (69%). Forty-four percent of the patients were assigned more than 1 dizziness subtype. Cardiovascular disease was considered to be the most common major contributory cause of dizziness (57%), followed by peripheral vestibular disease (14%), and psychiatric illness (10%). An adverse drug effect was considered to be the most common minor contributory cause of dizziness (23%). Sixty-two percent of the patients were assigned more than 1 contributory cause of dizziness. CONCLUSIONS Contrary to most previous studies, cardiovascular disease was found to be the most common major cause of dizziness in elderly patients in primary care. In one-quarter of all patients an adverse drug effect was considered to be a contributory cause of dizziness, which is much higher than reported in previous studies. PMID:20458102
Parker, D.; Wensing, M.; Esmail, A.; Valderas, J.M.
BACKGROUND: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. OBJECTIVE: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance
Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan
Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice.
WHAT IS ALREADY KNOWN IN THIS AREA • The acquisition of clinical reasoning skills from novice to advanced student has been described and compared with experienced clinicians Research from the field of cognitive psychology suggests that development of such skills depends upon organizing packages of information into coherent structures which are quickly accessible from memory. These are called 'instance scripts?. Various strategies are employed in reasoning, starting with step-by-step analysis by novices, moving towards categorisation processes in-advanced practitioners (e.g. pattern recognition). WHAT THIS WORK ADDS • This work suggests a reference framework for reasoning skills and expertise development from novice to experienced practitioner within primary care. It extends ideas from existing Studies using medical students into postgraduate professional development, encompassing various transitions from newly qualified doctor to training registrar, and from new principal towards the experienced practitioner. • Within these transitory stages, reasoning strategies are highlighted, including potential problem areas and appropriate educational implications. The role of follow up mechanisms for GP registrars is suggested to enable validation of illness vectors in the natural history of disease and recovery. Extension of training schemes to provide for expertise development in primary care is proposed as the logical context where such skills can be improved. SUGGESTIONS FOR FUTURE RESEARCH • Current research in medical education in the UK appears to be heavily concentrated upon skills and competency assessment. These are more easily measured than cognitive skills. However, the impact of early clinical contact in UK medical schools upon cognitive skills could be compared with other countries where clinical contact is still delayed. Early patient contact may shift acquisition of some cognitive skills back in the proposed framework. • In addition to this, the
Shrank, William H
Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-based primary care are explored. If the correct payment and connectivity enablers are in place, some examples of consumer-driven care are well-positioned to support primary care physicians in their mission to deliver high-quality, efficient care for the populations they serve. However, concerns about access and equity make other trends less consistent with that mission.
McCarthy, E; Russell, A; Kearney, P M
Subclinical hypothyroidism (SCH) is defined as a raised serum thyroid stimulating hormone level with normal thyroxine. Despite a prevalence of up to 9% of the adult population there is widespread uncertainty on how to manage it. The aim of this study was to assess how older adults with SCH are managed in primary care. A retrospective case-note review was carried out on patients attending Mallow Primary Healthcare Centre. This study identified patients 65 years and over meeting the criteria for SCH in one year. The prevalence of SCH in this study was calculated as 2.9%. 22.2% of patients were treated with thyroxine. 6.1% of untreated patients progressed to clinical hypothyroidism within the study period while 18.2% spontaneously reverted to normal TSH levels.
Sibbald, B.; Laurant, M.G.H.; Reeves, D.
Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected
Sibbald, B.; Laurant, M.G.H.; Reeves, D.
Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected
Huguet, M; Bou, M; Argimon, J M; Escarrabill, J
A representative group of primary care physicians from Areas 4 and 5 of the Institut Català de la Salut were surveyed in orden to know their opinion about the spreading of HIV infection, the value of serological tests and the methods to prevent the infection of health care providers. More than half of the physicians (58.5%) had never been in contact with an HIV infected patient. Of the surveyed physicians, 47.2% believe that it is necessary to spread out more information on preventive measures amongst health professionals. 48.4% believe that confidentiality is important but only 16.9% consider it is important to obtain an informed consent to perform serological testing and another 22.5% mainly trust systematic serological testing. Primary care can play an important role avoiding the spread of HIV infection and, in fact, the importance of preventive measures and confidentiality are assumed by an elevated percentage of health professionals. The usefulness of serological testing, however, is not properly assessed valued and little importance is granted to the patient's consent for their performance.
Samarasinghe, K; Fridlund, B; Arvidsson, B
Involuntary migrant families in cultural transition face a number of challenges to their health and to family cohesion. Primary health care nurses (PHCNs) therefore play a vital role in the assessment and promotion of their health. The aim of this study was to describe the promotion of health in involuntary migrant families in cultural transition as conceptualized by Swedish PHCNs. Interviews were conducted with 34 strategically chosen PHCNs covering the entire range of the primary health care sector in two municipalities of Southern Sweden. A contextual approach with reference to phenomenography was used in interpreting the data. There are three qualitatively different descriptive categories epitomizing the characteristics of the PHCNs' promotion of health: (1) an ethnocentric approach promoting physical health of the individual, (2) an empathic approach promoting mental health of the individual in a family context, and (3) a holistic approach empowering the family to function well in everyday life. For nurses to promote involuntary migrant families'health in cultural transition, they need to adopt a holistic approach. Such an approach demands that nurses cooperate with other health care professionals and community authorities, and practise family-focused nursing; it also demands skills in intercultural communication paired with cultural self-awareness in interacting with these families. Adequate knowledge regarding these skills should therefore be included in the education of nurses, both at under- and at post-graduate level.
Patrizia Gallo MD
Full Text Available Background: Epidemiologic evidences suggest a strong association between low birth weight and some diseases in adult life ( hypertension, diabetes, cardiovascular diseases.Aim of this study was to evaluate the obesity/overweight prevalence in a population of children born small for gestation age, SGA children 400, 208 males and 192 females compared to a population of children born appropriate for gestational age 6818 AGA children, 3502 males and 3316 females, during childhood. Our intention was also to build the natural history of weight gain during prepubertal age in children born SGA and AGA. Design and Methods: Observational prospective longitudinal study. We followed our patients from January2001 up to December 2010; weight, height and body mass index (BMI were evaluated in all the SGA and AGA children. BMI z-score range for defining overweight and obesity was, respectively, 1.13 to 1.7 and >1.7 according to CDC growth charts. Results: In transversal evaluation, we prove that 10-year-old SGA females are twice obese and more overweight compared to equal age AGA females. In longitudinal evaluation, we highlight different observations: SGA children obese at 2 years are still obese at 10 years; the number of obese SGA children increases gradually until the age of 10; AGA children, appear to be less obese than SGA children at 10 years. Conclusion: SGA males and females are more obese at 5 and 10 years compared to the AGA population. Primary care pediatricians, through early detection of the children at risk, can carry out an effective obesity prevention project in SGA children.
Full Text Available Problem statement: Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Description of policy development: Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and ‘community medicine nurses’. Conclusion and discussion: Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans
Poulsen, Erik; Overgaard, Søren; Vestergaard, Jacob T
BACKGROUND: Hip osteoarthritis (OA) is the most common diagnosis in primary care adult patients presenting with hip pain but pain location and pain distribution in primary care patients with hip OA have been reported inadequately. OBJECTIVE: To describe pain location and pain distribution...
Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L.; Serrano, Neftali
Summary After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population. PMID:24185149
Verbakel, N.J.; Melle, M. van; Langelaan, M.; Verheij, T.J.M.; Wagner, C.; Zwart, D.L.M.
Objective: To explore perceptions of safety culture in nine different types of primary care professions and to study possible differences. Design Cross-sectional survey: Setting: Three hundred and thirteen practices from nine types of primary care profession groups in the Netherlands. Participants:
Creswell, John W.; Fetters, Michael D.; Ivankova, Nataliya V.
BACKGROUND Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations.
Oort, M. van; Devillé, W.; Bakker, D. de
In 2000 policymakers decided that primary care for asylum seekers should be organized as it is for Dutch residents. Nurses of the Community Health Services organize selection and referral to primary care. General practitioners have practice in the different Centres of Asylum Seekers or in their own
The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.
Oort, M. van; Devillé, W.; Bakker, D. de
In 2000 policymakers decided that primary care for asylum seekers should be organized as it is for Dutch residents. Nurses of the Community Health Services organize selection and referral to primary care. General practitioners have practice in the different Centres of Asylum Seekers or in their own
Creswell, John W.; Fetters, Michael D.; Ivankova, Nataliya V.
BACKGROUND Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations.
The primary care psychologist (PCP) in the Netherlands has 30 years of experience. The PCP is a generalist who, in close cooperation with the family physician and other providers of primary health care, has a mindset and manner of working that is largely determined by the context in which the PCP
2NIHR School for Primary Care Research, Centre for Primary Care, Institute of ... patient evaluation of PHC and draw implications for the Nigerian practice setting. Design: A systematic review .... The data analysis that followed the extraction was .... survey. Here the length of the questionnaire and the response pattern were ...
Faber, M.J.; Burgers, J.S.; Westert, G.P.
The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving ca
Florentinus, S.R.; Heerdink, R.; Dijk, L. van; Griens, F.A.M.G.; Groenewegen, P.P.; Leufkens, H.G.M
Background: Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. Methods: This study estimates the influence of medical specialists on new drug prescribing in primary care
Florentinus, S.R.; Heerdink, E.R.; Dijk, L. van; Griens, F.; Groenewegen, P.P.; Leufkens, H.G.M.
BACKGROUND: Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. METHODS: This study estimates the influence of medical specialists on new drug prescribing in primary care
The primary care psychologist (PCP) in the Netherlands has 30 years of experience. The PCP is a generalist who, in close cooperation with the family physician and other providers of primary health care, has a mindset and manner of working that is largely determined by the context in which the PCP wo
Meyer, William J.; Morrison, Patrick; Lombardero, Anayansi; Swingle, Kelsey; Campbell, Duncan G.
Unwillingness to share depression experiences with primary care physicians contributes to the undertreatment of depression. This project examined college students' reasons for depression nondisclosure to primary care providers (PCPs). Undergraduate participants read a vignette describing someone with depression and completed measures of disclosure…
Branch, William T., Jr.; And Others
The problems encountered, diagnostic procedures performed, and treatments prescribed in dermatology were studied in a primary care practice and in a dermatology clinic. It is proposed that the findings of this study be the basis for designing a curriculum in dermatology for residents in primary care medicine. (Author/MLW)
Bakker, D.H. de; Groenewegen, P.P.
Background: Primary care in the Netherlands has a strong international reputation. However, this picture may be qualified in two respects. First of all, the Dutch primary care system is less cohesive than is sometimes suggested. Secondly, there are major challenges in the Dutch system (as is the
In this thesis, the primary aim was to gain insight into management of obstetric emergencies occurring in primary midwifery care in the Netherlands. Secondly, we aimed to develop preventative strategies and tools to optimise care in case of an obstetric emergency. From 2008-2010, a unique dataset of
Full Text Available Martin Johnson,1 Beverly Collett,2 José M Castro-Lopes3On behalf of OPENMinds Primary Care1Community Pain Medicine, Cardiff University, Cardiff, UK; 2Pain Management Service, University Hospitals of Leicester NHS Trust, Leicester, UK; 3Department of Experimental Biology, Faculty of Medicine of the University of Porto, Porto, PortugalBackground: The OPENMinds Primary Care group is a group of European primary care physicians (PCPs with an interest in pain management, formed to improve the understanding and management of chronic pain in primary care.Objective: A survey was conducted to assess the challenges of chronic nonmalignant pain (CNMP management in primary care in Europe, focusing particularly on pain assessment, opioid therapy, and educational needs.Methods: A questionnaire was developed for online use by PCPs in 13 European countries (Belgium, Denmark, France, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Spain, Sweden, and the UK.Results: A total of 1309 PCPs completed the questionnaire, approximately 100 from each country. Most PCPs (84% perceived CNMP to be one of the most challenging conditions to treat, yet a low priority within healthcare systems. Only 48% of PCPs used pain assessment tools, and 81% considered chronic pain and its impact on quality of life to be underassessed in primary care. PCPs were less confident about prescribing strong opioids for CNMP than for use in cancer pain. Most PCPs (84% considered their initial training on CNMP was not comprehensive, with 89% recognizing a need for more education on the topic.Conclusion: These findings reveal that PCPs in Europe find CNMP a challenge to treat. Areas to address with training include underuse of pain assessment tools and lack of confidence in use of opioid therapy. Guidelines on CNMP management in primary care would be welcomed. The insights gained should provide the basis for future initiatives to support primary care management of chronic pain
Eiser, A R; Eiser, B J
The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.
Rocafort Gil, Javier; Herrera Molina, Emilio; Fernández Bermejo, Félix; Grajera Paredes María, María Eulalia; Redondo Moralo, María José; Díaz Díez, Fátima; Espinosa Rojas, José Armando
To find out if the activity of palliative care support teams (PCST) does not negatively influences the performance of the primary care "care of terminally ill patients" service. Terminally ill patients cared for at home. Multicentre observational study. The observed variable is the increase in the number of registered patients in primary care, and the number of patients covered between the years 2002 and 2003 and the 4 intervention variables are: total visits, joint visits, assessments, and teaching sessions. The number of patients covered in 2002 was 41.19%, increasing to 45.44% in 2003. The activity rate of the PCST for each 100 000 inhabitants was 526 home visits in 2003, 86.15 joint visits, 313.68 professional assessments, and 23.14 teaching sessions. The joint visits and the teaching sessions were strongly associated with an improvement in the coverage of primary care (Pearson correlation of 0.784 and 0.759, respectively). The total visits were moderately associated (0.525) and the assessments were weakly associated (0.245). Joint visits and teaching sessions of a PCST are associated to an increase in the activity of primary care teams. Assessments and total visits did not have a negative influence.
Bower, P; Campbell, S; Bojke, C; Sibbald, B
To determine whether practice structure (for example, list size, number of staff) predicts team processes and whether practice structure and team process in turn predict team outcomes Observational study using postal questionnaires and medical note audit. Team process was assessed through a measure of "climate" which examines shared perceptions of organisational policies, practices, and procedures. Primary care. Members of the primary health care team from 42 practices. Objective measures of quality of chronic disease management, patients' evaluations of practices, teams' self-reported ratings of effectiveness, and innovation. Team climate was better in singlehanded practices than in partnerships. Practices with longer booking intervals provided superior chronic disease management. Higher team climate scores were associated with superior clinical care in diabetes, more positive patient evaluations of practice and self-reported innovation and effectiveness. Although the conclusions are preliminary because of the limited sample size, the study suggests that there are important relationships between team structure, process, and outcome that may be of relevance to quality improvement initiatives in primary care. Possible causal mechanisms that might underlie these associations remain to be determined.
O. A. Shtegman
Full Text Available Aim. To evaluate primary care efficacy in patients with chronic heart failure (CHF.Material and methods. Outpatients (n=139 with CHF and 35 primary care physicians were included into the study. The evaluation of drug therapy and patient awareness of the principles of non-drug CHF treatment were performed. An anonymous survey among doctors in terms of current CHF guidelines knowledge, patient information provided by physicians, and doctors’ burnout status was also carried out.Results. Only 39% and 10% of CHF outpatients received target doses of ACE inhibitors/sartans and beta-blockers, respectively. Majority of CHF outpatients and their doctors need in additional education/training. 56% of primary care physicians demonstrated an emotional burnout.Conclusion. Author considers it essential to distribute short pocket-guidelines on CHF management among primary care physicians, and to reduce the load on primary care physicians with simultaneous strengthening of their performance control.
O. A. Shtegman
Full Text Available Aim. To evaluate primary care efficacy in patients with chronic heart failure (CHF.Material and methods. Outpatients (n=139 with CHF and 35 primary care physicians were included into the study. The evaluation of drug therapy and patient awareness of the principles of non-drug CHF treatment were performed. An anonymous survey among doctors in terms of current CHF guidelines knowledge, patient information provided by physicians, and doctors’ burnout status was also carried out.Results. Only 39% and 10% of CHF outpatients received target doses of ACE inhibitors/sartans and beta-blockers, respectively. Majority of CHF outpatients and their doctors need in additional education/training. 56% of primary care physicians demonstrated an emotional burnout.Conclusion. Author considers it essential to distribute short pocket-guidelines on CHF management among primary care physicians, and to reduce the load on primary care physicians with simultaneous strengthening of their performance control.
primary care provider and support staff—a nurse care manager, clinical associate, and administrative clerk. Letter Page 2 GAO-16-328...Health Eligibility Center, VHA central office—VHA’s Health Resource Center, Office of Primary Care, and Access and Clinical Administration Program ...newly enrolled veterans were able to access primary care from the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA), and others
Rodriguez, Hector P; Rogers, William H; Marshall, Richard E; Safran, Dana Gelb
Multidisciplinary teams may hold promise for improving primary care quality. This study examined the influence of multidisciplinary teams on patients' assessments of primary care, including access, integration, and clinician-patient interaction quality. From January 2004 through March 2005, a large multispecialty practice in Massachusetts obtained data monthly from patients of 145 primary care physicians using a well-validated patient questionnaire. The analytic sample included respondents with at least 2 primary care visits over the study period (n=14,835). For each respondent, administrative data were used to compute visit continuity over the study period and to classify each primary care visit as PCP, on-team, or off-team. Multivariate regression modeled the relationship of visit continuity to each primary care measure. Approximately one-third of patients (35%) saw only their PCP; 15% had only PCP and "on-team" visits; 9% had a mix of PCP, on-, and off-team visits; and 41% had only "off-team" visits when not seeing their PCP. Greater PCP continuity was associated with more favorable scores on nearly all measures (P<0.001). An exception was patients' assessments of teams, which were better when on- versus off-team visits occurred (P<0.01). For other measures, the decrements associated with discontinuity were the same irrespective of whether discontinuities involved on- or off-team visits. The finding that PCP visit discontinuities are associated with more negative care experiences, irrespective of whether discontinuities involve on- or off-team visits, highlights the challenges of incorporating teams into primary care in ways that patients experience as value-added rather than disruptive to primary care relationships.
Computer-administered screening of reproductive-aged women for diabetes risk in primary care settings, feasibility and acceptability of such screening, and validity of risk assessments based on self-reported weight.
Hussain, Shazia; Taylor, Martina; Waltermaurer, Eve; McCauley, Jeanne; Ford, Daniel E; Campbell, Jacquelyn C; McNutt, Louise-Anne
Obesity, a major public health problem, is the key modifiable component of diabetes risk. Addressing obesity and diabetes risk during primary care visits is recommended but, because of time constraints, is often difficult for health care providers to do. The purpose of this study was to determine whether technology can streamline risk assessment and leave more time to educate patients. We also tested the validity of self-reported weight in assessing diabetes risk. We recruited English-speaking women aged 18 to 44 years who came to a clinic for medical appointments from July through October 2003. Study participants completed a self-administered computer questionnaire that collected the following data: weight, height, family history of diabetes, level of exercise, amount of television time, and daily servings of fruits and vegetables. Self-reported and scale-measured weights were compared to determine the effect of self-reported weight on results of the American Diabetes Association's Diabetes Risk Test (DRT). In determining the sensitivity and specificity of self-reported weight, we used scale measurements as the standard. Complete data were collected on 231 women, including 214 women without a history of a diabetes diagnosis. Compared with DRT results (determined by scale-measured weight), questionnaire results (determined by self-reported weight) had sensitivities of 93.9% (95% confidence interval [CI], 85.2%-97.6%) for high risk for diabetes and 90.4% (95% CI, 83.3%-94.7%) for moderate risk. The specificity of the self-administered DRT for any diabetes risk was 97.8% (95% CI, 88.4%-99.6%). About half the women reported discussing nutrition and exercise with their health care providers Health care professionals can provide personalized diabetes education and counseling on the basis of information collected by self-administered computerized questionnaires. In general, patients provided a self-reported weight that did not substantially bias estimates of diabetes
Pittrow, D; Kirch, W; Bramlage, P; Lehnert, H; Höfler, M; Unger, T; Sharma, A M; Wittchen, H-U
In the treatment of hypertension, physicians' attitudes and practice patterns are receiving increased attention as contributors to poor blood pressure (BP) control. Thus, current use of antihypertensive drugs in primary care was analyzed and the association with selected physician and patient characteristics was assessed. The Hypertension and Diabetes Risk Screening and Awareness (HYDRA) study is a cross-sectional point prevalence study of 45,125 primary care attendees recruited from a representative nationwide sample of 1912 primary care practices in Germany. Prescription frequencies of the various antihypertensive drugs in the individual patients were recorded by the physicians using standardized questionnaires. We assessed the association of patient variables [age, gender; co-morbidities such as diabetes, nephropathy or coronary heart disease (CHD)] and physician variables (general practitioner vs internist, guideline adherence, etc.) with drug treatment intensity and prescription patterns. Of all 43,549 patients for whom a physician diagnosis on hypertension or diabetes was available, 17,485 (40.1%) had hypertension. Of these hypertensive patients, 1647 (9.4%) received no treatment at all, 1191 (6.8%) received non-pharmacological measures only, and 14,647 (83.8%) were given one or more antihypertensive drugs. Drug treatment rates were lower in young patients (16-40 years: 57.4%). BP control was poor: 70.6% of all patients were not normalized, i.e., had BP >/=140/90 mmHg. Antihypertensive treatment was generally intensified with increasing age, or if complications or comorbidities were present. The use of the different drug classes was rather uniform across the various patient subgroups (e.g., by age and gender). Individualized treatment with regard to co-morbidities as recommended in guidelines was not the rule. Adherence to guidelines as self-reported by physicians as well as other physician characteristics (region, training etc.) did not result in more
Choi, Phillip A; Xu, Shuai; Ayanian, John Z
Despite a growing need for primary care physicians in the United States, the proportion of medical school graduates pursuing primary care careers has declined over the past decade. To assess the association of medical school research funding with graduates matching in family medicine residencies and practicing primary care. Observational study of United States medical schools. One hundred twenty-one allopathic medical schools. The primary outcomes included the proportion of each school's graduates from 1999 to 2001 who were primary care physicians in 2008, and the proportion of each school's graduates who entered family medicine residencies during 2007 through 2009. The 25 medical schools with the highest levels of research funding from the National Institutes of Health in 2010 were designated as "research-intensive." Among research-intensive medical schools, the 16 private medical schools produced significantly fewer practicing primary care physicians (median 24.1% vs. 33.4%, p private schools. In contrast, the nine research-intensive public medical schools produced comparable proportions of graduates pursuing primary care careers (median 36.1% vs. 36.3%, p = 0.87) and matching in family medicine residencies (median 7.4% vs. 10.0%, p = 0.37) relative to the other 66 public medical schools. To meet the health care needs of the US population, research-intensive private medical schools should play a more active role in promoting primary care careers for their students and graduates.
Vives-Relats, Carme; Ferré-Grau, Carme; Rodero-Sánchez, Virtudes; Cid-Buera, Dolors
This case discussion starts from the Uncertainty Theory of illness of Merle Mishel, who raised the idea that even without a solution to the uncertainty, a person should accept it as a part of their life and reinterpret it as an opportunity to promote a new view of life governed by probability. The author proposes theoretical concepts that allow the phenomena experienced by family caregivers to be approached from the perspective of their experiences and stress. It establishes uncertainty and indecisiveness as contradictions that should not create anxiety permanently. This can be released gradually, if we create lines of flight though the care. Among these lines are located the Problem Solving Method as a strategy useful in primary health care to reduce the uncertainty of the caregivers. This article describes the outcome of Isabel, a 63- year-old female family caregiver of her dependent mother and her daughter with anorexia. The primary care nurse identifies the problem of weariness of the care-givers role and that of conflict of decisions during home visits. It describes the assessment made from the main concepts of the theory and the work with the care-givers by the problem solving method in order to reduce anxiety and help to mobilize internal resources and increase their welfare.
Kringos, D.S.; Bolibar, Y.; Bourgueil, T.; Cartier, T.; Dedeum, T.; Hasvold, A.; Hutchinson, M.; Lember, M.; Oleszczyk, D.; Rotar Pavlick, I.; Svab, P.; Tedeschi, A.; Wilson, S.; Wilm, A.; Windak, A.; Boerma, W.
Background: A strong primary care (PC) system provides accessible, comprehensive care in an ambulatory setting on a continuous basis and by coordinated care processes. These features give PC the opportunity to play a key role in providing public health (PH) services to their practice population. Th
Kringos, D.S.; Bolibar, Y.; Bourgueil, T.; Cartier, T.; Dedeum, T.; Hasvold, A.; Hutchinson, M.; Lember, M.; Oleszczyk, D.; Rotar Pavlick, I.; Svab, P.; Tedeschi, A.; Wilson, S.; Wilm, A.; Windak, A.; Boerma, W.
Background: A strong primary care (PC) system provides accessible, comprehensive care in an ambulatory setting on a continuous basis and by coordinated care processes. These features give PC the opportunity to play a key role in providing public health (PH) services to their practice population. Th
Smits, M.; Francissen, O.; Weerts, M.; Janssen, K.; Grunsven, P. van; Giesen, P.
OBJECTIVE: To examine patient and care characteristics of emergency ambulance call-outs and to determine how many of them were, in retrospect, effectively providing primary care. DESIGN: Retrospective cross-sectional study. METHOD: We charted patient and care characteristics of 598 emergency
McColl, Mary Ann; Shortt, Samuel; Godwin, Marshall; Smith, Karen; Rowe, Kirby; O'Brien, Patti; Donnelly, Catherine
To describe the scope and breadth of knowledge currently available regarding the integration of rehabilitation and primary care services. Peer-reviewed journals were searched using CINAHL, MEDLINE, and EBM Reviews for the years 1995 through 2007. This process identified 172 items. To be considered for the subsequent review, the article had to describe a service delivery program that offered primary care and rehabilitation, or services specifically designed for people with chronic conditions/disabilities. Further, it had to be available in English or French. No methodological limitations were applied to screen for levels of evidence. Based on these criteria, 38 articles remained that pertained to both primary care and rehabilitation. These were reviewed, sorted, and categorized to discover commonalities and differences among the approaches used to integrating rehabilitation into primary care. In consultation with the team of investigators, it was determined that there were 6 different models for providing primary health care and rehabilitation services in an integrated approach: clinic, outreach, self-management, community-based rehabilitation, shared care, and case management. In addition, a number of themes were identified across models that may act as either supports or impediments to the integration of rehabilitation services into primary care settings: team approach, interprofessional trust, leadership, communication, compensation, accountability, referrals, and population-based approach. Rehabilitation providers interested in working in the primary care sector may be assisted in conceptualizing the benefits that they bring to the setting by considering these models and issues.
Misra, Vasundhra; Vashist, Praveen; Malhotra, Sumit; Gupta, Sanjeev K
Blindness and visual impairment continues to be a major public health problem in India. Availability and easy access to primary eye care services is essential for elimination of avoidable blindness. 'Vision 2020: The Right to Sight - India' envisaged the need for establishing primary eye care units named vision centers for every 50,000 population in the country by the year 2020. The government of India has given priority to develop vision centers at the level of community health centers and primary health centers under the 'National Program for Control of Blindness'. NGOs and the private sector have also initiated some models for primary eye care services. In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.
Grove, Lexie R; Olesiuk, William J; Ellis, Alan R; Lichstein, Jesse C; DuBard, C Annette; Farley, Joel F; Jackson, Carlos T; Beadles, Christopher A; Morrissey, Joseph P; Domino, Marisa Elena
Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home. We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010. Using a fixed-effects regression approach, we also assessed the effect of medical home enrollment on utilization of primary care and specialty mental health care and medication adherence. A substantial majority (78.5%) of person-years had at least one primary care visit, and 17.9% had at least one primary care visit but no specialty mental health services use. Medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence. Medical home enrollees with schizophrenia and comorbid chronic conditions exhibited significant engagement in primary care, suggesting that primary-care-based medical homes could serve a care coordination function for persons with schizophrenia. Copyright © 2017 Elsevier Inc. All rights reserved.
Srivastava, Anita; Kahan, Meldon; Nader, Maya
Abstract Objective To advise physicians on which treatment options to recommend for specific patient populations: abstinence-based treatment, buprenorphine-naloxone maintenance, or methadone maintenance. Sources of information PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. Both observational and interventional studies were included. Main message Both methadone and buprenorphine-naloxone are substantially more effective than abstinence-based treatment. Methadone has higher treatment retention rates than buprenorphine-naloxone does, while buprenorphine-naloxone has a lower risk of overdose. For all patient groups, physicians should recommend methadone or buprenorphine-naloxone treatment over abstinence-based treatment (level I evidence). Methadone is preferred over buprenorphine-naloxone for patients at higher risk of treatment dropout, such as injection opioid users (level I evidence). Youth and pregnant women who inject opioids should also receive methadone first (level III evidence). If buprenorphine-naloxone is prescribed first, the patient should be promptly switched to methadone if withdrawal symptoms, cravings, or opioid use persist despite an optimal buprenorphine-naloxone dose (level II evidence). Buprenorphine-naloxone is recommended for socially stable prescription oral opioid users, particularly if their work or family commitments make it difficult for them to attend the pharmacy daily, if they have a medical or psychiatric condition requiring regular primary care (level IV evidence), or if their jobs require higher levels of cognitive functioning or psychomotor performance (level III evidence). Buprenorphine-naloxone is also recommended for patients at high risk of methadone toxicity, such as the elderly, those taking high doses of benzodiazepines or other sedating drugs, heavy drinkers, those with a lower