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Sample records for primary care prevalence

  1. Prevalence of chronic kidney disease in Peruvian primary care setting.

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    Herrera-Añazco, Percy; Taype-Rondan, Alvaro; Lazo-Porras, María; Alberto Quintanilla, E; Ortiz-Soriano, Victor Manuel; Hernandez, Adrian V

    2017-07-19

    Chronic Kidney Disease (CKD) is a worldwide public health problem. There are few studies in Latin America, especially in primary care settings. Our objective was to determine the prevalence, stages, and associated factors of CKD in primary care setting. We did a retrospective secondary analysis of a database from the Diabetes and Hypertension Primary Care Center of the Peruvian Social Security System (EsSalud) in Lima, Peru. We defined CKD as the presence of eGFR 30 mg/day in 24 h, according to Kidney Disease: Improving Global Outcomes (KDIGO). Factors associated with CKD were evaluated with Poisson Regression models; these factors included age, gender, type 2 diabetes mellitus (DM2), hypertension (HTN), body mass index (BMI), and uric acid. Associations were described as crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI). We evaluated 1211 patients (women [59%], mean age 65.8 years [SD: 12.7]). Prevalence of CKD was 18%. Using the estimated glomerular filtration rate (eGFR), the prevalence was 9.3% (95% CI 5.3 - 13.3) in patients without HTN or DM2; 20.2% (95% CI 17.6 - 22.8) in patients with HTN, and 23.9% (95% CI 19.4 - 28.4) in patients with DM2. The most common stages were 1 and 2 with 41.5% and 48%, respectively. Factors associated with CKD in the adjusted analysis were: age in years (PR = 1.03, 95% CI 1.01 - 1.04), DM2 (PR = 3.37, 95% CI 1.09 - 10.39), HTN plus DM2 (PR = 3.90, 95% CI 1.54 - 9.88), and uric acid from 5 to DM2, older age and hyperuricemia have higher prevalence of CKD.

  2. Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes

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    Katerndahl, David A.; Bell, Iris R.; Palmer, Raymond F.; Miller, Claudia S.

    2012-01-01

    PURPOSE This study extends previous community-based studies on the prevalence and clinical characteristics of chemical intolerance in a sample of primary care clinic patients. We evaluated comorbid medical and psychiatric disorders, functional status, and rates of health care use. METHODS A total of 400 patients were recruited from 2 family medicine clinic waiting rooms in San Antonio, Texas. Patients completed the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to assess chemical intolerance; the Primary Care Evaluation of Mental Disorders (PRIME-MD) screen for possible psychiatric disorders; the Dartmouth–Northern New England Primary Care Cooperative Information Project (Dartmouth COOP) charts for functional status; and the Healthcare Utilization Questionnaire. RESULTS Overall, 20.3% of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. The total number of possible mental disorders was correlated with chemical intolerance scores (P intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non–chemically intolerant patients. After controlling for comorbid psychiatric conditions, the groups differed significantly only regarding limitations of social activities. CONCLUSIONS Chemical intolerance occurs in 1 of 5 primary care patients yet is rarely diagnosed by busy practitioners. Psychiatric comorbidities contribute to functional limitations and increased health care use. Chemical intolerance offers an etiologic explanation. Symptoms may resolve or improve with the avoidance of salient chemical, dietary (including caffeine and alcohol), and drug triggers. Given greater medication

  3. Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings

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    Sun-Jin Jo

    2015-09-01

    Full Text Available Objectives: Although the prevalence of depressive disorders in South Korea’s general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities. Methods: Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated. Results: The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2, with major depressive disorder 5.4% (95% CI, 2.1 to 8.7, dysthymia 1.1% (95% CI, 0.0 to 2.6, and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5. Among the 26 patients with depressive disorder, 19 patients were newly diagnosed. Conclusions: As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.

  4. Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings.

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    Jo, Sun-Jin; Yim, Hyeon Woo; Jeong, Hyunsuk; Song, Hoo Rim; Ju, Sang Yhun; Kim, Jong Lyul; Jun, Tae-Youn

    2015-09-01

    Although the prevalence of depressive disorders in South Korea's general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities. Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated. The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2), with major depressive disorder 5.4% (95% CI, 2.1 to 8.7), dysthymia 1.1% (95% CI, 0.0 to 2.6), and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5). Among the 26 patients with depressive disorder, 19 patients were newly diagnosed. As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.

  5. Prevalence of chronic pancreatitis: Results of a primary care physician-based population study.

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    Capurso, Gabriele; Archibugi, Livia; Pasquali, Piera; Aceti, Alessandro; Balducci, Paolo; Bianchi, Patrizia; Buono, Francesco; Camerucci, Stefano; Cantarini, Rosanna; Centofanti, Sergio; Colantonio, Patrizia; Cremaschi, Riccarda; Crescenzi, Sergio; Di Mauro, Caterina; Di Renzi, Davide; Filabozzi, Andrea; Fiorillo, Alfonso; Giancaspro, Giuseppe; Giovannetti, Paola; Lanna, Giuseppe; Medori, Claudio; Merletti, Emilio; Nunnari, Enzo; Paris, Francesca; Pavone, Marco; Piacenti, Angela; Rossi, Almerindo; Scamuffa, Maria Cristina; Spinelli, Giovanni; Taborchi, Marco; Valente, Biagio; Villanova, Antonella; Chiriatti, Alberto; Delle Fave, Gianfranco

    2017-05-01

    Data on chronic pancreatitis prevalence are scanty and usually limited to hospital-based studies. Investigating chronic pancreatitis prevalence in primary care. Participating primary care physicians reported the prevalence of chronic pancreatitis among their registered patients, environmental factors and disease characteristics. The data were centrally reviewed and chronic pancreatitis cases defined according to M-ANNHEIM criteria for diagnosis and severity and TIGAR-O classification for etiology. Twenty-three primary care physicians participated in the study. According to their judgment, 51 of 36.401 patients had chronic pancreatitis. After reviewing each patient data, 11 turned out to have definite, 5 probable, 19 borderline and 16 uncertain disease. Prevalence was 30.2/100.000 for definite cases and 44.0/100.000 for definite plus probable cases. Of the 16 patients with definite/probable diagnosis, 8 were male, with mean age of 55.6 (±16.7). Four patients had alcoholic etiology, 5 post-acute/recurrent pancreatitis, 6 were deemed to be idiopathic. Four had pancreatic exocrine insufficiency, 10 were receiving pancreatic enzymes, and six had pain. Most patients had initial stage and non-severe disease. This is the first study investigating the prevalence of chronic pancreatitis in primary care. Results suggest that the prevalence in this context is higher than in hospital-based studies, with specific features, possibly representing an earlier disease stage. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  6. Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis.

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    Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Gómez-Urquiza, Jose L; Albendín-García, Luis; Aguayo, Raimundo; Cañadas-De la Fuente, Guillermo A

    2018-05-10

    burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses. We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017. After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment. Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.

  7. Child Maltreatment Prevalence and Mental Disorders Outcomes among American Indian Women in Primary Care

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    Duran, Bonnie; Malcoe, Lorraine Halinka; Sanders, Margaret; Waitzkin, Howard; Skipper, Betty; Yager, Joel

    2004-01-01

    Objective: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. Methods: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient…

  8. Prevalence of depression among women attending a primary urban care clinic in Malaysia.

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    Sidik, Sherina Mohd; Arroll, Bruce; Goodyear-Smith, Felicity; Ahmad, Rozali

    2012-07-01

    Depression affects more women than men in Malaysia. The objective of this paper was to determine the prevalence of depression and its associated factors among women attending a government primary care clinic. A cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive adult female patients attending the clinic during the data collection period were invited to participate. The participants completed self-administered questionnaires (including the validated Patient Health Questionnaire [PHQ-9], which was translated into the Malay language). A total of 895 female patients participated in the study (response rate 87.5%). The prevalence of depression (PHQ-9 scores ≥ 10) was 12.1%. Based on multiple logistic regression analysis, certain stressful life events were found to be associated with depression (p depression among participants in this study was clinically significant and corresponded with the findings of other international studies. Factors associated with depression need to be highlighted and addressed accordingly. Clinicians in Malaysia should be aware of this prevalence when making diagnoses in primary care.

  9. Prevalence and laterality of lattice retinal degeneration within a primary eye care population.

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    Semes, L P; Holland, W C; Likens, E G

    2001-04-01

    The purpose of this study was to determine the prevalence of lattice retinal degeneration (LRD) in a primary eye care population and to compare this prevalence to that of other studies reported from selected populations. In addition, the percentage of unilateral and bilateral cases was to be determined. A prospective study design was conceived to examine 600 consecutive patients presenting to the UABSO Primary Care Clinics. Each patient had been appointed for general eye examination. The following data were collected contemporaneously over six months from September 1993 to March 1994: demographics, medical and ocular history; refractive correction (calculated and recorded as spherical equivalent, SE); best-corrected visual acuity; and the presence and features of all ocular fundus findings, as evaluated through a dilated pupil. Of the 600 patients examined, 31 (5.2%) had LRD. Subjects ranged in age from 14 to 78 years (mean, 37.4 +/- 17.9 yrs.). Seventeen (55%) of the patients were white and 14 (45%) were black; 21 patients (68%) were female and 14 (32%) were male. The mean refractive correction (SE) was -1.77 D (range, +2.25 to -8.00 D). The lesions were bilateral in 19 (61.3%) of the patients; unilateral in 12 (38.7%). LRD lesions were observed in the vertical meridian (within 30 degrees of 6 or 12 o'clock) in all patients. The prevalence of LRD in a primary eye care population is comparable to that reported from other, selected populations. The proportion of bilateral cases in our material was greater than that from some other studies. Another item of note from the present data was exclusively vertical geographic location. We attribute the greater prevalence of bilateral cases in this material to the nature of the eye care delivery system.

  10. Incidence and prevalence of inflammatory bowel diseases in gastroenterology primary care setting.

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    Tursi, Antonio; Elisei, Walter; Picchio, Marcello

    2013-12-01

    The incidence of inflammatory bowel diseases (IBDs) has markedly increased over the last years, but no epidemiological study has been performed in gastroenterology primary care setting. We describe the epidemiology of IBD in a gastroenterology primary care unit using its records as the primary data source. Case finding used predefined read codes to systematically search computer diagnostic and prescribing records from January 2009 to December 2012. A specialist diagnosis of Ulcerative colitis (UC), Crohn's disease (CD), inflammatory bowel disease unclassified (IBDU) or segmental colitis associated with diverticulosis (SCAD), based on clinical, histological or radiological findings, was a prerequisite for the inclusion in the study. Secondary, infective and apparent acute self-limiting colitis were excluded. We identified 176 patients with IBD in a population of 94,000 with a prevalence 187.2/100,000 (95% CI: 160.6-217.0). Between 2009 and 2012 there were 61 new cases. In particular, there were 23 new cases of UC, 19 new cases of CD, 15 new cases of SCAD, and 4 new cases of IBDU. The incidence of IBD was 16.2/100,000 (95% CI 12.5-20.7) per year. The incidence per year was 6/100,000 (95% CI 3.8 to 8.9) for UC, 5/100,000 (95% CI 3.0-7.7) for CD, 4/100,000 (95% CI 2.3-6.5) for SCAD, and 1/100,000 (95% CI 0.3-2.6) for IBDU. We assessed for the first time which is the prevalence and incidence of IBD in a gastroenterology primary care unit. This confirms that specialist primary care unit is a key factor in providing early diagnosis of chronic diseases. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  11. Prevalence of health promotion programs in primary health care units in Brazil

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    Ramos, Luiz Roberto; Malta, Deborah Carvalho; Gomes, Grace Angélica de Oliveira; Bracco, Mário M; Florindo, Alex Antonio; Mielke, Gregore Iven; Parra, Diana C; Lobelo, Felipe; Simoes, Eduardo J; Hallal, Pedro Curi

    2014-01-01

    OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil. PMID:25372175

  12. Prevalence of problem alcohol use among patients attending primary care for methadone treatment

    LENUS (Irish Health Repository)

    Ryder, Niamh

    2009-06-11

    Abstract Background Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. Methods We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. Results We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. Conclusion Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make

  13. [Prevalence of burnout syndrome and its associated factors in Primary Care staff].

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    Navarro-González, D; Ayechu-Díaz, A; Huarte-Labiano, I

    2015-01-01

    Burnout syndrome is an emerging disease among health professionals. The aim of this study is to determine the prevalence of occupational burnout among Primary Care staff, as well as to determine the differences in prevalence between family doctors, paediatricians, nurses, administrative-officers, and social-workers, and to evaluate the different related factors. A cross-sectional, descriptive study was conducted on 178 professionals from 5 different occupational groups in 54 Primary Care centres in Navarre from September to December 2010. An anonymous, self-administered questionnaire that included: the Maslach Burnout Inventory and a questionnaire on socio-demographic and work-related factors. Burnout was detected in 39.3% of staff. Those with higher levels are administrative-officers and family doctors, with an OR compared to nurses of 4.58 and 5.37, respectively in the dimension of emotional exhaustion, 4.98 and 2.87 in depersonalization, and 8.37 for administrative-officers in personal accomplishment. An association was found between burnout and the following factors: to be a male (for the dimensions of emotional exhaustion and depersonalization, 25.5 and 31.9%, respectively), to be employed in an urban area (for emotional exhaustion and depersonalization, 20 and 27.8%, respectively), use of psychiatric medication (for emotional exhaustion, 30%), size of patient-quota (for depersonalization, with an average of 1,565 patients), and welfare pressure (for emotional exhaustion and depersonalization, averages of 170.35 and 153.54 patients/week, respectively). About one-third of Primary Care professionals have a high level of burnout, which is mainly associated with the working area, the size of the quota, and professional group, with higher prevalence in administrative-officers and family doctors. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Prevalence of problem alcohol use among patients attending primary care for methadone treatment.

    LENUS (Irish Health Repository)

    Ryder, Niamh

    2012-02-01

    BACKGROUND: Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed to determine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. METHODS: We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. RESULTS: We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28-41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. CONCLUSION: Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this

  15. Social deprivation and prevalence of chronic kidney disease in the UK: workload implications for primary care.

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    Hossain, M P; Palmer, D; Goyder, E; El Nahas, A M

    2012-02-01

    The 'inverse care law' suggests that populations with the poorest health outcomes also tend to have poorer access to high-quality care. The new general practitioner (GP) contract in the UK aimed to reduce variations in care between areas by collecting information on processes and outcomes of chronic disease management. This study investigated whether, despite reductions in inequalities, primary care in deprived areas is still at a disadvantage due to the higher prevalence of chronic diseases, using chronic kidney disease (CKD) as an example. Initially, data from a hospital-based cohort of CKD patients were analysed to investigate the clustering of CKD patients across area-level deprivation using a geographical information system that employed kernel density estimation. Data from the Quality and Outcomes Framework were then analysed to explore the burden of CKD and associated non-communicable chronic diseases (NCD) and assess the potential impact on GPs' workload by area-level deprivation. There was a significant clustering of CKD patients referred to the hospital in the most deprived areas. Both the prevalence of CKD and associated conditions and caseload per GP were significantly higher in deprived areas. In the most deprived areas, there is an increased burden of major chronic disease and a higher caseload for clinicians. These reflect significant differences in workload for practices in deprived areas, which needs to be addressed.

  16. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia.

    Science.gov (United States)

    Leelavathi, M; Azimah, M N; Kharuddin, N F; Tzar, M N

    2013-05-01

    Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.

  17. [Prevalence of neurodevelopmental, behavioural and learning disorders in Pediatric Primary Care].

    Science.gov (United States)

    Carballal Mariño, Marta; Gago Ageitos, Ana; Ares Alvarez, Josefa; Del Rio Garma, Mercedes; García Cendón, Clara; Goicoechea Castaño, Ana; Pena Nieto, Josefina

    2017-11-20

    To determine the prevalence of psychiatric disorders in primary care pediatrics in Atlantic Galicia. An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruña and Pontevedra with a population of 8293 children between September and November 2015. A total of 1286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorization was obtained from the Research Ethics Committee of Galicia number 2015/427. 148 of 1286 patients presented psychiatric pathology (11,5% IC 95% 9.73-13,29), 68% male. Between 0 and 5years, the prevalence was 4.5%; between 6y and 10y, 18.5% and between 11y and 14y 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behavior disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment. The prevalence of psychiatric disorders in pediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  18. Adjustment disorder with anxiety in old age: comparing prevalence and clinical management in primary care and mental health care.

    Science.gov (United States)

    Arbus, C; Hergueta, T; Duburcq, A; Saleh, A; Le Guern, M-E; Robert, P; Camus, V

    2014-05-01

    Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age. This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management. Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n=136). Up to 39% (n=53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently. AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. [Chronic kidney disease in Primary Health Care: prevalence and associated risk factors].

    Science.gov (United States)

    Salvador González, Betlem; Rodríguez Pascual, Mercedes; Ruipérez Guijarro, Laura; Ferré González, Antonia; Cunillera Puertolas, Oriol; Rodríguez Latre, Luisa M

    2015-04-01

    To determine the prevalence of chronic kidney disease and associated risk factors in subjects over 60 years of age, as well as its staging by determining the glomerular filtration rate (GFR). Cross-sectional observational study. Primary Health Care. Patients≥60 years of age who were seen in 40 Primary Health Care centres with serum creatinine measured in a central laboratory between January 1 and December 31, 2010. kidney transplant, home care. Social-demographic and anthropometric data, cardiovascular risk factors, and diseases established according to electronic clinical records. Serum creatinine was measured using standardised Jaffe kinetic method, and GFR estimated with MDRD-4-IDMS and CKD-EPI. A total of 97,665 subjects (57.3% women, median age 70.0 years [Q1: 65.0, Q3: 77.0]). GFR-MDRD prevalence<60=15.1% (16.6% in women, 13.2% in men; P<.001) and increased with age. Multivariate analysis showed a positive association between GFR-MDRD<60 and age (OR=1.74; 95% CI 1.70 to 1.77), hypertension (OR=2.18; 95% CI 2.08 to 2.30), heart failure (OR=2.03; 95% CI 1.83 to 2.25), atrial fibrillation (OR=1.57; 95% CI 1.41 to 1.76), ischaemic heart disease (OR=1.40; 95% CI 1.30 to 1.50), peripheral arterial disease (OR=1.31; 95% CI 1.09 to 1.57), dyslipidaemia (OR=1.28; 95% CI 1.23 to 1.33), diabetes (OR=1.26; 95% CI 1.17 to 1.34), and stroke (OR=1.17; 95% CI 1.09 to 1.25). The GFR-CKD-EPI model showed an increase in OR with age and male sex, that became significant as a chronic kidney disease risk factor. Chronic kidney disease has considerable prevalence in subjects≥60 years seen in Primary Health Care, more in women, and increasing with age. Hypertension, more than diabetes, was the main associated cardiovascular risk factor. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  20. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility

    Directory of Open Access Journals (Sweden)

    Archana Jain

    2013-01-01

    Full Text Available In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence.The sex ratio of Diabetic males to females was almost equal (1:0.97.Obesity was present in 114 people (64%.High prevalence of hypertension was found in Diabetic elderly population (80%. Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries′. This is real world urban diabetes prevalence, also associated hypertension

  1. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility.

    Science.gov (United States)

    Jain, Archana; Paranjape, Shilpa

    2013-10-01

    In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence). The sex ratio of Diabetic males to females was almost equal (1:0.97). Obesity was present in 114 people (64%). High prevalence of hypertension was found in Diabetic elderly population (80%). Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries'. This is real world urban diabetes prevalence, also associated hypertension and central

  2. Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients

    Directory of Open Access Journals (Sweden)

    Zailinawati Abu-Hassan

    2012-11-01

    Full Text Available Abstract Background Insomnia is a common public health problem and the prevalence and impact of insomnia in primary care attendees is not well documented in the Asian population. Objectives To determine the prevalence of self-reported insomnia symptoms amongst adult primary care attendees and the association with socio-demographic factors; to ascertain the impact of insomnia on daily functioning and to describe the psychological profile of patients with insomnia. Methods In this cross-sectional survey, 2049 adult patients (≥18 year old attending seven primary care clinics in Peninsular Malaysia, completed the questionnaire asking about symptoms of insomnia (defined according to the International Classification of Sleep Disorders and DSM IV criteria daytime impairment and psychological symptoms (assessed by Hospital Anxiety and Depression Scale. Results The response rate was 86.2%. A total of 60% reported insomnia symptoms, 38.9% had frequent insomnia symptoms (>3 times per week, 30.7% had chronic insomnia without daytime consequences and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity (OR 1.79; 95%CI, 1.28-2.49, age ≥ 50 or older (OR 1.82; 95%CI, 1.10-3.01, anxiety symptoms (OR 1.65; 95%CI, 1.21-2.22 and depression symptoms (OR 1.65; 95%CI, 1.21-2.26 were risk factors for chronic insomnia with daytime dysfunction. Amongst those with chronic insomnia with daytime dysfunction, 47.8% had anxiety symptoms (OR, 2.01; 95%CI, 1.57-2.59 and 36.5% had depression symptoms (OR, 2.74; 95%CI, 2.04-3.68 based on HADs score. They also had tendency to doze off while driving and to be involved in road traffic accidents. Conclusions A third of primary care attendees have insomnia symptoms and chronic insomnia, associated with significant daytime dysfunction and psychological morbidity. By identifying those at risk of having chronic insomnia, appropriate interventions can be commenced.

  3. Prevalence of Work-Related Asthma and its Impact in Primary Health Care.

    Science.gov (United States)

    Vila-Rigat, Rosa; Panadès Valls, Rafael; Hernandez Huet, Enric; Sivecas Maristany, Joan; Blanché Prat, Xavier; Muñoz-Ortiz, Laura; Torán Monserrat, Pere; Rabell Santacana, Ventura

    2015-09-01

    To determine the prevalence of occupational asthma (OA) and work-exacerbated asthma (WEA) among asthmatic patients diagnosed in Primary Health Care (PHC). To analyze the impact at PHC level caused by under-diagnosis and inappropriate referral of OA. A descriptive, cross-sectional multicenter study in patients aged between 16 and 64years diagnosed with asthma, according to their medical record; all were working or had worked, and were assigned to one of 16 PHC centers in a healthcare district. Based on the responses to the questionnaire completed at the study visit, which included a thorough review of the subject's entire working history, patients were classified into three categories by an expert in occupational asthma: OA, WEA or common asthma (CA). Three hundred and sixty-eight patients completed the questionnaire. The prevalence of OA was 18.2% (25% in men and 14.6% in women, P=.046), and 54 patients (14.7%) were classified as WEA. The proportion of patients with work-related asthma (WRA) was therefore 32.9%. Asthmatic patients with WRA took more sick leave than CA patients (P<.001). A high prevalence of WRA was found, mostly treated in PHC. Under-diagnosis of WRA is widespread in PHC. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  4. Prevalence of suicidal behaviour & associated factors among tuberculosis patients in public primary care in South Africa.

    Science.gov (United States)

    Peltzer, Karl; Louw, Julia

    2013-01-01

    In spite of the high prevalence of tuberculosis worldwide, there are only a few studies on its psychiatric complications such as suicidal behaviour. We undertook this study to assess the prevalence of suicidal behaviour and its associated factors among tuberculosis patients in public primary care in South Africa. In a cross-sectional survey conducted in three provinces of South Africa new TB and new re-treatment patients were assessed within one month of anti-tuberculosis treatment. The sample included 4900 (54.5% men and women 45.5%) consecutively selected tuberculosis patients from 42 public primary care clinics in three districts in South Africa. A total of 322 patients (9.0%) reported suicidal ideation and 131 (3.1%) had a history of a suicide attempt. In multivariate analysis female gender [Odds Ratio (OR)= 0.56, Confidence Interval (CI)= 0.43-0.74], psychological distress (OR=2.36, CI=1.04-2.29), post-traumatic stress disorders (PTSD) (OR=4.98, CI=3.76-6.59), harmful alcohol use (OR=1.97, CI=1.25-3.09) and being a TB re-treatment patient (OR=1.76, CI=1.32-2.34) were associated with suicidal ideation, and psychological distress (OR=3.27, CI=1.51-7.10), PTSD symptoms (OR=4.48, CI=3.04-6.61) and harmful alcohol use (OR=3.01, CI=1.83-4.95) were associated with a suicide attempt. Our findings suggest that co-morbid illnesses of psychological distress, PTSD and harmful alcohol use and HIV infection should be assessed in TB patients under TB control programmes to prevent suicidal behaviour. Clinicians should be aware about suicidality in tuberculosis patients to reduce mortality.

  5. Prevalence of suicidal behaviour & associated factors among tuberculosis patients in public primary care in South Africa

    Directory of Open Access Journals (Sweden)

    Karl Peltzer

    2013-01-01

    Full Text Available Background & objectives: In spite of the high prevalence of tuberculosis worldwide, there are only a few studies on its psychiatric complications such as suicidal behaviour. We undertook this study to assess the prevalence of suicidal behaviour and its associated factors among tuberculosis patients in public primary care in South Africa. Methods: In a cross-sectional survey conducted in three provinces of South Africa new TB and new re-treatment patients were assessed within one month of anti-tuberculosis treatment. The sample included 4900 (54.5% men and women 45.5% consecutively selected tuberculosis patients from 42 public primary care clinics in three districts in South Africa. Results: A total of 322 patients (9.0% reported suicidal ideation and 131 (3.1% had a history of a suicide attempt. In multivariate analysis female gender [Odds Ratio (OR= 0.56, Confidence Interval (CI= 0.43-0.74], psychological distress (OR=2.36, CI=1.04-2.29, post-traumatic stress disorders (PTSD (OR=4.98, CI=3.76-6.59, harmful alcohol use (OR=1.97, CI=1.25-3.09 and being a TB re-treatment patient (OR=1.76, CI=1.32-2.34 were associated with suicidal ideation, and psychological distress (OR=3.27, CI=1.51-7.10, PTSD symptoms (OR=4.48, CI=3.04-6.61 and harmful alcohol use (OR=3.01, CI=1.83-4.95 were associated with a suicide attempt. Interpretation & conclusions: Our findings suggest that co-morbid illnesses of psychological distress, PTSD and harmful alcohol use and HIV infection should be assessed in TB patients under TB control programmes to prevent suicidal behaviour. Clinicians should be aware about suicidality in tuberculosis patients to reduce mortality.

  6. [Prevalence of renal involvement in a population of type Ii diabetics followed up in primary care].

    Science.gov (United States)

    Marín, R; Coca, A; Tranche, S; Rodríguez Mañas, L; Abellán, J; Moyá, A

    2002-01-01

    Patients with type 2 diabetes use to be managed in their primary care settings during the early stages of the disease. The main objective of the study was to determine renal impairment prevalence, and to assess its significance, within type 2 diabetics controlled by their family physicians. Transverse observation of patients with type 2 diabetes who were the first 20 unselected cases seen by 183 family physicians from 16 of the 17 Autonomic Communities of our country. The following variables were determined: serum creatinine, glucose, and HbA1c concentrations, proteinuria (dipstick test in a first-voided morning urine sample), blood pressure levels, and associated cardiovascular disease. Data from 3,583 type 2 diabetic subjects were evaluated. Mean age was 64 +/- 10 years and 45% were male. A serum creatinine > or = 1.2 mg/dl was observed in 523 (15.5%) patients. Proteinuria was present in 794 (23.5%) cases, being > or = 2 + in 215 (6.5%) subjects. Patients with a serum creatinine > or = 1.2 mg/dl were older, shower higher blood pressure levels, and suffered from more cardiovascular disease (32.0 vs 19.5%) than those with a serum creatinine or = 2 + proteinuria (p or = 140/90 mmHg in 69% of the cases, being < 130/85 mmHg in only 8% of the subjects. There is a high prevalence of renal impairment, approximately of 25% within type 2 diabetic patients seen at the primary care level. Optimal blood pressure level seems to be extremely infrequent bearing in mind the diagnosis of diabetes and the associated cardiovascular disease.

  7. Prevalence of subclinical hypothyroidism in adults visiting primary health-care setting in Riyadh.

    Science.gov (United States)

    Al Eidan, Eidan; Ur Rahman, Saeed; Al Qahtani, Saeed; Al Farhan, Ali I; Abdulmajeed, Imad

    2018-01-01

    Background and objectives : Subclinical hypothyroidism is an asymptomatic condition with normal thyroxin and raised thyroid stimulating hormone (TSH) level. The objective of the study was to determine the prevalence of subclinical hypothyroidism in primary health care (PHC) settings in Riyadh and explore the relationship of TSH level with age, gender, family history, body mass index, and co-morbid conditions. Subjects and methods : A cross-sectional study of adult visitors to nine satellites PHC clinics in military housing in Riyadh was carried out. TSH concentration and free T4 levels were measured. Data were collected by nurses and physicians during routine clinical practice in primary care. Descriptive analysis was performed on all variables in study, and relationships were explored using chi-square, t -test, analysis of variance, and linear regression. Results : A total of 340 out of 394 participants in the study gave blood samples. Subclinical hyperthyroidism was identified in 2.1% ( p  = .001) and subclinical hypothyroidism in 10.3% ( p  = .001) of the PHC visitors. TSH levels were found to be significantly higher ( p  = .047) in elderly population of ≥60 years and those with family history of thyroid disease. Non-significant upward trends were noted in TSH levels with hyperlipidemia and increasing blood pressure. No overt hyperthyroidism or hypothyroidism was found in our study sample. Conclusion : Subclinical hypothyroidism has a prevalence of 10% of adults visiting PHC's. TSH levels are higher in the elderly, which warrants screening of those aged 60 years and above.

  8. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units,

    OpenAIRE

    Meneses, Tatiana Mota Xavier de; Oliveira, Maria Inês Couto de; Boccolini, Cristiano Siqueira

    2017-01-01

    Abstract Objective: To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Methods: Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted preva...

  9. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units

    OpenAIRE

    Tatiana Mota Xavier de Meneses; Maria Inês Couto de Oliveira; Cristiano Siqueira Boccolini

    2017-01-01

    Abstract Objective: To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Methods: Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted preva...

  10. Prevalence of fatigue and chronic fatigue syndrome in a primary care practice.

    Science.gov (United States)

    Bates, D W; Schmitt, W; Buchwald, D; Ware, N C; Lee, J; Thoyer, E; Kornish, R J; Komaroff, A L

    1993-12-27

    Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population. We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing. Five patients who came because of CFS studies were excluded. Of the remaining 995, 323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months' duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS. While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.

  11. A comparison of UK primary care data with other national data sources for monitoring the prevalence of smoking during pregnancy.

    Science.gov (United States)

    Dhalwani, Nafeesa N; Tata, Laila J; Coleman, Tim; Fiaschi, Linda; Szatkowski, Lisa

    2015-09-01

    We aimed to assess the potential usefulness of primary care data in the UK for estimating smoking prevalence in pregnancy by comparing the primary care data estimates with those obtained from other data sources. In The Health Improvement Network (THIN) primary care database, we identified pregnant smokers using smoking information recorded during pregnancy. Where this information was missing, we used smoking information recorded prior to pregnancy. We compared annual smoking prevalence from 2000 to 2012 in THIN with measures from the Infant Feeding Survey (IFS), Smoking At Time of Delivery (SATOD), Child Health Systems Programme (CHSP) and Scottish Morbidity Record (SMR). Smoking estimates from THIN data converged with estimates from other sources after 2004, though still do not agree completely. For example, in 2012 smoking prevalence at booking was 11.6% in THIN using data recorded only during pregnancy, compared with 19.6% in SMR data. However, the use of smoking data recorded up to 27 months before conception increased the THIN prevalence to 20.3%, improving the comparability. Under-recording of smoking status during pregnancy results in unreliable prevalence estimates from primary care data and needs improvement. However, in the absence of gestational smoking data, the inclusion of pre-conception smoking records may increase the utility of primary care data. One strategy to improve gestational smoking status recording in primary care could be the inclusion of pregnancy in the Quality and Outcome's Framework as a condition for which smoking status and smoking cessation advice must be recorded electronically in patient records. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health.

  12. [Prevalence of carotid artery stenosis in nonagenarians: Survey in a primary care hospital].

    Science.gov (United States)

    Bohlender, J; Nussberger, J; Ménard, J; Bohlender, B

    2017-06-01

    Carotid artery stenosis increases with age and may cause brain ischemia if arterial hypotension occurs. We performed a monocentric pilot study to investigate its prevalence in the very elderly and to assess its potential influence on blood pressure (BP) goals during antihypertensive treatment. All patients≥90 years of a primary care medical ward were prospectively included over 15 months. Ultrasound exams of the precerebral arteries were offered to all elderly patients for routine evaluation of their cardiovascular risk. Frequencies of stenosed common, internal and external carotid arteries (CCA, ICA, ECA) were analyzed together with clinical BP and antihypertensive therapy. Patients with circulatory shock and readmissions were excluded. Sixty-three patients aged 92±3 years (78% female) hospitalized for a median of 11 days were included. On admission, 76% were on antihypertensive drugs vs. 86% at discharge. Mean admission BP was 149/77 vs. 129/72mmHg at discharge; systolic BP<140mmHg 36% vs 64% (P<0.05). Mean intima-media thickness (ACC, right/left) was 8.7/9.4mm. Prevalence of plaque or stenosis<60% was: CCA 19.0%, ICA 19.0%, ECA 31.7%, bulb 74.6%; of stenosis≥60%: CCA 0%, ICA 7.9%, ECA 19.0%, ICA bilateral 1.6% (unilateral occlusion 3.1%, no bilateral). Coincidence of systolic BP<120mmHg and ACI stenosis≥60% had a probability of 1-2%. Concerning the risk of brain ischemia due to carotid artery stenosis, a BP goal<140mmHg should be safe for most nonagenarians. If individual BP goals are lower, searching for significant stenosis by ultrasound may be useful. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units.

    Science.gov (United States)

    Meneses, Tatiana Mota Xavier de; Oliveira, Maria Inês Couto de; Boccolini, Cristiano Siqueira

    To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted prevalence ratios (APR) by Poisson regression with robust variance. The final model included the variables associated with breast milk donation (p≤0.05). 7.3% of the mothers had donated breast milk. Having been encouraged to donate breast milk by healthcare professionals, relatives, or friends (APR=7.06), receiving information on breast milk expression by the primary health care unit (APR=3.65), and receiving help from the unit professionals to breastfeed (APR=2.24) were associated with a higher prevalence of donation. Admission of the newborn to the neonatal unit was associated with a lower prevalence of donation (APR=0.09). Encouragement to breast milk donation, and information and help provided by primary health care unit professionals to breastfeeding were shown to be important for the practice of human milk donation. Copyright © 2017. Published by Elsevier Editora Ltda.

  14. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units,

    Directory of Open Access Journals (Sweden)

    Tatiana Mota Xavier de Meneses

    Full Text Available Abstract Objective: To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Methods: Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted prevalence ratios (APR by Poisson regression with robust variance. The final model included the variables associated with breast milk donation (p ≤ 0.05. Results: 7.3% of the mothers had donated breast milk. Having been encouraged to donate breast milk by healthcare professionals, relatives, or friends (APR = 7.06, receiving information on breast milk expression by the primary health care unit (APR = 3.65, and receiving help from the unit professionals to breastfeed (APR = 2.24 were associated with a higher prevalence of donation. Admission of the newborn to the neonatal unit was associated with a lower prevalence of donation (APR = 0.09. Conclusions: Encouragement to breast milk donation, and information and help provided by primary health care unit professionals to breastfeeding were shown to be important for the practice of human milk donation.

  15. Parental Perception, Prevalence and Primary Care Physicians’ Knowledge on Childhood Food Allergy in Croatia

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    Tamara Voskresensky Baricic

    2015-07-01

    Full Text Available Food allergy in children is increasing and the perception of food allergy among parents is even more common. In a questionnaire-based study of 702 children aged 6 to 48 months in four primary care settings, the aim was to determine the prevalence of perception vs. proven food allergy, parental anxiety and general pediatrician knowledge of food allergy. In 95/702 children (13.5% parentally-reported food was associated reactions. IgE and/or skin prick test (SPT and/or an open provocation test were performed in 48 (6.8% and allergy was proven in 38 (5.4% children. Discrepancy between parental perception and proven allergy is significant (p < 0.001, especially for food other than milk, egg and peanut (p < 0.001. Allergy to milk was the most common. Allergy to peanut was significantly more common in children ≥2 years (p < 0.05. Severe reactions occurred in 5/95 (5.2% of all children and in 5/38 (13.1% of allergic children, in 3/5 caused by peanut. Parents of children with proven allergy do not experience high degree of anxiety. The perception of food allergy among general pediatricians is limited, and in children with severe reactions precautionary measures and information to parents were insufficient. Parents and general pediatricians need additional education in food allergy.

  16. Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study.

    Science.gov (United States)

    Toft, Tomas; Fink, Per; Oernboel, Eva; Christensen, Kaj; Frostholm, Lisbeth; Olesen, Frede

    2005-08-01

    Prevalence and co-occurrence of mental disorders is high among patients consulting their family general practitioner (GP) for a new health problem, but data on diagnostics and socio-demographics are sketchy. A cross-sectional two-phase epidemiological study. A total of 1785 consecutive patients with new complaints, aged 18-65 years, consulting 28 family practices during March-April 2000 in Aarhus County, Denmark were screened, in the waiting room, for mental and somatic symptoms with SCL-8 and SCL-Somatization questionnaires, for illness worry with Whitely-7 and for alcohol dependency with CAGE. In a stratified random sample of 701 patients, physician interviewers established ICD-10 diagnoses using the SCAN interview. Prevalence was calculated using weighted logistic regression, thus correcting for sample skewness. Half of the patients fulfilled criteria for an ICD-10 mental disorders and a third of these for more than one group of disorders. Women had higher prevalence of somatization disorder and overall mental disorders than men. Men had higher prevalence of alcohol abuse and hypochondriasis than women. Psychiatric morbidity tended to increase with age. Prevalence of somatoform disorders was 35.9% (95% CI 30.4-41.9), anxiety disorders 164% (95% CI 12.7-20.9), mood disorders 13.5% (95% CI 11.1-16.3), organic mental disorders 3.1% (95% CI 1.6-5.7) and alcohol abuse 2.2% (95% CI 1.5-3.1). Co-morbidities between these groups were highest for anxiety disorders, where 89% also had another mental diagnosis, and lowest for somatoform disorders with 39%. ICD-10 mental disorders are very prevalent in primary care and there is a high co-occurrence between most disorders. Somatoform disorders, however, more often than not exist without other mental disorders.

  17. Primary care ... where?

    Science.gov (United States)

    Adcock, G B

    1999-07-01

    Corporate-based nurse managed centers are not the national norm. More prevalent is the use of an occupational health or physician-directed medical model of care. The author describes how a 14-year-old primary care center at a North Carolina computer software company is just "business as usual" when viewed in the context of the company's philosophy, goals, and culture. Included are considerations for nurse practitioners interested in the successful transplantation of this primary care model to other settings.

  18. Prevalence and typology of potential drug interactions occurring in primary care patients.

    Science.gov (United States)

    Lopez-Picazo, Julio J; Ruiz, Juan C; Sanchez, Jose F; Ariza, Angeles; Aguilera, Belen; Lazaro, Dolores; Sanz, Gonzalo R

    2010-06-01

    To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. Cross-sectional descriptive study. Two areas in Spain comprising 715,661 inhabitants. 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.

  19. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England.

    Directory of Open Access Journals (Sweden)

    Dan G O Neill

    Full Text Available Purebred dog health is thought to be compromised by an increasing occurence of inherited diseases but inadequate prevalence data on common disorders have hampered efforts to prioritise health reforms. Analysis of primary veterinary practice clinical data has been proposed for reliable estimation of disorder prevalence in dogs. Electronic patient record (EPR data were collected on 148,741 dogs attending 93 clinics across central and south-eastern England. Analysis in detail of a random sample of EPRs relating to 3,884 dogs from 89 clinics identified the most frequently recorded disorders as otitis externa (prevalence 10.2%, 95% CI: 9.1-11.3, periodontal disease (9.3%, 95% CI: 8.3-10.3 and anal sac impaction (7.1%, 95% CI: 6.1-8.1. Using syndromic classification, the most prevalent body location affected was the head-and-neck (32.8%, 95% CI: 30.7-34.9, the most prevalent organ system affected was the integument (36.3%, 95% CI: 33.9-38.6 and the most prevalent pathophysiologic process diagnosed was inflammation (32.1%, 95% CI: 29.8-34.3. Among the twenty most-frequently recorded disorders, purebred dogs had a significantly higher prevalence compared with crossbreds for three: otitis externa (P = 0.001, obesity (P = 0.006 and skin mass lesion (P = 0.033, and popular breeds differed significantly from each other in their prevalence for five: periodontal disease (P = 0.002, overgrown nails (P = 0.004, degenerative joint disease (P = 0.005, obesity (P = 0.001 and lipoma (P = 0.003. These results fill a crucial data gap in disorder prevalence information and assist with disorder prioritisation. The results suggest that, for maximal impact, breeding reforms should target commonly-diagnosed complex disorders that are amenable to genetic improvement and should place special focus on at-risk breeds. Future studies evaluating disorder severity and duration will augment the usefulness of the disorder prevalence information

  20. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England.

    Science.gov (United States)

    O Neill, Dan G; Church, David B; McGreevy, Paul D; Thomson, Peter C; Brodbelt, Dave C

    2014-01-01

    Purebred dog health is thought to be compromised by an increasing occurence of inherited diseases but inadequate prevalence data on common disorders have hampered efforts to prioritise health reforms. Analysis of primary veterinary practice clinical data has been proposed for reliable estimation of disorder prevalence in dogs. Electronic patient record (EPR) data were collected on 148,741 dogs attending 93 clinics across central and south-eastern England. Analysis in detail of a random sample of EPRs relating to 3,884 dogs from 89 clinics identified the most frequently recorded disorders as otitis externa (prevalence 10.2%, 95% CI: 9.1-11.3), periodontal disease (9.3%, 95% CI: 8.3-10.3) and anal sac impaction (7.1%, 95% CI: 6.1-8.1). Using syndromic classification, the most prevalent body location affected was the head-and-neck (32.8%, 95% CI: 30.7-34.9), the most prevalent organ system affected was the integument (36.3%, 95% CI: 33.9-38.6) and the most prevalent pathophysiologic process diagnosed was inflammation (32.1%, 95% CI: 29.8-34.3). Among the twenty most-frequently recorded disorders, purebred dogs had a significantly higher prevalence compared with crossbreds for three: otitis externa (P = 0.001), obesity (P = 0.006) and skin mass lesion (P = 0.033), and popular breeds differed significantly from each other in their prevalence for five: periodontal disease (P = 0.002), overgrown nails (P = 0.004), degenerative joint disease (P = 0.005), obesity (P = 0.001) and lipoma (P = 0.003). These results fill a crucial data gap in disorder prevalence information and assist with disorder prioritisation. The results suggest that, for maximal impact, breeding reforms should target commonly-diagnosed complex disorders that are amenable to genetic improvement and should place special focus on at-risk breeds. Future studies evaluating disorder severity and duration will augment the usefulness of the disorder prevalence information reported

  1. Prevalence of urinary tract infection (UTI) in sequential acutely unwell children presenting in primary care: exploratory study.

    Science.gov (United States)

    O'Brien, Kathryn; Stanton, Naomi; Edwards, Adrian; Hood, Kerenza; Butler, Christopher C

    2011-03-01

    Due to the non-specific nature of symptoms of UTI in children and low levels of urine sampling, the prevalence of UTI amongst acutely ill children in primary care is unknown. To undertake an exploratory study of acutely ill children consulting in primary care, determine the feasibility of obtaining urine samples, and describe presenting symptoms and signs, and the proportion with UTI. Exploratory, observational study. Four general practices in South Wales. A total of 99 sequential attendees with acute illness aged less than five years. UTI defined by >10(5) organisms/ml on laboratory culture of urine. Urine samples were obtained in 75 (76%) children. Three (4%) met microbiological criteria for UTI. GPs indicated they would not normally have obtained urine samples in any of these three children. However, all had received antibiotics for suspected alternative infections. Urine sample collection is feasible from the majority of acutely ill children in primary care, including infants. Some cases of UTI may be missed if children thought to have an alternative site of infection are excluded from urine sampling. A larger study is needed to more accurately determine the prevalence of UTI in children consulting with acute illness in primary care, and to explore which symptoms and signs might help clinicians effectively target urine sampling.

  2. Prevalence and determinants of antenatal depression among women attending primary health care centers in Western Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Jamala A. Bawahab

    2017-12-01

    Full Text Available Objectives: To measure the prevalence of antenatal depression among pregnant women attending the primary health care (PHC antenatal care clinics in Jeddah, Saudi Arabia and to determine associated factors. Methods: Following a cross-sectional study design, 320 pregnant women attending the antenatal care clinics in the Ministry of Health PHC Centers in Jeddah, Saudi Arabia between January 1st 2017 and February 15th 2017 were interviewed. A self-administered questionnaire used for data collection asked about socio-demographic variables and included the Edinburgh Postnatal Depression Scale. Results: The most common contributor was the harming herself (mean±SD, 2.7±0.60. Factors significantly associated with depression among participants were the number of daughters, previous diagnosis of depression, and financial problems. Conclusions: The prevalence of antepartum depression among pregnant women in Jeddah is 57.5%, and the greatest contributor is the thought of harming herself.

  3. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

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    McNair Peter J

    2011-05-01

    Full Text Available Abstract Background The prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB, acromioclavicular joint (ACJ and glenohumeral joint (GHJ. Methods Consecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR to diagnostic blocks. Results In the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively and MRA (65% and 76% respectively. The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p p p p ≤ 0.05. Conclusions Rotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.

  4. Prevalence of antimicrobial resistant Escherichia coli from patients with suspected urinary tract infection in primary care, Denmark.

    Science.gov (United States)

    Córdoba, Gloria; Holm, Anne; Hansen, Frank; Hammerum, Anette M; Bjerrum, Lars

    2017-10-10

    Escherichia coli is the most common pathogen causing Urinary Tract Infections (UTI). Data from the current National Surveillance program in Denmark (DANMAP) may not accurately represent the prevalence of resistant E. coli in primary care, because only urine samples from complicated cases may be forwarded to the microbiological departments at hospitals for diagnostic examination. The aim of this study was to assess the prevalence of resistant E. coli to the most commonly used antimicrobial agents in primary care in a consecutive sample of patients from general practice. Observational study carried out from December 2014 to December 2015. Thirty-nine general practices from The Capital Region of Denmark included adult patients with urinary tract symptoms and suspected UTI. All urine samples were sent to the central laboratory Statens Serum Institut (SSI). Significant bacteriuria was interpreted according to the European Urinalysis Standards. Susceptibility testing was performed and interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. From the 39 general practices 505 patients were recruited. Completed data were obtained from 485 (96%) patients. According to the European Urinalysis Standards, 261 (54%) patients had positive bacteriuria. The most common uropathogen in patients with uncomplicated (uUTI) and complicated (cUTI) urinary tract infection was E. coli 105 (69%) and 76 (70%), respectively. Eighty-two (45%) of 181 E. coli isolates were resistant to at least one of the tested antibiotics and 50 out of 82 isolates were resistant to two or more antimicrobial agents. The highest resistance-rate was found against ampicillin 34% (95% CI 24;42) in uUTI and 36% (24;46) in cUTI. There were no differences in the distribution of resistance between uncomplicated and complicated cases. The prevalence of resistance was similar to the one reported in DANMAP 2014. In E. coli from uUTI there is high resistance rates to

  5. Prevalence of Trichomonas vaginalis by PCR in men attending a primary care urology clinic in South Korea.

    Science.gov (United States)

    Seo, Jun-Hyeok; Yang, Hye-Won; Joo, So-Young; Song, Su-Min; Lee, Yu-Ran; Ryu, Jae-Sook; Yoo, Eun Sang; Lee, Won Kee; Kong, Hyun-Hee; Lee, Sang-Eun; Lee, Won-Ja; Goo, Youn-Kyoung; Chung, Dong-Il; Hong, Yeonchul

    2014-10-01

    Trichomonas vaginalis, a causative agent of trichomoniasis, may trigger symptomatic or asymptomatic nongonococcal urethritis and chronic prostatitis in men. Despite the availability of highly sensitive diagnostic tests, such as nucleic acid amplification tests, including PCR, few prospective studies present data on male T. vaginalis infection in South Korea. In the present study, the prevalence of T. vaginalis and associated clinical conditions were evaluated in 201 male patients from a primary care urology clinic in South Korea. The prevalence of T. vaginalis infection in our cohort was 4% (8/201) by PCR. T. vaginalis infection was common in men older than 40 years (median age, 52 years). Among the 8 Trichomonas-positive patients, 87.5% (7/8) had prostatic diseases, such as prostatitis and benign prostatic hyperplasia, and 25.0% (2/8) and 12.5% (1/8) were coinfected with Chlamydia trachomatis and Mycoplasma genitalium, respectively. Our results suggest that T. vaginalis infection is not rare in men attending primary care urology clinics in South Korea, especially in those older than 40 years, in whom it may explain the presence of prostatic disease. The possibility of T. vaginalis infection should be routinely considered in older male patients with prostatic diseases in South Korea.

  6. Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa.

    Science.gov (United States)

    Peltzer, Karl; Rodriguez, Violeta J; Jones, Deborah

    2016-12-01

    This study aimed to assess the prevalence of depressed symptoms and associated factors in prenatal HIV-positive women in primary care facilities in rural South Africa. In a cross-sectional study, 663 HIV-positive prenatal women in 12 community health centres in Mpumalanga province, South Africa, were recruited by systematic sampling (every consecutive patient after HIV post-test counselling). Results indicate that overall, 48.7% [95% CI: 44.8, 52.6] of women during the prenatal period reported depressed mood (scores of ≥ 13 on the Edinburgh Postnatal Depression Scale 10). In multivariate analysis, not being employed, unplanned pregnancy, not having an HIV-positive child, poor antiretroviral therapy adherence, non-condom use at last sex, and intimate partner violence were associated with depressive symptoms. Potential risk factors among HIV-infected prenatal women were identified which could be utilized in interventions. Routine screening for depression may be integrated into prenatal care settings.

  7. Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence.

    Science.gov (United States)

    Russell, Paul; Banerjee, Sube; Watt, Jen; Adleman, Rosalyn; Agoe, Belinda; Burnie, Nerida; Carefull, Alex; Chandan, Kiran; Constable, Dominie; Daniels, Mark; Davies, David; Deshmukh, Sid; Huddart, Martin; Jabin, Ashrafi; Jarrett, Penelope; King, Jenifer; Koch, Tamar; Kumar, Sanjoy; Lees, Stavroula; Mir, Sinan; Naidoo, Dominic; Nyame, Sylvia; Sasae, Ryuichiro; Sharma, Tushar; Thormod, Clare; Vedavanam, Krish; Wilton, Anja; Flaherty, Breda

    2013-12-23

    Improving dementia care is a policy priority nationally and internationally; there is a 'diagnosis gap' with less than half of the cases of dementia ever diagnosed. The English Health Department's Quality and Outcomes Framework (QOF) encourages primary care recognition and recording of dementia. The codes for dementia are complex with the possibility of underidentification through miscoding. We developed guidance on coding of dementia; we report the impact of applying this to 'clean up' dementia coding and records at a practice level. The guidance had five elements: (1) identify Read Codes for dementia; (2) access QOF dementia register; (3) generate lists of patients who may have dementia; (4) compare search with QOF data and (5) review cases. In each practice, one general practitioner conducted the exercise. The number of dementia QOF registers before and after the exercise was recorded with the hours taken to complete the exercise. London primary care. 23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants. The number on dementia QOF registers; time taken. The number of people with dementia on QOF registers increased from 1007 to 1139 (χ(2)=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average. These data demonstrate the potential of a simple primary care coding exercise, requiring no specific training, to increase the dementia identification rate. An improvement of 8.8% between 2011 and 2012 is equivalent to that of the fourth most improved primary care trust in the UK. In absolute terms, if this effects were mirrored across the UK primary care, the number of cases with dementia identified would rise by over 70 000 from 364 329 to 434 488 raising the recognition rate from 46% to 54.8%. Implementing this exercise appears to be a simple and effective way to improve recognition rates in primary care.

  8. The prevalence and burden of psychiatric disorders in primary health care visits in Qatar: Too little time?

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    Abdulbari Bener

    2015-01-01

    Full Text Available Background: Psychiatric disorders including anxiety, depression, somatization, obsessive compulsive, and bipolar disorders are recognized as causing the biggest burden of disease worldwide. Aim: In this study, we aimed to assess the prevalence and burden of common mental disorders at Primary Health Care Centers (PHCC using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI in the Qatari population, aged 18-65 who attended Primary Health Care (PHC settings. Design: A prospective cross-sectional study conducted during November 2011 to October 2012. Setting: Primary Health Care Centers of the Supreme Council of Health, Qatar. Subjects: A total of 2,000 Qatari subjects aged 18-65 years were approached; 1475 (73.3% agreed to participate. Methods: Prevalence and severity of International Classification of Disease-10 disorders were assessed with the WHO-CIDI (Version 3.0. Results: Of the 1475 participants, 830 (56.3% were females and 645 (43.7% was males. One-third were aged 35-49 years 558 (37.8%. The three most common disorders were major depression disorders (18.31%, any anxiety disorders (17.3%, any mood disorders (16.95%, followed by separation anxiety disorders (15.25%, personality disorder (14.1%. In the present study, prevalence in women was significantly higher than men for the most common psychiatric disorders, specifically generalized anxiety disorder, panic disorder, social phobia, specific phobias, obsessive compulsive disorders, posttraumatic disorder, somatization, major depressive disorder, bipolar disorder, dysthymia, and oppositional defiant disorder. Of the total 20% had only one psychiatric diagnosis and 12% had two disorders, 9.7% respondents with three diagnoses, and finally 4.3% of respondents had four or more diagnoses. Conclusion: One-fifth of all adults who attended the PHCC (20% had at least one psychiatric diagnosis. The CIDI is a useful instrument for psychiatric diagnosis in community

  9. Prevalence of atherogenic dyslipidemia in primary care patients at moderate-very high risk of cardiovascular disease. Cardiovascular risk perception.

    Science.gov (United States)

    Plana, Nuria; Ibarretxe, Daiana; Cabré, Anna; Ruiz, Emilio; Masana, Lluis

    2014-01-01

    Atherogenic dyslipidemia is an important risk factor for cardiovascular disease. We aim to determine atherogenic dyslipidemia prevalence in primary care patients at moderate-very high cardiovascular risk and its associated cardiovascular risk perception in Spain. This cross-sectional study included 1137 primary care patients. Patients had previous cardiovascular disease, diabetes mellitus, SCORE risk ≥ 3, severe hypertension or dyslipidemia. Atherogenic dyslipidemia was defined as low HDL-C (<40 mg/dL [males], <50 mg/dL [females]) and elevated triglycerides (≥ 150 mg/dL). A visual analog scale was used to define a perceived cardiovascular disease risk score. Mean age was 63.9 ± 9.7 years (64.6% males). The mean BMI was 29.1 ± 4.3 kg/m(2), and mean waist circumference 104.2 ± 12.7 cm (males), and 97.2 ± 14.0 cm (females). 29.4% were smokers, 76.4% had hypertension, 48.0% were diabetics, 24.7% had previous myocardial infarction, and 17.8% peripheral arterial disease. European guidelines classified 83.6% at very high cardiovascular risk. Recommended HDL-C levels were achieved by 50.1% of patients and 37.3% had triglycerides in the reference range. Target LDL-C was achieved by 8.8%. The overall atherogenic dyslipidemia prevalence was 27.1% (34.1% in diabetics). This prevalence in patients achieving target LDL-C was 21.4%. Cardiovascular risk perceived by patients was 4.3/10, while primary care physicians scored 5.7/10. When LDL-C levels are controlled, atherogenic dyslipidemia is more prevalent in those patients at highest cardiovascular risk and with diabetes. This highlights the importance of intervention strategies to prevent the residual vascular risk in this population. Both patients and physicians underestimated cardiovascular risk. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  10. Prevalence and control of high blood pressure in primary care: results from the German Metabolic and Cardiovascular Risk Study (GEMCAS).

    Science.gov (United States)

    Balijepalli, Chakrapani; Bramlage, Peter; Lösch, Christian; Zemmrich, Claudia; Humphries, Karin H; Moebus, Susanne

    2014-06-01

    Contemporary epidemiological data on blood pressure readings, hypertension prevalence and control in unselected patient populations covering a broad age range are scarce. The aim here is to report the prevalence of high blood pressure and to identify factors associated with blood pressure control in a large German primary care sample. We used data from the German Metabolic and Cardiovascular Risk Study including 35 869 patients aged 18-99 years. High blood pressure was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or using antihypertensive therapy. Factors associated with blood pressure control among patients receiving antihypertensive therapy were examined using multiple logistic regressions to estimate odds ratios and 95% confidence intervals. The prevalence of high blood pressure, uncontrolled high blood pressure and untreated high blood pressure was 54.8%, 21.3% and 17.6%, respectively. Age >50 years (1.52; 1.40-1.65), male sex (1.30; 1.20-1.41), elevated waist circumference (1.55; 1.45-1.65), high cholesterol (1.24; 1.16-1.33), high triglycerides (1.11; 1.04-1.19) and concomitant diabetes (1.29; 1.20-1.40) were independently associated with uncontrolled high blood pressure. In a majority of patients we observed hypertension despite treatment for high blood pressures. Studies examining the reasons for treatment failure are highly warranted.

  11. A systematic review of anxiety prevalence in adults within primary care and community settings in Malaysia.

    Science.gov (United States)

    Wong, Chin Hoong; Sultan Shah, Zia U Bakt; Teng, Cheong Lieng; Lin, Tzi Quen; Majeed, Zainab Abdul; Chan, Chun Wai

    2016-12-01

    Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole. A systematic review of databases, reference lists, internet sources, and input from content experts revealed 42 studies that documented the prevalence of anxiety symptoms or disorders. 12 of these studies specifically evaluated anxiety disorders. 4 studies looked at the prevalence of anxiety disorders in the general population, whilst the remainder focused on selected population groups: university students (4 studies); substance abuse (3 studies); and victims of abuse (1 study). Studies in the general population showed that the prevalence of generalised anxiety disorder was 0.4-5.6%, mixed anxiety and depression were 3-5%, panic without agoraphobia 0.4%, phobia unspecified 0.5-%, and anxiety not-otherwise-specified 0.3-6.5%. We found significant variability in anxiety disorders in the studies in selected population groups. The variability could also have been affected by methodological factors within each study. This study provides a broad overview of the prevalence of anxiety disorders in Malaysia. More research is required to develop diagnostic instruments that are validated for local use and comparable with international standards. Reliable prevalence estimates are lacking within certain groups, e.g. those in rural, indigenous, migrant population groups and those exposed to natural disasters. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Pre-conception counselling in primary care: Prevalence of risk factors among couples contemplating pregnancy

    NARCIS (Netherlands)

    Pal van der-Bruin, K.M. de; Cessie, S. le; Elsinga, J.; Jong de-Potjer, L.C.; Haeringen, A. van; Knuistingh Neven, A.; Verloove-Vanhorick, S.P.; Assendelft, P.

    2008-01-01

    The outcome of pregnancy can be influenced by several risk factors. Women who are informed about these risks during pre-conception counselling (PCC) have an opportunity to take preventive measures in time. Several studies have shown that high-risk populations have a high prevalence of such risk

  13. Prevalence of antimicrobial resistant Escherichia coli from patients with suspected urinary tract infection in primary care, Denmark

    DEFF Research Database (Denmark)

    Cordoba, Gloria; Holm, Anne; Hansen, Frank

    2017-01-01

    Background: Escherichia coli is the most common pathogen causing Urinary Tract Infections (UTI). Data from the current National Surveillance program in Denmark (DANMAP) may not accurately represent the prevalence of resistant E. coli in primary care, because only urine samples from complicated......: Observational study carried out from December 2014 to December 2015. Thirty-nine general practices from The Capital Region of Denmark included adult patients with urinary tract symptoms and suspected UTI. All urine samples were sent to the central laboratory Statens Serum Institut (SSI). Significant bacteriuria...... 485 (96%) patients. According to the European Urinalysis Standards, 261 (54%) patients had positive bacteriuria. The most common uropathogen in patients with uncomplicated (uUTI) and complicated (cUTI) urinary tract infection was E. coli 105 (69%) and 76 (70%), respectively. Eighty-two (45%) of 181 E...

  14. The prevalence of prescribing antibiotics by primary health care physicians in Turkey: A multi-centered survey

    International Nuclear Information System (INIS)

    Acimis, N.M.; Yazici, A.C.; Gocmen, L.; Mas, R.

    2009-01-01

    Objective: Antibiotics are widely used in the treatment of infections and for empirical treatment purposes. Despite this common consumption of antibiotics, it is difficult to state that antibiotics are chosen and used consciously. This study was planned to determine the prevalence of prescribing antibiotics in Turkey. Methodology: This cross-sectional study was conducted in November 2003. The study was carried out in a total of 46 primary care health centers of the following cities; Central Anatolian, Western Anatolian, Eastern Anatolian regions. Results: Two hundred sixty seven physicians participated in the study, 38.9% (104) of which were women and 61.1% (163) were men. The proportion of antibiotic prescription was by 22,6%, and the most frequently chosen antibiotics were 15.6% (3301) Amoxycilline + Clavulanic acid (Amox/Clav), 15.1% (3184) Ampicilline + Sulbactam 12.84% (2711), respectively. When prescriptions with antibiotics were evaluated according to diagnosis, the most frequent diagnoses were found to be as follows: 53.3% (11430) Acute Upper Respiratory Infections, 16.4% (3516) Urinary Tract Infections. Conclusions: The findings of the study suggest that primary health care physicians most often prescribe for acute respiratory tract infections, and prescribe Amoxycilline + Clavunic the most. It may be argued that more extensive studies are needed in this field. (author)

  15. Prevalence, correlates, attitude and treatment seeking of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics

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    Wai Hon Lo

    2014-10-01

    Full Text Available To investigate the prevalence, correlates, attitude and treatment seeking behavior of erectile dysfunction (ED in type 2 diabetes mellitus (T2DM patients in the primary care setting, a multi-center cross-sectional survey using a structured anonymous self-administered questionnaire was performed in 10 general outpatient clinics. Of the 603 subjects (91% response rate, the prevalence of ED men, as defined by the International Index of Erectile Function, was 79.1%. Most subjects had mild ED (28.9%, followed by mild-to-moderate ED (27.9%, then moderate ED (13.4% and severe ED (9%. Nearly 55% of those with ED did not consider themselves as having ED. Less than 10% of them had ever sought medical treatment, although 76.1% of them wished to receive management from doctor(s should they be diagnosed with ED. They considered the most important management from doctors to be clinical assessment (41.7%, followed by management of potential underlying cause (37.8%, referral to specialist (27.5%, education (23.9%, prescription of phosphodiesterase type 5 inhibitors (16.9% and referral to counseling service (6.7%. The prevalence of ED was strongly associated with subjects who thought they had ED (odds ratio (OR = 90.49 (20.00-409.48, P< 0.001 and were from the older age group (OR = 1.043 (1.011-1.076, P= 0.008. In conclusion, ED is highly prevalent among T2DM men. The majority of them wanted management from doctors should they have ED, but only a minority would actually voice out the request. Screening of ED among T2DM men using structural questionnaire allowed the diagnosis of more than half of the ED cases, which otherwise would have gone undiagnosed.

  16. Prevalence of postnatal depression and associated factors among HIV-positive women in primary care in Nkangala district, South Africa

    Directory of Open Access Journals (Sweden)

    K Peltzer

    2011-12-01

    Full Text Available Background. The prevalence of postpartum depression in South Africa is high, but there is lack of prevalence data on postnatal depression among HIV-infected women. Aim. The aim of this study was to determine the prevalence of depressed mood and associated factors in postnatal HIV-positive women in primary care facilities in Nkangala district, Mpumalanga, South Africa. Methods. This cross-sectional study was carried out on 607 HIV-positive postnatal women in 48 primary health care clinics and community health centres in Nkangala district. Postnatal women were recruited by systematic sampling (every consecutive patient over a period of 2 months. Demographic and other data were obtained from all the women who responded to a questionnaire in the local language on male involvement, HIV test disclosure, delivery and infant profile, infant HIV diagnosis, stigma, discrimination, postnatal depression, attendance of support groups and social support. Results. Overall, 45.1% of women reported a depressed mood in the postnatal period. Depressed mood in a multivariable analysis was significantly associated with internalised stigma (odds ratio (OR 1.12, 95% confidence interval (CI 1.05 - 1.19; p=0.000, discrimination experiences (OR 1.22, CI 1.03 - 1.46; p=0.023, lack of social support (OR 0.86, CI 0.74 - 0.99; p=0.037 and having had an STI in the past 12 months (OR 2.22, CI 1.21 - 4.04; p=0.010. There were no statistically significant correlations between the Edinburgh Postnatal Depression Scale (EPDS scores of the women and age, marital status, level of education, employment status and number of own children. Conclusion. Depressed mood is common among HIV-positive postpartum women. This is significantly associated with lack of social support, stigma and discrimination. Routine screening to identify those currently depressed or at risk of depression should be integrated into postnatal care settings to target those most needing intervention.

  17. Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics.

    Science.gov (United States)

    Kirmayer, L J; Robbins, J M

    1991-11-01

    Three definitions of somatization were operationalized: (a) high levels of functional somatic distress, measured by the Somatic Symptom Index (SSI) of the Diagnostic Interview Schedule; (b) hypochondriasis measured by high scores on a measure of illness worry in the absence of evidence for serious illness; and (c) exclusively somatic clinical presentations among patients with current major depression or anxiety. Of 685 patients attending two family medicine clinics, 26.3% met criteria for one or more forms of somatization. While DSM-III somatization disorder had a prevalence of only 1% in this population, 16.6% of the patients met abridged criteria for subsyndromal somatization disorder (SSI 4,6). Hypochondriacal worry had a prevalence of 7.7% in the clinic sample. Somatized presentations of current major depression or anxiety disorder had a prevalence of 8%. The three forms of somatization were associated with different sociodemographic and illness behavior characteristics. A majority of patients met criteria for only one type of somatization, suggesting that distinct pathogenic processes may be involved in each of the three types.

  18. Dyslipidemia in primary careprevalence, recognition, treatment and control: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS

    Directory of Open Access Journals (Sweden)

    Wasem Jürgen

    2008-10-01

    Full Text Available Abstract Background Current guidelines from the European Society of Cardiology (ESC define low thresholds for the diagnosis of dyslipidemia using total cholesterol (TC and LDL-cholesterol (LDL-C to guide treatment. Although being mainly a prevention tool, its thresholds are difficult to meet in clinical practice, especially primary care. Methods In a nationwide study with 1,511 primary care physicians and 35,869 patients we determined the prevalence of dyslipidemia, its recognition, treatment, and control rates. Diagnosis of dyslipidemia was based on TC and LDL-C. Basic descriptive statistics and prevalence rate ratios, as well as 95% confidence intervals were calculated. Results Dyslipidemia was highly frequent in primary care (76% overall. 48.6% of male and 39.9% of female patients with dyslipidemia was diagnosed by the physicians. Life style intervention did however control dyslipidemia in about 10% of patients only. A higher proportion (34.1% of male and 26.7% female was controlled when receiving pharmacotherapy. The chance to be diagnosed and subsequently controlled using pharmacotherapy was higher in male (PRR 1.15; 95%CI 1.12–1.17, in patients with concomitant cardiovascular risk factors, in patients with hypertension (PRR 1.20; 95%CI 1.05–1.37 and cardiovascular disease (PRR 1.46; 95%CI 1.29–1.64, previous myocardial infarction (PRR 1.32; 95%CI 1.19–1.47, and if patients knew to be hypertensive (PRR 1.18; 95%CI 1.04–1.34 or knew about their prior myocardial infarction (PRR 1.17; 95%CI 1.23–1.53. Conclusion Thresholds of the ESC seem to be difficult to meet. A simple call for more aggressive treatment or higher patient compliance is apparently not enough to enhance the proportion of controlled patients. A shift towards a multifactorial treatment considering lifestyle interventions and pharmacotherapy to reduce weight and lipids may be the only way in a population where just to be normal is certainly not ideal.

  19. Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

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    Kenia Vieira da Silva

    2016-01-01

    Full Text Available Abstract Background: Obstructive sleep apnea syndrome (OSAS is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global were included in logistic regression models (p < 0.05. Results: Of the total (616, 403 individuals (65.4% reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

  20. Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care.

    Science.gov (United States)

    Teepe, Jolien; Broekhuizen, Berna D L; Ieven, Margareta; Loens, Katherine; Huygen, Kris; Kretzschmar, Mirjam; de Melker, Hester; Butler, Chris C; Little, Paul; Stuart, Beth; Coenen, Samuel; Goossens, Herman; Verheij, Theo J M

    2015-10-01

    Most cases of adult pertussis probably remain undiagnosed. To explore the prevalence, diagnosis, and disease course of acute pertussis infection in adult patients presenting with acute cough. Prospective observational study between 2007 and 2010 in primary care in 12 European countries. Adults presenting with acute cough (duration of ≤28 days) were included. Bordetella pertussis infection was determined by polymerase chain reaction (from nasopharyngeal flocked swabs and sputa) and by measurement of immunoglobulin G antibodies to pertussis toxin (PT) in venous blood at day 28. An antibody titre to PT of ≥125 IU/ml or PCR positive result in a respiratory sample defined recent infection. Patients completed a symptom diary for 28 days. Serum and/or respiratory samples were obtained in 3074 patients. Three per cent (93/3074) had recent B. pertussis infection. Prior cough duration >2 weeks discriminated to some extent between those with and without pertussis (adjusted odds ratio 1.89, 95% confidence interval = 1.17 to 3.07; P = 0.010). Median cough duration after presentation was 17 and 12 days in patients with and without pertussis, respectively (P = 0.008). Patients with pertussis had longer duration of phlegm production (P = 0.010), shortness of breath (P = 0.037), disturbed sleep (P = 0.013) and interference with normal activities or work (P = 0.033) after presentation. Pertussis infection plays a limited role among adults presenting with acute cough in primary care, but GPs should acknowledge the possibility of pertussis in uncomplicated lower respiratory tract infection. As in children, pertussis also causes prolonged symptoms in adults. However, pertussis is difficult to discern from other acute cough syndromes in adults at first presentation. © British Journal of General Practice 2015.

  1. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units

    Directory of Open Access Journals (Sweden)

    Tatiana Mota Xavier de Meneses

    2017-07-01

    Conclusions: Encouragement to breast milk donation, and information and help provided by primary health care unit professionals to breastfeeding were shown to be important for the practice of human milk donation.

  2. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden : an investigation of 2000 randomly selected patient records

    OpenAIRE

    Wiitavaara, Birgitta; Fahlström, Martin; Djupsjöbacka, Mats

    2017-01-01

    Abstract Rationale, aims and objectives The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC. Methods Patient records (2000) for patients in working age were randomly s...

  3. Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms.

    Science.gov (United States)

    Bhui, Kamaldeep; Bhugra, Dinesh; Goldberg, David; Sauer, Justin; Tylee, Andre

    2004-09-01

    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.

  4. Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

    Science.gov (United States)

    Butler, Christopher C; O’Brien, Kathryn; Pickles, Timothy; Hood, Kerenza; Wootton, Mandy; Howe, Robin; Waldron, Cherry-Ann; Thomas-Jones, Emma; Hollingworth, William; Little, Paul; Van Der Voort, Judith; Dudley, Jan; Rumsby, Kate; Downing, Harriet; Harman, Kim; Hay, Alastair D

    2015-01-01

    Background The prevalence of targeted and serendipitous treatment for, and associated recovery from, urinary tract infection (UTI) in pre-school children is unknown. Aim To determine the frequency and suspicion of UTI in children who are acutely ill, along with details of antibiotic prescribing, its appropriateness, and whether that appropriateness impacted on symptom improvement and recovery. Design and setting Prospective observational cohort study in primary care sites in urban and rural areas in England and Wales. Method Systematic urine sampling from children aged children’s urine samples, 339 (5.6%) met laboratory criteria for UTI and 162 (47.9%) were prescribed antibiotics at the initial consultation. In total, 576/7101 (8.1%) children were suspected of having a UTI prior to urine sampling, including 107 of the 338 with a UTI (clinician sensitivity 31.7%). Children with a laboratory-diagnosed UTI were more likely to be prescribed antibiotics when UTI was clinically suspected than when it was not (86.0% versus 30.3%, Pchildren with unsuspected UTI, 70 (30.3%) received serendipitous antibiotics (that is, antibiotics prescribed for a different reason). Overall, 176 (52.1%) children with confirmed UTI did not receive any initial antibiotic. Organism sensitivity to the prescribed antibiotic was higher when UTI was suspected than when treated serendipitously (77.1% versus 26.0%; PChildren with UTI prescribed appropriate antibiotics at the initial consultation improved a little sooner than those with a UTI who were not prescribed appropriate antibiotics initially (3.5 days versus 4.0 days; P = 0.005). Conclusion Over half of children with UTI on culture were not prescribed antibiotics at first presentation. Serendipitous UTI treatment was relatively common, but often inappropriate to the organism’s sensitivity. Methods for improved targeting of antibiotic treatment in children who are acutely unwell are urgently needed. PMID:25824181

  5. Prevalence and Risk Factors of Domestic Violence Against Women Attending a Primary Care Center in Riyadh, Saudi Arabia.

    Science.gov (United States)

    Barnawi, Fatima Hamza

    2015-05-27

    Domestic violence (DV) against women can negatively affect the physical, mental, sexual, and reproductive health of the women as well as the well-being of their children. The objective was to estimate among Saudi women the prevalence of different types of DV, to identify its associated risk factors, and to determine the immediate victims' reactions to such violence. A cross-sectional study was carried between March and July, 2011. Self-administrated questionnaire was administered to ever-married Saudi women attending Al-Wazarat primary health care center, in Riyadh, Saudi Arabia. Out of the 720 women studied, 144 (20%) reported exposure to DV over the last year. The most common DV types were emotional (69%), social (34%), economic (26%), physical (20%), and sexual violence (10%). In multivariate logistic regression analysis, the following characteristics were independently associated with DV: younger women age, longer duration of marriage, higher women education, lower husband education, working husbands, military occupation, fewer children, husbands with multiple wives, smoking husbands, aggressive husbands, presence of chronic disease in women or husbands, and non-sufficient family income. The most common impacts of DV on women were medical or behavioral problems (72%) and psychiatric problems (58%). The most common reactions to DV were seeking separation (56%) and doing nothing (41%). More than 90% of children of abused women suffered psychological or behavioral problems. In conclusion, DV against Saudi women is considerable and the response is generally passive. Promoting a culture non-tolerant to DV and providing accessible, effective, and trustful social services to abused women are critically needed. © The Author(s) 2015.

  6. Scenarios cancer in primary care.

    NARCIS (Netherlands)

    Velden, L.F.J. van der; Schellevis, F.G.

    2011-01-01

    Introduction: Previous studies predicted an increase in both the incidence and prevalence of cancer in the Netherlands. Other studies showed that cancer patients use primary care more frequently than non-cancer patients. Finally, during the “chronic phase” of the disease, task substitution from

  7. Prevalence and correlates of suicidal ideation and suicide attempts among veterans in primary care referred for a mental health evaluation.

    Science.gov (United States)

    Ashrafioun, Lisham; Pigeon, Wilfred R; Conner, Kenneth R; Leong, Shirley H; Oslin, David W

    2016-01-01

    The Veterans Health Administration has made concerted efforts to increase mental health services offered in primary care. However, few studies have evaluated correlates of suicidal ideation and suicide attempt in veterans in primary care-mental health integration (PCMHI). The purpose of the present study is to examine associations between suicidal ideation and suicide attempts as dependent variables and demographic and clinical factors as the independent variables. Veterans (n=3004) referred from primary care to PCMHI were contacted for further assessment, which included past-year severity of suicidal thoughts (none, low, high) and attempts using the Paykel Suicide Scale, mental health disorders, and illicit drug use. Multinomial logistic regression models were used to identify correlates of suicidal ideation and suicide attempts. Thoughts of taking one's life was endorsed by 24% of participants and suicide attempts were reported in 2%. In adjusted models, depression, psychosis, mania, PTSD and generalized anxiety disorder were associated with high severity suicidal ideation, but not suicide attempt. Illicit drug use was not associated with suicidal ideation, but was the only variable associated with suicide attempt. The study was cross-sectional, focused on one clinical setting, and the suicide attempt analyses had limited power. PCMHI is a critical setting to assess suicidal ideation and suicide attempt and researchers and clinicians should be aware that the differential correlates of these suicide-related factors. Future research is needed to identify prospective risk factors and assess the utility of follow-up care in preventing suicide. Published by Elsevier B.V.

  8. Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis.

    Science.gov (United States)

    Clark, Christopher E; Taylor, Rod S; Shore, Angela C; Campbell, John L

    2016-11-01

    Various prevalence figures have been reported for inter-arm differences in blood pressure (IAD); variation may be explained by differing population vascular risk and by measurement method. To review the literature to derive robust estimates of IAD prevalence relevant to community populations. Systematic review and meta-analysis. MEDLINE, Embase, and CINAHL were searched for cross-sectional studies likely to represent general or primary care populations, reporting prevalence of IAD and employing a simultaneous method of measurement. Using study-level data, pooled estimates of mean prevalence of systolic IADs were calculated and compared using a random effects model. Eighty IAD studies were identified. Sixteen met inclusion criteria: pooled estimates of prevalence for systolic IAD ≥10 mmHg were 11.2% (95% confidence interval [CI] = 9.1 to 13.6) in hypertension, 7.4% (95% CI = 5.8 to 9.2) in diabetes, and 3.6% (95% CI = 2.3 to 5.0) for a general adult population (Pdifferences). Differences persisted for higher cut-off values. Prevalences were lower for East Asian than for Western populations and were overestimated by sequential measurement where this could be compared with simultaneous measurement within studies (relative risk for IAD: 2.9 [95% CI = 2.1 to 4.1]). Studies with higher mean absolute systolic pressures had higher prevalences for a systolic IAD ≥10 mmHg (P = 0.04). Prevalences of IADs rise in relation to underlying cardiovascular comorbidities of the population studied, and are overestimated threefold when sequential measurement is used. Population-specific variation in prevalences of IAD should be taken into account in delivering clinical care and in planning future studies. © British Journal of General Practice 2016.

  9. [Primary care in Ireland].

    Science.gov (United States)

    Sánchez-Sagrado, T

    Spanish doctors are still leaving the country to look for quality work. Ireland is not a country with many Spanish professionals but it is interesting to know its particular Health care system. Ireland is one of the countries with a national health care system, although it has a mixture of private health care insurance schemes. People have a right to health care if they have been living in Ireland at least for a year. Access to the primary care health system depends on age and income: free of charge for Category 1 and co-payments for the rest. This division generates great inequalities among the population. Primary Care doctors are self-employed, and they work independently. However, since 2001 they have tended to work in multidisciplinary teams in order to strengthen the Primary Care practice. Salary is gained from a combination of public and private incomes which are not differentiated. The role of the General Practitioner consists in the treatment of acute and chronic diseases, minor surgery, child care, etc. There is no coordination between Primary and Secondary care. Access to specialised medicine is regulated by the price of consultation. Primary Care doctors are not gatekeepers. To be able to work here, doctors must have three years of training after medical school. After that, Continuing Medical Education is compulsory, and the college of general practitioners monitors it annually. The Irish health care system does not fit into the European model. Lack of a clear separation between public and private health care generates great inequalities. The non-existence of coordination between primary and specialised care leads to inefficiencies, which Ireland cannot allow itself after a decade of economic crisis. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Prevalence, incidence, and risk factors of intestinal parasites in Danish primary care patients with irritable bowel syndrome

    DEFF Research Database (Denmark)

    Engsbro, Anne Line; Stensvold, Christen Rune; Nielsen, Henrik Vedel

    2014-01-01

    The gut microbiota may be involved in the aetiopathogenesis of irritable bowel syndrome (IBS). We studied the role of intestinal parasites by describing the epidemiology and risk factors for infection in primary care patients aged 18-50 y with IBS. One hundred and thirty-eight patients at baseline...... and 78/116 patients returning 1 y later, submitted faecal samples that were examined by microscopy, culture for Blastocystis, and real-time PCR for Dientamoeba fragilis, Entamoeba (dispar and histolytica), Cryptosporidium spp., and Giardia intestinalis. Overall, 42-45% of patients harboured intestinal...

  11. Prevalence of comorbidity in primary care patients with type 2 diabetes and its association with elevated HbA1c: A cross-sectional study in Croatia.

    Science.gov (United States)

    Bralić Lang, Valerija; Bergman Marković, Biserka

    2016-01-01

    To the authors' knowledge, there are few valid data that describe the prevalence of comorbidity in type 2 diabetes mellitus (T2DM) patients seen in family practice. This study aimed to investigate the prevalence of comorbidities and their association with elevated (≥ 7.0%) haemoglobin A1c (HbA1c) using a large sample of T2DM patients from primary care practices. A cross-sectional study in which multivariate logistic regression was applied to explore the association of comorbidities with elevated HbA1c. Primary care practices in Croatia. Altogether, 10 264 patients with diabetes in 449 practices. Comorbidities and elevated HbA1c. In total 7979 (77.7%) participants had comorbidity. The mean number of comorbidities was 1.6 (SD 1.28). Diseases of the circulatory system were the most common (7157, 69.7%), followed by endocrine and metabolic diseases (3093, 30.1%), and diseases of the musculoskeletal system and connective tissue (1437, 14.0%). After adjustment for age and sex, the number of comorbidities was significantly associated with HbA1c. The higher the number of comorbidities, the lower the HbA1c. The prevalence of physicians' inertia was statistically significantly and negatively associated with the number of comorbidities (Mann-Whitney U test, Z = -12.34; p < 0.001; r = -0.12). There is a high prevalence of comorbidity among T2DM patients in primary care. A negative association of number of comorbidities and HbA1c is probably moderated by physicians' inertia in treatment of T2DM strictly according to guidelines. There is a high prevalence of comorbidity among T2DM patients in primary care. Patients with breast cancer, obese patients, and those with dyslipidaemia and ischaemic heart disease were more likely to have increased HbA1c. The higher the number of comorbidities, the lower the HbA1c.

  12. Insights into social disparities in smoking prevalence using Mosaic, a novel measure of socioeconomic status: an analysis using a large primary care dataset

    Directory of Open Access Journals (Sweden)

    Szatkowski Lisa

    2010-12-01

    Full Text Available Abstract Background There are well-established socio-economic differences in the prevalence of smoking in the UK, but conventional socio-economic measures may not capture the range and degree of these associations. We have used a commercial geodemographic profiling system, Mosaic, to explore associations with smoking prevalence in a large primary care dataset and to establish whether this tool provides new insights into socio-economic determinants of smoking. Methods We analysed anonymised data on over 2 million patients from The Health Improvement Network (THIN database, linked via patients' postcodes to Mosaic classifications (11 groups and 61 types and quintiles of Townsend Index of Multiple Deprivation. Patients' current smoking status was identified using Read Codes, and logistic regression was used to explore the associations between the available measures of socioeconomic status and smoking prevalence. Results As anticipated, smoking prevalence increased with increasing deprivation according to the Townsend Index (age and sex adjusted OR for highest vs lowest quintile 2.96, 95% CI 2.92-2.99. There were more marked differences in prevalence across Mosaic groups (OR for group G vs group A 4.41, 95% CI 4.33-4.49. Across the 61 Mosaic types, smoking prevalence varied from 8.6% to 42.7%. Mosaic types with high smoking prevalence were characterised by relative deprivation, but also more specifically by single-parent households living in public rented accommodation in areas with little community support, having no access to a car, few qualifications and high TV viewing behaviour. Conclusion Conventional socio-economic measures may underplay social disparities in smoking prevalence. Newer classification systems, such as Mosaic, encompass a wider range of demographic, lifestyle and behaviour data, and are valuable in identifying characteristics of groups of heavy smokers which might be used to tailor cessation interventions.

  13. Prevalence of childhood and early adolescence mental disorders among children attending primary health care centers in Mosul, Iraq: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Al-Jawadi Asma A

    2007-10-01

    Full Text Available Abstract Background Children and adolescents are more vulnerable to the affects of war and violence than adults. At the time of initiation of this study, nothing was known about the prevalence of childhood and early adolescence mental disorders. The aim of the present study is to measure the point prevalence of mental disorders among children of 1–15 years age in the city of Mosul, Iraq. Methods A cross-sectional study design was adopted. Four primary health care centers were chosen consecutively as a study setting. The subjects of the present study were mothers who came to the primary health care center for vaccination of their children. The chosen mothers were included by systematic sampling randomization. All children (aged 1–15 that each mother had were considered in the interview and examination. Results Out of 3079 children assessed, 1152 have childhood mental disorders, giving a point prevalence of 37.4%, with a male to female ratio of to 1.22:1. The top 10 disorders among the examined children are post-traumatic stress disorder (10.5%, enuresis (6%, separation anxiety disorder (4.3%, specific phobia (3.3% stuttering and refusal to attend school (3.2% each, learning and conduct disorders (2.5% each, stereotypic movement (2.3% and feeding disorder in infancy or early childhood (2.0%. Overall, the highest prevalence of mental disorders was among children 10–15 years old (49.2% while the lowest was among 1–5 year olds (29.1%. Boys are more affected than girls (40.2% and 33.2%, respectively. Conclusion Childhood mental disorders are a common condition highly prevalent amongst the children and early adolescents in Mosul. Data from the present study mirrors the size of the problem in local community. Several points deserve attention, the most important of which include giving care at the community level, educating the public on mental health, involving communities and families, monitoring community mental health indicators, and

  14. [Primary care in France].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-01-01

    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.

  15. [Primary care in Italy].

    Science.gov (United States)

    Sánchez-Sagrado, T

    Italy is not a country where Spanish doctors emigrate, as there is an over-supply of health care professionals. The Italian Servizio Sanitario Nazionale has some differences compared to the Spanish National Health System. The Servizio Sanitario Nazionale is financed by national and regional taxes and co-payments. There are taxes earmarked for health, and Primary Care receives 50% of the total funds. Italian citizens and residents in Italy have the right to free health cover. However, there are co-payments for laboratory and imaging tests, pharmaceuticals, specialist ambulatory services, and emergencies. Co-payments vary in the different regions. The provision of services is regional, and thus fragmentation and major inequities are the norm. Doctors in Primary Care are self-employed and from 2000 onwards, there are incentives to work in multidisciplinary teams. Salary is regulated by a national contract and it is the sum of per-capita payments and extra resources for specific activities. Responsibilities are similar to those of Spanish professionals. However, medical care is more personal. Relationships between Primary Care and specialised care depend on the doctors' relationships. Primary Care doctors are gatekeepers for specialised care, except for gynaecology, obstetrics and paediatrics. Specialised training is compulsory in order to work as general practitioner. The Italian Health Care System is a national health system like the Spanish one. However, health care professionals are self-employed, and there are co-payments. In spite of co-payments, Italians have one of the highest average life expectancy, and they support a universal and publicly funded health-care system. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Dsm-iv hypochondriasis in primary care

    OpenAIRE

    Escobar, JI; Gara, M; Waitzkin, H; Silver, RC; Holman, A; Compton, W

    1998-01-01

    The object of this study was to assess the prevalence and correlates of the DSM-IV diagnosis of hypochondriasis in a primary care setting. A large sample (N = 1456) of primary care users was given a structured interview to make diagnoses of mood, anxiety, and somatoform disorders and estimate levels of disability. The prevalence of hypochondriasis (DSM-IV) was about 3%. Patients with this disorder had higher levels of medically unexplained symptoms (abridged somatization) and were more impair...

  17. Thoughts on primary care.

    Science.gov (United States)

    Raskin, Lynne

    2010-01-01

    The uptake of family health teams in Ontario has been tremendous. And the creation of group practices in primary care has taken root in other provinces as well. For many people, being involved with something new is exciting. At the same time, once they are committed, they discover the challenges that can be simultaneously exhilarating and frustrating. This issue of Healthcare Quarterly offers two articles that provide interesting reflections on what has been learned so far from the perspectives of both team leadership and the team members themselves within a transforming primary care system.

  18. in primary care

    African Journals Online (AJOL)

    Claire van Deventer

    Keywords: child HIV, doctor involvement, primary health care, quality improvement ... expertise increased, PHC facilities are now expected to be able to .... organised patient documentation were revisited. .... Review: what can we learn from quality ... South Pacific: Review of evidence and lessons from an innovative.

  19. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS in three regions of England: a repeated cross-sectional study in primary care

    Directory of Open Access Journals (Sweden)

    Fayyaz Shagufta

    2011-07-01

    Full Text Available Abstract Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS or chronic fatigue syndrome (CFS has been used to name a range of chronic conditions characterized by extreme fatigue and other disabling symptoms. Attempts to estimate the burden of disease have been limited by selection bias, and by lack of diagnostic biomarkers and of agreed reproducible case definitions. We estimated the prevalence and incidence of ME/CFS in three regions in England, and discussed the implications of frequency statistics and the use of different case definitions for health and social care planning and for research. Methods We compared the clinical presentation, prevalence and incidence of ME/CFS based on a sample of 143,000 individuals aged 18 to 64 years, covered by primary care services in three regions of England. Case ascertainment involved: 1 electronic search for chronic fatigue cases; 2 direct questioning of general practitioners (GPs on cases not previously identified by the search; and 3 clinical review of identified cases according to CDC-1994, Canadian and Epidemiological Case (ECD Definitions. This enabled the identification of cases with high validity. Results The estimated minimum prevalence rate of ME/CFS was 0.2% for cases meeting any of the study case definitions, 0.19% for the CDC-1994 definition, 0.11% for the Canadian definition and 0.03% for the ECD. The overall estimated minimal yearly incidence was 0.015%. The highest rates were found in London and the lowest in East Yorkshire. All but one of the cases conforming to the Canadian criteria also met the CDC-1994 criteria, however presented higher prevalence and severity of symptoms. Conclusions ME/CFS is not uncommon in England and represents a significant burden to patients and society. The number of people with chronic fatigue who do not meet specific criteria for ME/CFS is higher still. Both groups have high levels of need for service provision, including health and social

  20. [Primary care in Belgium].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2017-09-01

    Belgium is an attractive country to work in, not just for doctors but for all Spanish workers, due to it having the headquarters of European Union. The health job allure is double; on the one hand, the opportunity to find a decent job, and on the other, because it is possible to develop their professional abilities with patients of the same nationality in a health system with a different way of working. The Belgium health care system is based on security social models. Health care is financed by the government, social security contributions, and voluntary private health insurance. Primary care in Belgium is very different to that in Spain. Citizens may freely choose their doctor (general practitioner or specialist) increasing the lack of coordination between primary and specialized care. This leads to serious patient safety problems and loss of efficiency within the system. Belgium is a European country with room to improve preventive coverage. General practitioners are self-employed professionals with free choice of setting, and their salary is linked to their professional activity. Ambulatory care is subjected to co-payment, and this fact leads to great inequities on access to care. The statistics say that there is universal coverage but, in 2010, 14% of the population did not seek medical contact due to economic problems. It takes 3 years to become a General Practitioner and continuing medical education is compulsory to be revalidated. In general, Belgian and Spaniards living and working in Belgium are happy with the functioning of the health care system. However, as doctors, we should be aware that it is a health care system in which access is constrained for some people, and preventive coverage could be improved. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care--an observational study.

    Science.gov (United States)

    Wiegner, Lilian; Hange, Dominique; Björkelund, Cecilia; Ahlborg, Gunnar

    2015-03-19

    Prolonged stress may lead to mental illness, but the prevalence of stress in a working age population seeking primary health care for whatever reason, is unknown. This paper seeks to examine to what extent this group perceives stress, as well as symptoms of burnout/exhaustion, depression and anxiety. In 2009, 587 primary health care patients aged 18-65 years (377 women, 210 men), with an appointment with a primary health care physician, participated in the study. A screening questionnaire with questions about age, gender, marital status, employment, reason for medical consultation, and the QPS Nordic screening question about stress was distributed:" Stress is defined as a condition where you feel tense, restless, anxious or worried or cannot sleep at night because you think of problems all the time. Do you feel that kind of stress these days? There were five possible answers; "not at all" and "only a little" (level 1),"to some extent" (level 2),"rather much" and "very much" (level 3). In a second step, symptoms of burnout/exhaustion (Shirom-Melamed Burnout Questionnaire and the Self-rated Exhaustion Disorder instrument) and anxiety/depression (Hospital Depression and Anxiety scale) were assessed among those with higher levels of perceived stress. 345 (59%) of the study patients indicated stress levels 2 or 3 (237 women and 108 men). Women more often indicated increased levels of stress than men. Two thirds of the participants expressing stress levels 2-3 indicated a high degree of burnout, and approximately half of them indicated Exhaustion Disorder (ED). Among highly stressed patients (level 3), 33% reported symptoms indicating possible depression and 64% possible anxiety. More than half of this working age population perceived more than a little stress, as defined, women to a greater extent than men. Symptoms of burnout and exhaustion were common. A high level of perceived stress was often accompanied by symptoms of depression and/or anxiety.

  2. [Prevalence and characterization of overactive bladder detected in a population in Madrid with self-administered OAB-V3 questionnaire in Primary Care].

    Science.gov (United States)

    Angulo, Javier C; Calderín, María P; Fernández, Yolanda; González, Miriam; Gómez, Esther; Herreros, Maria B; Peñasco, Purificación; Zapatero, Manuela; Dorado, Juan F

    2018-02-01

    Determining the prevalence of symptoms suggestive of overactive bladder (OAB) in a Spanish population and evaluate the impact of these symptoms on well-being and labour productivity in this population. Transversal study. Primary health care, Madrid, Spain. Males and females >30 years. Classification by primary care physicians with the Overactive Bladder Awareness Tool abbreviated version (OAB-V3). Subjects with score ≥3 and a similarly balanced control population with score <3 were clinically investigated. History, physical examination, urinalysis, sonography, general well-being scale and the questionnaires PPBC, OAB-q y WPAI-SHP. A total 923 subjects were screened, of which 209 (22.6%), 35% males and 65% females, had probable OAB. Age distribution increased from 11.1% in 4th decade to 44.4% in 9th decade. Kappa coefficient between suspected OAB and definite diagnosis was .83. The area under ROC curve for diagnosis based on OAB-V3 questionnaire and the presence of perceived bother and coping strategies was 92%. Subjects classified by score ≥3 had worse well-being, higher PPBC score and worse parameters on total OAB-q and transformed scores for each OAB-q subscale (P<.0001). In these subjects labour productivity was not affected (P=.14) but the capacity to perform regular activities was (P<.0001). OAB-V3 is a simple questionnaire to screen OAB with good predictive accuracy in a primary care setting and reveals important implications on health related quality of life issues. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. Prevalence of mental disorders in a population requesting health services at a primary health care center and its association with suicidal ideation and perceived disability

    Directory of Open Access Journals (Sweden)

    Mérida R. Rodríguez

    2012-10-01

    Full Text Available Objective: this study’s goal was to determine the most prevalent mental disorders and the impact on the perception of disability and suicidal ideation among the population from a primary health care center in the city of Cali. Methodology: a cross sectional study was conducted on 254 patients who were screened with the prime-md instrument. Descriptive statistics was used in the analysis to determine the most frequent disorders. Similarly, a multiple analysis with logistic and Poisson regressions using robust variance was conducted to determine the influence of mental disorders on disability and suicidal ideation. Results: most patients were female, young, and mature adults. Depression was present in 66.8% of all cases, followed by somatization disorder and anxiety. Half of the patients had had suicidal ideations at some point in their lives, and three out of four patients claimed to suffer from some kind of disability. Upon adjusting for the covariables, depression and anxiety disorders had a strong association with suicidal ideation and perceived disability that was overestimated by the logistic regression. Conclusion: depression and anxiety were the most common disorders and showed a strong association with suicidal ideation and disability. This is why it is necessary to screen for those disorders among adults using primary health care services. Likewise, we suggest considering Poisson regression with robust variance in cross-sectional studies in health services.

  4. Prevalence and factors associated with the presence of non alcoholic fatty liver disease in an apparently healthy adult population in primary care units

    Directory of Open Access Journals (Sweden)

    Pizarro Gregorio

    2007-11-01

    Full Text Available Abstract Background Fatty liver disease is characterized by the accumulation of fat vacuoles inside of the hepatocytes. Non alcoholic fatty liver is associated with obesity, type 2 diabetes, dyslipemia, the intake of certain drugs and with the so-called metabolic syndrome. However, there is little information on the clinical relevance of this disorder as a healthcare problem in the general population, since the studies published generally include a limited number of patients and the diagnosis is established on the basis of clear biochemical alterations and liver biopsy. Methods/Design The aim of the study is the prevalence of non-alcoholic fatty liver disease in a general adult population by hepatic ultrasonography. A population-based, descriptive, transversal, multicentre study. Eighteen primary care centres of the north of Barcelona and the Maresme Areas of Healthcare Management attending an urban and semi-urban population of 360.000 inhabitants. A randomized sample of 786 subjects of 15 years or older were selected from the population and assigned to the participating centres according to the Primary Care Information System (SIAP: This population is practically the same as the general population of the area. The following determinations will be carried out in all the participants: hepatic ultrasonography to detect fatty liver, a questionnaire concerning liver diseases, alcohol intake, smoking and drug use, physical examination including abdominal perimeter and body mass index and biochemical analysis including liver function tests and parameters related to the metabolic syndrome and the HAIR score. Ultrasonographic diagnosis of fatty liver will be made according to established criteria (American Gastroenterology Association and diagnosis of metabolic syndrome according to the criteria of the European Group for the Study of Insulin Resistance. Discussion This study will attempt to determine the prevalence of non alcoholic fatty liver disease

  5. Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil

    Directory of Open Access Journals (Sweden)

    Julio Baldisserotto

    2016-07-01

    Full Text Available Abstract Background Systemic arterial hypertension and diabetes mellitus, and their related morbidity and mortality, are currently the most common public health problems and also a higher burden of disease in Brazil. They represent a real challenge for primary health care. This study describes the methodology and baseline data of an adult population with hypertension and diabetes attending in primary health care. Methods It is a cross sectional study which presents data from a longitudinal research. 3784 adults were randomly selected from the registry of a health service in Porto Alegre, Brazil. The eligibility criteria were: confirmed diagnosis of hypertension and/or diabetes, consulted at least once in the prior 3 years and 18 years of age or older. Home data collection consisted of a questionnaire with information on demographic, medical history, life style and socio-economic factors. Results A total of 2482 users were interviewed (response rate of 71 %. The median age was 64 (IQR = 55.7 and the majority were women (68 %, and married (52 %. Whereas 66.5 % (CI 95 % 64.5-68.3 of the sample had only hypertension, 6.5 % (CI 95 % 5.5-7.5 had diabetes and 27.1 % (CI 95 % 25.3-28.8 had both diseases. The prevalence of diseases increased with age and with fewer years of study (p < 0.05. Subjects with both diseases had significantly more associated comorbidities. Conclusions Hypertension and diabetes are more prevalent in older individuals, especially women, and less educated people. People suffering with both chronic conditions simultaneously are more likely to have additional comorbidities.

  6. Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil.

    Science.gov (United States)

    Baldisserotto, Julio; Kopittke, Luciane; Nedel, Fulvio Borges; Takeda, Silvia Pasa; Mendonça, Claunara Schilling; Sirena, Sérgio Antonio; Diercks, Margarita Silva; de Lima, Lena Azeredo; Nicolau, Belinda

    2016-07-15

    Systemic arterial hypertension and diabetes mellitus, and their related morbidity and mortality, are currently the most common public health problems and also a higher burden of disease in Brazil. They represent a real challenge for primary health care. This study describes the methodology and baseline data of an adult population with hypertension and diabetes attending in primary health care. It is a cross sectional study which presents data from a longitudinal research. 3784 adults were randomly selected from the registry of a health service in Porto Alegre, Brazil. The eligibility criteria were: confirmed diagnosis of hypertension and/or diabetes, consulted at least once in the prior 3 years and 18 years of age or older. Home data collection consisted of a questionnaire with information on demographic, medical history, life style and socio-economic factors. A total of 2482 users were interviewed (response rate of 71 %). The median age was 64 (IQR = 55.7) and the majority were women (68 %), and married (52 %). Whereas 66.5 % (CI 95 % 64.5-68.3) of the sample had only hypertension, 6.5 % (CI 95 % 5.5-7.5) had diabetes and 27.1 % (CI 95 % 25.3-28.8) had both diseases. The prevalence of diseases increased with age and with fewer years of study (p < 0.05). Subjects with both diseases had significantly more associated comorbidities. Hypertension and diabetes are more prevalent in older individuals, especially women, and less educated people. People suffering with both chronic conditions simultaneously are more likely to have additional comorbidities.

  7. Spirometry in primary care

    Science.gov (United States)

    Coates, Allan L; Graham, Brian L; McFadden, Robin G; McParland, Colm; Moosa, Dilshad; Provencher, Steeve; Road, Jeremy

    2013-01-01

    Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province. Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement. PMID:23457669

  8. The prevalence of exposure to domestic violence and the factors associated with co-occurrence of psychological and physical violence exposure: a sample from primary care patients

    Science.gov (United States)

    2011-01-01

    Background Since many health problems are associated with abuse and neglect at all ages, domestic violence victims may be considered as a group of primary care patients in need of special attention. Methods The aim of this multi-centre study was to assess the prevalence of domestic violence in primary care patients, and to identify those factors which influence the co-occurrence of psychological and physical violence exposure and their consequences (physical, sexual and reproductive and psychological) as obtained from medical records. A study was carried out in 28 family practices in Slovenia in 2009. Twenty-eight family physicians approached every fifth family practice attendee, regardless of gender, to be interviewed about their exposure to domestic violence and asked to specify the perpetrator and the frequency. Out of 840 patients asked, 829 individuals, 61.0% women (n = 506) and 39.0% men (n = 323) were assessed (98.7% response rate). They represented a randomised sample of general practice attendees, aged 18 years and above, who had visited their physician for health problems and who were given a physical examination. Visits for administrative purposes were excluded. Multivariate binary logistic regression analysis was used to determine the factors associated with exposure to both psychological and physical violence. Results Of 829 patients, 15.3% reported some type of domestic violence experienced during the previous five years; 5.9% reported physical and 9.4% psychological violence; of these 19.2% of men and 80.8% of women had been exposed to psychological violence, while 22.4% of men and 77.6% of women had been exposed to physical violence. The domestic violence victims were mostly women (p violence was more prevalent than exposure to physical violence. Of the women, 20.0% were exposed to either type of violence, compared to 8.0% of male participants, who reported they were rarely exposed to physical violence, while women reported often or constant

  9. [Primary care in Portugal].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2018-04-01

    The economic crisis and deterioration of the Portuguese National Health service has forced professionals to leave the country. The Portuguese National Health System was introduced in 1976, but it has been unable to provide citizens with the social and health advantages of an equality of access and free national health system. The Portuguese National Health System is financed by taxes. However, a 35% of its incomes are from private sources. The health minister decides the budget, and it is based on an historical financing plus a per capita system. Portuguese citizens and immigrants are entitled to free health care, but there is a co-payment for care, diagnostic, pharmacy, and emergency care. Health care provision is a mixture of public and private health care at a regional level. It leads to fragmentation of services and greater inequalities. Doctors are civil servants. Salary is regulated and it depends on seniority and on-call shifts. Primary care activities are similar to those of their Spanish counterparts. General practitioners have gatekeeper function, but the system is imperfect, and patients with private insurance get direct access to the specialist. Specialist training is similar to the training system in Spain. Continuing education is not regulated. The Portuguese Health System has been trying to become a national health system since 1979. Political instability, fragmentation of services, lack of clarity between public and private and co-payments are important constraints. Inequalities are an important problem to reconsider while discussing a national health system. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Prevalence of adherence to treatment in homebound elderly people in primary health care: a descriptive, cross-sectional, multicentre study.

    Science.gov (United States)

    Cárdenas-Valladolid, Juan; Martín-Madrazo, Carmen; Salinero-Fort, Miguel A; Carrillo de-Santa Pau, Enrique; Abánades-Herranz, Juan C; de Burgos-Lunar, Carmen

    2010-08-01

    Adherence to the therapeutic plan is one of the most important health issues in terms of treatment efficacy, healthcare costs and patient safety. Unfortunately, homebound elderly patients are especially vulnerable to nonadherence because they have higher morbidity rates combined with cognitive and social problems that hinder their correct use of drugs. The level of therapeutic adherence in homebound elderly people has not been adequately studied. To estimate the prevalence of therapeutic adherence, using the Morisky-Green test, in homebound elderly patients taking polypharmacy (defined as use of four or more drugs), and to study the factors associated with adherence. This was a descriptive, cross-sectional, multicentre study. A total of 327 patients were selected by random start systematic sampling from the total number of homebound patients taking four or more drugs in Healthcare Area 4 of the Madrid Autonomous Region, Spain. Through an in-home survey of patients and their caregivers, information was gathered on sociodemographic data, co-morbidities, number of hospital admissions, responsibility for purchasing and preparation of the medication, level of cognitive impairment (Pfeiffer questionnaire), functional dependence in activities of daily living (Katz Index), knowledge of the disease (Batalla test), adherence to treatment (Morisky-Green test), visual and auditory perception, and caregiver burden (Zarit interview). Of the homebound patients, 65.7% (95% CI 60.6, 70.9) had good adherence to treatment. The variables most negatively associated with therapeutic adherence, after adjustment for age, sex, number of drugs, knowledge of the disease, and cognitive function, were a large caregiver burden (odds ratio [OR] 3.09; 95% CI 1.75, 5.48) and impaired hearing (OR 2.00; 95% CI 1.17, 3.40). There was also a trend toward a positive association between nonadherence and patients aged <85 years (OR 1.57; 95% CI 0.93, 2.65) and patients who had nine or more drug

  11. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna

    2009-01-01

    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 ...: Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed....

  12. Achieving Value in Primary Care: The Primary Care Value Model.

    Science.gov (United States)

    Rollow, William; Cucchiara, Peter

    2016-03-01

    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. © 2016 Annals of Family Medicine, Inc.

  13. Depression in elderly primary health care clinic attendees in Ilorin ...

    African Journals Online (AJOL)

    Depression in the elderly presenting at primary care settings is usually under- detected by primary care physicians. This study assessed the prevalence of depression and the utility of the Geriatric Depression Scale (Short Form) in detecting depression in elderly patients in primary care populations in Ilorin, Nigeria. This was ...

  14. The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial

    Directory of Open Access Journals (Sweden)

    Sharp Debbie

    2011-08-01

    Full Text Available 1 Abstract 1.1 Background Suicide is a leading cause of perinatal maternal deaths in industrialised countries but there has been little research to investigate prevalence or correlates of postpartum suicidality. The Edinburgh Postnatal Depression Scale is widely used in primary and maternity services to screen for perinatal depressive disorders, and includes a question on suicidal ideation (question 10. We aimed to investigate the prevalence, persistence and correlates of suicidal thoughts in postpartum women in the context of a randomised controlled trial of treatments for postnatal depression. 1.2 Methods Women in primary care were sent postal questionnaires at 6 weeks postpartum to screen for postnatal depression before recruitment into an RCT. The Edinburgh Postnatal Depression Scale (EPDS was used to screen for postnatal depression and in those with high levels of symptoms, a home visit with a standardised psychiatric interview was carried out using the Clinical Interview Schedule-Revised version (CIS-R. Other socio-demographic and clinical variables were measured, including functioning (SF12 and quality of the marital relationship (GRIMS. Women who entered the trial were followed up for 18 weeks. 1.3 Results 9% of 4,150 women who completed the EPDS question relating to suicidal ideation reported some suicidal ideation (including hardly ever; 4% reported that the thought of harming themselves had occurred to them sometimes or quite often. In women who entered the randomised trial and completed the EPDS question relating to suicidal ideation (n = 253, suicidal ideation was associated with younger age, higher parity and higher levels of depressive symptoms in the multivariate analysis. Endorsement of 'yes, quite often' to question 10 on the EPDS was associated with affirming at least two CIS-R items on suicidality. We found no association between suicidal ideation and SF-12 physical or mental health or the EPDS total score at 18 weeks. 1

  15. Validity of estimated prevalence of decreased kidney function and renal replacement therapy from primary care electronic health records compared with national survey and registry data in the United Kingdom.

    Science.gov (United States)

    Iwagami, Masao; Tomlinson, Laurie A; Mansfield, Kathryn E; Casula, Anna; Caskey, Fergus J; Aitken, Grant; Fraser, Simon D S; Roderick, Paul J; Nitsch, Dorothea

    2017-04-01

    Anonymous primary care records are an important resource for observational studies. However, their external validity is unknown in identifying the prevalence of decreased kidney function and renal replacement therapy (RRT). We thus compared the prevalence of decreased kidney function and RRT in the Clinical Practice Research Datalink (CPRD) with a nationally representative survey and national registry. Among all people ≥25 years of age registered in the CPRD for ≥1 year on 31 March 2014, we identified patients with an estimated glomerular filtration rate (eGFR) primary care data have good external validity for the prevalence of decreased kidney function and RRT. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

  16. Primary care research in Denmark

    DEFF Research Database (Denmark)

    Vedsted, Peter; Kallestrup, Per

    2016-01-01

    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 inter-professional nature of the discipline, the book also features a section on cross-nation organisations and primary care networks supporting research. National perspectives are offered from researchers in 20 countries that form part of the World Organization of Family Doctors, providing case...... histories from research-rich to resource-poor nations that illustrate the range of research development and capacity building. This book argues the importance of primary care research, especially to policy makers, decision makers and funders in informing best practice, training primary health care providers...

  17. DSM-IV hypochondriasis in primary care.

    Science.gov (United States)

    Escobar, J I; Gara, M; Waitzkin, H; Silver, R C; Holman, A; Compton, W

    1998-05-01

    The object of this study was to assess the prevalence and correlates of the DSM-IV diagnosis of hypochondriasis in a primary care setting. A large sample (N = 1456) of primary care users was given a structured interview to make diagnoses of mood, anxiety, and somatoform disorders and estimate levels of disability. The prevalence of hypochondriasis (DSM-IV) was about 3%. Patients with this disorder had higher levels of medically unexplained symptoms (abridged somatization) and were more impaired in their physical functioning than patients without the disorder. Of the various psychopathologies examined, major depressive syndromes were the most frequent among patients with hypochondriasis. Interestingly, unlike somatization disorder, hypochondriasis was not related to any demographic factor. Hypochondriasis is a relatively rare condition in primary care that is largely separable from somatization disorder but seems closely intertwined with the more severe depressive syndromes.

  18. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... Ladoke Akintola University of Technology, PMB 4400, Osogbo, Osun State. ... weak management and poor adherence to the basic infrastructure e.g. primary, secondary and tertiary.

  19. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Client Satisfaction with Antenatal Care Services in Primary Health Care. Centres in Sabon ... important information about how well clinicians and the population of women within child bearing. 8 ..... model. Health and Quality of Life outcomes.

  20. Allegheny County Primary Care Access

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

  1. Primary Medical Care in Chile

    DEFF Research Database (Denmark)

    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...

  2. African Primary Care Research: qualitative interviewing in primary care.

    Science.gov (United States)

    Reid, Steve; Mash, Bob

    2014-06-05

    This article is part of a series on African Primary Care Research and focuses on the topic of qualitative interviewing in primary care. In particular it looks at issues of study design, sample size, sampling and interviewing in relation to individual and focus group interviews.There is a particular focus on helping postgraduate students at a Masters level to write their research proposals.

  3. [Prevalence of non-alcoholic fatty liver disease in a population with elevated transaminases and level of accuracy of the diagnosis in Primary Care].

    Science.gov (United States)

    Samperio-González, María Amelia; Selvi-Blasco, Marta; Manzano-Montero, Mónica; Méndez-Gómez, Judit; Gil-Prades, Montserrat; Azagra, Rafael

    2016-05-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated transaminases in adults. Determine the prevalence of NASH in patients with sustained hypertransaminasemia, and Know the adequacy of the registered in Primary Care (AP) diagnosis. 1) Cross-sectional study with a random sample of patients with elevated alanine aminotransferase (ALT) held (ALT> 32 for ≥6 months), ruling out other causes of liver disease, according to clinical, laboratory and ultrasound scan criteria in AP and 2) cross-sectional description of all cases diagnosed with NASH recorded (K76 - ICD10) with diagnostic adequacy analysis according to standard criteria. 290 patients were analyzed: 76 were diagnosed as NASH (26.1%), 44 women (57.9%). Multivariate analysis adjusted for age and sex showed no association between NASH and male gender (OR: 0.5; CI95%: 0.3-0.9), diabetes mellitus (DM) (OR: 2.42; CI95%: 1.2-4.9) and hypertension blood pressure (HBP) (OR: 3.07; CI 95% 1.6-5.6). Of the 209 diagnosed with NASH record: 51 (24.4%) met the criteria for NASH. The rest had insufficient records. 53.1% lacked sustained hypertransaminasemia; 48% of viral serology; 11% supported and 53.1% abdominal ultrasound registration of alcohol. Severe NASH is frequent among patients with sustained hypertransaminasemia. The DM and hypertension significantly increase the risk of NASH. The diagnosis of NASH is recorded without considering all criteria and mainly NASH made by ultrasonography. They should unify diagnostic criteria in the register of NASH. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  4. The Coming Primary Care Revolution.

    Science.gov (United States)

    Ellner, Andrew L; Phillips, Russell S

    2017-04-01

    The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

  5. Diverticular Disease in the Primary Care Setting.

    Science.gov (United States)

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-10-01

    Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases.

  6. Prevalence of Mathematic Disability in Primary Schools

    Directory of Open Access Journals (Sweden)

    Siavash Talepasand

    2012-04-01

    Full Text Available Objectives: One of the issues that have consistently been the concern for the health affair specialists and cure and massive social governors in health fields is the rate of disorders prevalence, diseases and the related subjects to epidemiology. Purpose of this study was to estimate the prevalence of mathematic disability amongst primary schools of Karaj. Methods: Totally 432 students were selected with multi-stage sampling method. Participants completed Raven test, Frostig Visual-Perception test and Wepman Auditory discrimination test, Rutter behavioral questionnaire and Iran Key-math test. In order to diagnosis mathematic disability, inter criterion was normal quotient intelligence and out criteria were to have one of visual perception, auditory and behavioral problems. The participants whose total standard scores in Iran Key-math test were one standard deviation below the mean were selected as a mathematical disability (MD. Results: The mathematic disability prevalence in primary students was estimated 0.46%. In addition, proportion of mathematic disability prevalence was not function of gender or grade. Discussion: The findings demonstrated that the prevalence of mathematic disability is much less than the previous researches. A possible explanation was that inappropriate screening co morbid disorders with the mathematic disability. The theoretical implications of findings are discussed in detail.

  7. Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

    Directory of Open Access Journals (Sweden)

    Eliane Patricia Lino Pereira-Franchi

    Full Text Available Abstract INTRODUCTION: Wounds can be colonized by methicillin-resistant Staphylococcus aureus (MRSA. METHODS: We evaluated the prevalence of S. aureus and MRSA in the wounds of patients treated at Basic Health Units in Brazil and identified risk factors associated with their presence. RESULTS: The prevalence rates of S. aureus and MRSA were 51.5% and 8.7%, respectively. There was a correlation between the presence of S. aureus in wounds and nostrils (p<0.01. A positive association was detected between S. aureus infection and previous benzylpenicillin use (p=0.02. No associations were observed for MRSA. CONCLUSIONS: Multidrug-resistant pathogens are present in primary healthcare settings in Brazil.

  8. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations ... of Dust Mask among Crushers of Selected Quarry (Crushed ... Journal of Community Medicine and Primary Health Care.

  9. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    3Department of Community and Primary Health Care, College of Medicine, University of Lagos, Idiaraba, ... Some of the participants (45.3%) carry out physical exercises such as walking ..... hypertension, continuous effective management of.

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

  11. Suicidal ideations, plans and attempts in primary care: cross ...

    African Journals Online (AJOL)

    Introduction: the aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. Methods: we conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among ...

  12. Prevalence and Determinants of Pre-Hypertension among Omani Adults Attending Non-Communicable Disease Screening Program in Primary Care Setting in Sohar City

    Directory of Open Access Journals (Sweden)

    Ali Abdullah Al-Maqbali

    2013-09-01

    Full Text Available Objectives: To estimate the prevalence of pre-hypertension and its association with some selected cardiovascular risk factors among the Omani adult population in the primary healthcare setting.Method: A cross-sectional study involving a sample taken from a National Screening Program of chronic non-communicable diseases in primary healthcare institutions, Sohar city, Sultanate of Oman (July 2006 - December 2007. Inclusion criteria included Omanis aged 40 years or above residents of Sohar city attending primary healthcare institutions not previously diagnosed with diabetes mellitus, hypertension, or chronic kidney diseases. Descriptive statistics were used to describe the demographic, physical and metabolic characteristics. Univariate analysis was used to identify the significant association between the characteristics and normal blood pressure, pre-hypertension and hypertension. Chi-squared test was used for categorical variables analysis and independent t-test was used for continuous variables analysis. In order to examine the strength of significant associations, the multinomial logistic regression analysis was used.Results: There were 1498 participants, 41% were males and 59% were females. Overall, pre-hypertension was observed in 45% of the total study population (95% CI: 0.422 - 0.473. There were more males affected than females (46% versus 44%. About 34% of the total study population was hypertensive. The multinomial logistic regression analysis revealed that an increase of one unit of age, body mass index, fasting blood glucose and total blood cholesterol, were significantly associated with higher risk in both pre-hypertension and hypertension. High odds ratio of pre-hypertension and hypertension was found with the total blood cholesterol.Conclusion: The prevalence of pre-hypertension was high among the Omani adult population. The determinants of pre-hypertension in this research age, body mass index, fasting blood glucose and total blood

  13. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    2Department of Community Medicine & Primary Care, Faculty of Clinical Sciences, ... It may result from road traffic accident, near saving basic principles in emergency care that even drowning, electric ... (4.3%) at place of work, 8 (11.4%) at.

  14. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    Journal of Community Medicine and Primary Health Care. 26 (1) 12-20 .... large proportions of the population work in the poor people use health care services far less than. 19 ... hypertension, cancers and road traffic accidents) below 1 dollar ...

  15. Patient evaluations of primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Schellevis, F.G.; Groenewegen, P.P.

    2012-01-01

    Background: So far, studies about people’s appreciation of primary care services has shown that patient satisfaction seems to be lower in health care systems with regulated access to specialist services by gate keeping. Nevertheless, international comparative research about patients’ expectations

  16. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Background: The well-being of women and children is one of the major determinants ... The Sample for the study were women recruited from 11 primary health care ... respondents educational level and knowledge of preconception care (X =24.76, ... single adult or married couple) are in an optimal state .... The major site for.

  17. Primary care performance in Dominica

    Directory of Open Access Journals (Sweden)

    James Macinko

    2015-02-01

    Full Text Available Objective. To document the structure and functions of primary care (PC in the country of Dominica using the Primary Care Assessment Tools (PCAT, a set of questionnaires that evaluate PC functions. Methods. This cross-sectional study combined data from two surveys. The systems PCAT (S-PCAT survey gathered national-level data from key informants about health system characteristics and PC performance. The provider version (P-PCAT survey collected data on PC performance from health providers (nurses and physicians at all PC facilities in the country. Provider-level data were aggregated to obtain national and district-level results for PC domains scored from 0.00 (worst to 1.00 (best. Results. From the systems perspective, results showed several knowledge gaps in PC policy, financing, and structure. Key informants gave “Good” (adequate ratings for “first-contact” care (0.74, continuity of care (0.77, comprehensive care (0.70, and coordinated care (0.78; middling scores for family-centered care and community-oriented care (0.65; and low scores for access to care (0.57. PC providers assessed access to care (which included “first-contact” care, in the P-PCAT surveys (0.84, continuity of care (0.86, information systems (0.84, family-centered care (0.92, and community-oriented care (0.85 as “Very Good”; comprehensive care as “Good” (0.79; and coordinated care as “Reasonable” (0.68. Overall, the scores for the country's health districts were good, although the ratings varied by specific PC domain. Conclusions. The assessments described here were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving PC, and identification of priority areas for further investigation. This two-staged approach could be adapted and used in other countries.

  18. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study.

    Science.gov (United States)

    Ghandour, Lilian; Minassian, Vatche; Al-Badr, Ahmed; Abou Ghaida, Rami; Geagea, Sandra; Bazi, Tony

    2017-01-01

    The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD. Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities. The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m 2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level. In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.

  19. Prevalence of hyponatremia in palliative care patients

    Directory of Open Access Journals (Sweden)

    Shoba Nair

    2016-01-01

    Conclusions: Prevalence of hyponatremia is significant in palliative care patients. A prospective study looking at the causes and clinical outcomes associated with hyponatremia in palliative care patients is needed.

  20. Knowledge of primary care nurses regarding domestic violence ...

    African Journals Online (AJOL)

    Knowledge of primary care nurses regarding domestic violence. ... It included also knowledge about prevalence of DV, and four main aspects relevant to DV, namely deprivation, psychological, ... schools, training courses and conferences.

  1. Knowledge of Primary Care Physicians Regarding Domestic Violence.

    African Journals Online (AJOL)

    Knowledge of Primary Care Physicians Regarding Domestic Violence. ... prevalence of DV, and 4 main aspects relevant to DV, namely deprivation, psychological, ... and instructions about DV from scientific formal sources as medical schools, ...

  2. Assessing primary care data quality.

    Science.gov (United States)

    Lim, Yvonne Mei Fong; Yusof, Maryati; Sivasampu, Sheamini

    2018-04-16

    Purpose The purpose of this paper is to assess National Medical Care Survey data quality. Design/methodology/approach Data completeness and representativeness were computed for all observations while other data quality measures were assessed using a 10 per cent sample from the National Medical Care Survey database; i.e., 12,569 primary care records from 189 public and private practices were included in the analysis. Findings Data field completion ranged from 69 to 100 per cent. Error rates for data transfer from paper to web-based application varied between 0.5 and 6.1 per cent. Error rates arising from diagnosis and clinical process coding were higher than medication coding. Data fields that involved free text entry were more prone to errors than those involving selection from menus. The authors found that completeness, accuracy, coding reliability and representativeness were generally good, while data timeliness needs to be improved. Research limitations/implications Only data entered into a web-based application were examined. Data omissions and errors in the original questionnaires were not covered. Practical implications Results from this study provided informative and practicable approaches to improve primary health care data completeness and accuracy especially in developing nations where resources are limited. Originality/value Primary care data quality studies in developing nations are limited. Understanding errors and missing data enables researchers and health service administrators to prevent quality-related problems in primary care data.

  3. Prevalence of upper gastrointestinal symptoms and their influence on nutritional state and performance status in patients with different primary tumors receiving palliative care.

    Science.gov (United States)

    Bovio, Giacomo; Fonte, Maria Luisa; Baiardi, Paola

    2014-02-01

    The aim of this study was to investigate the relationship between gastrointestinal symptoms, nutritional balance, and performance status in patients receiving palliative care for advanced cancers originating in different sites. We studied a total of 105 patients. Upper gastrointestinal symptoms, Eastern Cooperative Oncology Group Performance Status score (ECOG-PS), dietary intakes, anthropometric measures, and some serum proteins were determined. Unintentional weight loss, alterations in anthropometric measures, and highest number of symptoms were greater in patients with lung and stomach cancer. No differences were found in ECOG-PS according to cancer site. Patients with gastric or lung cancer have most evidence of protein-calorie malnutrition and a higher prevalence of upper gastrointestinal symptoms. The performance status is not affected by tumor site. Early nutritional support should be planned for all patients with cancer, especially for patients with gastric or lung cancer.

  4. Primary prevention of chronic obstructive pulmonary disease in primary care.

    Science.gov (United States)

    van der Molen, Thys; Schokker, Siebrig

    2009-12-01

    Chronic obstructive pulmonary disease (COPD) is a prevalent disease, with cigarette smoking being the main risk factor. Prevention is crucial in the fight against COPD. Whereas primary prevention is targeted on whole populations, patient populations are the focus of primary care; therefore, prevention in this setting is mainly aimed at preventing further deterioration of the disease in patients who present with the first signs of disease (secondary prevention). Prevention of COPD in primary care requires detection of COPD at an early stage. An accurate definition of COPD is crucial in this identification process. The benefits of detecting new patients with COPD should be determined before recommending screening and case-finding programs in primary care. No evidence is available that screening by spirometry results in significant health gains. Effective treatment options in patients with mild disease are lacking. Smoking cessation is the cornerstone of COPD prevention. Because cigarette smoking is not only a major cause of COPD but is also a major cause of many other diseases, a decline in tobacco smoking would result in substantial health benefits.

  5. Phytotherapy in primary health care

    Science.gov (United States)

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    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

  6. Managing obesity in primary care.

    Science.gov (United States)

    Goldie, Christine; Brown, Jenny

    Obesity is a complex problem and often difficult to tackle in primary care. A year-long pilot of a practice nurse-led scheme that used a holistic approach towards self-care in obesity management was set up to reduce the cardiovascular risk of patients who were obese and improve their quality of life. This person-centred approach may offer an important tool in the management of these patients in the GP surgery.

  7. [Mental disorders in primary care].

    Science.gov (United States)

    Herzig, Lilli; Mühlemann, Nicole; Bischoff, Thomas

    2010-05-19

    Mental disorders (depression, anxiety and somatization) are frequent in Primary care and are often associated to physical complaints and to psychosocial stressors. Mental disorders have in this way a specific presentation and in addition patients may present different associations of them. Sometimes it is difficult to recognize them, but it is important to do so and to take rapidly care of these patients. Specific screening questions exist and have been used in a research of the Institute of General Medicine and the Department of Ambulatory Care and Community Medicine (PMU), University of Lausanne, Switzerland.

  8. The Primary Dental Care Workforce.

    Science.gov (United States)

    Neenan, M. Elaine; And Others

    1993-01-01

    A study describes the characteristics of the current primary dental care workforce (dentists, hygienists, assistants), its distribution, and its delivery system in private and public sectors. Graduate dental school enrollments, trends in patient visits, employment patterns, state dental activities, and workforce issues related to health care…

  9. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    VPDs, this represents 17% of global total. 1 ... Knowledge, Attitude and Practice of Childhood Immunization ... Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, P.M.B. 12003, ... include access to services, parental (maternal) ... Calmette Guerin (BCG) vaccine Oral Polio.

  10. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    ... Experience in a primary health care facility in Rivers State, South-South Nigeria. ... health center increased by 3.09% (p-value > 0.05); the patients that had their babies in the facility were ... 100, 000 live births, based on historical studies and.

  11. Management of postmenopausal osteoporosis for primary care.

    Science.gov (United States)

    Miller, P; Lukert, B; Broy, S; Civitelli, R; Fleischmann, R; Gagel, R; Khosla, S; Lucas, M; Maricic, M; Pacifici, R; Recker, R; Sarran, H S; Short, B; Short, M J

    1998-01-01

    The shift in health care delivery from a subspecialty to primary care system has transferred the responsibility of preventing osteoporotic fractures from specialists in metabolic bone disease to the web of physicians--family practitioners, general internists, pediatricians, and gynecologists--who provide the bulk of primary care. The challenge for this group of physicians is to decrease the rising prevalence of osteoporotic hip and vertebral fractures while operating within the cost parameters. It is the goal of this brief summary to provide primary practitioners with focused guidelines for the management of postmenopausal osteoporosis based on new and exciting developments. Prevention and treatment will change rapidly over the next decade and these advances will require changes in these recommendations. We identified patients at risk for osteoporosis and provided indications for bone mass measurement, criteria for diagnosis of osteoporosis, therapeutic interventions, and biochemical markers of the disease. Prevention and treatment are discussed, including hormone replacement therapy and use of calcitonin, sodium fluoride, bisphosphonates, and serum estrogen receptor modulators. Postmenopausal osteoporosis should no longer be an accepted process of aging. It is both preventable and treatable. Primary care physicians must proactively prevent and treat osteoporosis in their daily practice, and combination therapies are suggested.

  12. Prevalence of post-traumatic stress symptoms and associated factors in tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa.

    Science.gov (United States)

    Peltzer, Karl; Naidoo, Pamela; Matseke, Gladys; Louw, Julia; McHunu, Gugu; Tutshana, Bomkazi

    2013-01-01

    High rates of tuberculosis (TB) and TB/HIV co-infection is often linked with mental health issues such as post-traumatic stress disorder (PTSD) symptoms, which is further associated with poor health outcomes. In a country such as South Africa where rates of these infectious diseases are high, it is concerning that there is limited/no data on prevalence rates of mental disorders such as PTSD and its associated factors. Therefore, the aim of this study was to establish the prevalence of PTSD symptoms and associated factors in TB, TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa. Brief screening self-report tools were used to measure: PTSD symptoms, psychological distress (anxiety and depression) and alcohol misuse. Other relevant measures, such as adherence to medication, stressful life events and sexual risk-taking behaviours, were obtained through structured questions. A total of 4900 public primary care adult patients from clinics in high TB burden districts from three provinces in South Africa participated. All the patients screened positive for TB (either new or retreatment cases). The prevalence of PTSD symptoms was 29.6%. Patients who screened positive for PTSD symptoms and psychological distress were more likely to be on antidepressant medication. Factors that predicted PTSD symptoms were poverty, residing in an urban area, psychological distress, suicide attempt, alcohol and/or drug use before sex, unprotected sex, TB-HIV co-infected and the number of other chronic conditions. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of TB and HIV.

  13. Primary care workforce development in Europe.

    NARCIS (Netherlands)

    Groenewegen, P.; Heinemann, S.; Gress, S.; Schäfer, W.

    2014-01-01

    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.

  14. US Approaches to Physician Payment: The Deconstruction of Primary Care

    OpenAIRE

    Berenson, Robert A.; Rich, Eugene C.

    2010-01-01

    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary ...

  15. Treatment of Type 2 Diabetes Mellitus in a Primary Care Setting in Taiwan: Comparison with Secondary/Tertiary Care

    Directory of Open Access Journals (Sweden)

    Tong-Yuan Tai

    2006-01-01

    Conclusion: Diabetes control was poorer in primary care than in secondary/tertiary care patients, but control of blood pressure was better in primary care patients. The shorter duration of diabetes and better control of blood pressure in primary care patients and in patients aged < 65 years compared with their elderly counterparts might be related to a lower prevalence of complications.

  16. Registered prevalence of borderline personality disorder in primary care databases Prevalencia registrada del trastorno límite de personalidad en las bases de datos de atención primaria

    Directory of Open Access Journals (Sweden)

    Enric Aragonès

    2013-04-01

    Full Text Available Objective: Borderline personality disorder (BPD is a common personality disorder, with a population prevalence of 1.4-5.9%, although the epidemiology of this disorder in primary care is insufficiently known. Our objective was to determine the registered prevalence of BPD in primary care databases and to study the demographic and clinical characteristics of these patients. Methods: We performed a cross-sectional study of the computerized databases of primary care clinical records. The target population consisted of all adults (> 16 years old registered in the Catalan Health Institute (n = 4,764,729. Results: The prevalence of recorded BPD was 0.017%, and was higher in patients with other mental disorders, particularly substance-abuse disorders (0.161%. These patients had twice as many appointments with the general practitioner as the general population (8.1 vs. 4.4. Conclusion: The number of diagnoses of BPD recorded in primary care is extremely low, which contrasts with the available population-based data.Objetivo: El trastorno límite de la personalidad (TLP es frecuente, con una prevalencia poblacional del 1,4% al 5,9%, aunque la epidemiología de este trastorno en atención primaria es escasamente conocida. Nuestro objetivo es determinar la prevalencia registrada de TLP en atención primaria y estudiar las características de estos pacientes. Métodos: Estudio transversal de las bases de datos informatizadas de las historias clínicas de atención primaria. La población diana son los adultos (>16 años registrados en el Instituto Catalán de la Salud (n = 4.764.729. Resultados: La prevalencia de TLP registrada es del 0,017%, y es mayor en los pacientes con otros trastornos mentales, particularmente trastornos por abuso de sustancias (0,161%. Estos pacientes duplican las visitas al médico general de la población general (8,1 frente a 4,4. Conclusión: Los diagnósticos de TLP registrados en atención primaria son escasos, lo que contrasta

  17. Cinema Sessions in Primary Care

    Directory of Open Access Journals (Sweden)

    Francisco Ignacio MORETA-VELAYOS

    2016-04-01

    Full Text Available For a long time films have been used in teaching and at various levels of professional training  and more specifically in the medical area. In this case, through the description of a project developed in a Primary Care Health Center, we intend to justify the use of movies as a tool that could ease, the sometimes difficult task of continued education among Primary Care professionals. We propose different aspects of everyday practice in which cinema can be potentially useful, as well as the way to include it in the Plan of Continued Education of the Centre and its accreditation.Films and issues discussed in each session, and the project evaluation, are detailed.

  18. The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services.

    Science.gov (United States)

    Spira, Thomas; Lindegren, Mary Lou; Ferris, Robert; Habiyambere, Vincent; Ellerbrock, Tedd

    2009-06-01

    The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms.

  19. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-08-01

    The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

  20. Improving Services for Women with Depression in Primary Care Settings

    Science.gov (United States)

    Katon, Wayne J.; Ludman, Evette J.

    2003-01-01

    Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early…

  1. Dementia prevalence, care arrangement, and access to care in Lebanon

    DEFF Research Database (Denmark)

    Phung, Kieu T T; Chaaya, Monique; Prince, Martin

    2017-01-01

    INTRODUCTION: In North Africa and the Middle East, studies about dementia prevalence are scarce. A pilot study was conducted in Lebanon to assess dementia prevalence, using the Arabic-validated 10/66 Dementia Research Group (DRG) diagnostic assessment for case ascertainment. The study also examined...... care arrangement and access to care. METHODS: A random sample of 502 persons older than 65 years and their informant were recruited from Beirut and Mount Lebanon governorates through multistage cluster sampling. RESULTS: The crude and age-standardized dementia prevalences were 7.4% and 9.......0%, respectively. People with dementia were mainly cared for by relatives at home. Access to formal care was very limited. DISCUSSION: Dementia prevalence in Lebanon ranks high within the global range of estimates. These first evidence-based data about disease burden and barriers to care serve to raise awareness...

  2. Oncology in primary health care

    International Nuclear Information System (INIS)

    Mendoza del Pino, Mario Valentín

    2009-01-01

    The book O ncology in the primary health care , constitutes an important contribution to the prevention and treatment of cancer, from a very comprehensive assessment. It's a disease that is the second leading cause of death in our country, to much pain and suffering is for the patient and their family. The book has a very useful for basic health equipment approach, since it emphasizes that cancer can be prevented if achieved in the population changes in lifestyle. The book is valued not correct food as responsible for one third of all cancers. Currently important research being developed in relation to psiconeuroinmuno-Endocrinology, who is studying the association between psychological factors and the development of cancer valuing that kept stress and depression reduces the antitumor activity of the immune system; that made programs with encouraging results where the treatment of cancer has joined elements of psychotherapy, immunotherapy and the use of the biotherapy. The focus of the book fills an important place in the primary health care and is an indispensable guide for professionals at this level of care (author)

  3. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    NARCIS (Netherlands)

    Odusola, A.O.; Stronks, K.; Hendriks, M.E.; Schultsz, C.; Akande, T.; Osibogun, A.; van Weert, H.; Haafkens, J.A.

    2016-01-01

    Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and

  4. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    NARCIS (Netherlands)

    Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; Weert, Henk van; Haafkens, Joke A.

    2016-01-01

    Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and

  5. Depressive Disorders in Primary Health Care

    OpenAIRE

    Vuorilehto, Maria

    2008-01-01

    The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in prima...

  6. Characterization of care for patients with wounds in Primary Care

    Directory of Open Access Journals (Sweden)

    Isabel Cristina Ramos Vieira Santos

    2014-10-01

    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.

  7. Screening and Identification in Pediatric Primary Care

    Science.gov (United States)

    Simonian, Susan J.

    2006-01-01

    This article reviews issues related to behavioral screening in pediatric primary care settings. Structural-organizational issues affecting the use of pediatric primary care screening are discussed. This study also reviewed selected screening instruments that have utility for use in the primary care setting. Clinical and research issues related to…

  8. 45 CFR 96.47 - Primary care.

    Science.gov (United States)

    2010-10-01

    ... 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 for...

  9. Blueprint for an Undergraduate Primary Care Curriculum.

    Science.gov (United States)

    Fazio, Sara B; Demasi, Monica; Farren, Erin; Frankl, Susan; Gottlieb, Barbara; Hoy, Jessica; Johnson, Amanda; Kasper, Jill; Lee, Patrick; McCarthy, Claire; Miller, Kathe; Morris, Juliana; O'Hare, Kitty; Rosales, Rachael; Simmons, Leigh; Smith, Benjamin; Treadway, Katherine; Goodell, Kristen; Ogur, Barbara

    2016-12-01

    In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students' exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine-pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.

  10. Primary care clinicians' recognition and management of depression: a model of depression care in real-world primary care practice.

    Science.gov (United States)

    Baik, Seong-Yi; Crabtree, Benjamin F; Gonzales, Junius J

    2013-11-01

    Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered. This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions. Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data. Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners. A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression. The clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

  11. Primary health care in India.

    Science.gov (United States)

    Deodhar, N S

    1982-03-01

    relative neglect of development of health manpower for nursing, environmental engineering, and other technical and paramedical personnel. Community involvement and participation were at a minimum if they existed at all. The basic concern about primary health care for all continued unabated however. To realize the goal of health care for all, 3 programs will have to be pursued simultaneously during the next 2 decades: integrated overall development including family planning; improvement in nutrition, environment, and health education; and the provision of adequate health care services for all, particularly the poor and underprivileged. It is necessary to redefine the roles of the central and state governments in view of the large power powers delegated to local bodies at the district level and below. Voluntary agencies will have to function within the overall plan/aid down by the state.

  12. Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

    Directory of Open Access Journals (Sweden)

    Liddy Clare

    2009-06-01

    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

  13. Primary care nurses: effects on secondary care referrals for diabetes?

    NARCIS (Netherlands)

    Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de

    2010-01-01

    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

  14. Improving eye care in the primary health care setting

    Directory of Open Access Journals (Sweden)

    M de Wet

    2000-09-01

    Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

  15. [Update of hidradenitis suppurativa in Primary Care].

    Science.gov (United States)

    García-Martínez, F J; Pascual, J C; López-Martín, I; Pereyra-Rodríguez, J J; Martorell Calatayud, A; Salgado-Boquete, L; Labandeira-García, J

    Hidradenitis suppurativa is a prevalent disease that is noted for its clinical variability and by its severe impact on quality of life. A meticulous scientific literature review is presented in this article in order to give an update on what is known on this condition. Primary Care physicians obviously play an important role in the early diagnosis and management of hidradenitis suppurativa. This review aims to provide a current and practical overview about this disease in order to optimise the healthcare for these patients by making the best use of available resources. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Diversity of primary care systems analysed.

    NARCIS (Netherlands)

    Kringos, D.; Boerma, W.; Bourgueil, Y.; Cartier, T.; Dedeu, T.; Hasvold, T.; Hutchinson, A.; Lember, M.; Oleszczyk, M.; Pavlick, D.R.

    2015-01-01

    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.

  17. [Burnout and teamwork in primary care teams].

    Science.gov (United States)

    Vilà Falgueras, Maite; Cruzate Muñoz, Carlota; Orfila Pernas, Francesc; Creixell Sureda, Joan; González López, María Pilar; Davins Miralles, Josep

    2015-01-01

    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 (p<0.001). Permanent staff have a greater degree of emotional exhaustion (p<0.002). Those who rated their leaders worst and least rated teamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (p<0.001). The level of burnout among professionals is considerable, with differences existing between occupational categories. Teamwork and appreciating their leaders protect from burnout. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  18. Costs of health care across primary care models in Ontario

    OpenAIRE

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-01-01

    Background The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients? primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Methods Utilization data for a one year period was measured using administrative databases for a 1...

  19. Primary care in Switzerland gains strength.

    Science.gov (United States)

    Djalali, Sima; Meier, Tatjana; Hasler, Susann; Rosemann, Thomas; Tandjung, Ryan

    2015-06-01

    Although there is widespread agreement on health- and cost-related benefits of strong primary care in health systems, little is known about the development of the primary care status over time in specific countries, especially in countries with a traditionally weak primary care sector such as Switzerland. The aim of our study was to assess the current strength of primary care in the Swiss health care system and to compare it with published results of earlier primary care assessments in Switzerland and other countries. A survey of experts and stakeholders with insights into the Swiss health care system was carried out between February and March 2014. The study was designed as mixed-modes survey with a self-administered questionnaire based on a set of 15 indicators for the assessment of primary care strength. Forty representatives of Swiss primary and secondary care, patient associations, funders, health care authority, policy makers and experts in health services research were addressed. Concordance between the indicators of a strong primary care system and the real situation in Swiss primary care was rated with 0-2 points (low-high concordance). A response rate of 62.5% was achieved. Participants rated concordance with five indicators as 0 (low), with seven indicators as 1 (medium) and with three indicators as 2 (high). In sum, Switzerland achieved 13 of 30 possible points. Low scores were assigned because of the following characteristics of Swiss primary care: inequitable local distribution of medical resources, relatively low earnings of primary care practitioners compared to specialists, low priority of primary care in medical education and training, lack of formal guidelines for information transfer between primary care practitioners and specialists and disregard of clinical routine data in the context of medical service planning. Compared to results of an earlier assessment in Switzerland, an improvement of seven indicators could be stated since 1995. As a

  20. Factors associated with prevalence and types of 'may be fit' advice on fit notes: a cross-sectional primary care analysis.

    Science.gov (United States)

    Shiels, Chris; Gabbay, Mark; Hillage, Jim

    2014-03-01

    The 'fit note', with the opportunity for the GP to advise that a patient 'may be fit' to do some work, was introduced in April 2010. To estimate numbers of fit notes with 'may be fit' advice, the types of advice, and factors associated with any inclusion of such advice in the fit note. Cross-sectional analysis of fit note data from 68 general practices in eight regions of England, Wales and Scotland. Collection of practice fit note data via GP use of carbonised pads of fit notes for a period of 12 months. The 'may be fit' box was ticked on 5080 fit notes (6.4% of all fit notes in study). But there was a wide variation in completion rates across the 68 practices (from 1% to 15%). The most prevalent individual item of advice was to 'amend duties' of patient as a prerequisite for return to work (included in 42% of all notes containing any 'may be fit' advice). Advice was often incomplete or irrelevant, with some GPs failing to comply with official guidance. Inclusion of any 'may be fit' advice was independently associated with the patient being female, less socially deprived and having a physical health reason for receiving a fit note. Unlike other studies that have relied upon eliciting opinion, this study investigates how the fit note is being used in practice. Findings provide some evidence that the fit note is not yet being used to the optimum benefit of patients (and their employers).

  1. [Teenager counselling in primary care].

    Science.gov (United States)

    Millán, Teresa; Morera, Iván; Vargas, Nelson A

    2007-04-01

    Teenager counseling to recognize risks and reinforce strengths is carried out in a primary care outpatient clinic since 2003. To describe the epidemiology and causes for consultation in this teenage counseling program. Retrospective review of the records of 116 teenagers (median age 13 years, 67% females) that received teenager counseling. Seventy percent of women and 50% of men came from nuclear families. More than two thirds were primogenital. Most adolescents were accompanied by their mother, that were the main adult raw model. Fifty percent had dysfunctional families. All were attending school regularly and 21% of women and 29% of men had repeated a school level. Sixty eight percent of women and 62% of men declared to have a life project. Twenty percent were worried about their physical appearance. Seventy seven percent of women and 62% of men considered themselves as happy. Thirty six percent of women and 14% of men smoked. The figures for alcohol consumption were 21% and 14%, respectively. The causes for consultation were obesity, overweight, unspecific symptoms, behavioral problems, bad school achievement, communication problems or pregnancy. Reasons for counseling were family dysfunction, low self esteem, bad school achievement and information about sexuality. The information obtained could help to improve the interdisciplinary work and to coordinate counseling with the family and schools.

  2. Barriers for domestic violence screening in primary health care centers

    African Journals Online (AJOL)

    Iman Y. Alotaby

    2012-08-09

    Aug 9, 2012 ... the field work of the study in the selected centers were the target population of this ... program; several methods were used to verify data entry. ..... asked about abuse.18 Based on the synthesis and interpretation of data from 25 ... in a primary care setting: the validity of ''feeling safe at home'' and prevalence ...

  3. VHA Support Service Center Primary Care Management Module (PCMM)

    Data.gov (United States)

    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...

  4. The myth of standardized workflow in primary care.

    Science.gov (United States)

    Holman, G Talley; Beasley, John W; Karsh, Ben-Tzion; Stone, Jamie A; Smith, Paul D; Wetterneck, Tosha B

    2016-01-01

    Primary care efficiency and quality are essential for the nation's health. The demands on primary care physicians (PCPs) are increasing as healthcare becomes more complex. A more complete understanding of PCP workflow variation is needed to guide future healthcare redesigns. This analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. Two patient visits from 10 PCPs from 10 different United States Midwestern primary care clinics were analyzed to determine physician workflow. Tasks and the progressive sequence of those tasks were observed, documented, and coded by task category using a PCP task list. Variations in the sequence and prevalence of tasks at each stage of the primary care visit were assessed considering the physician, the patient, the visit's progression, and the presence of an electronic health record (EHR) at the clinic. PCP workflow during patient visits varies significantly, even for an individual physician, with no single or even common workflow pattern being present. The prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit. PCP workflows were unpredictable during face-to-face patient visits. Workflow emerges as the result of a "dance" between physician and patient as their separate agendas are addressed, a side effect of patient-centered practice. Future healthcare redesigns should support a wide variety of task sequences to deliver high-quality primary care. The development of tools such as electronic health records must be based on the realities of primary care visits if they are to successfully support a PCP's mental and physical work, resulting in effective, safe, and efficient primary care. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Factors influencing the prevalence of primary dysmenorrhoea ...

    African Journals Online (AJOL)

    ... of primary dysmenorrhoea amongst Abia State university medical students, South ... its impact on school and social activities and the students' management strategies. ... is high, and not consistently associated with demographic risk factors.

  6. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    care policy which was intended to make health care which of the two alternative methods of health care available to individuals and families in the financing options of free health or DRF was community at very little or no cost at all. However, preferred by the community members within most health facilities would appear to ...

  7. Prevalence and determinants of burnout syndrome among primary ...

    African Journals Online (AJOL)

    Prevalence and determinants of burnout syndrome among primary healthcare ... Background: General practitioners (GPs) in particular are prone to developing ... Fatigue, the use of analgesics and irritability were the most common symptoms.

  8. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    Prevalence of psychiatric disorders in HIV patients in the ... mania) and anxiety disorders (General anxiety, agoraphobia, social phobia, obsessive-compulsive disorder and post traumatic stress disorder). ..... Belfer, M. L. Child and adolescent.

  9. Prevalence of overweight and obesity among primary school ...

    African Journals Online (AJOL)

    The prevalence of childhood overweight and obesity is increasing at an alarming rate worldwide and has implications for a variety of diseases. This has been due to various causes such as poor nutrition, inactivity or both. The purpose of this study was to establish the prevalence of overweight and obesity among primary ...

  10. Suicidal ideation in German primary care

    NARCIS (Netherlands)

    Wiborg, J.F.; Gieseler, D.; Lowe, B.

    2013-01-01

    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

  11. Prediabetes Diagnosis and Treatment in Primary Care.

    Science.gov (United States)

    Mainous, Arch G; Tanner, Rebecca J; Baker, Richard

    2016-01-01

    The increasing prevalence of diabetes is a major health problem. The detection and treatment of prediabetes can delay the onset of diabetes and presents an important diabetes prevention strategy. Using data from the 2012 National Ambulatory Medical Care Survey, we studied visits by adults aged ≥45 years without diagnosed diabetes who had an HbA1c test within 90 days of the visit (n = 518 unweighted visits; n = 11,167,004 weighted visits). HbA1c results were categorized into normal, prediabetes, and diabetes, and we examined patient characteristics (age, sex, race, payer type, body mass index) and treatment of prediabetes. Among visiting adults, 54.6% had a normal HbA1c value, 33.6% had prediabetes, and 11.9% had diabetes. Of those patient visits with HbA1c consistent with prediabetes, the number of patients diagnosed with prediabetes was too low for a reliable population estimate. Indication of treatment in the medical record (lifestyle modification counseling and/or metformin) was present in 23.0% of those with diagnosed or undiagnosed prediabetes. The most common treatment was lifestyle modification counseling. Our findings show that there are missed opportunities for diabetes prevention in primary care. Providers need to change their approach to prediabetes and play a more effective role in preventing diabetes. © Copyright 2016 by the American Board of Family Medicine.

  12. Third sector primary care for vulnerable populations.

    Science.gov (United States)

    Crampton, P; Dowell, A; Woodward, A

    2001-12-01

    This paper aims to describe and explain the development of third sector primary care organisations in New Zealand. The third sector is the non-government, non-profit sector. International literature suggests that this sector fulfils an important role in democratic societies with market-based economies, providing services otherwise neglected by the government and private for-profit sectors. Third sector organisations provided a range of social services throughout New Zealand's colonial history. However, it was not until the 1980s that third sector organisations providing comprehensive primary medical and related services started having a significant presence in New Zealand. In 1994 a range of union health centres, tribally based Mäori health providers, and community-based primary care providers established a formal network -- Health Care Aotearoa. While not representing all third sector primary care providers in New Zealand, Health Care Aotearoa was the best-developed example of a grouping of third sector primary care organisations. Member organisations served populations that were largely non-European and lived in deprived areas, and tended to adopt population approaches to funding and provision of services. The development of Health Care Aotearoa has been consistent with international experience of third sector involvement -- there were perceived "failures" in government policies for funding primary care and private sector responses to these policies, resulting in lack of universal funding and provision of primary care and continuing patient co-payments. The principal policy implication concerns the role of the third sector in providing primary care services for vulnerable populations as a partial alternative to universal funding and provision of primary care. Such an alternative may be convenient for proponents of reduced state involvement in funding and provision of health care, but may not be desirable from the point of view of equity and social cohesion

  13. The primary care amplification model: taking the best of primary care forward

    Directory of Open Access Journals (Sweden)

    Nicholson Caroline

    2008-12-01

    Full Text Available Abstract Background Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to de-stabilise and challenge established general practice and primary care. Discussion The Primary Care Amplification Model offers a means to harness the change agenda by 'amplifying' the strengths of established general practices around a 'beacon' practice. Conclusion Such 'beacon' practices can provide a mustering point for an expanded scope of practice for primary care, integrated primary/secondary service delivery, interprofessional learning, relevant local clinical research, and a focus on local service innovation, enhancing rather than fragmenting the collective capacity of existing primary care.

  14. Integrated primary health care in Australia

    Directory of Open Access Journals (Sweden)

    Gawaine Powell Davies

    2009-10-01

    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.

  15. Integrated primary health care in Australia.

    Science.gov (United States)

    Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

    2009-10-14

    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. 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. 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.

  16. Work-Related Depression in Primary Care Teams in Brazil.

    Science.gov (United States)

    da Silva, Andréa Tenório Correia; Lopes, Claudia de Souza; Susser, Ezra; Menezes, Paulo Rossi

    2016-11-01

    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.

  17. Prevalence and clinical characteristics of dyslexia in primary school students.

    Science.gov (United States)

    Roongpraiwan, Rawiwan; Ruangdaraganon, Nichara; Visudhiphan, Pongsak; Santikul, Kanitta

    2002-11-01

    Dyslexia is the most common subtype of learning disabilities with a prevalence ranging from 5-10 per cent. The central difficulty in dyslexia is the phonological awareness deficit. The authors have developed a screening test to assess the reading ability of Thai primary school students. 1. To study the prevalence of dyslexia in first to sixth grade students at Wat Samiannaree School. 2. To study the clinical characteristics such as sex, neurological signs, verbal intelligence and comorbid attention deficit hyperactive disorder (ADHD) of the dyslexia group. A total of 486 first to sixth grade students were administered "Raven's progressive matrices test" for estimation of intellectual functioning. Those who scored below the fifth percentile were labeled as mental retardation and excluded from the study. The students' reading ability was evaluated by 3 steps; first by classroom teachers using some items of the screening test, second by the researchers examining some more items individually, and third by the special educator assessing more details in reading and phonology. The students who had a reading ability two-grade levels below their actual grades and impairment in phonology were diagnosed with dyslexia. The prevalence of dyslexia and probable dyslexia were found to be 6.3 per cent and 12.6 per cent, respectively. The male to female ratio of dyslexia was 3.4:1. The dyslexia group had significantly lower Thai language scores than those of the normal group (p dyslexia group had a normal grossly neurological examination but 90 per cent showed positive soft neurological signs. Mean verbal intellectual quotient score in the dyslexia group assessed by using Wechsler Intelligence Scales for Children--Revised was 76 +/- 7. The comorbid ADHD was 8.7 per cent in the dyslexia group. Dyslexia was a common problem among primary school students in this study. Further studies in a larger population and different socioeconomic statuses are required to determine the prevalence

  18. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA in community-acquired primary pyoderma

    Directory of Open Access Journals (Sweden)

    Patil Rahul

    2006-01-01

    Full Text Available Background: Although prevalence of MRSA strains is reported to be increasing, there are no studies of their prevalence in community-acquired primary pyodermas in western India. Aims: This study aimed at determining the prevalence of MRSA infection in community-acquired primary pyodermas. Methods: Open, prospective survey carried out in a tertiary care hospital in Mumbai. Materials and Methods: Eighty-six patients with primary pyoderma, visiting the dermatology outpatient, were studied clinically and microbiologically. Sensitivity testing was done for vancomycin, sisomycin, gentamicin, framycetin, erythromycin, methicillin, cefazolin, cefuroxime, penicillin G and ciprofloxacin. Phage typing was done for MRSA positive strains. Results : The culture positivity rate was 83.7%. Staphylococcus aureus was isolated in all cases except two. Barring one, all strains of Staphylococcus were sensitive to methicillin. Conclusions: Methicillin resistance is uncommon in community-acquired primary pyodermas in Mumbai. Treatment with antibacterials active against MRSA is probably unwarranted for community-acquired primary pyodermas.

  19. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    dearth of information on patient satisfaction with HIV/AIDS care. This study sought ... with the doctor. Satisfaction rates were: 94.9% technical quality, ... of the delivery of care into several dimensions of contributed by studies carried out in Western. 14 ... efficiency of services as an index of patient needs of its clients. Secondly ...

  20. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

    2007-01-01

    to the patients. Topical, dermatological medications and medications not used regularly were excluded. RESULTS: 212 patients were prescribed 1621 medications by their GPs at baseline. In all, 640 (39.5%) of the medications had one or more inappropriate ratings in the 10 criteria making up the MAI. The main part...... is good. However, the majority of patients used one or more medications with inappropriate ratings. The inappropriate prescribing relates to specific therapeutic groups and criteria, which should be targeted in future interventions....

  1. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    percentage of mortality and morbidity especially in. 1 ... prevalent in communities with poor food hygiene,. 1 ... and 650mls of clean water will constitute 45-70 ... second to India among 11 countries that were .... 15-30. 31-43. 128. 75. 57.4. 33.6. Marital Status. Single. Married. Separated .... women in child bearing age group.

  2. Prevalence of asthma, allergic rhinitis and dermatitis in primary ...

    African Journals Online (AJOL)

    Objective: to establish the relative increase in the prevalence of asthma, allergic rhinitis and eczema in primary school children aged 13-14 years over a six year interval. Design: Cross sectional comparative study. Setting: Primary schools in three rural divisions at Uasin Gishu district in the Rift Valley Province of Kenya.

  3. Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

    OpenAIRE

    Chan, KTY; Wong, SYS; Chiu, BCF; Chin, WY; Lam, TP; Lam, CLK; Fong, DYT; Lo, YCY

    2014-01-01

    Background This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong. Methods A cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management. Results 10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screeni...

  4. Prevalência de hipertensão do avental branco na atenção primária de saúde Prevalence of white coat hypertension in primary health care

    Directory of Open Access Journals (Sweden)

    Leila Maria Marchi Alves

    2007-07-01

    Full Text Available OBJETIVO: Avaliar a prevalência de hipertensão do avental branco no município de Dumont, Estado de São Paulo, caracterizando os participantes da pesquisa em relação a fatores demográficos e a alterações tanto fisiológicas como metabólicas. MÉTODOS: Foram selecionados 109 usuários da Unidade de Saúde municipal, divididos em três grupos (normotensão, hipertensão essencial e hipertensão do avental branco, após medidas de pressão arterial com aparelho oscilométrico e exame de monitorização ambulatorial da pressão arterial. Foram realizadas entrevista, mensuração de dados e coleta de exames laboratoriais para comparação das variáveis encontradas entre os grupos. Para o tratamento estatístico, foram utilizados os testes ANOVA e Tukey. Os resultados foram expressos como médias ± erros padrão das médias. As diferenças foram consideradas estatisticamente significativas para p OBJECTIVE: Assess the prevalence of white coat hypertension in the municipality of Dumont, in São Paulo State, and map study participants' demographics, and physiologic and metabolic changes. METHODS: One hundred and nine (109 users of the Municipal Health Service were selected and then divided into three groups: normotension, essential hypertension, and white coat hypertension after blood pressure was measured through oscilometry and blood pressure monitoring exam at outpatient unit. Variables found between the groups were compared based on interview, data measurements, and laboratory exams. ANOVA and Tukey tests were used for statistical data. Results were expressed as means ± standard error of means. p<0.05 was considered statistically significant. RESULTS: The prevalence of white coat hypertension was 34.1%. Females were predominant: mean age 45.3 years, increased body mass index, waist/hip ratio, plasma glucose level and creatinine when compared to hypertensives and/or normotensives. No correlation was found between white coat hypertension

  5. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    Family planning is an important preventive measure against maternal and child ... users of the services, desire for more children, fear of side effects and partner's ... It is an essential component of primary development across the regions .

  6. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    %) was the least common. On bivariate analysis ... the power to determine what their wives do or fail to ... pregnancy care while joint decision-making ... Other maternal health services rendered This data collection was done by a team of trained.

  7. LGBTQ Youth's Perceptions of Primary Care.

    Science.gov (United States)

    Snyder, Barbara K; Burack, Gail D; Petrova, Anna

    2017-05-01

    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.

  8. Applying organizational behavior theory to primary care.

    Science.gov (United States)

    Mullangi, Samyukta; Saint, Sanjay

    2017-03-01

    Addressing the mounting primary care shortage in the United States has been a focus of educators and policy makers, especially with the passage of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act in 2015, placing increased pressure on the system. The Association of American Medical Colleges recently projected a shortage of as many as 65,000 primary care physicians by 2025, in part because fewer than 20% of medical students are picking primary care for a career. We examined the issue of attracting medical students to primary care through the lens of organizational behavior theory. Assuming there are reasons other than lower income potential for why students are inclined against primary care, we applied various principles of the Herzberg 2-factor theory to reimagine the operational flow and design of primary care. We conclude by proposing several solutions to enrich the job, such as decreasing documentation requirements, reducing the emphasis on specialty consultations, and elevating physicians to a supervisory role.

  9. Quality Assessment in the Primary care

    Directory of Open Access Journals (Sweden)

    Muharrem Ak

    2013-04-01

    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

  10. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    Result: Majority of the mothers (89.2%) had primary/secondary education and 69.4% were traders. Most ... regards immunization, 22.7% of the children were not fully immunized. A total of 69 ..... Nigeria: Perception and Attitudes of the. 17.

  11. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    one strategy that could be conducted anywhere, if the health care workers are trained and positively disposed ... places; regulate advertising, manufacturing. 13 .... Gender. Male. 52 (46.0). 61 (54.0). 0.0001. Significant. Female. 82 (73.2).

  12. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    about teething the world over and especially ... children`s out-patients, dental and the ear, nose and throat clinics of a tertiary hospital in south-west Nigeria. ... parents, health care workers and personal experiences were the sources of beliefs ... None (0%) of the respondents had prior knowledge of proven causes of ear.

  13. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    enrol in an insurance scheme feeling that they need more information on health insurance and the willingness to enrol in a ... and utilize the benefits of different types of health insurance services. Conclusion: The findings ..... improvements in access and quality of care, and the ... the 'rising tide' of and information technology.

  14. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    these lines: eating together 261/669 (39%), hugging 149/668 (22%), shaking ... Level of education was associated with positive attitudes towards ocular .... the about 250 ethnic groups of Nigeria. ..... ocular cancer are reflection of challenges ... Care: Focus Groups with Older African ... youths in a Nigerian local population.

  15. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    2012-05-01

    May 1, 2012 ... with the quality of care in a tertiary health facility in Delta State, Nigeria ... includes contributions from families, charges have been .... employees at 23.5%, self employed 19.1% of showed that most of the respondents (41.3%).

  16. Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge.

    Science.gov (United States)

    De Sanctis, Vincenzo; Soliman, Ashraf; Bernasconi, Sergio; Bianchin, Luigi; Bona, Gianni; Bozzola, Mauro; Buzi, Fabio; De Sanctis, Carlo; Tonini, Giorgio; Rigon, Franco; Perissinotto, Egle

    2015-12-01

    Dysmenorrhea is commonly categorized into two types; primary and secondary. Primary dysmenorrhea (PD) is the focus of this review. PD is defined as painful menses with cramping sensation in the lower abdomen that is often accompanied by other symptoms, such as sweating, headache, nausea, vomiting, diarrhea, and tremulousness. All these symptoms occur just before or during the menses in women with normal pelvic anatomy. In adolescents the prevalence of PD varies between 16% and 93%, with severe pain perceived in 2% to 29% of the studied girls. Several studies suggest that severe menstrual pain is associated with absenteeism from school or work and limitation of other daily activities. One-third to one-half of females with PD are missing school or work at least once per cycle, and more frequently in 5% to 14% of them. The wide variation in the prevalence rates may be attributed to the use of selected groups of subjects. Many risk factors are associated with increased severity of dysmenorrhea including earlier age at menarche, long menstrual periods, heavy menstrual flow, smoking and positive family history. Young women using oral contraceptive pills (OCP) report less severe dysmenorrhea. The considerably high prevalence of dysmenorrhea among adolescents verified that this condition is a significant public health problem that requires great attention. SUMMARY OF MAIN RESULTS: Many methodological problems are encountered during quantifying and grading severity of pain related to dysmenorrhea. Quantifying and assessment tools depend on women's self-reporting with potential bias. There is a scarcity of longitudinal studies on the natural history of dysmenorrhea as well as the possible effects of many modifiable risk factors. In addition, the duration of follow-up in the available studies is relatively short. Therefore, several aspects are still open for research. Medical treatment for dysmenorrhea includes anti-inflammatory drugs (NSAIDs), OCP or surgical intervention

  17. Primary care providers' experiences caring for complex patients in primary care: a qualitative study.

    Science.gov (United States)

    Loeb, Danielle F; Bayliss, Elizabeth A; Candrian, Carey; deGruy, Frank V; Binswanger, Ingrid A

    2016-03-22

    Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of

  18. Suicidal ideations, plans and attempts in primary care: cross-sectional study of consultants at primary health care system in Morocco.

    Science.gov (United States)

    Oneib, Bouchra; Sabir, Maria; Otheman, Yassine; Abda, Naima; Ouanass, Abderrazzak

    2016-01-01

    The aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. We conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among 396 consultants in the primary health care system, using the Mini International neuropsychiatric interview. Patients were 18 years and older, without known psychiatric or chronic somatic disease. Statistical analysis was performed by the SPSS 13.0 software. The prevalence of suicidal ideation was 5.3%, and 2.7% of the patients planned their suicide and 1.2% tried to commit suicide. The multivariate analysis did not demonstrate significant association. Suicidal ideation, plan and suicide attempts are prevalent in primary health care patients, but they are still under diagnosed. An adequate training of physicians and the establishment of education programs is essential to reduce the rate of suicide.

  19. Exploring primary care activities in ACT teams.

    Science.gov (United States)

    Vanderlip, Erik R; Williams, Nancy A; Fiedorowicz, Jess G; Katon, Wayne

    2014-05-01

    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.

  20. Diabetes care: model for the future of primary care.

    Science.gov (United States)

    Posey, L Michael; Tanzi, Maria G

    2010-01-01

    To review relevant trends threatening primary care and the evidence supporting use of nonphysicians in primary and chronic care of patients with diabetes. Current medical and pharmacy literature as selected by authors. The care needed by patients with diabetes does not fit well into our current medical model for primary care, and an adequate supply of physicians is not likely to be available for primary care roles in coming years. Patients with diabetes who are placed on evidence-based regimens, are educated about their disease, are coached in ways that motivate them to lose weight and adopt other therapeutic lifestyle changes, and are adhering to and persisting with therapy will soon have improved clinical parameters. These quickly translate into fewer hospitalizations and emergency department visits. A growing body of literature supports the use of pharmacists and other nonphysicians in meeting the needs of patients with diabetes. Pharmacists should join nurse practitioners, specially trained nurses, and physician assistants as integral members of the health care team in providing care to patients with diabetes and, by logical extension, other chronic conditions. Demand for primary care is likely to outstrip the available supply of generalist physicians in the coming years. In addition to nurse practitioners and physician assistants, pharmacists should be considered for key roles in future interdisciplinary teams that triage and provide direct care to patients, including those with diabetes and other chronic conditions.

  1. Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

    Science.gov (United States)

    Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk

    2018-05-09

    In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

  2. The strength of primary care in Europe

    NARCIS (Netherlands)

    Kringos, D.S.|info:eu-repo/dai/nl/352077131

    2012-01-01

    This thesis aimed to get insight into the elements that form (the strength of) primary care (PC) in Europe, their determinants and their impact on health care system outcomes. The results strengthen the evidence-base for policymakers to prioritise PC strengthening on the health policy agenda and

  3. Patient safety culture in primary care

    NARCIS (Netherlands)

    Verbakel, N.J.

    2015-01-01

    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

  4. Adult-onset celiac disease for the primary care physician

    Directory of Open Access Journals (Sweden)

    Kamil Naidoo

    2017-10-01

    Full Text Available Celiac disease is a common autoimmune condition with a prevalence of 1%–2%. In recent years there has been a paradigm shift in management from tertiary care into the community. With a wide array of manifestations, including nonspecific and extraintestinal symptoms, this disorder can be difficult to diagnose, prolonging morbidity for patients. This review article aims to augment the primary physician’s knowledge of the common presentation, diagnosis, management, and follow-up of this disease.

  5. Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

    Science.gov (United States)

    Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

    2016-12-01

    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

  6. Nursing Practice in Primary Care and Patients' Experience of Care.

    Science.gov (United States)

    Borgès Da Silva, Roxane; Brault, Isabelle; Pineault, Raynald; Chouinard, Maud-Christine; Prud'homme, Alexandre; D'Amour, Danielle

    2018-01-01

    Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better. Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups. Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher. Results indicated that systematic follow-up of patients by nurses improved patients' experience of care in terms of accessibility. Using nurses' scope of practice to its full potential is a promising avenue for enhancing both patients' experience of care and health services efficiency.

  7. Primary Care Practice: Uncertainty and Surprise

    Science.gov (United States)

    Crabtree, Benjamin F.

    I will focus my comments on uncertainty and surprise in primary care practices. I am a medical anthropologist by training, and have been a full-time researcher in family medicine for close to twenty years. In this talk I want to look at primary care practices as complex systems, particularly taking the perspective of translating evidence into practice. I am going to discuss briefly the challenges we have in primary care, and in medicine in general, of translating new evidence into the everyday care of patients. To do this, I will look at two studies that we have conducted on family practices, then think about how practices can be best characterized as complex adaptive systems. Finally, I will focus on the implications of this portrayal for disseminating new knowledge into practice.

  8. Restructuring primary care for performance improvement.

    Science.gov (United States)

    Fawcett, Kenneth J; Brummel, Stacy; Byrnes, John J

    2009-01-01

    Primary care practices can no longer consider ongoing quality assessment and management processes to be optional. There are ever-increasing demands from any number of interested parties for objectively measured proof of outcomes and quality of care. Primary Care Partners (PCP), a 16-site ambulatory affiliate of the Spectrum Health system in Grand Rapids, Michigan, began such a continuous quality improvement (CQI) effort in 2005. The intent was to develop an ongoing systematic process that would raise its performance potential and improve patient outcomes in the areas of chronic disease management and preventive services. This article describes the partnerships PCP established, specific benchmarks and measurements used, processes utilized, and results to date. This could be used as a roadmap for other primary care systems that are working to establish CQI in their daily operations.

  9. Diabetes care provision in UK primary care practices.

    Directory of Open Access Journals (Sweden)

    Gillian Hawthorne

    Full Text Available 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.Postal surveys with all healthcare professionals and a random sample of 100 patients with Type 2 diabetes from 99 UK primary care practices.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.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.

  10. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

    ...] Medicare Program; Comprehensive Primary Care Initiative AGENCY: Centers for Medicare & Medicaid Services... organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to... the Comprehensive Primary Care initiative or the application process. SUPPLEMENTARY INFORMATION: I...

  11. Integrating mental health into primary care: a global perspective

    National Research Council Canada - National Science Library

    Funk, Michelle

    2008-01-01

    ... for mental disorders is enormous 4. Primary care for mental health enhances access 5. Primary care for mental health promotes respect of human rights 6. Primary care for mental health is affordab...

  12. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    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. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  13. prevalence of rheumatic heart disease among primary school pupils

    African Journals Online (AJOL)

    2013-01-01

    Jan 1, 2013 ... ABSTRACT. Objective: To determine the prevalence of RHD among primary school pupils in Egor ... Results: Of the 1764 pupils recruited, 900 (51.02%) were females while 864 (48.98%) were males. The mean age of the pupils was 8.86 ± 2.14 years. ..... of socio-economic class in voluntary infertility control.

  14. Low prevalence of cardiovascular risk factors among primary school ...

    African Journals Online (AJOL)

    Background: Identification of obesity and other risk factors for cardiovascular disease in childhood is strongly recommended for prevention of the diseases in adulthood. Objectives: To determine the prevalence of the conventional cardiovascular risk factors among primary school children aged 6-15 years in Urban Dar es ...

  15. Prevalence of Anti-Thyroid Antibodies in Patients with Primary ...

    African Journals Online (AJOL)

    Objective: To determine prevalence of thyroid antimicrosomal and antithyroglobulin antibodies among patients with primary thyroid disorders. Design: Descriptive cross-sectional study. Setting: Kenyatta National Hospital, July 2003 to August 2004. Results: Antimicrosomal antibodies (anti-TPOAbs) were detected in 51.4% ...

  16. Study Heterogeneity and Estimation of Prevalence of Primary Aldosteronism: A Systematic Review and Meta-Regression Analysis.

    Science.gov (United States)

    Käyser, Sabine C; Dekkers, Tanja; Groenewoud, Hans J; van der Wilt, Gert Jan; Carel Bakx, J; van der Wel, Mark C; Hermus, Ad R; Lenders, Jacques W; Deinum, Jaap

    2016-07-01

    For health care planning and allocation of resources, realistic estimation of the prevalence of primary aldosteronism is necessary. Reported prevalences of primary aldosteronism are highly variable, possibly due to study heterogeneity. Our objective was to identify and explain heterogeneity in studies that aimed to establish the prevalence of primary aldosteronism in hypertensive patients. PubMed, EMBASE, Web of Science, Cochrane Library, and reference lists from January 1, 1990, to January 31, 2015, were used as data sources. Description of an adult hypertensive patient population with confirmed diagnosis of primary aldosteronism was included in this study. Dual extraction and quality assessment were the forms of data extraction. Thirty-nine studies provided data on 42 510 patients (nine studies, 5896 patients from primary care). Prevalence estimates varied from 3.2% to 12.7% in primary care and from 1% to 29.8% in referral centers. Heterogeneity was too high to establish point estimates (I(2) = 57.6% in primary care; 97.1% in referral centers). Meta-regression analysis showed higher prevalences in studies 1) published after 2000, 2) from Australia, 3) aimed at assessing prevalence of secondary hypertension, 4) that were retrospective, 5) that selected consecutive patients, and 6) not using a screening test. All studies had minor or major flaws. This study demonstrates that it is pointless to claim low or high prevalence of primary aldosteronism based on published reports. Because of the significant impact of a diagnosis of primary aldosteronism on health care resources and the necessary facilities, our findings urge for a prevalence study whose design takes into account the factors identified in the meta-regression analysis.

  17. Depression, quality of life and primary care: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Panos Andriopoulos

    2013-12-01

    Conclusion: The prevalence of both depressive symptomatology and impairment of quality of life is significant and primary care with simple, validated tools can be the setting for identifying and helping such patients.

  18. Multimorbidity patterns in a primary care population aged 55 years and over

    NARCIS (Netherlands)

    Sinnige, J.; Korevaar, J.C.; Westert, G.P.; Spreeuwenberg, P.; Schellevis, F.G.; Braspenning, J.C.C.

    2015-01-01

    BACKGROUND: To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns. OBJECTIVE: To identify the common and distinctive multimorbidity patterns. METHODS: Clinical data of 120480 patients (>/=55 years) were extracted from 158 general

  19. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

    Science.gov (United States)

    Goodwin, N

    2001-01-01

    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. 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. 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. 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. 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.

  20. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2001-03-01

    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.

  1. Assessment of primary care services and perceived barriers to care in persons with disabilities.

    Science.gov (United States)

    Harrington, Amanda L; Hirsch, Mark A; Hammond, Flora M; Norton, H James; Bockenek, William L

    2009-10-01

    To determine what percentage of persons with disabilities have a primary care provider, participate in routine screening and health maintenance examinations, and identify perceived physical or physician barriers to receiving care. A total of 344 surveys, consisting of 66 questions, were collected from adults with disabilities receiving care at an outpatient rehabilitation clinic. A total of 89.5% (95% CI 86.3%-92.8%) of participants reported having a primary care physician. Younger persons (P brain injury (P use, and safety with relationships at home ranged from 26.6% to 37.5% compared with screening for depression, diet, exercise, and smoking (64.5%-70%). Completion rates of age- and gender-appropriate health maintenance examinations ranged from 42.4% to 90%. A total of 2.67% of participants reported problems with physical access at their physician's office, and 36.4% (95% CI 30.8%-42.1%) of participants reported having to teach their primary care physician about their disability. Most persons with disabilities have a primary care physician. In general, completion rates for routine screening and health maintenance examinations were high. Perceived deficits in primary care physicians' knowledge of disability issues seem more prevalent than physical barriers to care.

  2. Translation of clinical prediction rules for febrile children to primary care practice : an observational cohort study

    NARCIS (Netherlands)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y.; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henritte A.; Oostenbrink, Rianne

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and

  3. Fibromyalgia: management strategies for primary care providers.

    Science.gov (United States)

    Arnold, L M; Gebke, K B; Choy, E H S

    2016-02-01

    Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

  4. US approaches to physician payment: the deconstruction of primary care.

    Science.gov (United States)

    Berenson, Robert A; Rich, Eugene C

    2010-06-01

    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

  5. PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede

    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...... approach.RESULTS. The analyses revealed several key areas, e.g.: 1) How to take, give and maintain professional responsibility for palliative home care. 2) A need for transparent communication both among primary care professionals and among professionals across the primary/secondary interface. 3...

  6. Prevalence of primary glaucoma in an urban South Indian population

    Directory of Open Access Journals (Sweden)

    Jacob Aby

    1998-01-01

    Full Text Available Glaucoma is fast emerging as a major cause of blindness in India. In order to estimate the prevalence of primary open angle glaucoma (POAG and primary angle closure glaucoma (PACG in an urban South Indian population, we examined 972 individuals aged 30-60 years, chosen using a cluster sampling technique from 12 census blocks of Vellore town. They underwent a complete ocular examination, including applanation tonometry and gonioscopy, at the Medical College Hospital. Characteristic field defects on automated perimetry was a diagnostic requisite for POAG. Prevalence (95% CI of POAG, PACG, and ocular hypertension were 4.1 (0.08-8.1, 43.2 (30.14-56.3, and 30.8 (19.8-41.9 per 1,000, respectively. All the PACG cases detected were of the chronic type. Hitherto unavailable community-based information on primary glaucoma in our study population indicates that PACG is about five times as common as POAG.

  7. Reducing the health consequences of opioid addiction in primary care.

    Science.gov (United States)

    Bowman, Sarah; Eiserman, Julie; Beletsky, Leo; Stancliff, Sharon; Bruce, R Douglas

    2013-07-01

    Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. Lack of routine addiction screening results in missed treatment opportunities in this setting. We reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Effective communication with primary care providers.

    Science.gov (United States)

    Smith, Karen

    2014-08-01

    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.

  9. Initiatives to Enhance Primary Care Delivery

    Directory of Open Access Journals (Sweden)

    Jan L. Losby

    2015-01-01

    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.

  10. Top studies relevant to primary care practice.

    Science.gov (United States)

    Perry, Danielle; Kolber, Michael R; Korownyk, Christina; Lindblad, Adrienne J; Ramji, Jamil; Ton, Joey; Allan, G Michael

    2018-04-01

    To summarize 10 high-quality studies from 2017 that have strong relevance to primary care practice. Study selection involved routine literature surveillance by a group of primary care health professionals. This included screening abstracts of important journals and Evidence Alerts, as well as searching the American College of Physicians Journal Club. Topics of the 2017 articles include whether treating subclinical hypothyroidism improves outcomes or symptoms; whether evolocumab reduces cardiovascular disease as well as low-density lipoprotein levels; whether lifestyle interventions reduce medication use in patients with diabetes; whether vitamin D prevents cardiovascular disease, cancer, or upper respiratory tract infections; whether canagliflozin reduces clinical events in patients with diabetes; how corticosteroid injections affect knee osteoarthritis; whether drained abscesses benefit from antibiotic treatment; whether patients with diabetes benefit from bariatric surgery; whether exenatide reduces clinical events in patients with diabetes; and whether tympanostomy tubes affect outcomes in recurrent acute otitis media or chronic otitis media. We provide brief summaries, context where needed, and final recommendations for 10 studies with potential effects on primary care. We also briefly review 5 "runner-up" studies. Research from 2017 produced several high-quality studies in diabetes management. These have demonstrated benefit for alternative therapies and offered evidence not previously available. This year's selection of studies also provided information on a variety of conditions and therapies that are, or might become, more common in primary care settings. Copyright© the College of Family Physicians of Canada.

  11. Detecting meniscal tears in primary care

    NARCIS (Netherlands)

    Snoeker, B.A.M.

    2017-01-01

    Although meniscal tears are a very common phenomenon uncertainty exists about the diagnosis and treatment of meniscal tears in primary care. This thesis aims to provide evidence for general practitioners and physical therapists regarding the diagnosis and management of patients with a suspected

  12. The delivery of primary care services.

    NARCIS (Netherlands)

    Wilson, A.; Windak, A.; Oleszczyk, M.; Wilm, S.; Hasvold, T.; Kringos, D.

    2015-01-01

    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,

  13. Nurses improve migraine management in primary care

    NARCIS (Netherlands)

    Veenstra, Petra; Kollen, Boudewijn J.; de Jong, Gosse; Baarveld, Frans; van den Berg, J. S. Peter

    Introduction Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve

  14. Financial incentive schemes in primary care

    Directory of Open Access Journals (Sweden)

    Gillam S

    2015-09-01

    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

  15. Socioeconomic position and the primary care interval

    DEFF Research Database (Denmark)

    Vedsted, Anders

    2018-01-01

    to the easiness to interpret the symptoms of the underlying cancer. Methods. We conducted a population-based cohort study using survey data on time intervals linked at an individually level to routine collected data on demographics from Danish registries. Using logistic regression we estimated the odds......Introduction. Diagnostic delays affect cancer survival negatively. Thus, the time interval from symptomatic presentation to a GP until referral to secondary care (i.e. primary care interval (PCI)), should be as short as possible. Lower socioeconomic position seems associated with poorer cancer...... younger than 45 years of age and older than 54 years of age had longer primary care interval than patients aged ‘45-54’ years. No other associations for SEP characteristics were observed. The findings may imply that GPs are referring patients regardless of SEP, although some room for improvement prevails...

  16. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    Directory of Open Access Journals (Sweden)

    Aina O. Odusola

    2016-02-01

    Full Text Available Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design: Qualitative study using semi-structured individual interviews with primary care staff (n = 11 and health insurance managers (n=4. Data were analysed using standard qualitative techniques. Results: Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions: By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

  17. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers.

    Science.gov (United States)

    Odusola, Aina O; Stronks, Karien; Hendriks, Marleen E; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A

    2016-01-01

    Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider-insurer relationships; automated administration systems; and tailoring guidelines/patient education. By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

  18. Opportunity Knocks: HIV Prevention in Primary Care.

    Science.gov (United States)

    Thrun, Mark W

    2014-06-01

    Expansions in health care coverage, a comprehensive framework for HIV prevention and care, electronic medical records, and novel HIV prevention modalities create a current opportunity to change the trajectory of the HIV epidemic in the United States. HIV is increasingly disproportionately found in populations historically at higher risk, including gay men and other men who have sex with men, transgender women, injection drug users, and persons of color. This underscores the need for providers to identify persons at higher risk for HIV and assure the provision of screening and prevention services. In turn, universal screening for HIV-testing every adolescent and adult at least once in their lifetime-will increasingly be necessary to find the infrequent cases of HIV in lower risk populations. In both these domains, primary care providers will play a unique role in complementing traditional providers of HIV prevention and care services by increasing the proportion of their patients who have been screened for HIV, opening dialogues around sexual health, including asking about sexual orientation and gender identity, and prescribing antivirals as pre- and postexposure prophylaxis for their non-HIV-infected patients. Primary care providers must understand and embrace their importance along the HIV prevention and care continuum.

  19. Slack resources and quality of primary care.

    Science.gov (United States)

    Mohr, David C; Young, Gary J

    2012-03-01

    Research generally shows that greater resource utilization fails to translate into higher-quality healthcare. Organizational slack is defined as extra organizational resources needed to meet demand. Divergent views exist on organizational slack in healthcare. Some investigators view slack negatively because it is wasteful, inefficient, and costly, whereas others view slack positively because it allows flexibility in work practices, expanding available services, and protecting against environmental changes. We tested a curvilinear relationship between organizational slack and care quality. The study setting was primary care clinics (n=568) in the Veterans Health Administration. We examined organizational slack using the patient panel size per clinic capacity ratio and support staff per provider ratio staffing guidelines developed by the Veterans Health Administration. Patient-level measures were influenza vaccinations, continuity of care, and overall quality of care ratings. We obtained 2 independent patient samples with approximately 28,000 and 62,000 observations for the analysis. We used multilevel modeling and examined the linear and quadratic terms for both organizational slack measures. We found a significant curvilinear effect for panel size per clinic capacity for influenza vaccinations and overall quality of care. We also found support staff per provider exhibited a curvilinear effect for continuity of care and influenza vaccinations. Greater available resources led to better care, but at a certain point, additional resources provided minimal quality gains. Our findings highlight the importance of primary care clinic managers monitoring staffing levels. Healthcare systems managing a balanced provider workload and staff-mix may realize better patient care delivery and cost management.

  20. The epidemiology and natural history of depressive disorders in Hong Kong's primary care

    OpenAIRE

    Chin Weng; Lam Cindy LK; Wong Samuel YS; Lo Yvonne YC; Fong Daniel YT; Lam Tai; Lee Peter WH; Wong Josephine WS; Chiu Billy CF; Chan Kit TY

    2011-01-01

    Abstract Background Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the ...

  1. Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

    Science.gov (United States)

    Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

    2015-01-01

    (1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

  2. Choice and privatisation in Swedish primary care.

    Science.gov (United States)

    Anell, Anders

    2011-10-01

    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.

  3. Understanding performance management in primary care.

    Science.gov (United States)

    Rogan, Lisa; Boaden, Ruth

    2017-02-13

    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.

  4. Prevalence of ADHD in primary school children in Vinh Long, Vietnam.

    Science.gov (United States)

    Pham, Hoai Danh; Nguyen, Huu Bao Han; Tran, Diep Tuan

    2015-10-01

    Attention-deficit hyperactivity disorder (ADHD) is the most common behavioral disorder in children. It affects not only the subjects but also their families and society. The purpose of this study was to determine the prevalence of ADHD in primary school children in South Vietnam, especially Vinh Long province. Children were chosen randomly from primary schools in Vinh Long from February to March in 2009 in a cross-sectional study to determine the prevalence of ADHD using the ADHD Rating Scale-IV for parents/caregivers and teachers. ADHD Rating Scale-IV was based on DSM-IV for diagnosis of ADHD. A total of 600 children were chosen and 1200 reports were collected from parents/caregivers and teachers. The prevalence rate of ADHD was 7.7%. The rates of the predominantly inattentive type, predominantly hyperactive type and combined type were 1.7%, 5% and 1%, respectively. The difference in sex was not significant across all subtypes. The prevalence of ADHD in urban children was 2.2-fold that in rural children. The prevalence of ADHD in primary school children in Vinh Long, southern Vietnam, is in the same range as other regions in the world. Therefore, awareness of ADHD needs to be raised, to ensure suitable psychiatric care for children. © 2015 Japan Pediatric Society.

  5. Introducing care pathway commissioning to primary dental care: measuring performance.

    Science.gov (United States)

    Harris, R; Bridgman, C; Ahmad, M; Bowes, L; Haley, R; Saleem, S; Singh, R; Taylor, S

    2011-12-09

    Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.

  6. Primary Headache in Yemen: Prevalence and Common Medications Used

    Directory of Open Access Journals (Sweden)

    Salah A. Abdo

    2014-01-01

    Full Text Available Background and Objective. Primary headaches is a major medical concern in certain Arabic countries, for example Oman, Jordan, and Qatar. This study was aimed at increasing understanding of the prevalence of headache in Arabic countries and identifying common medications used for treatment because of the lack of research done in this field in Yemen. Methods. This is a cross-sectional observational study conducted by recruiting case-series of adults and elderly who have primary headache within the age group from 18 to 85 years. 12640 subjects received a simple explanation for the aim of the study as ethical issue. The subjects were allowed to complete a self-conducted screening questionnaire. The data were diagnosed according to the International Headache Society’s diagnostic criteria (2004. Results. The results showed that 76.5% of the primary headache is prevalent at least once per year, 27.1% of the tension type headache (TTH was the maximum percentage of type of headache, and 14.48% of the migraine headache (MH was the minimum percentage. On the other hand, the relationship between the primary headache and age of subjects was statistically significant (P0.05. In addition, 70.15% of the subjects said that headache attacks affected their activity of daily livings (ADL. 62.26% of the subjects used the medications without medical advice regarding their headache. 37.73% of the subjects relied on medical professionals (physicians and pharmacist regarding analgesics use. The most common agent used among the medications was paracetamol (38.4%. Others included ibuprofen, aspirin, diclofenac sodium, naproxen, mefenamic acid, ergotamine and (11.45% were unknown agents. Conclusion. We concluded that absence of health attention from the Yemeni Community and education from the health system in the country regarding analgesics use and their potential risk led to abuse of such medications and could be a reason beyond high prevalence of headache in Yemen.

  7. Collaborative HIV care in primary health care: nurses' views.

    Science.gov (United States)

    Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S

    2017-12-01

    Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.

  8. [Update of breast cancer in primary care (IV/V)].

    Science.gov (United States)

    Álvarez-Hernández, C; Brusint, B; Vich, P; Díaz-García, N; Cuadrado-Rouco, C; Hernández-García, M

    2015-01-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  9. The entrepreneurial role in primary care dentistry.

    Science.gov (United States)

    Willcocks, S

    2012-03-09

    This paper explores the entrepreneurial role of dentists in primary care dentistry. It reviews the changing context of dentistry, not least the reforms being introduced by the health and social care bill. It suggests that this new context will reinforce the need to consider the business side of dental practice, in particular, the importance of quality, creativity and innovation, alongside the importance of meeting the needs of patients. An entrepreneurial approach will be required in order to sustain dental practice in an increasingly competitive environment.

  10. Behavioral medicine interventions for adult primary care settings: A review.

    Science.gov (United States)

    Funderburk, Jennifer S; Shepardson, Robyn L; Wray, Jennifer; Acker, John; Beehler, Gregory P; Possemato, Kyle; Wray, Laura O; Maisto, Stephen A

    2018-06-07

    Health care organizations are embracing integrated primary care (IPC), in which mental health and behavioral health are addressed as part of routine care within primary care settings. Behavioral medicine concerns, which include health behavior change and coping with medical conditions, are common in primary care populations. Although there are evidence-based behavioral interventions that target a variety of behavioral medicine concerns, integrated behavioral health providers need interventions that are sufficiently brief (i.e., ≤6 appointments) to be compatible with IPC. We conducted a literature review of published studies examining behavioral interventions that target prevalent behavioral medicine concerns and can feasibly be employed by IPC providers in adult primary care settings. A total of 67 published articles representing 63 original studies met eligibility criteria. We extracted data on the behavioral interventions employed, results comparing the active intervention to a comparison group, general fit with IPC, and methodological quality. The vast majority of studies examined brief interventions targeting sleep difficulties and physical activity. The most commonly employed interventions were derived from cognitive-behavioral therapy and motivational interviewing. Outcomes were generally statistically significantly in favor of the active intervention relative to comparison, with highly variable methodological quality ratings (range = 0-5; M = 2.0). Results are discussed in relation to the need for further evidence for brief behavioral interventions targeting other behavioral medicine concerns beyond sleep and physical activity, as well as for more specificity regarding the compatibility of such interventions with IPC practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  11. [Evolution of burnout and associated factors in primary care physicians].

    Science.gov (United States)

    Matía Cubillo, Angel Carlos; Cordero Guevara, José; Mediavilla Bravo, José Javier; Pereda Riguera, Maria José; González Castro, Maria Luisa; González Sanz, Ana

    2012-09-01

    To analyse the course of burnout and develop an explanatory model. Prospective cohort dynamics. SITE: All primary health care centres in Burgos. All physicians except medical emergencies, paediatrics and residents. Anonymous self-report questionnaire: Maslach Burnout Inventory (MBI) and related variables. An analysis was performed using the Student-t, X(2) test and logistic regression. The response rate was 47.76% in 2007, which was lower than that of 2005. There were significant differences between 2005 and 2007, for increases in the percentage of physicians who smoked, postgraduate training, residency, and those who believe that coordination with nursing and specialist care and institutional communication is appropriate. There was an increase in the prevalence of burnout by almost one point compared with 2005, a decrease in maximum burnout and emotional exhaustion (EC), and an increase in depersonalisation (DP) and personal accomplishment (RP). The incidence density of burnout was 1/113. 5 primary care physicians per year. The existence of burnout is associated with the use of chronic medication and inadequate coordination between nursing and EC, and also with the high workload. The increase in the prevalence found is consistent with the idea of burnout as a dynamic development and the theoretical model described. Stable and quality employment is one way to indirectly mitigate (by encouraging internal communication) professional burnout. In the multivariate analysis, the most critical variable in the onset of burnout is the inadequate coordination with nursing. Copyright © 2008 Elsevier España, S.L. All rights reserved.

  12. Low Back Pain in Primary Care

    DEFF Research Database (Denmark)

    Hestbæk, Lise; Munck, Anders; Hartvigsen, Lisbeth

    2014-01-01

    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...... of five patients had had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often females, and generally worse on all disease-related parameters than chiropractic patients. All...

  13. [The scientific entertainer in primary health care].

    Science.gov (United States)

    Ortega-Calvo, Manuel; Santos, José Manuel; Lapetra, José

    2012-09-01

    The scientific method is capable of being applied in primary care. In this article we defend the role of the "scientific entertainer "as strategic and necessary in achieving this goal. The task has to include playful and light-hearted content. We explore some words in English that may help us to understand the concept of "scientific entertainer" from a semantic point of view (showman, master of ceremonies, entrepreneur, go-between) also in Spanish language (counsellor, mediator, methodologist) and finally in Latin and Greek (tripalium, negotium, chronos, kairos). We define the clinical, manager or research health-worker who is skilled in primary care as a "primarylogist". Copyright © 2011 Elsevier España, S.L. All rights reserved.

  14. Human factors and ergonomics for primary care.

    Science.gov (United States)

    Bowie, Paul; Jeffcott, Shelly

    2016-03-01

    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.

  15. Multiple somatic symptoms in primary care

    DEFF Research Database (Denmark)

    Goldberg, D. P.; Reed, G. M.; Robles, R.

    2016-01-01

    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 distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations. This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs......) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability. Method PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability. Results Of 587 patients...

  16. Outsourcing of Primary Health Cares: Which Activities?

    Directory of Open Access Journals (Sweden)

    Sayed Mahdi Madani

    2016-07-01

    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

  17. Primary medical care in Irish prisons

    OpenAIRE

    Barry, Joe M; Darker, Catherine D; Thomas, David E; Allwright, Shane PA; O'Dowd, Tom

    2010-01-01

    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)...

  18. Primary medical care in Irish prisons

    OpenAIRE

    ALLWRIGHT, SHANE PATRICIA ANN; DARKER, CATHERINE; BARRY, JOSEPH; O'DOWD, THOMAS

    2010-01-01

    PUBLISHED 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 ...

  19. African Primary Care Research: Participatory action research

    OpenAIRE

    Mash, Bob

    2014-01-01

    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 researc...

  20. DEPRESSION IN PRIMARY CARE. PART 2: MANAGEMENT

    Directory of Open Access Journals (Sweden)

    XV Pereira

    2007-01-01

    Full Text Available The management of depression in the primary care setting should ideally take a biological, psychological, and sociologicalapproach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychologicaltherapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy.Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.

  1. Primary care physician insights into a typology of the complex patient in primary care.

    Science.gov (United States)

    Loeb, Danielle F; Binswanger, Ingrid A; Candrian, Carey; Bayliss, Elizabeth A

    2015-09-01

    Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology. We conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach. The 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses. This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients. © 2015 Annals of Family Medicine, Inc.

  2. Primary care for opioid use disorder

    Directory of Open Access Journals (Sweden)

    Mannelli P

    2016-08-01

    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. 

  3. Classification Model That Predicts Medical Students' Choices of Primary Care or Non-Primary Care Specialties.

    Science.gov (United States)

    Fincher, Ruth-Marie E.; And Others

    1992-01-01

    This study identified factors in graduating medical students' choice of primary versus nonprimary care specialty. Subjects were 509 students at the Medical College of Georgia in 1988-90. Students could be classified by such factors as desire for longitudinal patient care opportunities, monetary rewards, perception of lifestyle, and perception of…

  4. Prevalência de constipação intestinal crônica em crianças atendidas em unidade básica de saúde Prevalence of chronic constipation in children at a primary health care unit

    Directory of Open Access Journals (Sweden)

    Ieda Regina Lopes Del Ciampo

    2002-12-01

    Full Text Available Objetivos: estudar a prevalência de constipação intestinal crônica funcional na infância, em uma unidade básica de saúde, e observar as suas principais características clínicas nessa população. Casuística e métodos: 313 crianças, pacientes da unidade básica de saúde Centro de Saúde Escola de Vila Tibério, Ribeirão Preto (SP, com idades entre 1 a 10 anos incompletos, compuseram a amostra. Destas, foram selecionadas 84 constipadas por critérios instituídos pelos autores. O teste do qui-quadrado foi aplicado para a comparação entre os grupos de constipados e não constipados (nível de significância = 0,01. Resultados: a prevalência de constipação intestinal crônica funcional foi de 26,8%. Das crianças constipadas, 85,7% tinham fezes endurecidas, 25% volume fecal diminuído, 17,9% intervalos às evacuações maiores que 2 dias (todas as crianças que apresentavam intervalo maior que 2 dias eram constipadas, 14,3% escape fecal, e 21,4% sangramento às evacuações. Conclusões: a prevalência de constipação intestinal foi elevada, e o intervalo entre as evacuações foi um critério diagnóstico importante para a seleção das crianças constipadas.Objective: to study the frequency of chronic constipation in childhood at a Primary Health Care Unit and to observe its characteristics in this population. Methods: The sample consisted of 313 children aged between one and 10 years treated at the Centro de Saúde Escola, in the district of Tibério, in the town of Ribeirão Preto. Among these, 84 children with chronic constipation were selected. The chi-squared test was used to compare the groups of constipated and nonconstipated children (p = 0.01. Results: The prevalence of chronic constipation was 26.8%. In the group of chronic constipation, 85.7% of the children had hardened stools, 25% showed reduction in fecal mass, 17.9% had an interval between evacuations longer than 2 days (constipated children, 14.3% revealed fecal

  5. Management of dizziness in primary care.

    Science.gov (United States)

    Sloane, P D; Dallara, J; Roach, C; Bailey, K E; Mitchell, M; McNutt, R

    1994-01-01

    We sought to determine the types of dizziness problems that are commonly seen in primary care practices, and to bring to light clinical and demographic factors that predict management decisions. We undertook a prospective cohort study with a 6-month follow-up using data gathered in nine primary care practices in two North Carolina counties. Subjects were 144 dizziness patients examined by primary care physicians. Data collected included demographic characteristics, a standardized dizziness history, physician estimation of symptom severity and diagnostic certainty, and physician "worry" about arrhythmia, transient ischemic attack, and brain tumor. Physicians reported their management decisions and diagnosis (or differential diagnosis) by responding to a questionnaire after completing the patient encounter. A 6-month follow-up chart review and physician interview were completed on 140 patients (97.2 percent); information obtained included changes in diagnosis and patient mortality. The most common diagnoses were labyrinthitis, otitis media, benign positional vertigo, unspecified presyncope, sinusitis, and transient ischemic attack. The initial diagnosis changed during the 6-month follow-up period in 34 (24.3 percent) of patients. The overall course of these patients was benign, however, with only one death occurring during the 6-month follow-up period. Patients' dizziness tended to be managed using a combination of strategies, including office laboratory testing (33.6 percent), advanced testing (11.4 percent), referral to a specialist (9.3 percent), medication (61.3 percent), observation (71.8 percent), reassurance (41.6 percent), and behavioral recommendations (15.0 percent). Office laboratory testing was associated with younger patient age, a suspected metabolic or endocrine disorder, and physician worry about a cardiac arrhythmia; advanced laboratory testing was associated with suspected cardiovascular or neurologic disorders. Medication tended to be prescribed

  6. Primary Care for Refugees: Challenges and Opportunities.

    Science.gov (United States)

    Mishori, Ranit; Aleinikoff, Shoshana; Davis, Dawn

    2017-07-15

    Since 1975, more than 3 million refugees have settled in the United States, fleeing unrest, conflict, and persecution. Refugees represent diverse ethnic, cultural, religious, socioeconomic, and educational backgrounds. Despite this heterogeneity, there are commonalities in the refugee experience. Before resettlement, all refugees must undergo an overseas medical screening to detect conditions that pose a potential health threat in the United States. On arrival, they should undergo an examination to detect diseases with high prevalence in their country of origin or departure. Refugees have higher rates of chronic pain compared with the general population, and their mental health and wellbeing are strongly influenced by their migration history. Refugees have higher rates of mood disorders, posttraumatic stress disorder, and anxiety than the general population. Some refugees have been tortured, which contributes to poorer health. Chronic noncommunicable diseases, such as diabetes mellitus and hypertension, are also prevalent among refugees. Many refugees may be missing routine immunizations and screenings for cancer and chronic diseases. Attention to reproductive health, oral health, and vision care will help identify and address previously unmet needs. Refugees face barriers to care as a result of cultural, language, and socioeconomic factors.

  7. Substance use among persons with homeless experience in primary care.

    Science.gov (United States)

    Stringfellow, Erin J; Kim, Theresa W; Gordon, Adam J; Pollio, David E; Grucza, Richard A; Austin, Erika L; Johnson, N Kay; Kertesz, Stefan G

    2016-01-01

    Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.

  8. Smoking cessation in primary care clinics.

    Science.gov (United States)

    Sippel, J M; Osborne, M L; Bjornson, W; Goldberg, B; Buist, A S

    1999-11-01

    To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements. Randomized clinical trial. Two university-affiliated community primary care clinics. Two hundred five smokers with routinely scheduled appointments. All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements. Quit rate was evaluated at 9-month follow-up. Eleven percent of smokers were sustained quitters at follow-up. Sustained quit rate was no different for intervention and control groups (9% vs 14%; [OR] 0.6; 95% [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95% CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy ( p =.05). Historical data from previously published studies showed that 2% of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5%. The sustained smoking cessation rate achieved by following AHCPR guidelines was 11% at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here.

  9. Primary health care: a necessity in developing countries?

    Directory of Open Access Journals (Sweden)

    Evaezi Okpokoro

    2013-12-01

    Full Text Available Resource limited countries continue to be plagued with rising prevalence of malaria, tuberculosis, HIV/AIDS as well as other emerging diseases despite the huge financial support provided by bilateral and multilateral agencies to combat these diseases. While progress may have been made in reducing the global burden caused by these diseases on one hand, there has also been a weakening of the primary health care facility on the other hand which was the hallmark to the Alma Ata declaration of 1978. More attention has been placed on our global health needs while the diverse health needs of every community have been neglected. This fatal neglect at the community level highlights the need for the provision of specialize primary health care (PHC facilities which should not only be affordable, accessible and available, but be appropriate to the priority health needs of the community, especially at the rural level. Hence specialized PHC facilities will be tailored to meet the most pressing health needs of the communities it covers among other diseases. Consequently, this innovative approach will not only strengthen the primary health care system by improving wellbeing especially at the rural level but will also improve the outcome of vertical program at communities where it is most needed.

  10. [Frequent attendance in a Primary Health Care District].

    Science.gov (United States)

    Menéndez Granados, Nicolás; Vaquero Abellán, Manuel; Toledano Estepa, Manuel; Pérez Díaz, Manuel Modesto; Redondo Pedraza, Rosa

    2017-10-09

    To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain). An ecological study was performed, including data from 2011 to 2015. Defining FA as those subjects who made12 or more appointments per year; independently analysed for nursing, general practice and paediatrics. Prevalence of frequent attendance and FA/professional ratio were used as dependent variables. Demographic characteristics from district population, number of health professionals and use of general facilities were also examinated. Aiming to understand FA distribution, primary health settings were classified according to facility size and environmental location (urban, suburban and rural). The mean prevalence for FA was 10.86% (0.5 SE) for nursing; general practice 21.70% (0.7 SE) and for paediatrics 16.96% (0.7 SE). FA/professional ratios for the different professional categories were: 101.07 (5.0 SE) for nursing, 239.74 (9.0 SE) for general practice and 159.54 (9.8 SE) for paediatrics. A major part of primary health care users make a high number of consultations. From this group, women overuse nursing and general practitioner services more compared to men. A higher prevalence of FAs was observed in smaller settings, in rural areas. Although taking the FAs:professional ratio as the bar, medium-size practices are more highly overused. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Fall Prevention in a Primary Care Setting.

    Science.gov (United States)

    Siegrist, Monika; Freiberger, Ellen; Geilhof, Barbara; Salb, Johannes; Hentschke, Christian; Landendoerfer, Peter; Linde, Klause; Halle, Martin; Blank, Wolfgang A

    2016-05-27

    Falls and fall-related injuries are common in community-dwelling elderly people. Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls. In a cluster randomized trial in 33 general practices 378 people living independently and at high risk of falling (65 to 94 years old; 285 women) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises, combined with a 12 week home-based exercise program (222 participants), or to usual care (156 participants). The main outcome was number of falls over a period of 12 months. Secondary outcomes were the number of fall-related injuries, physical function (Timed-Up-and-Go-Test, TUG, Chair-Stand-Test, CST, modified Romberg Test), and fear of falling. In the intervention group (n=222 patients in 17 general practices) 291 falls occurred, compared to 367 falls in the usual care group (n=156 patients in 16 general practices). We observed a lower incidence rate for falls in the intervention group (incidence rate ratio/IRR: 0.54; 95% confidence interval (CI): [0.35; 0.84], p=0.007) and for fall-related injuries (IRR: 0.66; [0.42; 0.94], p=0.033). Additionally, patients in the intervention group showed significant improvements in secondary endpoints (TUG: -2.39 s, [-3.91; -0.87], p=0.014; mRomberg: 1.70 s, [0.35; 3.04], p=0.037; fear of falling: -2.28 points, [-3.87; -0.69], p=0.022) compared to usual care. A complex falls prevention program in a primary care setting was effective in reducing falls and fall-related injuries in community dwelling older adults at risk.

  12. Prediction of dementia in primary care patients.

    Directory of Open Access Journals (Sweden)

    Frank Jessen

    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.

  13. Low prevalence of primary HIV resistance in western Massachusetts.

    Science.gov (United States)

    Iarikov, Dmitri E; Irizarry-Acosta, Melina; Martorell, Claudia; Hoffman, Robert P; Skiest, Daniel J

    2010-01-01

    Most studies of primary antiretroviral (ARV) resistance have been conducted in large metropolitan areas with reported rates of 8% to 25%. We collected data on 99 HIV-1-infected antiretroviral-naive patients from several sites in Springfield, MA, who underwent genotypic resistance assay between 2004 and 2008. Only major resistance mutations per International AIDS Society-USA (IAS-USA) drug resistance mutations list were considered. The prevalence of resistance was 5% (5 of 99). Three patients had one nonnucleoside reverse transcriptase inhibitor (NNRTI) mutation: 103N, 103N, and 190A, 1 patient had a protease inhibitor (PI) mutation: 90M; and 1 patient had 3-class resistance with NNRTI: 181C, 190A, PI: 90M, and nucleoside analogue reverse transcriptase inhibitor (NRTI): 41L, 210W. Mean time from HIV diagnosis to resistance testing was shorter in patients with resistance versus those without: 9 (range 0.3-42 months) versus 27 (range 0.1-418 months), P = .11. There was a trend to lower mean CD4 count in those with resistance, 170 versus 318 cells/mm(3), P = .06. No differences were noted in gender, age, HIV risk category, or HIV RNA level. The low prevalence of primary resistance may be explained by differences in demographic and risk factors or may reflect the time from infection to resistance testing. Our findings emphasize the importance of continued resistance surveillance.

  14. Gambling addiction in primary care: a survey of general practitioners ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    experiences of, and confidence in, managing these patients in primary care, their perceived role and ... KEY WORDS: Gambling addiction; Primary care; General practitioners; Management ..... Petry NM, Blanco C, Auriacombe M, Borges.

  15. [Reliability of Primary Care computerised medication records].

    Science.gov (United States)

    García-Molina Sáez, Celia; Urbieta Sanz, Elena; Madrigal de Torres, Manuel; Piñera Salmerón, Pascual; Pérez Cárceles, María D

    2016-03-01

    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.

  16. Perceived risk of mental health problems in primary care

    Directory of Open Access Journals (Sweden)

    Constança ePaúl

    2015-11-01

    Full Text Available In the face of limited resources and an ageing population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalisation, hospitalisation and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care. We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community (RISC to rank perceived risk of mental health concerns (including neurocognitive and mood disorders from 1 (mild to 3 (Severe. The mean age of the 4499 people assessed was 76.3 years (sd=7.3 and 2645 (58.8% were female. According to the primary care team 1616 (35.9% were perceived to have mental health concerns of whom 847 (52.4% were mild, 559 (34.6% were moderate and 210 (13% were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR=2.22, 95% CI 1.83-2.69 for institutionalisation; OR=1.66, 95% CI 1.41-1.94 for hospitalisation; OR=1.69, 95% CI 1.42-2.01 for death. These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

  17. Optimizing the Primary Prevention of Type-2 Diabetes in Primary Health Care

    Science.gov (United States)

    2017-08-18

    Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style

  18. Prevalence of Occupational Accidents/Injuries among Health Care ...

    African Journals Online (AJOL)

    BACKGROUND: Health care workers (HCWs) are prone to occupational accidents and injuries such as needle pricks in the course of their day to day activities in the health care setting. OBJECTIVE: To determine the prevalence of needle sticks and other occupational exposures among HCWs in a Nigerian tertiary hospital.

  19. Functioning of primary health care in opinion of managers of primary health care units.

    Science.gov (United States)

    Bojar, I; Wdowiak, L; Kwiatosz-Muc, M

    2006-01-01

    The aim of the research is to get to know opinions of primary health care managers concerning working of primary health care and concerning quality of medical services offered by family doctors out-patient clinics. The research among managers of primary health care units took place in all out-patient clinics in Lublin province. Research instrument was survey questionnaire of authors own construction. Results were statistically analyzed. From 460 surveys sent, 108 questionnaires were accepted to analysis. Majority of managers of out-patient clinics of primary health care is satisfied with the way and the quality of work of employed staff. In opinion of 71.3% of managers access to family doctor services is very good. Availability of primary health care services is better estimated by managers of not public units. The occupied local provide comfortable work for the staff in opinion of 78.5% of surveyed managers of out-patient clinics. Managers estimate the level of their services as very good (37.96%) and good (37.96%) comparing to other such a subjects present in the market. Internal program of improving quality is run in 22% of out-patient clinics, which were investigated. Managers of primary health care units assess the quality of their services as good and very good. They estimate positively the comfort and politeness in serving patients as well as technical status of equipment and the lodging. They assess availability of their services as very good. Large group of managers of family doctors practices recognizes neighborhood practices as a competitors.

  20. [Urine incontinence referral criteria for primary care].

    Science.gov (United States)

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-05-01

    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. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  1. Competition and rural primary care programs.

    Science.gov (United States)

    Ricketts, T C

    1990-04-01

    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.

  2. Dementia prevalence and care in assisted living.

    Science.gov (United States)

    Zimmerman, Sheryl; Sloane, Philip D; Reed, David

    2014-04-01

    Assisted living residences have become prominent sites of long-term residential care for older adults with dementia. Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs. Policy-relevant recommendations from our study include the need to examine the use of psychotropic medications and cultures related to prescribing, better train assisted living staff to handle medications and provide nonpharmacological treatments, use best practices in caring for people with dementia, and promote consumer education regarding policies and practices in assisted living.

  3. Primary health care in the Southern Mediterranean region.

    NARCIS (Netherlands)

    Weide, M.G.; Fakiri, F. el; Kulu Glasgow, I.; Grielen, S.J.; Zee, J. van der

    1998-01-01

    This book gives an overview of primary health care in the Southern Mediterranean region. For twelve countries detailed information is provided on the structure and financing of health care, the organisation of primary care (including mother and child health care and immunisation programmes), health

  4. Development of an allergy management support system in primary care

    Directory of Open Access Journals (Sweden)

    Flokstra - de Blok BMJ

    2017-03-01

    Full Text Available Bertine MJ Flokstra - de Blok,1,2 Thys van der Molen,1,2 Wianda A Christoffers,3 Janwillem WH Kocks,1,2 Richard L Oei,4 Joanne NG Oude Elberink,2,4 Emmy M Roerdink,5 Marie Louise Schuttelaar,3 Jantina L van der Velde,1,2 Thecla M Brakel,1,6 Anthony EJ Dubois2,5 1Department of General Practice, 2GRIAC Research Institute, 3Department of Dermatology, 4Department of Allergology, 5Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, 6Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands 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

  5. Primary health care and public policy.

    Science.gov (United States)

    Mangelsdorf, K L; Luna, J; Smith, H L

    1988-01-01

    The health problems of Ecuador are similar to those in other developing countries where the standard of living is low, and housing and sanitation are inadequate. Women, children, and those living in rural areas are those most severely affected. National policy has been to attempt to increase access to health care in rural areas through the construction of new facilities and the appointment of highly paid medical staff. However, little attention was paid to sociocultural factors, which caused the peasantry to reject the medical care system, or to problems of internal efficiency which inhibited utilization. Since the 1970s various national and international organizations have attempted to implement primary health care (PHC) through the use of trained community health workers (CHWs). The primary problems faced by the CHWs were shortages of medicines and supplies, an almost total lack of supervision, and lack of transportation available to take staff to isolated villages. The poor supervision is blamed for the 17% drop out rate among CHWs since 1980. Independent PHC programs have also been established in Ecuador by voluntary organizations. These work best when coordinated with governmental programs, in order to allow monitoring and to avoid the duplication of services. Problems with the establishment of PHC programs in Ecuador will continue, as the government has no clear cut policy, and difficulties financing on a broad national scale. Other problems include the absence of effective supervision and logistical support for even small pilot programs, and inconsistencies in the training and role definition for CHWs. These problems need to be met in the implementation of a national PHC policy.

  6. Primary medical care in Irish prisons.

    Science.gov (United States)

    Barry, Joe M; Darker, Catherine D; Thomas, David E; Allwright, Shane P A; O'Dowd, Tom

    2010-03-22

    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. 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. 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. 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.

  7. Primary medical care in Irish prisons

    Directory of Open Access Journals (Sweden)

    Allwright Shane PA

    2010-03-01

    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.

  8. A Participatory Model of the Paradox of Primary Care

    Science.gov (United States)

    Homa, Laura; Rose, Johnie; Hovmand, Peter S.; Cherng, Sarah T.; Riolo, Rick L.; Kraus, Alison; Biswas, Anindita; Burgess, Kelly; Aungst, Heide; Stange, Kurt C.; Brown, Kalanthe; Brooks-Terry, Margaret; Dec, Ellen; Jackson, Brigid; Gilliam, Jules; Kikano, George E.; Reichsman, Ann; Schaadt, Debbie; Hilfer, Jamie; Ticknor, Christine; Tyler, Carl V.; Van der Meulen, Anna; Ways, Heather; Weinberger, Richard F.; Williams, Christine

    2015-01-01

    PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care. METHODS In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity. RESULTS In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease

  9. Practice of preventive dentistry for nursing staff in primary care

    Science.gov (United States)

    Acuña-Reyes, Raquel; Cigarroa-Martínez, Didier; Ureña-Bogarín, Enrique; Orgaz-Fernández, Jose David

    2014-01-01

    Objectives: Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. Methods: Prospective descriptive study, questionnaire validation, and prevalence study. In the first stage, the questionnaire for the practice of preventive dentistry (CPEP, for the term in Spanish) was validated; consistency and reliability were measured by Cronbach's alpha, Pearson's correlation, factor analysis with intra-class correlation coefficient (ICC). In the second stage, the domain in preventive dental nurses was explored. Results: The overall internal consistency of CPEP is α= 0.66, ICC= 0.64, CI95%: 0.29-0.87 (p >0.01). Twenty-one subjects in the study, average age 43, 81.0% female, average seniority of 12.5 were included. A total of 71.5% showed weak domain, 28.5% regular domain, and there was no questionnaire with good domain result. The older the subjects were, the smaller the domain; female nurses showed greater mastery of preventive dentistry (29%, CI95%: 0.1-15.1) than male nurses. Public health nurses showed greater mastery with respect to other categories (50%, CI95%: 0.56-2.8). Conclusions: The CDEP has enough consistency to explore the domain of preventive dentistry in health-care staff. The domain of preventive dentistry in primary care nursing is poor, required to strengthen to provide education in preventive dentistry to the insured population. PMID:25386037

  10. Primary health care progress and problems.

    Science.gov (United States)

    Favin, M; Parlato, P; Kessler, S

    1984-01-01

    The 1st generation of primary health care efforts were assessed in order to temper future efforts with implementation realities. With support from the US Agency for International Development (USAID), the American Public Health Association (APHA) studied 52 primary health care (PHC) projects from 1980-82, documenting the numerous lessons learned. The contrast between the ideology of PHC and field realities provides valuable insights which must be fed back into 2nd generation projects. The projects were in 33 developing countries in Asia, Latin America, Africa, and the Near East. Approximately 1/3 were national level efforts; one-half, variously sized regional efforts; and the remainder, small scale pilot efforts. The sources of information were project documents and interviews with individuals who knew field activities firsthand. All the projects had as their primary goal provision of low-cost health services to previously unserved rural communities, using community personnel, and strengthening community institutions. Regarding overall assessment, while data continue to be limited on the impact of the approach on health status, there are some positive indications, especially for the projects of longer duration. For example, in Nepal and Thailand, there were modest improvements in health status of the target population in 2 project areas. A project in Kitui, Kenya reported reductions in infant mortality rates. A PHC program in Panama was responsible for decreases in the incidence of diarrhea, parasites, and typhoid. Many of the projects have been successful in setting up a PHC structure that extends coverage for health measures such as immunizations, family planning, and prenatal care. Many new facilities are in place. Skills of health workers have been upgraded, and new categories of paraprofessionals have been trained. Additionally, sizable numbers of community health workers have been trained and deployed. There is some evidence that in a few cases projects have

  11. Assessing primary care in Austria: room for improvement.

    Science.gov (United States)

    Stigler, Florian L; Starfield, Barbara; Sprenger, Martin; Salzer, Helmut J F; Campbell, Stephen M

    2013-04-01

    There is emerging evidence that strong primary care achieves better health at lower costs. Although primary care can be measured, in many countries, including Austria, there is little understanding of primary care development. Assessing the primary care development in Austria. A primary care assessment tool developed by Barbara Starfield in 1998 was implemented in Austria. This tool defines 15 primary care characteristics and distinguishes between system and practice characteristics. Each characteristic was evaluated by six Austrian primary care experts and rated as 2 (high), 1 (intermediate) or 0 (low) points, respectively, to their primary care strength (maximum score: n = 30). Austria received 7 out of 30 points; no characteristic was rated as '2' but 8 were rated as '0'. Compared with the 13 previously assessed countries, Austria ranks 10th of 14 countries and is classified as a 'low primary care' country. This study provides the first evidence concerning primary care in Austria, benchmarking it as weak and in need of development. The practicable application of an existing assessment tool can be encouraging for other countries to generate evidence about their primary care system as well.

  12. The european primary care monitor: structure, process and outcome indicators

    Directory of Open Access Journals (Sweden)

    Wilson Andrew

    2010-10-01

    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

  13. Primary care in a new era: disillusion and dissolution?.

    Science.gov (United States)

    Sandy, Lewis G; Schroeder, Steven A

    2003-02-04

    The current dilemmas in primary care stem from 1) the unintended consequences of forces thought to promote primary care and 2) the "disruptive technologies of care" that attack the very function and concept of primary care itself. This paper suggests that these forces, in combination with "tiering" in the health insurance market, could lead to the dissolution of primary care as a single concept, to be replaced by alignment of clinicians by economic niche. Evidence already exists in the marketplace for both tiering of health insurance benefits and corresponding practice changes within primary care. In the future, primary care for the top tier will cater to the affluent as "full-service brokers" and will be delivered by a wide variety of clinicians. The middle tier will continue to grapple with tensions created by patient demand and bureaucratic systems but will remain most closely aligned to primary care as a concept. The lower tier will become increasingly concerned with community health and social justice. Each primary care specialty will adapt in a unique way to a tiered world, with general internal medicine facing the most challenges. Given this forecast for the future, those concerned about primary care should focus less on workforce issues and more on macro health care financing and organization issues (such as Medicare reform); appropriate training models; and the development of a conception of primary care that emphasizes values and ethos, not just function.

  14. Prostate cancer in primary care, Port Harcourt, Nigeria

    Directory of Open Access Journals (Sweden)

    Andrew Bock-Oruma

    2014-01-01

    Full Text Available Context: Prostate cancer (PC is under-researched in primary care settings in the developing world, and diagnostic modalities available to the primary care physician could limit the making of the diagnosis, thus affecting the prevalence. Aims: This study aims to determine the prevalence of prostate cancer in patients that presented with LUTS to a family medicine clinic, using the screening tools (DRE and PSA available in the facility. Settings and Design: A cross-sectional study of middle-aged and elderly men that presented to the Family Medicine Clinic, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, with LUTS. Materials and Methods: Consenting and eligible males that presented to the Family Medicine Clinic with LUTS were assessed for prostate cancer using the PSA and digital rectal examination (DRE between October 2010 and April 2012. Data were entered and analyzed using the statistical package for the social sciences (SPSS version 16.0. Association between the variables was compared using chi-Square test with statistical significance set at P < 0.05. Results: Two hundred and ninety subjects participated in the study; the mean age of the subjects was 62.50 ± 11.66 years with an age range of 40 to 100 years. The prevalence for DRE-detected abnormal prostate was 13%, suggestive of PC. One hundred and sixty-one (55.5% of the subjects had their PSA done and results retrieved, with 51.6% of them having PSA values within the normal range of 0-4 ng/ml, and 48.4% had PSA values outside the normal limits. An association of PSA and DRE gave 24.2% prevalence for probable PC and a significant association between elevated PSA and DRE. Conclusion: The diagnostic modality in study is inconclusive, but it offers the family physician the opportunity of improving the quality of life of the patient that presented to him with PC by initiating early referral for secondary care.

  15. Management of neonatal jaundice in primary care

    Directory of Open Access Journals (Sweden)

    Angeline Wan Seng Lian

    2016-02-01

    Full Text Available The Clinical Practice Guidelines on Management of Neonatal Jaundice 2003 was updated by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2014. A systematic review of 13 clinical questions was conducted using evidence retrieved mainly from Medline and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills Programme checklist. Recommendations were formulated based on the accepted 103 evidences and tailored to local setting as stated below. Neonatal jaundice (NNJ is a common condition seen in primary care. Multiple risk factors contribute to severe NNJ, which if untreated can lead to adverse neurological outcomes. Visual assessment, transcutaneous bilirubinometer (TcB and total serum bilirubin (TSB are the methods used for the detection of NNJ. Phototherapy remains the mainstay of the treatment. Babies with severe NNJ should be followed-up to detect and manage sequelae. Strategies to prevent severe NNJ include health education, identification of risk factors, proper assessment and early referral.

  16. Occupational Therapy and Primary Care: Updates and Trends

    Science.gov (United States)

    Mroz, Tracy M.; Fogelberg, Donald J.; Leland, Natalie E.

    2018-01-01

    As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care. PMID:29689169

  17. Primary care and health reform in New Zealand.

    Science.gov (United States)

    Grant, C C; Forrest, C B; Starfield, B

    1997-02-14

    (1) To describe New Zealand's primary care system (2) to compare New Zealand to other Anglo-American members of the OECD with respect to the adequacy of primary care, and (3) to assess the cost-efficiency and effectiveness of New Zealand's system by comparing health spending and health indicators relevant to primary care. A cross-national comparison of primary care, health spending and health indicators in New Zealand, Australia, Canada, the United Kingdom and the United States of America. Main outcome measures were health spending measured in purchasing power parties. Health indicators: mean life expectancy in years, years of potential life lost and infant mortality rates. New Zealand's primary care system ranked below the UK, above the USA and similar to Canada and Australia. Favourable characteristics of New Zealand's primary care system were the use of generalists as the predominant type of practitioner and the low proportion of active physicians who were specialists. Compared to the other countries, New Zealand scored poorly for financial that are necessary for the practise of good primary care. New Zealand and the UK had the lowest spending per capita on health care. New Zealand and the USA scored lowest for all three of the health care indicators. The quality of primary care in New Zealand is limited by barriers to access to care and the intermediate level of practise characteristics essential to primary care. Compared to other AngloAmerican OECD nations, New Zealand has relatively low levels of national health expenditure. In order to improve the quality of primary care, future reform should aim to facilitate access to care, increase the gatekeeping role of primary care physicians, and promote the practise characteristics essential to primary care.

  18. Primary care training and the evolving healthcare system.

    Science.gov (United States)

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

  19. Prevalência e fatores associados à deficiência de ferro em lactentes atendidos em um centro de saúde-escola em Belém, Pará, Brasil Prevalence and factors associated with iron deficiency in infants treated at a primary care center in Belém, Pará, Brazil

    Directory of Open Access Journals (Sweden)

    Márcia Bitar Portella Neves

    2005-12-01

    Full Text Available Determinar a prevalência de deficiência de ferro e fatores associados em lactentes. Neste estudo transversal, foram estudados 365 lactentes atendidos em um centro de saúde-escola, em Belém, Pará, Brasil. Anemia ferropriva (hemoglobina 11g/dl e ferritina 11g/dl e ferritina > 12µg/l, em 18,1%. Em 12,5% dos lactentes, não incluídos na avaliação dos fatores associados com a deficiência de ferro, encontraram-se hemoglobina 12µg/l. Os resultados do modelo de regressão logística mostraram associação entre deficiência de ferro (ferritina The objective was to verify the occurrence of iron deficiency and associated factors in infants. This cross-sectional study included 365 infants (defined here as 6-24 months of age treated at a primary care center in Belém, Pará, Brazil. Iron-deficiency anemia (hemoglobin < 11g/dl and ferritin < 12µg/l was diagnosed in 55.1% of the sample, depletion of body iron reserves (hemoglobin < 11g/dl and ferritin < 12µg/l in 15.3%, and iron sufficiency (hemoglobin < 11g/dl and ferritin < 12µg/l in 18.1%. The results of the logistic regression model showed associations between iron deficiency (ferritin < 12µg/l and: 6-12 month age group, OR (odds ratio = 3.67 and 95% CI: 1.93-7.04; non-utilization of iron-fortified formula as the first milk used after interrupting breastfeeding, OR = 1.93 and 95%CI: 1.04-3.60; and per capita income ¾ 1 minimum wage, OR = 2.69 and 95%CI: 1.30-5.59. The occurrence of iron deficiency was high, showing the need to adopt effective measures to prevent this important public health problem.

  20. Peritoneal dialysis: a primary care perspective.

    Science.gov (United States)

    Saxena, Ramesh; West, Cheryl

    2006-01-01

    As the population of chronic kidney disease (CKD) and end-stage renal disease (ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in the management of these patients. Early recognition of CKD and timely referral to a nephrologist when glomerular filtration rate approaches 30 mL/min/1.73 m(2) is extremely important to improve ESRD outcome and appropriate selection of dialysis modality. Peritoneal dialysis (PD) remains a viable treatment option for ESRD patients. PD is less expensive dialysis modality and may provide a survival advantages over hemodialysis in first 2 to 4 years of treatment. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. Thus preservation of RRF is an important goal in the management of PD patients. Every effort should be made to avoid nephrotoxic drugs like aminoglycosides and nonsteroidal anti-inflammatory drugs, and limit the use of radiocontrast agents in PD patients with RRF. Judicious use of prophylactic antibiotics to prevent peritonitis would further help to reduce morbidity from PD. Protecting peritoneal membrane from long-term toxic and metabolic effects of the conventional glucose-based solutions is another objective to further improve PD outcome. Development of new, more biocompatible PD solutions holds promise for the future. One such solution, icodextrin, is now approved for use in the United States. Although extremely safe to use, it is associated with unique metabolic effects that may concern primary care physicians. They include false elevation of blood glucose, a reversible increase in serum alkaline phosphatase and a false decline in serum amylase. Monitoring of glycemia by assays that use glucose dehydrogenase pyrroloquinoline quinone enzymes should be avoided and serum amylase alone should not be relied on in diagnosing pancreatitis in patients on icodextrin.

  1. [State of internal communication in primary care].

    Science.gov (United States)

    Ballvé Moreno, José Luis; Pujol Ribó, Gloria; Romaguera Lliso, Amparo; Bonet Esteve, Anna; Rafecas Ruiz, Montserrat; Zarza Carretero, Elvira

    2008-08-01

    To study internal communication between primary care health professionals Cross-sectional, descriptive. Catalan Health Institute Costa de Ponent Primary Care Area, Spain. All workers in the area (n=3565). Three part questionnaire: a) sociodemographic questions; b) questions scoring from 0 to 10 the current importance and operation of certain aspects; and c) questions on new communication tools. Of those sent a questionnaire, 39% (n=1388) responded, with a mean age of 43.2 years (95% CI, 42.75- 43.65), 28.9% being male. The major differences between importance and current events were said to be "to be informed of projects before they appear in the communication media," "by official routes and not by rumour," and "to be aware of projects of other teams." The least communicated within teams. The doctors considered upward communication to be more important. Doctors are those who appreciate communication within teams better and the professionals of the users services unit (UAU) less so. Doctors are the ones who give more importance to being informed of projects at the time. 55% do not use the intranet, mainly due to lack of time. The second reason is that they find it difficult. Sixty-two per cent read e-mail >2-3 times per week. Eighty-nine per cent want an electronic bulletin. The older workers use new technologies less. Downward, upward, and sideways communication needs to be improved, particularly upwards by doctors, and that of the teams for the UAU professionals. Intranet tools must be provided that make the work easier and training in handling new technologies must be offered.

  2. Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study

    NARCIS (Netherlands)

    Jaarsveld, C.H.M. van; Gulliford, M.C.

    2015-01-01

    OBJECTIVE: This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. DESIGN: Cohort study of primary care electronic health records. SETTING: 375 general

  3. Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky.

    Science.gov (United States)

    Wubu, Selam; Hall, Laura Lee; Straub, Paula; Bair, Matthew J; Marsteller, Jill A; Hsu, Yea-Jen; Schneider, Doron; Hood, Gregory A

    Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

  4. Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area.

    Science.gov (United States)

    Westerdahl, Christina; Bergenfelz, Anders; Isaksson, Anders; Nerbrand, Christina; Valdemarsson, Stig

    2011-03-01

    To evaluate the prevalence of primary aldosteronism (PA) in newly diagnosed and untreated hypertensive patients in primary care using the aldosterone/renin ratio (ARR), and to assess clinical and biochemical characteristics in patients with high and normal ARR. Patient survey study. A total of 200 consecutive patients with newly diagnosed and untreated hypertension from six primary health care centres in Sweden were included. ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was 65. Patients with an increased ARR were considered for confirmatory testing with the fludrocortisone suppression test (FST), followed by adrenal computed tomographic radiology (CT) and adrenal venous sampling (AVS). Of 200 patients, 36 patients had an ARR > 65. Of these 36 patients, 11 patients had an incomplete aldosterone inhibition during FST. Three patients were diagnosed with an aldosterone producing adenoma (APA) and eight with bilateral adrenal hyperplasia (BHA). Except for moderately lower level of P-K in patients with an ARR > 65 and in patients with PA, there were no biochemical or clinical differences found among hypertensive patients with PA compared with patients without PA. Eleven of 200 evaluated patients (5.5%) were considered to have PA. The diagnosis of PA should therefore be considered in newly diagnosed hypertensive subjects and screening for the diagnosis is warranted.

  5. Pioneering community-oriented primary care.

    Science.gov (United States)

    Susser, M

    1999-01-01

    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.

  6. Spatial analysis of elderly access to primary care services

    Directory of Open Access Journals (Sweden)

    Lozano-Gracia Nancy

    2006-05-01

    Full Text Available Abstract Background Admissions for Ambulatory Care Sensitive Conditions (ACSCs are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. Results We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. Conclusion The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across

  7. Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

    Science.gov (United States)

    Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

    2018-05-01

    Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

  8. Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors : A mixed-methods study

    NARCIS (Netherlands)

    Doekhie, K.; Buljac, M.; Strating, M.; Paauwe, J.

    2017-01-01

    Background: Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals

  9. Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors : A mixed-methods study

    NARCIS (Netherlands)

    K.D. Doekhie (Kirti); M. Buljac-Samardzic (Martina); M.M.H. Strating (Mathilde); J. Paauwe (Jaap)

    2017-01-01

    markdownabstract__Background:__ Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care

  10. Monitoring quality in Israeli primary care: The primary care physicians' perspective

    Directory of Open Access Journals (Sweden)

    Nissanholtz-Gannot Rachel

    2012-06-01

    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

  11. Prevalence of cardiovascular disease and evaluation of standard of care in type 2 diabetes

    DEFF Research Database (Denmark)

    Rungby, Jorgen; Schou, Morten; Warrer, Per

    2017-01-01

    -density lipoprotein cholesterol was 2.0 mmol/l. Conclusion: In a nationwide database survey in primary care, the prevalence of CVD in patients with type 2 diabetes was high (21.4%). Standard of care was largely in accordance with national guidelines. Identification of eligible patients is possible with existing......Objective: Cardiovascular disease (CVD) complicates type 2 diabetes. Empagliflozin and liraglutide have demonstrated improved survival in patients with type 2 diabetes and established CVD. We assessed prevalence and standard of care of patients with type 2 diabetes and established CVD managed.......6% were women. Mean estimated glomerular filtration rate was 68.2 ml/min, and 22.2% had microalbuminuria or macroalbuminuria. Standard of care was fair: mean glycated hemoglobin was 52.3 mmol/mol (Diabetes Control and Complications Trial=6.9%), mean blood pressure was 131.4/75.7 mmHg, and mean low...

  12. A future for primary care for the Greek population.

    Science.gov (United States)

    Groenewegen, Peter P; Jurgutis, Arnoldas

    2013-01-01

    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 and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

  13. Resistant hypertension: an approach to management in primary care

    Directory of Open Access Journals (Sweden)

    Julian P Yaxley

    2015-01-01

    Full Text Available Hypertension is widely encountered in family medicine. Despite its prevalence, many patients have uncontrolled or difficult-to-control blood pressure. Resistant hypertension is defined as hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges. It may be a consequence of secondary hypertension or have no identifiable cause. Resistant hypertension is important to recognise because it places patients at risk of end-organ damage. Primary care physicians should be aware of the therapeutic approach for hypertension when traditional therapy fails. This article aims to familiarise readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.

  14. Social anxiety disorder. A guide for primary care physicians.

    Science.gov (United States)

    Elliott, H W; Reifler, B

    2000-01-01

    Social anxiety disorder is prevalent, potentially disabling, but quite treatable. A thorough and directed history can distinguish social phobia from depression, panic disorder, and OCD. It can also screen for and identify possible substance abuse. Once the diagnosis is made, a combination of pharmacologic and psychotherapy is indicated. The SSRIs, MAOIs, benzodiazepines, and beta-blockers--as well as CBT--can effectively treat social anxiety symptoms. Primary care physicians may well want to begin by prescribing an SSRI like paroxetine, along with a high potency benzodiazepine to be taken on a regular or an as-needed basis, and a beta-blocker to take as needed in anticipation of stressful social situations. A referral for CBT should be considered. If the patient has marked side effects from drug treatment or a lack of adequate response to medication, psychiatric referral is definitely indicated.

  15. Skeletal muscle metastases: primary tumours, prevalence, and radiological features

    International Nuclear Information System (INIS)

    Surov, Alexey; Spielmann, Rolf Peter; Behrmann, Curd; Hainz, Michael; Holzhausen, Hans-Juergen; Arnold, Dirk; Katzer, Michaela; Schmidt, Joerg

    2010-01-01

    Although skeletal muscles comprise nearly 50% of the total human body mass and are well vascularised, metastases in the musculature are rare. The reported prevalence of skeletal muscle metastases from post-mortem studies of patients with cancer is inconstant and ranges from 0.03 to 17.5%. Of 5,170 patients with metastasised cancer examined and treated at our institution during the period from January 2000 to December 2007, 61 patients with muscle metastases (80 lesions) were identified on computed tomography (CT). Genital tumours (24.6%) were the most frequent malignancies metastasising into the skeletal musculature, followed by gastrointestinal tumours (21.3%), urological tumours (16.4%), and malignant melanoma (13.1%). Other primary malignancies were rarer, including bronchial carcinoma (8.2%), thyroid gland carcinoma (4.9%), and breast carcinoma (3.3%). In 8.2%, carcinoma of unknown primary was diagnosed. Skeletal muscle metastases (SMM) were located in the iliopsoas muscle (27.5%), paravertebral muscles (25%), gluteal muscles (16.3%), lower extremity muscles (12.5%), abdominal wall muscles (10%), thoracic wall muscles (5%), and upper extremity muscles (3.8%). Most (76.3%) of the 80 SMM were diagnosed incidentally during routine staging CT examinations, while 23.7% were symptomatic. Radiologically, SMM presented with five different types of lesions: focal intramuscular masses (type I, 52.5% of SMM), abscess-like intramuscular lesions (type II, 32.5%), diffuse metastatic muscle infiltration (type III, 8.8%), multifocal intramuscular calcification (type IV, 3.7%) and intramuscular bleeding (type V, 2.5%). (orig.)

  16. Skeletal muscle metastases: primary tumours, prevalence, and radiological features

    Energy Technology Data Exchange (ETDEWEB)

    Surov, Alexey; Spielmann, Rolf Peter; Behrmann, Curd [Martin-Luther-University Halle-Wittenberg, Department of Radiology, Halle (Germany); Hainz, Michael; Holzhausen, Hans-Juergen [Martin-Luther-University Halle-Wittenberg, Department of Pathology, Halle (Germany); Arnold, Dirk [Martin-Luther-University Halle-Wittenberg, Department of Haematology/Oncology, Halle (Germany); Katzer, Michaela [Martin-Luther-University Halle-Wittenberg, Department of Urology, Halle (Germany); Schmidt, Joerg [Martin-Luther-University Halle-Wittenberg, Department of Medical Statistics and Controlling, Halle (Germany)

    2010-03-15

    Although skeletal muscles comprise nearly 50% of the total human body mass and are well vascularised, metastases in the musculature are rare. The reported prevalence of skeletal muscle metastases from post-mortem studies of patients with cancer is inconstant and ranges from 0.03 to 17.5%. Of 5,170 patients with metastasised cancer examined and treated at our institution during the period from January 2000 to December 2007, 61 patients with muscle metastases (80 lesions) were identified on computed tomography (CT). Genital tumours (24.6%) were the most frequent malignancies metastasising into the skeletal musculature, followed by gastrointestinal tumours (21.3%), urological tumours (16.4%), and malignant melanoma (13.1%). Other primary malignancies were rarer, including bronchial carcinoma (8.2%), thyroid gland carcinoma (4.9%), and breast carcinoma (3.3%). In 8.2%, carcinoma of unknown primary was diagnosed. Skeletal muscle metastases (SMM) were located in the iliopsoas muscle (27.5%), paravertebral muscles (25%), gluteal muscles (16.3%), lower extremity muscles (12.5%), abdominal wall muscles (10%), thoracic wall muscles (5%), and upper extremity muscles (3.8%). Most (76.3%) of the 80 SMM were diagnosed incidentally during routine staging CT examinations, while 23.7% were symptomatic. Radiologically, SMM presented with five different types of lesions: focal intramuscular masses (type I, 52.5% of SMM), abscess-like intramuscular lesions (type II, 32.5%), diffuse metastatic muscle infiltration (type III, 8.8%), multifocal intramuscular calcification (type IV, 3.7%) and intramuscular bleeding (type V, 2.5%). (orig.)

  17. Curricula and Organization of Primary Care Residencies in Internal Medicine.

    Science.gov (United States)

    Eisenberg, John M.

    1980-01-01

    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…

  18. Work and workload of Dutch primary care midwives in 2010.

    NARCIS (Netherlands)

    Wiegers, T.A.; Warmelink, J.C.; Spelten, E.R.; Klomp, G.M.T.; Hutton, E.K.

    2014-01-01

    Objective: To re-assess the work and workload of primary care midwives in the Netherlands. Background: In the Netherlands most midwives work in primary care as independent practitioners in a midwifery practice with two or more colleagues. Each practice provides 24/7 care coverage through office

  19. Measuring the strength of primary care systems in Europe.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.

    2009-01-01

    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

  20. Journal of Community Medicine and Primary Health Care

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... environmental health, clinical care, health planning and management, health policy, health ... non-communicable diseases within the Primary Health Care system in the Federal ... Assessment of occupational hazards, health problems and safety practices of petrol ...

  1. [Management of adult secondary insomnia in primary health care].

    Science.gov (United States)

    Cavadas, Luís Filipe; Ribeiro, Lúcia

    2011-01-01

    Insomnia is the most common sleep disorder in adults, with secondary insomnia being the most prevalent. This sleep disorder is associated with important medical and social consequences. The General Practitioner (GP) plays a key role in the diagnosis of insomnia, which may affect about 69% of their patients in the PHC (Primary Health Care). Recognize the differential diagnosis of secondary insomnia in adults, evaluate and manage these patients in the PHC, appropriately use the treatments available and meet the criteria for referral. Bibliographic search in MEDLINE databases, and evidence based review databases, using the MeSH terms: Primary Health Care, Sleep Disorders, Insomnia, for articles published since January 2000 until July 2009, in English, Portuguese, French and Spanish. Index de Revistas Médicas Portuguesas and scientific societies dedicated to sleep disorders were searched. Mood and anxiety disorders are the main co-morbidities associated with secondary insomnia, being present in 30% to 50% of patients with insomnia. The medical pathology and substance abuse are present respectively in 10% of patients. It is essential a proper clinical history, with a history of sleep, sleep diary and the partner information. There is evidence that the combination of specific pharmacological treatments (benzodiazepines and the benzodiazepine receptor agonists) with the nonpharmacological (cognitive-behavioral therapy) may be useful in secondary insomnia, as co-adjuvant treatment of the underlying disease. There are several treatment options with their indications and adverse effects. The criteria for referral should be defined according to the availability of human resources. Due to the high prevalence and the serious consequences of secondary insomnia in adults, it must be systematically managed by the GP. It is important to know and to use non-pharmacological therapy in GP consultation, because this therapy was shown to be important in treating this type of insomnia

  2. Prevalence of latent Mycobacterium tuberculosis infection among professionals of the primary healthcare network

    Directory of Open Access Journals (Sweden)

    Tássia Silvana Borges

    2014-06-01

    Full Text Available Objective: To estimate the prevalence of latent M. tuberculosis infection and identify characteristics related to latent infection among workers of the primary healthcare network.Methods: Cross-sectional, observational and descriptive study, conducted in 2011, included 137 basic health workers who performed their activities in a municipality. Interviews were carried out addressing characteristics of exposure at work (BCG vaccination, length of time working in the health system, potential exposure to tuberculosis, HIV infection, use of corticosteroids, diabetes, use of tobacco or alcohol and subsequently performed tuberculin skin test (TST. Data was analyzed with Fischer and Student’s t-test (p < 0.05. Results: Health professionals were mostly women (n=126, 92% with mean age of 35.3 (± 9.1 years. Among the reactors, 25 (55.5% sought medical care, and of these, 7 (28% underwent prophylactic treatment. The prevalence of latent tuberculosis was 32.8%. Of the characteristics evaluated, only smoking (OR 3.03; 95%CI 1.05-8.77 was associated with latent infection. Conclusion: The estimated prevalence of latent M. tuberculosis infection among the evaluated health workers was 32.8%. As for the characteristics studied, it was not possible to relate them to latent infection among workers in primary healthcare network, with the exception of the smoking habit. doi: 10.5020/18061230.2014.p269

  3. The epidemiology and natural history of depressive disorders in Hong Kong's primary care

    Directory of Open Access Journals (Sweden)

    Chin Weng

    2011-11-01

    Full Text Available Abstract Background Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the factors affecting prognosis of these patients requires closer examination. Methods/Design The aim of this study is to examine the prevalence, incidence and natural history of depressive disorders in primary care and the factors influencing diagnosis, management and outcomes using a cross-sectional study followed by a longitudinal cohort study. Doctors working in primary care settings across Hong Kong have been invited to participate in this study. On one day each month over twelve months, patients in the doctor's waiting room are invited to complete a questionnaire containing items on socio-demography, co-morbidity, family history, previous doctor-diagnosed mental illness, recent mental and other health care utilization, symptoms of depression and health-related quality of life. Following the consultation, the doctors provide information regarding presenting problem, whether they think the patient has depression, and if so, whether the diagnosis is new or old, and the duration of the depressive illness if not a new diagnosis. If the doctor detects a depressive disorder, they are asked to provide information regarding patient management. Patients who consent are followed up by telephone at 2, 12, 26 and 52 weeks. Discussion The study will provide information regarding cross-sectional prevalence, 12 month incidence, remission rate, outcomes and factors affecting outcomes of patients with depressive disorders in primary care. The epidemiology, outcomes

  4. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

    NARCIS (Netherlands)

    Valentijn, P.P.; Schepman, S.M.; Opheij, W.; Bruijnzeels, M.A.

    2013-01-01

    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

  5. Effectiveness and cost effectiveness of counselling in primary care.

    Science.gov (United States)

    Bower, P; Rowland, N; Mellor, C l; Heywood, P; Godfrey, C; Hardy, R

    2002-01-01

    Counsellors are prevalent in primary care settings. However, there are concerns about the clinical and cost-effectiveness of the treatments they provide, compared with alternatives such as usual care from the general practitioner, medication or other psychological therapies. To assess the effectiveness and cost effectiveness of counselling in primary care by reviewing cost and outcome data in randomised controlled trials, controlled clinical trials and controlled patient preference trials of counselling interventions in primary care, for patients with psychological and psychosocial problems considered suitable for counselling. The original search strategy included electronic searching of databases (including the CCDAN Register of RCTs and CCTs) along with handsearching of a specialist journal. Published and unpublished sources (clinical trials, books, dissertations, agency reports etc.) were searched, and their reference lists scanned to uncover further controlled trials. Contact was made with subject experts and CCDAN members in order to uncover further trials. For the updated review, searches were restricted to those databases judged to be high yield in the first version of the review: MEDLINE, EMBASE, PSYCLIT and CINAHL, the Cochrane Controlled Trials register and the CCDAN trials register. All controlled trials comparing counselling in primary care with other treatments for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of June 2001 were included in the review. Data were extracted using a standardised data extraction sheet. The relevant data were entered into the Review Manager software. Trials were quality rated, using CCDAN criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95

  6. Primary health care in Canada: systems in motion.

    Science.gov (United States)

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

    2011-06-01

    During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

  7. Assessment of the Knowledge of Primary Health Care Staff about Primary Health Care

    OpenAIRE

    Elzubier, Ahmed G.; Bella, Hassan; Sebai, Zohair A.

    1995-01-01

    The orientation about Primary Health Care among staff working in the PHC centers was assessed. Staff members numbering 909 were studied. The main criteria for judging orientation were a working knowledge of the definition and elements of PHC in addition to knowledge of the meaning of the word Alma Ata. Differences of this knowledge depending on sex, age, spoken language, type of job, postgraduate experience, previous experience in PHC and previous training in PHC were assessed. The main findi...

  8. [Identification of sentinel events in primary care].

    Science.gov (United States)

    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.

  9. Leadership in primary health care: an international perspective.

    Science.gov (United States)

    McMurray, Anne

    2007-08-01

    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.

  10. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

    Directory of Open Access Journals (Sweden)

    Seekles Wike

    2009-06-01

    Full Text Available Abstract Background Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity. Methods This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1 Watchful waiting, (2 Guided self-help, (3 Problem Solving Treatment and (4 Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18–65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia, generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks. Discussion This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed. Trial Registration Current Controlled Trails: ISRCTN17831610.

  11. [The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care].

    Science.gov (United States)

    Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa

    2017-06-01

    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.

  12. Disease-specific clinical pathways - are they feasible in primary care? A mixed-methods study.

    Science.gov (United States)

    Grimsmo, Anders; Løhre, Audhild; Røsstad, Tove; Gjerde, Ingunn; Heiberg, Ina; Steinsbekk, Aslak

    2018-04-12

    To explore the feasibility of disease-specific clinical pathways when used in primary care. A mixed-method sequential exploratory design was used. First, merging and exploring quality interview data across two cases of collaboration between the specialist care and primary care on the introduction of clinical pathways for four selected chronic diseases. Secondly, using quantitative data covering a population of 214,700 to validate and test hypothesis derived from the qualitative findings. Primary care and specialist care collaborating to manage care coordination. Primary-care representatives expressed that their patients often have complex health and social needs that clinical pathways guidelines seldom consider. The representatives experienced that COPD, heart failure, stroke and hip fracture, frequently seen in hospitals, appear in low numbers in primary care. The quantitative study confirmed the extensive complexity among home healthcare nursing patients and demonstrated that, for each of the four selected diagnoses, a homecare nurse on average is responsible for preparing reception of the patient at home after discharge from hospital, less often than every other year. The feasibility of disease-specific pathways in primary care is limited, both from a clinical and organisational perspective, for patients with complex needs. The low prevalence in primary care of patients with important chronic conditions, needing coordinated care after hospital discharge, constricts transferring tasks from specialist care. Generic clinical pathways are likely to be more feasible and efficient for patients in this setting. Key points Clinical pathways in hospitals apply to single-disease guidelines, while more than 90% of the patients discharged to community health care for follow-up have multimorbidity. Primary care has to manage the health care of the patient holistically, with all his or her complex needs. Patients most frequently admitted to hospitals, i.e. patients with COPD

  13. Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices.

    Science.gov (United States)

    Friedberg, Mark W; Safran, Dana G; Coltin, Kathryn L; Dresser, Marguerite; Schneider, Eric C

    2009-02-01

    The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied. To measure the prevalence of recommended structural capabilities among primary care practices and to determine whether prevalence varies among practices of different size (number of physicians) and administrative affiliation with networks of practices. Cross-sectional analysis. One physician chosen at random from each of 412 primary care practices in Massachusetts was surveyed about practice capabilities during 2007. Practice size and network affiliation were obtained from an existing database. Presence of 13 structural capabilities representing 4 domains relevant to quality: patient assistance and reminders, culture of quality, enhanced access, and electronic health records (EHRs). Three hundred eight (75%) physicians responded, representing practices with a median size of 4 physicians (range 2-74). Among these practices, 64% were affiliated with 1 of 9 networks. The prevalence of surveyed capabilities ranged from 24% to 88%. Larger practice size was associated with higher prevalence for 9 of the 13 capabilities spanning all 4 domains (P < 0.05). Network affiliation was associated with higher prevalence of 5 capabilities (P < 0.05) in 3 domains. Associations were not substantively altered by statistical adjustment for other practice characteristics. Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments.

  14. Perceived risk of mental health problems in primary care.

    LENUS (Irish Health Repository)

    2015-01-01

    In the face of limited resources and an aging population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalization, hospitalization and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care (PC). We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community to rank perceived risk of mental health concerns (including neurocognitive and mood disorders) from 1 (mild) to 3 (severe). The mean age of the 4499 people assessed was 76.3 years (SD = 7.3) and 2645 (58.8%) were female. According to the PC team 1616 (35.9%) were perceived to have mental health concerns of whom 847 (52.4%) were mild, 559 (34.6%) were moderate and 210 (13%) were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR = 2.22, 95% CI 1.83-2.69 for institutionalization; OR = 1.66, 95% CI 1.41-1.94 for hospitalization; OR = 1.69, 95% CI 1.42-2.01 for death). These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

  15. Physical Profiling Performance of Air Force Primary Care Providers

    Science.gov (United States)

    2017-08-09

    AFRL-SA-WP-TR-2017-0014 Physical Profiling Performance of Air Force Primary Care Providers Anthony P. Tvaryanas1; William P...COVERED (From – To) September 2016 – January 2017 4. TITLE AND SUBTITLE Physical Profiling Performance of Air Force Primary Care Providers...encounter with their primary care team. An independent medical standards subject matter expert (SME) reviewed encounters in the electronic health record

  16. [An experience of collaboration between primary health care and mental health care in La Ribera Department of Health (Valencia, Spain)].

    Science.gov (United States)

    Morera-Llorca, Miquel; Romeu-Climent, José Enrique; Lera-Calatayud, Guillem; Folch-Marín, Blanca; Palop-Larrea, Vicente; Vidal-Rubio, Sonia

    2014-01-01

    Despite the high prevalence of mental health problems among patients attending primary care, diagnosis and treatment of these disorders remain inadequate. Sound training of primary care physicians in how to manage mental health problems is needed to reduce the health, economic and social impact associated with these disorders. Among other elements, there is a need for cooperation between primary care physicians and mental health services. Distinct models are available for such collaboration. In 2006, our health department started a collaboration between these two levels of heath care, using a liaison model. Delays until the first specialist visit were reduced and satisfaction among health professionals increased, although these results should be interpreted with caution. Evidence has recently accumulated on the usefulness of the collaborative model, but evaluation of this model and extrapolation of its results are complex. We intend to evaluate our model more thoroughly, similar to other projects in our environment. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model.

    Science.gov (United States)

    Sandoval, Brian E; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J

    2017-12-12

    Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

  18. Treating Teen Depression in Primary Care.

    Science.gov (United States)

    Santiago, Sabrina

    2015-11-01

    I recently had an adolescent patient who presented with a chief complaint of depression. He had classic symptoms of difficulty sleeping, dysthymia, and anhedonia (loss of interest in things that used to bring him joy). He was a very smart and self-aware 17-year-old, and was able to describe his symptoms easily. There were no concerns for manic episodes or psychosis, and he met diagnostic criteria for unipolar major depressive disorder. He denied suicidal ideation, and was already seeing a therapist weekly for the last several months. He had a strong family history of depression, with his father, aunts, and grandmother who also carried a diagnosis of depression. He presented with the support of his mother, asking about next steps, and specifically, pharmacotherapy. This patient is a perfect example of an adolescent who is a good candidate for initiation of antidepressant medication. Primary care pediatricians should feel comfortable with first-line agents for major depressive disorder in certain adolescents with depression, but many feel hesitant and rely on child and adolescent psychiatry colleagues for prescriptions. Copyright 2015, SLACK Incorporated.

  19. Health promotion practices in primary care groups.

    Science.gov (United States)

    Heidemann, Ivonete Teresinha Schulter Buss; Alonso da Costa, Maria Fernanda Baeta Neves; Hermida, Patrícia Madalena Vieira; Marçal, Cláudia Cossentino Bruck; Antonini, Fabiano Oliveira; Cypriano, Camilla Costa

    2018-04-01

    This is a descriptive-exploratory study using a qualitative approach, conducted in ten municipalities in southern Brazil. Data were obtained by talking to 21 nurses from February to November 2012, through semi-structured interviews using questions to probe their health promotion practices. Data were analyzed through thematic analysis focused on health promotion concepts. We identified four themes about health promotion practices of family health nurses in Brazil: a) training of nurses for health promotion practice was weak; b) nurses formed health promotion groups around diseases and life stages; c) nurses formed groups to meet community needs; and d) nurses used health promotion techniques in group work. These family health nurses were somewhat aware of the importance of health promotion, and how to assist the population against various ailments using some health promotion strategies. The main weaknesses were the lack of understanding about health promotion concepts, and the difficulty of understanding the relevance of its practice, probably attributable to limitations in training. We conclude that primary care groups in Brazil's unified health system could do better in applying health promotion concepts in their practice.

  20. Results of a multidisciplinary program for patients with fibromyalgia implemented in the primary care

    NARCIS (Netherlands)

    van Wilgen, C.P.; Bloten, H.; Oeseburg, B.

    2007-01-01

    Purpose. Fibromyalgia is a syndrome of unknown origin with a high prevalence. Multimodal approaches seem to be the treatment of choice in fibromyalgia. A multidisciplinary program was developed and implemented for patients with fibromyalgia in the primary care setting. The program included education

  1. Diagnosing Mental Health Disorders in Primary Care: Evaluation of a New Training Tool

    Science.gov (United States)

    Satter, Rachel

    2012-01-01

    Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD) are highly prevalent illnesses that can result in profound impairment. While many patients with these disorders present in primary care, research suggests that physicians under-detect and suboptimally manage MDD and PTSD in their patients. The development of more effective…

  2. Multimorbidity patterns in a primary care population aged 55 years and over.

    NARCIS (Netherlands)

    Sinnige, J.; Korevaar, J.C.; Westert, G.P.; Spreeuwenberg, P.; Schellevis, F.G.; Braspenning, J.C.C.

    2015-01-01

    Background. To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns. Objective. To identify the common and distinctive multimorbidity patterns. Methods. Clinical data of 120480 patients (≥55 years) were extracted from 158 general

  3. Multimorbidity patterns in a primary care population aged 55 years and over

    NARCIS (Netherlands)

    Sinnige, J.; Korevaar, J.C.; Westert, G.P.; Spreeuwenberg, P.; Schellevis, F.G.; Braspenning, J.C.

    2015-01-01

    Background. To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns. Objective. To identify the common and distinctive multimorbidity patterns. Methods. Clinical data of 120 480 patients (≥55 years) were extracted from 158 general

  4. Prevalence of Refractive errors in Primary school children in a rural ...

    African Journals Online (AJOL)

    Prevalence of Refractive errors in Primary school children in a rural community in Ebonyi state of Nigeria. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... However, no previous vision screening study among primary schools children ...

  5. Managing chronic conditions in a South African primary care context ...

    African Journals Online (AJOL)

    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.

  6. global health strategies versus local primary health care priorities

    African Journals Online (AJOL)

    CARE PRIORITIES - A CASE STUDY. OF NATIONAL ... development of comprehensive primary health care (pHC). The routine ..... on injection safety will be sustainable. On the negative side, ... This is mainly at management level, where time ...

  7. Knowledge, attitudes and practice pertaining to depression among primary health care workers in Tanzania

    Directory of Open Access Journals (Sweden)

    Shah Ajit

    2009-02-01

    Full Text Available Abstract Background Examination of consultation data in a variety of primary care settings in Tanzania shows that, while psychoses are routinely diagnosed and treated at primary care level, depression is rarely recorded as a reason for consultation. Since, epidemiological studies elswhere show that depression is a much more common disorder than psychosis, a series of studies were undertaken to elucidate this apparent paradox in Tanzania and inform mental health policy; firstly, a household prevalence study to ascertain the prevalence of common mental disorders at community level in Tanzania; secondly, a study to ascertain the prevalence of common mental disorders in primary care attenders; and thirdly, a study to ascertain the current status of the knowledge, attitude and practice pertaining to depression among primary health care workers. This paper reports the findings of the latter study. Methods All the primary health care workers (N = 14 in four primary health care centres in Tanzania were asked to complete the Depression Attitude Questionnaire, which assesses the health worker's knowledge and attitude towards the causes, consequences and treatment of depression. Results The majority of respondents felt that rates of depression had increased in recent years, believed that life events were important in the aetiology of depression, and generally held positive views about pharmacological and psychological treatments of depression, prognosis and their own involvement in the treatment of depressed patients. However, the majority of respondents felt that becoming depressed is a way that people with poor stamina deal with life difficulties. Conclusion The findings suggest a need to strengthen the training of primary health care workers in Tanzania about the detection of depression, pharmacological and psychological treatments, and psychosocial interventions.

  8. Knowledge, attitudes and practice pertaining to depression among primary health care workers in Tanzania

    Science.gov (United States)

    Mbatia, Joseph; Shah, Ajit; Jenkins, Rachel

    2009-01-01

    Background Examination of consultation data in a variety of primary care settings in Tanzania shows that, while psychoses are routinely diagnosed and treated at primary care level, depression is rarely recorded as a reason for consultation. Since, epidemiological studies elswhere show that depression is a much more common disorder than psychosis, a series of studies were undertaken to elucidate this apparent paradox in Tanzania and inform mental health policy; firstly, a household prevalence study to ascertain the prevalence of common mental disorders at community level in Tanzania; secondly, a study to ascertain the prevalence of common mental disorders in primary care attenders; and thirdly, a study to ascertain the current status of the knowledge, attitude and practice pertaining to depression among primary health care workers. This paper reports the findings of the latter study. Methods All the primary health care workers (N = 14) in four primary health care centres in Tanzania were asked to complete the Depression Attitude Questionnaire, which assesses the health worker's knowledge and attitude towards the causes, consequences and treatment of depression. Results The majority of respondents felt that rates of depression had increased in recent years, believed that life events were important in the aetiology of depression, and generally held positive views about pharmacological and psychological treatments of depression, prognosis and their own involvement in the treatment of depressed patients. However, the majority of respondents felt that becoming depressed is a way that people with poor stamina deal with life difficulties. Conclusion The findings suggest a need to strengthen the training of primary health care workers in Tanzania about the detection of depression, pharmacological and psychological treatments, and psychosocial interventions. PMID:19243596

  9. The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health

    OpenAIRE

    Fink, Per; ?rnb?l, Eva; Christensen, Kaj Sparle

    2010-01-01

    BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family p...

  10. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra

    2015-01-01

    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.

  11. [Inequality in primary care interventions in maternal and child health care in Mexico].

    Science.gov (United States)

    Ramírez-Tirado, Laura Alejandra; Tirado-Gómez, Laura Leticia; López-Cervantes, Malaquías

    2014-04-01

    To analyze the principal indicators associated with maternal mortality and mortality in children under 1 year of age and evaluate coverage levels and variability among the federative entities of Mexico. Eight interventions in maternal and child primary health care (variables) were studied: complete vaccination series, measles vaccine, and pentavalent vaccine in children under 1 year of age; early breast-feeding; prenatal care with at least one check-up by trained staff; prevalence of contraceptive use among married women of reproductive age; obstetric care in delivery by trained staff; and the administration of tetanus toxoid (TT) to pregnant women. The average and standard deviation of national coverage for each variable was calculated. Within each federative entity the proportion of municipalities with high, medium, and low marginalization was determined. States were ranked by the proportion of municipalities with high marginalization (highest to lowest) and divided into quintiles. Absolute inequality was measured using the observed difference and relative inequality, using the ratio of each variable studied. The average national coverage for the eight variables studied ranged from 86.5% to 97.5%, with administration of TT to pregnant women the lowest and administration of measles vaccine to children under 1 year of age the highest. Obstetric care in delivery, prevalence of contraceptive use, and prenatal checkup were the variables with less equitable coverage. In states with higher levels of marginalization, activities dependent on a structured health system-e.g., obstetric care in delivery-showed lower levels of coverage compared to preventive activities not requiring costly inputs or infrastructure-e.g., early breast-feeding. Interventions exhibiting greater inequity are associated with the lack of medical infrastructure and are more accentuated in federative entities with higher levels of marginalization. Greater public health expenditure is urgently needed

  12. Towards efficient use of research resources: a nationwide database of ongoing primary care research projects in the Netherlands.

    Science.gov (United States)

    Kortekaas, Marlous F; van de Pol, Alma C; van der Horst, Henriëtte E; Burgers, Jako S; Slort, Willemjan; de Wit, Niek J

    2014-04-01

    PURPOSE. Although in the last decades primary care research has evolved with great success, there is a growing need to prioritize the topics given the limited resources available. Therefore, we constructed a nationwide database of ongoing primary care research projects in the Netherlands, and we assessed if the distribution of research topics matched with primary care practice. We conducted a survey among the main primary care research centres in the Netherlands and gathered details of all ongoing primary care research projects. We classified the projects according to research topic, relation to professional guidelines and knowledge deficits, collaborative partners and funding source. Subsequently, we compared the frequency distribution of clinical topics of research projects to the prevalence of problems in primary care practice. We identified 296 ongoing primary care research projects from 11 research centres. Most projects were designed as randomized controlled trial (35%) or observational cohort (34%), and government funded mostly (60%). Thematically, most research projects addressed chronic diseases, mainly cardiovascular risk management (8%), depressive disorders (8%) and diabetes mellitus (7%). One-fifth of the projects was related to defined knowledge deficits in primary care guidelines. From a clinical primary care perspective, research projects on dermatological problems were significantly underrepresented (P = 0.01). This survey of ongoing projects demonstrates that primary care research has a firm basis in the Netherlands, with a strong focus on chronic disease. The fit with primary care practice can improve, and future research should address knowledge deficits in professional guidelines more.

  13. Rurality and mental health: an Australian primary care study.

    Science.gov (United States)

    Campbell, A; Manoff, T; Caffery, J

    2006-01-01

    Until recently, there has been a significant gap in the literature exploring the issues of the mental health needs for rural communities in Australia. In this study we investigated the prevalence of diagnosable psychological disorders in both a rural and a non-rural primary care sample in far north Queensland, Australia. In a previous study we had screened some 300 GP attendees, on a number of sociodemographic variables and measures of psychological wellbeing, from four rural GP practices and one regional GP practice. Of these, 130 participants agreed to further follow up. In this study, 118 of the participants were selected and contacted by phone to complete the Composite International Diagnostic Interview-Short Form (CIDI-SF). The CIDI-SF diagnosis was then analysed in relation to the sociodemographic indicators that had previously been collected. The prevalence of diagnosable mental health disorders in the rural sample was found to be higher in comparison with the regional urban sample. The sociodemographic factors of rural residence, gender, and length of residence were associated with having a CIDI-SF diagnosis. Although there were a number of methodological limitations to this study, there did appear to be a significant relationship between rural location and the likelihood of receiving a CIDI-SF diagnosis. Why this might be the case is not clear, and we consider a number of explanations, but our finding suggests that further research in mental health should consider the issue of rurality as a key feature to be explored.

  14. Child development in primary care: a surveillance proposal.

    Science.gov (United States)

    Coelho, Renato; Ferreira, José Paulo; Sukiennik, Ricardo; Halpern, Ricardo

    2016-01-01

    To evaluate a child development surveillance tool proposal to be used in primary care, with simultaneous use of the Denver II scale. This was a cross-sectional study of 282 infants aged up to 36 months, enrolled in a public daycare in a countryside community in Rio Grande do Sul/Brazil. Child development was assessed using the surveillance tool and the Denver II scale. The prevalence of probable developmental delay was 53%; most of these cases were in the alert group and 24% had normal development, but with risk factors. At the Denver scale, the prevalence of suspected developmental delay was 32%. When risk factors and sociodemographic variables were assessed, no significant difference was observed. The evaluation of this surveillance tool resulted in objective and comparable data, which were adequate for a screening test. It is easily applicable as a screening tool, even though it was originally designed as a surveillance tool. The inclusion of risk factors to the scoring system is an innovation that allows for the identification of children with suspected delay in addition to developmental milestones, although the definition of parameters and choice of indicators should be thoroughly studied. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  15. Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

    Directory of Open Access Journals (Sweden)

    Assendelft Willem JJ

    2008-01-01

    Full Text Available Abstract Background Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively. Methods In eight family practices 1046 consulting patients (25–79 yrs were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP. Results In the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7. Anxiety disorders had no independent effect. Conclusion Health care planning should focus on the recognition and treatment of somatoform as well as affective disorders.

  16. Primary care research conducted in networks: getting down to business.

    Science.gov (United States)

    Mold, James W

    2012-01-01

    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.

  17. [Risk factors and burnout levels in Primary Care nurses: A systematic review].

    Science.gov (United States)

    Gómez-Urquiza, Jose L; Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Fernández-Castillo, Rafael; Aguayo-Estremera, Raimundo; Cañadas-de la Fuente, Guillermo A

    2017-02-01

    To determine the risk factors and levels of burnout in Primary Care nurses. A systematic review was performed. CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Leaders, leadership and future primary care clinical research

    Directory of Open Access Journals (Sweden)

    Qureshi Nadeem

    2008-09-01

    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.

  19. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care : a review

    NARCIS (Netherlands)

    de Lange, E.; Verhaak, P. F. M.; van der Meer, K.

    Objective The aim of this study is to provide an overview of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalized long-term care. Design The method used in this study is a systematic PubMed search and literature review. Results The prevalence of delirium

  20. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review.

    NARCIS (Netherlands)

    Lange, E. de; Verhaak, P.F.M.; Meer, K. van der

    2013-01-01

    Objective: The aim of this study is to provide an overview of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalized long-term care. Design: The method used in this study is a systematic PubMed search and literature review. Results: The prevalence of

  1. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

    Science.gov (United States)

    Valentijn, Pim P; Schepman, Sanneke M; Opheij, Wilfrid; Bruijnzeels, Marc A

    2013-01-01

    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. 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. 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. 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.

  2. Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care.

    Science.gov (United States)

    Picardi, Angelo; Adler, D A; Rogers, W H; Lega, I; Zerella, M P; Matteucci, G; Tarsitani, L; Caredda, M; Gigantesco, A; Biondi, M

    2013-01-01

    Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a 'gold standard' diagnostic interview in primary care. A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available.

  3. [Poverty and disease: users of the primary care social services of a primary care center].

    Science.gov (United States)

    Doz Mora, J F; Mengual, L; Torné, M; Bonilla, P

    1994-06-15

    To find the individual and socio-family characteristics of that sector of the population which uses Primary Care Social Services (PCSS) at the Primary Care Centre (PCC) and the social problems which occasion demand. A retrospective descriptive study, based on checking over social work case files. A PCC situated in Barcelona's second industrial belt, serving a population with a low socio-economic level. The population group under study were the users with social work files open from January 1st 1985 to July 31st 1991 (a total of 690 case histories). A representative sample of 296 was selected. In comparison with the population of the basic Health Area, the user population of the PCSS at the PCC was predominantly women, and had an older average age, a higher proportion of divorce/separation and widowhood, and, in the labour context, higher unemployment and retirement. A high proportion of one-parent families (12.8%) was found. Analysis of the work situation showed that 50% of the workers were temporary and 75% of the unemployed received no benefit. 51% of the retired people received the minimum pension and 11% received no pension. Monthly family income, recorded for 46.5% of the cases, was 75,362 pesetas (SD 37,643). The most common problems were those related to the "HEALTH" section (61%). The user population of the PCSS at the PCC is, in socio-economic terms, deteriorated, a condition closely related to the development of chronic illnesses. Tackling health inequalities from Primary Care is under discussion.

  4. Primary Care Practice Transformation and the Rise of Consumerism.

    Science.gov (United States)

    Shrank, William H

    2017-04-01

    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.

  5. Implementation of primary health care - package or process ...

    African Journals Online (AJOL)

    After establishing the commitment of the government to comprehensive primary health care (PHC), the Department of Health and provinces are now faced with the challenge of implementation. An important response has come with the recent proposed'core package of primary health care services'.' After consultation with ...

  6. Political, cultural and economic foundations of primary care in Europe.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Zee, J. van der; Groenewegen, P.P.

    2013-01-01

    This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda,

  7. Political, cultural and economic foundations of primary care in Europe

    NARCIS (Netherlands)

    Kringos, Dionne S.; Boerma, Wienke G. W.; van der Zee, Jouke; Groenewegen, Peter P.

    2013-01-01

    This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda,

  8. Political, cultural and economic foundations of primary care in Europe

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Zee, J. van der; Groenewegen, P.P.

    2013-01-01

    This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political

  9. Consulting Psychiatry within an Integrated Primary Care Model

    Science.gov (United States)

    Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L.; Serrano, Neftali

    2014-01-01

    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

  10. Suicidality in primary care patients with somatoform disorders

    NARCIS (Netherlands)

    Wiborg, J.F.; Gieseler, D.; Fabisch, A.B.; Voigt, K.; Lautenbach, A.; Lowe, B.

    2013-01-01

    Objective To examine rates of suicidality in primary care patients with somatoform disorders and to identify factors that might help to understand and manage active suicidal ideation in these patients. Methods We conducted a cross-sectional study screening 1645 primary care patients. In total, 142

  11. College Students' Reasons for Depression Nondisclosure in Primary Care

    Science.gov (United States)

    Meyer, William J.; Morrison, Patrick; Lombardero, Anayansi; Swingle, Kelsey; Campbell, Duncan G.

    2016-01-01

    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…

  12. Abbreviated Pandemic Influenza Planning Template for Primary Care Offices

    Energy Technology Data Exchange (ETDEWEB)

    HCTT CHE

    2010-01-01

    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.

  13. Pain distribution in primary care patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Poulsen, Erik; Overgaard, Søren; Vestergaard, Jacob T

    2016-01-01

    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...

  14. [Primary care: A definition of the field to develop research].

    Science.gov (United States)

    Verga-Gérard, A

    2018-03-01

    Research in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l'offre de soins). The RECaP (Research in Clinical Epidemiology and Public Health) network is a French research network supported by Inserm, which recently implemented a specific working group focusing on research in primary care, based on a multidisciplinary approach. Researchers from different specialties participate in this group. The first aim of the group was to reach a common definition of the perimeter and of the panel of healthcare professionals and structures potentially involved in the field of primary care. For this purpose, a selection of different data sets of sources defining primary care was analyzed by the group, each participant collecting a set of sources, from which a synthesis was made and discussed. A definition of primary care at different levels (international, European and French) was summarized. A special attention was given to the French context in order to adapt the perimeter to the characteristics of the French healthcare system, notably by illustrating the different key elements of the definition with the inclusion of primary care actors and the type of practice premises. In conclusion, this work illustrates the diversity of primary care in France and the potential offered for research purposes. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. [Quality Indicators of Primary Health Care Facilities in Austria].

    Science.gov (United States)

    Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

    2017-07-11

    Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Integrated primary care in Germany: the road ahead

    Directory of Open Access Journals (Sweden)

    Sophia Schlette

    2009-04-01

    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

  17. Integrated primary care in Germany: the road ahead.

    Science.gov (United States)

    Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

    2009-04-20

    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. 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'. 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-sectoral education and training of providers.

  18. Borderline personality disorder in the primary care setting.

    Science.gov (United States)

    Dubovsky, Amelia N; Kiefer, Meghan M

    2014-09-01

    Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Identification of early childhood caries in primary care settings.

    Science.gov (United States)

    Nicolae, Alexandra; Levin, Leo; Wong, Peter D; Dave, Malini G; Taras, Jillian; Mistry, Chetna; Ford-Jones, Elizabeth L; Wong, Michele; Schroth, Robert J

    2018-04-01

    Early childhood caries (ECC) is the most common chronic disease affecting young children in Canada. ECC may lead to pain and infection, compromised general health, decreased quality of life and increased risk for dental caries in primary and permanent teeth. A multidisciplinary approach to prevent and identify dental disease is recommended by dental and medical national organizations. Young children visit primary care providers at regular intervals from an early age. These encounters provide an ideal opportunity for primary care providers to educate clients about their children's oral health and its importance for general health. We designed an office-based oral health screening guide to help primary care providers identify ECC, a dental referral form to facilitate dental care access and an oral health education resource to raise parental awareness. These resources were reviewed and trialled with a small number of primary care providers.

  20. Screening for anxiety, depression, and anxious depression in primary care

    DEFF Research Database (Denmark)

    Goldberg, David P.; Reed, Geoffrey M.; Robles, Rebeca

    2017-01-01

    Background In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. Methods The study was conducted in primary...... in primary care settings. Conclusions The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially...... care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted...

  1. Prevalence and severity of anemia among pregnant women in primary health centers/Erbil City

    Directory of Open Access Journals (Sweden)

    Rushna Ghazi Abdulwahid

    2017-07-01

    Full Text Available Anemia in pregnancy is a major public health problem, especially in developing countries. Nutritional anemia is the most common type of anemia worldwide and mainly includes iron, folic acid, vitamin B12 and vitamin C deficiencies. Iron deficiency contributes to half of the burden of anemia globally. The objectives of this study were to find out the prevalence and severity of anemia among pregnant women. A descriptive study was conducted on 600 pregnant women, during the period October 2015 to November 2016 at four primary health care centers in Erbil city. Data gathered through interview with study sample and filling questionnaire format and reviewing their antenatal records. Blood hemoglobin level was measured to assess the severity of anemia. Chi-square test and regression were used to analyze the data. Prevalence of anemia was 46.2%, and 67.1% of the anemic women had mild anemia. There was a significant association of severity of anemia with wife education and occupation, smoking, the number of abortions and cesarean section, ante partum hemorrhage, taking tablets of iron and folic acid per month. The study concluded that prevalence of anemia considered high in Erbil city, the highest percentage had mild anemia.

  2. Prevalence of Refractive errors among Primary School Pupils in ...

    African Journals Online (AJOL)

    Administrator

    Effective management of blindness due to refractive errors is readily available in developed countries. 1 ... Key words: Refractive errors, Children, Prevalence, Kenya. 165 .... financial support towards the funding of this study. REFERENCES. 1.

  3. Prevalence and correlates of hunger among primary and secondary ...

    African Journals Online (AJOL)

    data on the prevalence and associated factors of hunger among school children in Malawi. ... children in Malawi, we carried out this study to provide such information. .... due to the protection against hunger that children who are normally in ...

  4. Electronic consultation system demonstrates educational benefit for primary care providers.

    Science.gov (United States)

    Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S

    2017-01-01

    Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

  5. The prevalence of primary hereditary hemochromatosis in central Anatolia.

    Science.gov (United States)

    Karaca, Halit; Güven, Kadri; Önal, Müge; Gürsoy, Şebnem; Başkol, Mevlüt; Özkul, Yusuf

    2013-01-01

    Hereditary hemochromatosis is an autosomal recessive disorder associated with the HFE genes. Early identification and diagnosis is important as end stage organ damage may occur if treatment is delayed.. This study aimed to identify the prevalence of hereditary hemochromatosis in Kayseri and surroundings known as Central Anatolia. 2304 participants (1220 males, 1084 females) who were older then the age of 17 were included in the study conducted between December 2005 and December 2006 in Kayseri, Turkey. Transferin saturation was measured from overnight fasting blood samples. Serum iron, total iron binding capacity, and transferin saturation were measured. Serum ferritin levels and hereditary hemochromatosis genetic analysis were also performed after an overnight fasting blood samples from participants whose transferin saturation results were more than 50% in man and more than 45% in women. The homozygote C282Y mutation and heterozygote C282Y mutation prevalences were found as 0.08% (1/1220) and 0.08% (1/1220) in male participants, respectively. The heterozygote H63D mutation prevalence was found in 0.09% (1/1084) of female participants. Calculated prevalences in general population are as follows; The homozygote C282Y mutation prevalence is 0.043% (1/2304), the heterozygote C282Y mutation prevalence is 0.043% (1/2304) and the heterozygote H63D mutation prevalence is 0.043% (1/2304). The prevalence of hereditary hemochromatosis in Central Anatolia is 0.043% (1/2304). Because of the relatively low frequency, population screening studies are not cost-effective.

  6. Pharmaceutical care in Brazil’s primary health care

    Directory of Open Access Journals (Sweden)

    Patricia Sodré Araújo

    2017-11-01

    Full Text Available ABSTRACT OBJECTIVE To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015, a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285 were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. RESULTS From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were “pharmaceutical guidance” and “pharmaceutical care.” The registration of activities is mainly made in the users’ medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. CONCLUSIONS Activities of clinical nature

  7. The prevalence, aetiology and management of wounds in a community care area in Ireland.

    LENUS (Irish Health Repository)

    Skerritt, Louise

    2014-06-01

    This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care.

  8. Home health services in primary care: What can we do?

    Directory of Open Access Journals (Sweden)

    Yasemin Çayır

    2013-01-01

    Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

  9. Cross-cultural differences in the epidemiology of unexplained fatigue syndromes in primary care.

    Science.gov (United States)

    Skapinakis, Petros; Lewis, Glyn; Mavreas, Venetsanos

    2003-03-01

    Unexplained fatigue has been extensively studied but most of the samples used were from Western countries. To present international data on the prevalence of unexplained fatigue and fatigue as a presenting complaint in primary care. Method Secondary analysis of the World Health Organization study of psychological problems in general health care. A total of 5438 primary care attenders from 14 countries were assessed with the Composite International Diagnostic Interview. The prevalence of unexplained fatigue of 1-month duration differed across centres, with a range between 2.26 (95% CI 1.17-4.33) and 15.05 (95% CI 10.85-20.49). Subjects from more-developed countries were more likely to report unexplained fatigue but less likely to present with fatigue to physicians compared with subjects from less developed countries. In less-developed countries fatigue might be an indicator of unmet psychiatric need, but in more-developed countries it is probably a symbol of psychosocial distress.

  10. BURNOUT SYNDROME IN NURSES OF PRIMARY HEALTH CARE: AN INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    Magno Conceição das Merces

    2015-04-01

    Full Text Available Background and Objective: Burnout Syndrome (BS also known as burnout is described as a phenomenon composed of feelings of failure and exhaustion, caused by excessive wear and energy resources, mediated by practice and work stress. In this sense, the nurse Primary Health Care (PHC is not exempted in the development of the syndrome in question, since it is a profession that develops their work activities through direct contact with patients and families, making workloads too much which can depreciate the quality of care. This study becomes relevant because it will contribute to the PHC nurses have deeper knowledge of the BS, and few studies at this level of health care. He stood as guiding question: What is the prevalence of BS nurses in the PHC based in Brazilian literature from 2000 to 2014? And as objective to determine the prevalence of BS nurses in the PHC. Content: This is an integrative literature review. To that end, we conducted survey of manuscripts published from 2000 to 2014, using as descriptors, in combination: nurse; burnout and primary care in the Virtual Health Library (VHL. Conclusion: It is not yet possible to know the prevalence of BS nurses in the PHC due to lack of studies in the area. KEYWORDS: Nurse. Burnout, Professional. Primary Health Care.

  11. Primary care quality management in Slovenia.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Bulc, M.

    2008-01-01

    Of all GPs in Slovenia 86% are not interested in activities to systematically improve care. A clear national quality policy, further education for care managers and financial incentives for GPs could change the picture, as NIVEL research – done on the initiative of the World Health Organisation

  12. [Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience].

    Science.gov (United States)

    Calderón, Carlos; Balagué, Laura; Iruin, Álvaro; Retolaza, Ander; Belaunzaran, Jon; Basterrechea, Javier; Mosquera, Isabel

    2016-01-01

    To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. Pilot collaborative project from a participatory action research approach during 2013. Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetza registers of prevalences, referrals and treatments. Follow-up meetings. Improvement in the 4 axes of intervention in the participant centres compared with the controls. Identification of factors to be considered in the development and sustainability of PC-MH collaborative care. The pilot experience confirms that collaborative projects promoted by PC and MH can improve depression care and the satisfaction of professionals. They are complex projects that need simultaneous interventions adjusted to the particularities of the health services. Multidisciplinary and continuous participation and management and information system support are necessary for their implementation. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  13. Prevalence and risk factors of frailty among home care clients.

    Science.gov (United States)

    Miettinen, Minna; Tiihonen, Miia; Hartikainen, Sirpa; Nykänen, Irma

    2017-11-17

    Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients. The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities. Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty. Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems. ClinicalTrials.gov: NCT02214758 .

  14. Health psychology in primary care: recent research and future directions

    Directory of Open Access Journals (Sweden)

    Thielke S

    2011-06-01

    Full Text Available Stephen Thielke1, Alexander Thompson2, Richard Stuart31Psychiatry and Behavioral Sciences, University of Washington, Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA; 2Group Health Cooperative, Seattle, WA, USA; 3Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USAAbstract: Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.Keywords: health psychology, primary care, integrated care, collaborative care, referral, colocation

  15. Using Cognitive Behavior Therapy and Mindfulness Techniques in the Management of Chronic Pain in Primary Care.

    Science.gov (United States)

    Baker, Norah

    2016-06-01

    Chronic pain and its associated syndrome have become increasingly prevalent in primary care. With the increase in narcotic use and subsequent adverse events, primary care physicians often seek safer alternatives to treating this condition. Prescribing narcotics necessitates using methods to screen for high abuse risk and protect against misuse. With the understanding of how chronic pain is related to mental illnesses such as depression and posttraumatic stress disorder, mindfulness techniques and behavioral therapy can be used to help decrease the dependence on dangerous opioid medications and help patients understand, accept, and cope with their chronic pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Primary care patients with anxiety and depression: need for care from the patient's perspective.

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.F.M.; Meer, K. van der; Penninx, B.W.J.H.; Bensing, J.M.

    2009-01-01

    Many anxiety and depression patients receive no care, resulting in unnecessary suffering and high costs. Specific beliefs and the absence of a perceived need for care are major reasons for not receiving care. This study aims to determine the specific perceived need for care in primary care patients

  17. Development of a Proactive Care Program (U-CARE) to Preserve Physical Functioning of Frail Older People in Primary Care

    NARCIS (Netherlands)

    Bleijenberg, N.; Ten Dam, V.H.; Drubbel, I.; Numans, M.E.; De Wit, N.J.; Schuurmans, M.J.

    2013-01-01

    Purpose: Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in

  18. Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting

    OpenAIRE

    Kaur, Gurpreet; Tee, Guat Hiong; Ariaratnam, Suthahar; Krishnapillai, Ambigga S; China, Karuthan

    2013-01-01

    Background Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, ...

  19. Community nurses working in piloted primary care teams: Irish Republic.

    LENUS (Irish Health Repository)

    Burke, Triona

    2010-08-01

    Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse\\'s experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse\\'s roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.

  20. Prevalence of geohelminth in soil and primary school children in ...

    African Journals Online (AJOL)

    A study of geohelminthes infections among primary school children aged 8 to 13 years was conducted in four selected primary schools in Panda Development Area, Karu LGA, Nasarawa State, Nigeria. Out of four hundred and eighty (480) soil samples collected from the four schools, 314 (82.63) were found to be positive ...

  1. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    OpenAIRE

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    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...

  2. Patient, Satisfaction, Factor, Importance, Primary Health Care

    African Journals Online (AJOL)

    Dr Olaleye

    healthcare workers in outpatient clinics remain a challenge to quality care. The objective of the study is ... confidence on the quality of service provided by the facilities. Thus the objective ..... practitioner relationship. Journal of General Internal.

  3. Prevalence of Persistent Primary Reflexes and Motor Problems in Children with Reading Difficulties

    Science.gov (United States)

    McPhillips, M.; Sheehy, N.

    2004-01-01

    It has been shown that some children with reading difficulties have underlying developmental delay and that this may be related to the persistence of primary reflexes. This study investigated the prevalence of persistent primary reflexes in the ordinary primary school population and how this related to other cognitive and social factors. Three…

  4. Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study

    NARCIS (Netherlands)

    Ruijs, C.D.M.; Kerkhof, A.J.F.M.; van der Wal, G.; Onwuteaka-Philipsen, B.D.

    2013-01-01

    Background: Primary care physicians provide palliative home care. In cancer patients dying at home in the Netherlands (45% of all cancer patients) euthanasia in about one out of every seven patients indicates unbearable suffering. Symptom prevalence, relationship between intensity of symptoms and

  5. Improving Communication About Serious Illness in Primary Care: A Review.

    Science.gov (United States)

    Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

    2016-09-01

    The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will

  6. Measuring progress towards a primary care-led NHS.

    Science.gov (United States)

    Miller, P; Craig, N; Scott, A; Walker, A; Hanlon, P

    1999-07-01

    The push towards a 'primary care-led' National Health Service (NHS) has far-reaching implications for the future structure of the NHS. The policy involves both a growing emphasis on the role of primary care practitioners in the commissioning of health services, and a change from hospital to primary and community settings for a range of services and procedures. Although the terminology has changed, this emphasis remains in the recent Scottish Health Service White Paper and its English counterpart. To consider three questions in relation to this policy goal. First, does the evidence base support the changes? Secondly, what is the scale of the changes that have occurred? Thirdly, what are the barriers to the development of a primary care-led NHS? Programme budgets were compiled to assess changes over time in the balance of NHS resource allocation with respect to primary and secondary care. Total NHS revenue expenditure for the 15 Scottish health boards was grouped into four blocks or 'programmes': primary care, secondary care, community services, and a residual. The study period was 1991/2 to 1995/6. Expenditure data were supplied by the Scottish Office. Ambiguity of definitions and the absence of good data cause methodological difficulties in evaluating the scale and the appropriateness of the shift. The data that are available suggest that, at the aggregate level, there have been changes over time in the balance of resource allocation between care settings: relative investment into primary care has increased. It would appear that this investment is relatively small and from growth money rather than a 'shift' from secondary care. In addition, the impact of GP-led commissioning is variable but limited. General practitioners' (GPs') attitudes to the policy suggest that progress towards a primary care-led NHS will continue to be patchy. The limited shift to date, alongside evidence of ambivalent attitudes to the shift on the part of GPs, suggest that this is a policy

  7. Prevalence of dermatophytosis among primary school children in ...

    African Journals Online (AJOL)

    2011-01-13

    Jan 13, 2011 ... Another possible explanation for the low prevalence of ... April 12, 2011, IP: 41.185.171.107] || Click here to download free Android application for this journal ... appear to be neater than boys, as they pay more attention.

  8. Prevalence of amblyopia and refractive errors among primary school children

    Directory of Open Access Journals (Sweden)

    Zhale Rajavi

    2015-01-01

    Results: Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9% of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004. Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ≥+2.00D, myopia ≤-0.50D, astigmatism ≥0.75D, and anisometropia (≥1.00D was 3.5%, 4.9%, 22.6%, and 3.9%, respectively. With increasing age, the prevalence of myopia increased (P<0.001, that of hyperopia decreased (P=0.007, but astigmatism showed no change. Strabismus was found in 2.3% of cases. Strabismus (OR=17.9 and refractive errors, especially anisometropia (OR=12.87 and hyperopia (OR=11.87, were important amblyogenic risk factors. Conclusion: The high prevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations.

  9. Prevalence of enuresis among primary school children in Port ...

    African Journals Online (AJOL)

    Descriptive statistics and chi-square test were used for data analysis. Results: A total of 922 school children, consisting of 463 (50.2%) males and 459 (49.8%) females were studied. The response rate was 82.2%. The overall prevalence of enuresis was 23.2%. Enuresis was notably more common in boys (male: female ratio ...

  10. Prevalence and determinants of stunting among primary school ...

    African Journals Online (AJOL)

    Background: Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the ...

  11. prevalence and intensity of urinary schistosomiasis among primary ...

    African Journals Online (AJOL)

    DR. AMINU

    ABSTRACT. Urine samples were collected from 493 pupils (5-16 years) at Wasai and Dingim wards in Minjibir ... predominantly farmers. However, due ... of infection (113.36 EPC ) than females (33.67) EPC urine. These differences in prevalence and intensity of infection between males and females were highly significant.

  12. High prevalence of primary dyslipidaemia in black South African ...

    African Journals Online (AJOL)

    In South Africa (SA), premature deaths due to heart and blood vessel diseases in people of working age (35 - 64 years) have been predicted to increase by 41% between 2007 ... To assess the burden and prevalence of dyslipidaemia in the SA black population at Dr George Mukhari Hospital in the north region of Gauteng.

  13. A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol.

    Science.gov (United States)

    Bello, Aminu K; Ronksley, Paul E; Tangri, Navdeep; Singer, Alexander; Grill, Allan; Nitsch, Dorothea; Queenan, John A; Lindeman, Cliff; Soos, Boglarka; Freiheit, Elizabeth; Tuot, Delphine; Mangin, Dee; Drummond, Neil

    2017-08-04

    Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery. The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients' demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3-5 will be presented as age-sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age-sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods. The CPCSSN is committed to high ethical standards when dealing with

  14. Care of children with disabilities in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Thaís Giudice Schultz

    2016-07-01

    Full Text Available Objective: This article describes an experience report that aimed to present perceptions on the care of children with disabilities in the Family Health Strategy (FHS, showing its limits and potentials based on the experience of participation in the program ‘PET-Saúde’. Method: Data were collected from field notes which recorded the monitoring of the care process offered to children with disabilities by the FHS teams. The study was conducted in a health facility in the city of Rio de Janeiro for one year. Results: Content analysis results listed the two main themes that composed the issues of concern for child care in this experience: the coordination of health care and the family and community orientation as the core for child care in the FHS. Conclusion: Despite the weakness in compliance with these categories, which are principles and fundamentals of the FHS, this is a privileged space with regard to care practices for children with disabilities.

  15. Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

    Science.gov (United States)

    Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

    2018-01-01

    Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

  16. Nature and pattern of primary teeth extractions in a tertiary care hospital setting in South India

    Directory of Open Access Journals (Sweden)

    Shini Susan Samuel

    2018-01-01

    Full Text Available Background: Many studies have been carried out on the prevalence of dental diseases in children although not much information is available regarding its outcome among Indian children. Aim: The aim of the present study was to analyze the type of primary tooth extracted and the reasons for the extraction among children attending a tertiary care hospital in the Southern part of India. Materials and Methods: The dental records of pediatric patients who had visited the dental clinic of a tertiary care hospital located in Tamil Nadu, South India from December 2013 to November 2016 were reviewed. Patients who underwent extraction of at least one primary tooth under local or general anesthesia were included in the study. Results: A total of 943 primary teeth were extracted from 447 patients over 3 years. The most commonly extracted tooth type was the first primary molar followed by the primary central incisor. Grouping by age, the most frequently extracted tooth type between 2 and 5 years was the primary central incisor, the first primary molar among the 6–9-year-old and the second primary molar among 10–15-year-old. The majority of primary teeth extractions were performed in the age group of 6–9 years. No significant gender differences were noted. The most common reason for extraction of primary teeth in children was dental caries. Conclusions: This study demonstrates a high prevalence of untimely primary teeth extractions in young children and dental caries continues to be the leading cause. It clearly reflects on the lack of infant oral health care, the inadequacy of awareness and underutilization of oral health services among children in India.

  17. Improving primary care for persons with spinal cord injury: Development of a toolkit to guide care.

    Science.gov (United States)

    Milligan, James; Lee, Joseph; Hillier, Loretta M; Slonim, Karen; Craven, Catharine

    2018-05-07

    To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care. Modified Delphi consensus process; survey methodology. Primary care. Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys. Importance of care elements for inclusion in the toolkit (9-point scale: 1 = lowest level of importance, 9 = greatest level of importance) and identification of most responsible physician (family physician, specialist) for completing key categories of care. Open-ended comments were solicited. There was consensus between the respondent groups on the level of importance of various care elements. Mean importance scores were highest for autonomic dysreflexia, pain, and skin care and lowest for preventive care, social issues, and vital signs. Although, there was agreement across all respondents that family physicians should assume responsibility for assessing mental health, there was variability in who should be responsible for other care categories. Comments were related to the need for shared care approaches and capacity building and lack of knowledge and specialized equipment as barriers to optimal care. This study identified important components of SCI care to be included in a point-of-practice toolkit to facilitate primary care for persons with SCI.

  18. Older Patients' Perspectives on Quality of Serious Illness Care in Primary Care.

    Science.gov (United States)

    Abu Al Hamayel, Nebras; Isenberg, Sarina R; Hannum, Susan M; Sixon, Joshua; Smith, Katherine Clegg; Dy, Sydney M

    2018-01-01

    Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. To explore older patients' perspectives on the quality of serious illness care in primary care. Qualitative interview study. Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic's quality improvement initiative. We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians' perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

  19. Team-based primary care: The medical assistant perspective.

    Science.gov (United States)

    Sheridan, Bethany; Chien, Alyna T; Peters, Antoinette S; Rosenthal, Meredith B; Brooks, Joanna Veazey; Singer, Sara J

    Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs. The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences. In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction. Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged. Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels. To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.

  20. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

    Science.gov (United States)

    Verstappen, Wim; Gaal, Sander; Bowie, Paul; Parker, Diane; Lainer, Miriam; Valderas, Jose M.; Wensing, Michel; Esmail, Aneez

    2015-01-01

    ABSTRACT Background: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. Objective: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. Methods: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. Results: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Conclusion: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement. PMID:26339841

  1. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care.

    Science.gov (United States)

    Verstappen, Wim; Gaal, Sander; Bowie, Paul; Parker, Diane; Lainer, Miriam; Valderas, Jose M; Wensing, Michel; Esmail, Aneez

    2015-09-01

    Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. To outline a research agenda for patient safety improvement in primary care in Europe and beyond. The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.

  2. Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".

    Science.gov (United States)

    Koslov, Steven; Trowbridge, Elizabeth; Kamnetz, Sandra; Kraft, Sally; Grossman, Jeffrey; Pandhi, Nancy

    2016-09-01

    Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS

    Science.gov (United States)

    Baron, Richard J.

    2012-01-01

    Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007

  4. Prevention of anxiety disorders in primary care: A feasibility study

    Directory of Open Access Journals (Sweden)

    Batelaan Neeltje M

    2012-11-01

    Full Text Available Abstract Background Anxiety disorders are highly prevalent in primary care and cause a substantial burden of disease. Screening on risk status, followed by preventive interventions in those at risk may prevent the onset of anxiety disorders, and thereby reduce the disease burden. The willingness to participate in screening and interventions is crucial for the scope of preventive strategies, but unknown. This feasibility study, therefore, investigated participation rates of screening and preventive services for anxiety disorders in primary care, and explored reasons to refrain from screening. Methods In three general practices, screening was offered to individuals visiting their general practitioner (total n = 2454. To assess risk status, a 10-item questionnaire was followed by a telephone interview (including the CIDI when scoring above a predefined threshold. Preventive services were offered to those at risk. Participation rates for screening and preventive services for anxiety disorders were assessed. Those not willing to be screened were asked for their main reason to refrain from screening. Results Of all individuals, 17.3% participated in initial screening, and of those with a possible risk status, 56.0% continued screening. In 30.1% of those assessed, a risk status to develop an anxiety disorder was verified. Of these, 22.6% already received some form of mental health treatment and 38.7% of them agreed to participate in a preventive intervention and were referred. The most frequently mentioned reasons to refrain from screening were the emotional burden associated with elevated risk status, the assumption not to be at risk, and a lack of motivation to act upon an elevated risk status by using preventive services. Conclusions Screening in general practice, followed by offering services to prevent anxiety disorders in those at risk did not appear to be a feasible strategy due to low participation rates. To enable the development of

  5. Primary care practice organization influences colorectal cancer screening performance.

    Science.gov (United States)

    Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

    2007-06-01

    To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (pmanagement and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

  6. [ETAP: A smoking scale for Primary Health Care].

    Science.gov (United States)

    González Romero, Pilar María; Cuevas Fernández, Francisco Javier; Marcelino Rodríguez, Itahisa; Rodríguez Pérez, María Del Cristo; Cabrera de León, Antonio; Aguirre-Jaime, Armando

    2016-05-01

    To obtain a scale of tobacco exposure to address smoking cessation. Follow-up of a cohort. Scale validation. Primary Care Research Unit. Tenerife. A total of 6729 participants from the "CDC de Canarias" cohort. A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI). The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors. The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  7. Obesity and female fertility: a primary care perspective.

    Science.gov (United States)

    Wilkes, Scott; Murdoch, Alison

    2009-07-01

    Infertility affects approximately one in six couples during their lifetime. Obesity affects approximately half of the general population and is thus a common problem among the fertile population. Obese women have a higher prevalence of infertility compared with their lean counterparts. The majority of women with an ovulatory disorder contributing to their infertility have polycystic ovary syndrome (PCOS) and a significant proportion of women with PCOS are obese. Ovulation disorders and obesity-associated infertility represent a group of infertile couples that are relatively simple to treat. Maternal morbidity, mortality and fetal anomalies are increased with obesity and the success of assisted reproductive technology (ART) treatments is significantly reduced for obese women. Body mass index (BMI) treatment limits for ART throughout the UK vary. The mainstay for treatment is weight loss, which improves both natural fertility and conception rates with ART. The most cost-effective treatment strategy for obese infertile women is weight reduction with a hypo-caloric diet. Assisted reproduction is preferable in women with a BMI of 30 kg/m(2) or less and weight loss strategies should be employed within primary care to achieve that goal prior to referral.

  8. [Burnout syndrome and suicide risk among primary care nurses].

    Science.gov (United States)

    Tomás-Sábado, Joaquín; Maynegre-Santaulària, Montserrat; Pérez-Bartolomé, Meritxell; Alsina-Rodríguez, Marta; Quinta-Barbero, Roser; Granell-Navas, Sergi

    2010-01-01

    To observe the prevalence of the burnout syndrome and the relationship with suicide risk, self-esteem, anxiety and depression, in a sample of primary care nurses. Observational, cross-sectional and correlational study. The sample consisted of 146 nursing professionals, 131 women and 15 men, with an average age of 44.02 years (SD=10.89). Participants responded to a questionnaire which included the Spanish forms of the Maslach burnout inventory (MBI), the Plutchik Suicide Risk Scale (SR), the Kuwait University Anxiety Scale (KUAS), the Self-Rating Depression Scale (SDS) and the Rosenberg Self-esteem Scale (RSES). In the inferential statistical analysis, Pearson's r coefficients and multiple linear regression were calculated. Significant correlations between suicidal risk and anxiety, depression, self-esteem, emotional exhaustion and personal performance, were obtained. In the multiple regression analysis, depression was the main predictor of suicidal risk, followed by anxiety and emotional exhaustion. The scores obtained in burnout and suicidal risk were, in general, lower than those observed in other studies, emphasising the high level observed in personal performance, which reflects reasonable professional satisfaction. The results show the important role of working atmosphere and early recognition of mental disorders in burnout and suicidal risk prevention. Copyright (c) 2009 Elsevier España, S.L. All rights reserved.

  9. The role of nurses in commissioning services within primary care.

    Science.gov (United States)

    Leach, Katherine; Shepherd, Alison Burton

    2013-04-01

    This article is a critical reflection on the role of the nurse in commissioning a service within the primary care setting. It will use the fictitious example of commissioning a nurse-led crisis prevention service in the London borough of Lambeth as an exemplar to highlight the difficulties surrounding the commissioning process. In placing particular focus on the prevalence of smoking, it is suggested that designing services based around tackling 'clusters' of unhealthy risk factors such as smoking, diet and excessive alcohol consumption may be a more holistic approach to delivering better healthcare outcomes for more socioeconomically deprived populations as opposed to previous national siloed attempts (Buck and Forsini 2012;1). It will argue that despite multifaceted and evolving roles, community nurses are ideally placed to recognise compounding risk factors detrimental to health as they work at the interface between the individual and their environment. This awareness can be used to positively impact on the commissioning process but only if greater attention is paid towards enhancing leadership skills throughout nursing, and the rhetoric of effective collaboration across agencies is translated into practice (Ham et al, 2012; NHS Commissioning Board (NHS CB), 2012), NHS Alliance, 2011).

  10. Prevalência da amamentação em crianças menores de dois anos vacinadas nos centros de saúde escola Breastfeeding prevalence among children less than two years old immunized in primary health care school services

    Directory of Open Access Journals (Sweden)

    Daniella Fernandes Camilo

    2004-03-01

    Full Text Available OBJETIVO: Neste trabalho foi desenvolvido estudo transversal com o objetivo de verificar a prevalência da amamentação em 1 708 crianças menores de dois anos em Campinas, São Paulo. MÉTODOS: As informações sobre idade, sexo, serviço de saúde utilizado e alimentação foram obtidas por entrevistas com mães ou responsáveis durante a Campanha de Multivacinação de 2001. A amamentação foi classificada como exclusiva, predominante (incluindo outros líquidos, exceto leites, complementar (incluindo outros alimentos e/ou leites e total (soma de exclusivo, predominante e complementar. RESULTADOS: A análise demonstrou que a mediana de amamentação exclusiva foi de 68 dias e a de amamentação total foi de 6,4 meses. No primeiro semestre de vida, 38,1% das crianças estavam em amamentação exclusiva; 23,0% em predominante e 14,9% em complementar. No segundo semestre, 36,5% das crianças recebiam leite materno; no terceiro 26,4% e no quarto 13,9%. Crianças usuárias dos serviços públicos e das unidades locais de saúde apresentaram menor risco de desmame do que as usuárias dos serviços privados e de serviços não locais (pOBJECTIVE: A cross-sectional survey was developed aiming to identify the prevalence of breastfeeding among children aged 0-2 years living in Campinas, Sao Paulo state, Brazil. METHODS: Data on age, sex, health care service used and feeding were obtained by interviewing the mothers or caregivers of 1,708 children during the National Immunization Campaign in 2001. Breastfeeding was classified as exclusive, predominant (including others liquids, except milks, complementary (including others foods and/or others milks and total (sum of exclusive, predominant and complementary. RESULTS: The median exclusive breastfeeding was 68 days and median total breastfeeding was 6.4 months. In the first semester of life, 38.1% of the children were exclusively breastfed, 23.0 predominantly and 14.9% complementary breastfed. In the

  11. Knowledge of primary care nurses regarding domestic violence

    African Journals Online (AJOL)

    Nagham N. Alsafy

    2011-06-12

    Jun 12, 2011 ... Conclusion: Overall, primary care nurses had poor knowledge regarding DV. Although female ... Physical abuse is defined as any behavior in which the body ... activity.5 Psychological abuse essentially and significantly dif-.

  12. Pain management in primary care – current perspectives | Meyer ...

    African Journals Online (AJOL)

    According to a 1998 World Health Organization Survey of 26 000 primary care ... in pain medicine and continue to follow the biomedical approach, which ... The modern paradigm of pain management has moved from this biomedical to the ...

  13. Factors affecting the referral of primary health care doctors toward ...

    African Journals Online (AJOL)

    Hend Al-Namash

    2011-06-08

    Jun 8, 2011 ... There is a worldwide epidemic of overweight, obesity, and morbid obesity ... the evolution of bariatric surgery.4 Controversy exists regard- ing the best ..... attitudes and practices among Israeli primary care physicians. Int J.

  14. Caregivers' satisfaction and supervision of primary health care ...

    African Journals Online (AJOL)

    Caregivers' satisfaction and supervision of primary health care services in Nnewi, ... made in the reduction of childhood health indicators in the previous decade, ... supervision of PHCs should also improve the quality of child health services.

  15. The motivational needs of primary health care nurses to acquire ...

    African Journals Online (AJOL)

    The motivational needs of primary health care nurses to acquire power as leaders in ... Ethical considerations were adhered to and respondents gave written ... Validity and reliability principles were applied during the entire research process.

  16. Participatory action research in the training of primary health care ...

    African Journals Online (AJOL)

    Participatory action research in the training of primary health care nurses in Venda. ... who had been part of the nurse training programme with clinic attenders. ... enough access to financial decision making and were therefore powerless to ...

  17. Journal of Community Medicine and Primary Health Care - Vol 23 ...

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care - Vol 23, No 1-2 (2011) ... The Nigerian National Health Bill 2011: Delay of Presidential Assent to an Act: ... Knowledge And Practice of Occupational Safety Among Quarry Workers in A ...

  18. Effect of training intervention on primary health care workers ...

    African Journals Online (AJOL)

    Savannah Journal of Medical Research and Practice ... Design: A quasi experimental design, used multi stage sampling technique to select participants. ... Primary health care centers are fairly evenly distributed in all the 16 local government ...

  19. Managing chronic conditions in a South African primary care context ...

    African Journals Online (AJOL)

    Associate Professor, Department of Family Medicine and Primary Care,. University of Stellenbosch & Community Health Services Organisation,. Department of Health ..... helped to create an atmosphere of .... Journal of Mental Health. 1992 ...

  20. Advance directives: survey of primary care patients.

    Science.gov (United States)

    O'Sullivan, Rory; Mailo, Kevin; Angeles, Ricardo; Agarwal, Gina

    2015-04-01

    To establish the prevalence of patients with advance directives in a family practice, and to describe patients' perspectives on a family doctor's role in initiating discussions about advance directives. A self-administered patient questionnaire. A busy urban family medicine teaching clinic in Hamilton, Ont. A convenience sample of adult patients attending the clinic over the course of a typical business week. The prevalence of advance directives in the patient population was determined, and the patients' expectations regarding the role of their family doctors were elucidated. The survey population consisted of 800 participants (a response rate of 72.5%) well distributed across age groups; 19.7% had written advance directives and 43.8% had previously discussed the topic of advance directives, but only 4.3% of these discussions had occurred with family doctors. In 5.7% of cases, a family physician had raised the issue; 72.3% of respondents believed patients should initiate the discussion. Patients who considered advance directives extremely important were significantly more likely to want their family doctors to start the conversation (odds ratio 3.98; P < .05). Advance directives were not routinely addressed in the family practice. Most patients preferred to initiate the discussion of advance directives. However, patients who considered the subject extremely important wanted their family doctors to initiate the discussion. Copyright© the College of Family Physicians of Canada.

  1. Prevalence of somatization and minor psychiatric morbidity in primary healthcare in Saudi Arabia: A preliminary study in Asir region

    Directory of Open Access Journals (Sweden)

    Mohammed M Alqahtani

    2008-01-01

    Full Text Available Objective : To determine the prevalence of psychological disorders and somatization among primary care patients from a semi-urban area of the Kingdom of Saudi Arabia. Design : Screening of consecutive patients with the 12-item and 28-item versions of the General Health Questionnaires and assessments of physical symptoms associated with somatization, using the HSCL-12. Eight primary care health centres in Assir, Saudi Arabia. Results : About half of the sample had one or more psychological disorders. The prevalence of somatization detected by the GHQ-28 was 16%. The prevalence of somatization indicated by GPs′ identification of medically unexplained symptoms was 14%. Women displayed higher levels of somatization than men. Conclusion : This study reported prevalence of psychological disorders that was as high as found in the more modern areas of Saudi Arabia such as Riyadh. The view that individuals in less open areas are protected from psychological disorders associated with stress and lifestyle pressure seems to be unsubstantiated. The results highlight the potential value of screening for psychological disorders using such simple instruments as the GHQ

  2. Prevalence of somatization and minor psychiatric morbidity in primary healthcare in saudi arabia: a preliminary study in asir region.

    Science.gov (United States)

    Alqahtani, Mohammed M; Salmon, Peter

    2008-01-01

    To determine the prevalence of psychological disorders and somatization among primary care patients from a semi-urban area of the Kingdom of Saudi Arabia. Screening of consecutive patients with the 12-item and 28-item versions of the General Health Questionnaires and assessments of physical symptoms associated with somatization, using the HSCL-12. Eight primary care health centres in Assir, Saudi Arabia. About half of the sample had one or more psychological disorders. The prevalence of somatization detected by the GHQ-28 was 16%. The prevalence of somatization indicated by GPs' identification of medically unexplained symptoms was 14%. Women displayed higher levels of somatization than men. This study reported prevalence of psychological disorders that was as high as found in the more modern areas of Saudi Arabia such as Riyadh. The view that individuals in less open areas are protected from psychological disorders associated with stress and lifestyle pressure seems to be unsubstantiated. The results highlight the potential value of screening for psychological disorders using such simple instruments as the GHQ.

  3. Screening for alcohol and drug use disorders among adults in primary care: a review

    Directory of Open Access Journals (Sweden)

    Pilowsky DJ

    2012-04-01

    Full Text Available Daniel J Pilowsky1, Li-Tzy Wu21Departments of Epidemiology and Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City, NY, 2Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USABackground: The Patient Protection and Affordable Care Act of 2010 supports integration of substance abuse interventions and treatments into the mainstream health care system. Thus, effective screening and intervention for substance use disorders in health care settings is a priority.Objective: This paper reviews the prevalence of alcohol and drug use disorders (abuse or dependence in primary care settings and emergency departments, as well as current screening tools and brief interventions.Methods: MEDLINE was searched using the following keywords: alcohol use, alcohol use disorder, drug use, drug use disorder, screening, primary care, and emergency departments. Using the related-articles link, additional articles were screened for inclusion. This review focuses on alcohol and drug use and related disorders among adults in primary care settings.Conclusion: Screening, brief intervention, and referral for treatment are feasible and effective in primary care settings, provided that funding for screening is available, along with brief interventions and treatment facilities to which patients can be referred and treated promptly.Keywords: brief intervention, emergency departments

  4. Changing the lens: widening the approach to primary care research.

    Science.gov (United States)

    Checkland, Kath

    2003-10-01

    After years of being shielded from most of the managerial and organisational changes in health care, primary care is going through a period of change in many countries. Much of the research that has been done in primary care, in common with that in secondary care, puts at the centre of its methodology the concept of professionalism. However, there are other ways of theorising medical work, and using a wider range of theoretical 'lenses' when planning research into the impact of change will enhance and enrich that research. Viewing primary care physicians as 'workers', concerned, like other workers, with constructing understanding of what they do that helps them cope with pressures and uncertainties, shifts the focus of research questions away from issues of professional status towards the practical ways in which they deal with change in their local contexts. Research using this theoretical approach may be able to explain phenomena that other, more broad-brush approaches cannot.

  5. Guideline for primary care management of headache in adults

    Science.gov (United States)

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  6. DIAGNOSIS OF OSTEOARTHROSIS IN PRIMARY HEALTH CARE OF BULGARIA

    Directory of Open Access Journals (Sweden)

    Maria Panchovska

    2013-01-01

    Full Text Available Osteoarthrosis is the most common rheumatic disease and occurs in more than 50% of all rheumatic patients. These patients are diagnosed and treated by rheumatologists, orthopedists, and neurologists in the primary health care ofBulgaria. The problems in these patients are primarily encountered by general practitioners (family physicians who estimate the need for specialized medical care. The paper considers the organizational aspects of primary medical carefor patients with ostheoarthosis. Six-year data are analyzed.

  7. Effective recruitment strategies in primary care research: a systematic review.

    Science.gov (United States)

    Ngune, Irene; Jiwa, Moyez; Dadich, Ann; Lotriet, Jaco; Sriram, Deepa

    2012-01-01

    Patient recruitment in primary care research is often a protracted and frustrating process, affecting project timeframes, budget and the dissemination of research findings. Yet, clear guidance on patient recruitment strategies in primary care research is limited. This paper addresses this issue through a systematic review. Articles were sourced from five academic databases - AustHealth, CINAHL, the Cochrane Methodology Group, EMBASE and PubMed/Medline; grey literature was also sourced from an academic library and the Primary Healthcare Research & Information Service (PHCRIS) website. Two reviewers independently screened the articles using the following criteria: (1) published in English, (2) reported empirical research, (3) focused on interventions designed to increase patient recruitment in primary care settings, and (4) reported patient recruitment in primary care settings. Sixty-six articles met the inclusion criteria. Of these, 23 specifically focused on recruitment strategies and included randomised trials (n = 7), systematic reviews (n = 8) and qualitative studies (n = 8). Of the remaining articles, 30 evaluated recruitment strategies, while 13 addressed the value of recruitment strategies using descriptive statistics and/or qualitative data. Among the 66 articles, primary care chiefly included general practice (n = 30); nursing and allied health services, multiple settings, as well as other community settings (n = 30); and pharmacy (n = 6). Effective recruitment strategies included the involvement of a discipline champion, simple patient eligibility criteria, patient incentives and organisational strategies that reduce practitioner workload. The most effective recruitment in primary care research requires practitioner involvement. The active participation of primary care practitioners in both the design and conduct of research helps to identify strategies that are congruent with the context in which patient care is delivered. This is reported to be the

  8. Diagnosing binge eating disorder in a primary care setting.

    Science.gov (United States)

    Montano, C Brendan; Rasgon, Natalie L; Herman, Barry K

    2016-01-01

    Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that

  9. [Clinical bioethics for primary health care].

    Science.gov (United States)

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  10. Interprofessional collaboration regarding patients' care plans in primary care : a focus group study into influential factors

    NARCIS (Netherlands)

    Stephanie Anna Lenzen; Trudy van der Weijden; Anna Beurskens; Marloes Amantia van Bokhoven; Ramon Daniëls; Jerôme Jean Jacques van Dongen

    2016-01-01

    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

  11. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors

    NARCIS (Netherlands)

    Dongen, J.J. van; Lenzen, S.A.; Bokhoven, M.A. van; Daniels, R.; Weijden, T.T. van der; Beurskens, A.

    2016-01-01

    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

  12. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    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......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

  13. Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

    Directory of Open Access Journals (Sweden)

    Michael O. Olatawura

    2010-01-01

    Full Text Available Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ. A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy- six (42.7% of the subjects were males. A total of 120 (29.1% of the subjects had depressive disorder, 100 (24.3% had anxiety disorder, 196 (47.6% somatoform disorder and 104 (25.2% met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6% of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

  14. Reinventing your primary care practice: becoming an MDCEO™

    Directory of Open Access Journals (Sweden)

    Conard SE

    2013-03-01

    Full Text Available Scott E Conard,1 Maureen Reni Courtney21ACAP Health, Dallas, 2College of Nursing, University of Texas, Arlington, TX, USAAbstract: Primary care medicine in the United States is undergoing a revolutionary shift. Primary care providers and their staff have an extraordinary chance to create and participate in exciting new approaches to care. New strategies will require courage, flexibility, and openness to change by every member of the practice team, especially the lead clinician who is most often the physician, but can also be the nurse practitioner or physician's assistant. Providers must first recognize their need to alter their fundamental identity to incorporate a new kind of leadership role—that of the MDCEO™ (i.e., the individual clinician who leads the practice to ensure that quality, service, and financial systems are developed and effectively managed. This paper provides a practical vision and rationale for the required transition in primary care, pointing the way for how to achieve new practice effectiveness through new leadership roles. It also provides a model to evaluate the status of a primary care practice. The authors have extensive experience in working with primary care providers to radically evolve their clinical practices to become MDCEOs™. The MDCEO™ will articulate the vision and strategy for the practice, define and foster the practice culture, and create and facilitate team development and overall high level functioning. Each member of the team can then begin to lead their part of the practice: a 21st century population-oriented, purpose-based practice resulting in increased quality of care, improved patient outcomes, greater financial success, and enhanced peace of mind.Keywords: primary health care organization and administration, health care reform, leadership, patient-centered care

  15. Factors shaping intersectoral action in primary health care services.

    Science.gov (United States)

    Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

    2014-12-01

    To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

  16. Embracing a diversified future for US primary care.

    Science.gov (United States)

    Hoff, Timothy

    2013-01-01

    Although less focused upon given the current emphasis on the patient-centered medical home innovation, the future for US primary care is arguably one that will be characterized by diversity in service delivery structures and personnel. The drivers of this diversity include increased patient demand requiring a larger number of primary care access points; the need for lower-cost delivery structures that can flourish in a low-margin business model; greater interest in primary care delivery by retailers and hospitals that see their involvement as a means to enhance their core business goals; the increased desire by non-physician providers to gain work independence; and a growing cadre of younger PCPs whose career and job preferences leave them open to working in a variety of different settings and structures. A key issue to ask of a more diversified primary care system is whether or not it will be characterized by competition or cooperation. While a competitive system would not be unexpected given historical and current trends, such a system would likely stunt the prospects for a full revitalization of US primary care. However, there is reason to believe that a cooperative system is possible and would be advantageous, given the mutual dependencies that already exist among primary care stakeholders, and additional steps that could be taken to enhance such dependencies even more into the future.

  17. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.

    Science.gov (United States)

    Doocy, Shannon; Lyles, Emily; Roberton, Timothy; Akhu-Zaheya, Laila; Oweis, Arwa; Burnham, Gilbert

    2015-10-31

    There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Among adults, hypertension prevalence was the highest (9.7%, CI: 8.8-10.6), followed by arthritis (6.8%, CI: 5.9-7.6), diabetes (5.3%, CI: 4.6-6.0), chronic respiratory diseases (3.1%, CI: 2.4-3.8), and cardiovascular disease (3.7%, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7% (CI: 81.6-87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65%, (CI:0-88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89% (CI: 22-98) and 88% (CI: 13-98) lower odds of seeking care

  18. Primary care patients with anxiety and depression : Need for care from the patient's perspective

    NARCIS (Netherlands)

    Prins, Marijn A.; Verhaak, Peter F. M.; van der Meer, Klaas; Penninx, Brenda W. J. H.; Bensing, Jozien M.

    2009-01-01

    Background: Many anxiety and depression patients receive no care, resulting in unnecessary suffering and high costs. Specific beliefs and the absence of a perceived need for care are major reasons for not receiving care. This study aims to determine the specific perceived need for care in primary

  19. Self-perceived met and unmet care needs of frail older adults in primary care

    NARCIS (Netherlands)

    Hoogendijk, Emiel O; Muntinga, Maaike E; van Leeuwen, Karen M; van der Horst, Henriëtte E; Deeg, Dorly J H; Frijters, Dinnus H M; Hermsen, Lotte A H; Jansen, Aaltje P D; Nijpels, Giel; van Hout, Hein P J

    2013-01-01

    In order to provide adequate care for frail older adults in primary care it is essential to have insight into their care needs. Our aim was to describe the met and unmet care needs as perceived by frail older adults using a multi-dimensional needs assessment, and to explore their associations with

  20. Advancing primary care to promote equitable health: implications for China

    Directory of Open Access Journals (Sweden)

    Hung Li-Mei

    2012-01-01

    Full Text Available Abstract China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform.

  1. The ethics of complex relationships in primary care behavioral health.

    Science.gov (United States)

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  2. Organizational factors influencing successful primary care and public health collaboration.

    Science.gov (United States)

    Valaitis, Ruta; Meagher-Stewart, Donna; Martin-Misener, Ruth; Wong, Sabrina T; MacDonald, Marjorie; O'Mara, Linda

    2018-06-07

    Public health and primary care are distinct sectors within western health care systems. Within each sector, work is carried out in the context of organizations, for example, public health units and primary care clinics. Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored. We conducted an interpretive descriptive qualitative study involving in-depth interviews with 74 key informants from three provinces, one each in western, central and eastern Canada, and others representing national organizations, government, or associations. The sample included policy makers, managers, and direct service providers in public health and primary care. Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery. While each influencing factor was distinct, the many interactions among these influences are indicative of the complex nature of public health and primary care collaboration. These results can be useful for those working to set up new or maintain existing collaborations with public health and primary care which may or may not include other organizations.

  3. Assessment and management of suicide risk in primary care.

    Science.gov (United States)

    Saini, Pooja; While, David; Chantler, Khatidja; Windfuhr, Kirsten; Kapur, Navneet

    2014-01-01

    Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

  4. Prevalence and Pattern of Strabismus in Primary School Pupils in ...

    African Journals Online (AJOL)

    tulyasys

    the general population is about 3-5%[2], but studies in Africa show that the ... This was a cross-sectional study carried out on primary .... America, Brazil, Canada and Seoul,[19-23] it was similar to .... Environment, culture and eye disease in.

  5. prevalence and determinants of stunting among primary school

    African Journals Online (AJOL)

    conducted. An interviewer-administered questionnaire was used to collect information on respondents' and parents' .... Authority and were stratified into urban and rural categories. Based on the population of primary four ..... underestimated. Primarily because some of our respondents were excluded due to lack of parental.

  6. Sero-prevalence of hepatitis B surface antigen among primary ...

    African Journals Online (AJOL)

    of 2-7% in Southern and Eastern Europe to low rates of less than 2%, in .... Table 2. Distribution of HBsAg by Age and Gender amongst Primary School Pupils in the Hawal valley ... effective manner and the global assessment of hepatitis B. 13 ... settlement in the Middle Hawal Valley, Nigeria, Trans Roy. Soc Trop Med Hyg ...

  7. Primary care closed claims experience of Massachusetts malpractice insurers.

    Science.gov (United States)

    Schiff, Gordon D; Puopolo, Ann Louise; Huben-Kearney, Anne; Yu, Winnie; Keohane, Carol; McDonough, Peggy; Ellis, Bonnie R; Bates, David W; Biondolillo, Madeleine

    Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001). In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice

  8. Burnout syndrome among physicians working in primary health care ...

    African Journals Online (AJOL)

    Objective: The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods: The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health ...

  9. Migraine Nurses in Primary Care : Costs and Benefits

    NARCIS (Netherlands)

    van den Berg, Jan S. P.; Steiner, Timothy J.; Veenstra, Petra J. L.; Kollen, Boudewijn J.

    Objective. We examined the costs and benefits of introducing migraine nurses into primary care. Background. Migraine is one of the most costly neurological diseases. Methods. We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was

  10. Screening for diabetic retinopathy in primary care with a mobile ...

    African Journals Online (AJOL)

    A SWOT analysis of the pilot project was completed and recommendations were made on how to integrate it into the district health system. Conclusion. Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician ...

  11. Patients‟ perceptions of primary health care services in the Eastern ...

    African Journals Online (AJOL)

    Seeking to understand patient perspectives is an important step in the efforts to improve the quality of health care. The purpose of this study was to examine patient satisfaction with primary health care (PHC) services. A purposive sample of 19136 patients aged 18 years and above was interviewed at 266 PHC clinics in ...

  12. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.

    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which

  13. Primary care referral management: a marketing strategy for hospitals.

    Science.gov (United States)

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J

    1990-06-01

    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  14. Management of common eye conditions in a primary health care ...

    African Journals Online (AJOL)

    treated by properly trained middle cadre eye health worker working with simple diagnostic tools in a primary health care setting or by referring to secondary care in a timely ... Personal and environmental hygiene: (regular hand and face washing, proper disposal of garbage, human and animal waste and maintenance of a.

  15. Ophthalmic Skills Assessment of Primary Health Care Workers at ...

    African Journals Online (AJOL)

    Proficiency in the basic ophthalmic skills is a cri cal factor in the effec ve delivery of eye care services at the primary level of care. The aim of the study was to assess the ability of ... out visual acuity test and correctly iden fy cataract and conjunc vi s using pictures of eye condi ons and ..... Medical Laboratory Technician.

  16. Symptoms associated with an abnormal echocardiogram in elderly primary care hypertension patients

    DEFF Research Database (Denmark)

    Ringoir, L.; Widdershoven, J. W.; Pedersen, S. S.

    2014-01-01

    Background The prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown. Aim To assess the prevalence, sensitivity, specificity, positive and negative predictive value of symptoms in association with an abnormal echocardiogram. Design...... %, and oedema by 13 %. Oedema was the only symptom significantly associated with an abnormal echocardiogram (positive predictive value was 45 %, sensitivity 20 %, and specificity 90 %, OR 2.12; 95 % CI=1.23-3.64), apart from higher age (OR 1.06; 95 % CI=1.03-1.09), previous myocardial infarction (OR 3.00; 95...

  17. Pressure and Friction Injuries in Primary Care.

    Science.gov (United States)

    Phillips, Shawn; Seiverling, Elizabeth; Silvis, Matthew

    2015-12-01

    Pressure and friction injuries are common throughout the lifespan. A detailed history of the onset and progression of friction and pressure injuries is key to aiding clinicians in determining the underlying mechanism behind the development of the injury. Modifying or removing the forces that are creating pressure or friction is the key to both prevention and healing of these injuries. Proper care of pressure and friction injuries to the skin is important to prevent the development of infection. Patient education on positioning and ergonomics can help to prevent recurrence of pressure and friction injuries. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Is primary care access to CT brain examinations effective?

    International Nuclear Information System (INIS)

    Benamore, R.E.; Wright, D.; Britton, I.

    2005-01-01

    AIM: Primary care access to CT head examinations could enable common neurological conditions to be managed within primary care. Outcome data from the first 8 years of a local service were used to identify effective referral criteria. METHODS: Primary care head CT results from 1 March 1995 to 31 October 2003 were categorized as normal, incidental or significant findings. Normal reports were cross-referenced for referral to secondary care. Case notes with incidental or significant CT findings were reviewed for secondary care attendance and outcome. RESULTS: Records of 1403/1645 CT head examinations (85%) were available for review. Of these 1403, 951 (67.8%) returned normal findings, 317 (22.6%) incidental findings and 135 (9.6%) significant findings. The commonest indication for referral was investigation of headaches (46.6%). Of the total 533 patients under 50 years of age, 13 (2.4%) yielded significant findings and all 13 showed other features in addition to headache. Of 314 cases presenting with focal neurology, 83 (26.4%) showed significant findings. 314 patients were referred from primary to secondary care. 189 had normal scans and 74 had findings described as incidental. 60% of secondary care referrals were for normal CT scans. In patients with focal neurology, 90 of 314 were referred, allowing 71% to be managed in primary care. Yield was also 0% for headaches, dizziness, visual disturbance or nausea and vomiting. CONCLUSION: Primary care access to CT brain examinations is effective for patients with focal neurology, neurological symptoms or a known malignancy, but not for patients aged less than 50 years, or with uncomplicated headaches, dizziness or diplopia

  19. Is primary care access to CT brain examinations effective?

    Energy Technology Data Exchange (ETDEWEB)

    Benamore, R.E. [Department of Radiology, Pilgrim Hospital, Boston (United Kingdom)]. E-mail: rachelbenamore@doctors.org.uk; Wright, D. [Department of Radiology, Pilgrim Hospital, Boston (United Kingdom); Britton, I. [Department of Radiology, Pilgrim Hospital, Boston (United Kingdom)

    2005-10-01

    AIM: Primary care access to CT head examinations could enable common neurological conditions to be managed within primary care. Outcome data from the first 8 years of a local service were used to identify effective referral criteria. METHODS: Primary care head CT results from 1 March 1995 to 31 October 2003 were categorized as normal, incidental or significant findings. Normal reports were cross-referenced for referral to secondary care. Case notes with incidental or significant CT findings were reviewed for secondary care attendance and outcome. RESULTS: Records of 1403/1645 CT head examinations (85%) were available for review. Of these 1403, 951 (67.8%) returned normal findings, 317 (22.6%) incidental findings and 135 (9.6%) significant findings. The commonest indication for referral was investigation of headaches (46.6%). Of the total 533 patients under 50 years of age, 13 (2.4%) yielded significant findings and all 13 showed other features in addition to headache. Of 314 cases presenting with focal neurology, 83 (26.4%) showed significant findings. 314 patients were referred from primary to secondary care. 189 had normal scans and 74 had findings described as incidental. 60% of secondary care referrals were for normal CT scans. In patients with focal neurology, 90 of 314 were referred, allowing 71% to be managed in primary care. Yield was also 0% for headaches, dizziness, visual disturbance or nausea and vomiting. CONCLUSION: Primary care access to CT brain examinations is effective for patients with focal neurology, neurological symptoms or a known malignancy, but not for patients aged less than 50 years, or with uncomplicated headaches, dizziness or diplopia.

  20. Care guides: an examination of occupational conflict and role relationships in primary care.

    Science.gov (United States)

    Wholey, Douglas R; White, Katie M; Adair, Richard; Christianson, Jon B; Lee, Suhna; Elumba, Deborah

    2013-01-01

    Improving the efficiency and effectiveness of primary care treatment of patients with chronic illness is an important goal in reforming the U.S. health care system. Reducing occupational conflicts and creating interdependent primary care teams is crucial for the effective functioning of new models being developed to reorganize chronic care. Occupational conflict, role interdependence, and resistance to change in a proof-of-concept pilot test of one such model that uses a new kind of employee in the primary care office, a "care guide," were analyzed. Care guides are lay individuals who help chronic disease patients and their providers achieve standard health goals. The aim of this study was to examine the development of occupational boundaries, interdependence of care guides and primary care team members, and acceptance by clinic employees of this new kind of health worker. A mixed methods, pilot study was conducted using qualitative analysis; clinic, provider, and patient surveys; administrative data; and multivariate analysis. Qualitative analysis examined the emergence of the care guide role. Administrative data and surveys were used to examine patterns of interdependence between care guides, physicians, team members, and clinic staff; obtain physician evaluations of the care guide role; and evaluate the effect of care guides on patient perceptions of care coordination and follow-up. Evaluation of implementation of the care guide model showed that (a) the care guide scope of practice was clearly defined; (b) interdependent relationships between care guides and providers were formed; (c) relational triads consisting of patient, care guide, and physician were created; (d) patients and providers were supported in managing chronic disease; and (e) resistance to this model among traditional employees was minimized. The feasibility of implementing a new care model for chronic disease management in the primary care setting, identifying factors associated with a positive

  1. Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors.

    Science.gov (United States)

    Valaitis, Ruta K; O'Mara, Linda; Wong, Sabrina T; MacDonald, Marjorie; Murray, Nancy; Martin-Misener, Ruth; Meagher-Stewart, Donna

    2018-04-12

    AimThe aim of this paper is to examine Canadian key informants' perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration. Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context. This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor - effective communication - interacted with all of them. Results support and extend our understanding of what influences

  2. Evaluation and treatment of male hypogonadism in primary care.

    Science.gov (United States)

    Pickett, Kim Anne

    2016-08-18

    Male hypogonadism is increasing in prevalence, particularly in the older male population. Signs and symptoms associated with hypogonadism are often nonspecific and may be difficult to categorize. This article discusses parameters for screening patients at risk, reviews how to establish the diagnosis of primary or secondary male hypogonadism, and offers important considerations for treatment of patients with hypogonadism.

  3. Prevalence and Risk Factors of Voice Problems Among Primary School Teachers in India.

    Science.gov (United States)

    Devadas, Usha; Bellur, Rajashekhar; Maruthy, Santosh

    2017-01-01

    Teachers are more prone to develop voice problems (VPs) when compared with other professional voice users. The aim of present study was to investigate the prevalence and risk factors of VPs among primary school teachers in India. Epidemiological cross-sectional survey. Self-reporting questionnaire data were collected from 1082 teachers. Out of 1082 teachers who participated in the present study, 188 teachers reported VPs that account for a prevalence rate of 17.4%. Tired voice after long hours of talking was the most frequently reported symptom, followed by sore/dry throat, strain in voice, neck muscle tension, and difficulty in projecting voice. The adjusted odds ratio values showed number of years of teaching, high background noise levels in the classroom, experiencing psychological stress while teaching classes, improper breath management (holding breath while speaking), poor focus of the tone (clenching jaw/teeth while speaking), upper respiratory tract infection, thyroid problems, and acid reflux as significant risk factors for the development of VPs in the current cohort of teachers. Current results suggest that teachers develop VPs due to multiple risk factors. These factors may be either biological, psychomotor, or environment-related factors. A holistic approach (which could include educating teachers about voice care during their training, and if they develop VP during their career, then managing the VP by taking into consideration different risk factors) addressing all these factors needs to be adopted to prevent VPs in primary school teachers. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. Improving primary health care to increase efficiency

    Directory of Open Access Journals (Sweden)

    V. M. Kornatsky

    2017-02-01

    Full Text Available Thus, the convergence of medicine, psychiatry and psychology is the reality of today to eliminate the imbalance, psychosomatic health. The role of medical practice in the correction of psychosomatic disorders is large, but insufficient. Complementary medical becomes a psychological resource in decision psychosomatic problems. A study of the leading role of psychogenic factors and mechanisms of somatic response to stressful situations, underlying the formation of the most common and socially significant diseases, is a current trend psychosomatic direction in the PC. The data obtained may become the basis for developing measures for the identification, treatment, and prevention of psychosomatic disorders in conditions of emotional stress and their prevention. Successful interdisciplinary interaction fosters the following principles: collegiality in matters of surveillance, social functioning capabilities; continuity in matters of treatment and preventive care; adherence to the principles of medical ethics and deontology; implementation of accounting volume of medical care. The formation of a new system will bring to the population high-tech methods of diagnostics and treatment, strengthen the development of the system of prevention of socially significant diseases and expand the possibilities of rehabilitation.

  5. [Health care for migrant patients: primary care or specialized medicine?].

    Science.gov (United States)

    Durieux-Paillard, S; Dao, M Dominicé; Perron, N Junod

    2007-09-26

    When consulting with migrant patients, general practitioners should pay special attention to the quality of their communication, because language barriers and cultural differences may arise. They must also be aware that life events experienced in the home country, during transit and in the host country can impact negatively on their patients' health, and thus a detailed history must be carefully obtained. Finally, they must be conscious that the migratory policies of the host country can influence the delivery of health care to migrant patients as well as their health status.

  6. [Screening for bipolar disorder in primary care patients with psychological symptoms].

    Science.gov (United States)

    Aragonès, Enric; López-Rodríguez, Juan A; Escobar-Rabadán, Francisco; Téllez-Lapeira, Juan; Mínguez, José; Párraga, Ignacio; Suárez-Hernández, Tatiana; Piñero, María José; Guzón, Marta-Magdalena

    2015-03-01

    To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. Multicenter cross-sectional study. Nineteen Primary Care clinics in different Spanish regions. A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. Of the patients screened, 11.9% were positive (95%CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  7. [Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

    Science.gov (United States)

    Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

    2017-10-01

    The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

  8. The Practice Guidelines for Primary Care of Acute Abdomen 2015.

    Science.gov (United States)

    Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi

    2016-01-01

    Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information]. A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

  9. Third sector primary health care in New Zealand.

    Science.gov (United States)

    Crampton, P; Dowell, A C; Bowers, S

    2000-03-24

    To describe key organisational characteristics of selected third sector (non-profit and non-government) primary health care organisations. Data were collected, in 1997 and 1998, from 15 third sector primary care organisations that were members of a network of third sector primary care providers, Health Care Aotearoa (HCA). Data were collected by face-to-face interviews of managers and key informants using a semi-structured interview schedule, and from practice computer information systems. Overall the populations served were young: only 4% of patients were aged 65 years or older, and the ethnicity profile was highly atypical, with 21.8% European, 36% Maori, 22.7% Pacific Island, 12% other, and 7.5% not stated. Community services card holding rates were higher than recorded in other studies, and registered patients tended to live in highly deprived areas. HCA organisations had high patient to doctor ratios, in general over 2000:1, and there were significant differences in management structures between HCA practices and more traditional general practice. Third sector organisations provide services for populations that are disadvantaged in many respects. It is likely that New Zealand will continue to develop a diverse range of primary care organisational arrangements. Effort is now required to measure quality and effectiveness of services provided by different primary care organisations serving comparable populations.

  10. Integrated working between residential care homes and primary care: a survey of care homes in England

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2012-11-01

    Full Text Available Abstract Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621 in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7% worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs had visited the care homes in the last six months (SD 5.11, median 14; a mean of .39 (SD.163 professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60% managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low

  11. Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

    Directory of Open Access Journals (Sweden)

    Dolan Kate A

    2005-06-01

    Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

  12. Approach to Peripheral Neuropathy for the Primary Care Clinician.

    Science.gov (United States)

    Doughty, Christopher T; Seyedsadjadi, Reza

    2018-02-02

    Peripheral neuropathy is commonly encountered in the primary care setting and is associated with significant morbidity, including neuropathic pain, falls, and disability. The clinical presentation of neuropathy is diverse, with possible symptoms including weakness, sensory abnormalities, and autonomic dysfunction. Accordingly, the primary care clinician must be comfortable using the neurologic examination-including the assessment of motor function, multiple sensory modalities, and deep tendon reflexes-to recognize and characterize neuropathy. Although the causes of peripheral neuropathy are numerous and diverse, careful review of the medical and family history coupled with limited, select laboratory testing can often efficiently lead to an etiologic diagnosis. This review offers an approach for evaluating suspected neuropathy in the primary care setting. It will describe the most common causes, suggest an evidence-based workup to aid in diagnosis, and highlight recent evidence that allows for selection of symptomatic treatment of patients with neuropathy. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Prevalence of Speech Disorders in Arak Primary School Students, 2014-2015<