WorldWideScience

Sample records for strengthen primary care

  1. Strengthening Primary Health Care and Social Protection: Universal ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    One of the poorest countries in the world, Pakistan has been afflicted by both societal turmoil and natural disasters during the past decade. The resulting decline of an already-frail economy has made inequalities even more prominent. This development has acutely affected the health sector, which bears the burden of care ...

  2. 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

  3. Addressing the escalating burden of chronic diseases in India: Need for strengthening primary care.

    Science.gov (United States)

    Sinha, Rajeshwari; Pati, Sanghamitra

    2017-01-01

    The growing epidemic of noncommunicable diseases (NCDs) has impacted the national health systems, policies, and socioeconomic developments, thereby leading to increasing country level disparities. Despite substantial improvements in health indicators made in the past decade, the Indian health-care system continues to contribute disproportionately to the global disease burden, wherein NCDs holds significant prominence. Against this background, the present review analyzes the current NCD landscape from the perspective of India's health system preparedness toward meeting this growing challenge. Implementation and delivery of strategies and interventions are often impeded by existing grass root level challenges. Recognizing the importance of effective primary care, the review highlights the importance of implementing affordable, accessible, and comprehensive interventions, and delivering them at societal, a community and individual level. This simultaneously calls for strengthening of the primary care system through appropriate strategy and policy frameworks. Toward addressing India-specific needs in NCD prevention and management, concerted efforts on development of robust surveillance mechanisms, intersectoral and interdepartmental collaborations, integration of national programs, enhanced role of education and awareness should be made, to ensure effectivity, scale-up, and outreach of services in primary care.

  4. Strengthening of Oral Health Systems: Oral Health through Primary Health Care

    Science.gov (United States)

    Petersen, Poul Erik

    2014-01-01

    Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

  5. Strengthening of oral health systems: oral health through primary health care.

    Science.gov (United States)

    Petersen, Poul Erik

    2014-01-01

    Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. © 2014 P.E. Petersen, Geneva.

  6. Strengthening primary health care teams with palliative care leaders: protocol for a cluster randomized clinical trial.

    Science.gov (United States)

    Llobera, Joan; Sansó, Noemí; Ruiz, Amador; Llagostera, Merce; Serratusell, Estefania; Serrano, Carlos; Roselló, María Luisa Martín; Benito, Enric; Castaño, Eusebio J; Leiva, Alfonso

    2017-07-10

    The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. According to the World Health Organization (WHO), patients with advanced cancer and other terminal diseases benefit from early identification and proactive PC. We will evaluate the effectiveness of an intervention in which a PC leader is established in the primary health care center, and assess the effect of this intervention on the early identification of patients in need of PC, the efficient use of health care services, and direct health care costs. Design: A two-arm cluster randomized clinical trial of 30 Primary Health Care Centers (PHCC) in Mallorca (Spain), in which each center was randomized to an intervention arm or a usual care arm. We expect that the number of patients identified as suitable for PC (including non-oncological PC) is at least 5% greater in the intervention arm. A total of 4640 deceased patients. Outcomes will be assessed by a blinded external review of the electronic records. General practitioners (GPs) and nurse leaders in PC for each PHCC will be appointed. These leaders will help promote PC training of colleagues, improve symptom management and psychological support of patients, and evaluate the complexity of individual cases so that these cases receive assistance from PC home-based teams. Early identification (>90 days before death), evaluation of case complexity, level of case complexity (with referral to a home-based PC team), use and cost of hospital and primary care services, and quality of life during the last month of life (≥2 emergency room visits, ≥2 hospital admissions, ≥14 days of hospitalization). PC leaders in primary care teams will improve the early identification of patients eligible for PC. This initiative could improve the quality of end-of-life care and utilization of hospital resources. ISRCTN

  7. Strengthening Integrated Care Through Population-Focused Primary Care Services: International Experiences Outside the United States.

    Science.gov (United States)

    Loewenson, Rene; Simpson, Sarah

    2017-03-20

    Many high- and middle-income countries (HMICs) are experiencing a burden of comorbidity and chronic diseases. Together with increasing patient expectations, this burden is raising demand for population health-oriented innovation in health care. Using desk review and country case studies, we examine strategies applied in HMICs outside the United States to address these challenges, with a focus on and use of a new framework for analyzing primary care (PC). The article outlines how a population health approach has been supported by focusing assessment on and clustering services around social groups and multimorbidity, with support for community roles. It presents ways in which early first contact and continuity of PC, PC coordination of referral, multidisciplinary team approaches, investment in PC competencies, and specific payment and incentive models have all supported comprehensive approaches. These experiences locate PC as a site of innovation, where information technology and peer-to-peer learning networks support learning from practice.

  8. An educational process to strengthen primary care nursing practices in São Paulo, Brazil.

    Science.gov (United States)

    Chiesa, A M; Fracolli, L A

    2007-12-01

    To describe the experience of a registered nurse (RN) training process related to the Family Health Program (FHP) developed in the city of São Paulo, Brazil. The FHP is a national, government strategy to restructure primary care services. It focuses on the family in order to understand its physical and social structure in regards to the health-illness process. In the FHP, the RN is a member of a team with the same number as medical doctors - an unprecedented situation. The FHP requires a discussion of the RNs' practice, by qualifying and empowering them with tools and knowledge. The training process was based on Freire's approach founded on critical pedagogy in order to address the fundamental problem of inequalities in health. The first phase included workshops and the second one included a course. The workshops identified the following problems related to the RN's work: lack of tools to identify the population's needs; overload of work due to the accumulation of management and assistance activities; difficulties regarding teamwork; lack of tools to evaluate the impact of nursing interventions; lack of tools to improve the participation of the community. The course was organized to tackle these problems under five thematic headings. The RN's training process allowed the group to reflect deeply on its work. This experience led to the need for the construction of tools to intervene in the reality, mainly against social exclusion, rescuing and adapting of the knowledge accumulated in the healthcare practice, identifying settings which demand institutional solutions and engaging the RN in research groups in order to develop projects according to the complexity of the primary care services. The application of the concept of equity in the health sector represented a reaction against the processes of social exclusion, starting from performance at a local level to become a reality in the accomplishments achieved by the Brazilian National Health System. This training

  9. Strengthening of Oral Health Systems: Oral Health through Primary Health Care

    OpenAIRE

    Petersen, Poul Erik

    2014-01-01

    Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high b...

  10. Feasibility of a multifaceted educational strategy for strengthening rural primary health care.

    Science.gov (United States)

    Reyes-Morales, Hortensia; Gómez-Bernal, Enrique; Gutiérrez-Alba, Gaudencio; Aguilar-Ye, Arturo; Ruiz-Larios, José Arturo; Alonso-Núñez, Gabriel de Jesús

    2017-01-01

    To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strategy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams); Implementation of the strategy among health care teams for six priority causes of visit, through workshops, individual tutorials, and round-table case-review sessions. Feasibility and acceptability were evaluated using checklists, direct observation, questionnaires and in-depth interviews with key players. Despite some organizational barriers, the strategy was perceived as worthy by the participants because of the personalized tutorials and the improved integration of health teams within their usual professional practice. The educational strategy proved to be acceptable; its feasibility for usual care conditions will depend on the improvement of organizational processes at rural facilities.

  11. Feasibility of a multifaceted educational strategy for strengthening rural primary health care

    OpenAIRE

    Hortensia Reyes-Morales; Enrique Gómez-Bernal; Gaudencio Gutiérrez-Alba; Arturo Aguilar-Ye; José Arturo Ruiz-Larios; Gabriel de Jesús Alonso-Núñez

    2017-01-01

    Objective. To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. Materials and methods. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strat­egy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams); Impleme...

  12. Feasibility of a multifaceted educational strategy for strengthening rural primary health care

    Directory of Open Access Journals (Sweden)

    Hortensia Reyes-Morales

    2017-05-01

    Full Text Available Objective. To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. Materials and methods. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strat­egy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams; Implementation of the strategy among health care teams for six priority causes of visit, through workshops, individual tutorials, and round-table case-review sessions. Feasibility and acceptability were evaluated using checklists, direct observa­tion, questionnaires and in-depth interviews with key players. Results. Despite some organizational barriers, the strategy was perceived as worthy by the participants because of the personalized tutorials and the improved integration of health teams within their usual professional practice. Conclusion. The educational strategy proved to be acceptable; its feasibil­ity for usual care conditions will depend on the improvement of organizational processes at rural facilities.

  13. Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan.

    Science.gov (United States)

    Khan, Muhammad Amir; Ahmed, Maqsood; Anil, Shirin; Walley, John

    2015-01-01

    Respiratory diseases, namely asthma and chronic obstructive pulmonary disease (COPD), account for one-fourth of the patients at the primary health-care (PHC) facilities in Pakistan. Standard care practices to manage these diseases are necessary to reduce the morbidity and mortality rate associated with non-communicable diseases in developing countries. To develop and measure the effectiveness of operational guidelines and implementation materials, with sound scientific evidence, for expanding lung health care, especially asthma and COPD through PHC facilities already strengthened for tuberculosis (TB) care in Pakistan. A cluster randomized controlled trial with two arms (intervention and control), with qualitative and costing study components, is being conducted in 34 clusters; 17 clusters per arm (428 asthma and 306 COPD patients), in three districts in Pakistan from October 2014 to December 2016. The intervention consists of enhanced case management of asthma and COPD patients through strengthening of PHC facilities. The main outcomes to be measured are asthma and COPD control among the registered cases at 6 months. Cluster- and individual-level analyses will be done according to intention to treat. Residual confounding will be addressed by multivariable logistic and linear regression models for asthma and COPD control, respectively. The trial is registered with ISRCTN registry (ISRCTN 17409338). Currently, only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the respective PHC network. Lung health care and prevention has not been effectively integrated into the core PHC package, although a very well-functioning TB program exists at the PHC level. Inclusion of these diseases in the already existent TB program is expected to increase detection rates and care for asthma and COPD.

  14. Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Amir Khan

    2015-11-01

    Full Text Available Background: Respiratory diseases, namely asthma and chronic obstructive pulmonary disease (COPD, account for one-fourth of the patients at the primary health-care (PHC facilities in Pakistan. Standard care practices to manage these diseases are necessary to reduce the morbidity and mortality rate associated with non-communicable diseases in developing countries. Objective: To develop and measure the effectiveness of operational guidelines and implementation materials, with sound scientific evidence, for expanding lung health care, especially asthma and COPD through PHC facilities already strengthened for tuberculosis (TB care in Pakistan. Design: A cluster randomized controlled trial with two arms (intervention and control, with qualitative and costing study components, is being conducted in 34 clusters; 17 clusters per arm (428 asthma and 306 COPD patients, in three districts in Pakistan from October 2014 to December 2016. The intervention consists of enhanced case management of asthma and COPD patients through strengthening of PHC facilities. The main outcomes to be measured are asthma and COPD control among the registered cases at 6 months. Cluster- and individual-level analyses will be done according to intention to treat. Residual confounding will be addressed by multivariable logistic and linear regression models for asthma and COPD control, respectively. The trial is registered with ISRCTN registry (ISRCTN 17409338. Conclusions: Currently, only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the respective PHC network. Lung health care and prevention has not been effectively integrated into the core PHC package, although a very well-functioning TB program exists at the PHC level. Inclusion of these diseases in the already existent TB program is expected to increase detection rates and care for asthma and COPD.

  15. Strengthening primary healthcare through community involvement in ...

    African Journals Online (AJOL)

    Strengthening primary healthcare through community involvement in Cross River State, Nigeria: a descriptive study. Hilary Adie, Thomas Igbang, Akaninyene Otu, Ekanem Braide, Okpok Okon, Edet Ikpi, Charles Joseph, Alexander Desousa, Johannes Sommerfeld ...

  16. Strengthening Intersectoral Collaboration for Primary Health Care in Developing Countries: Can the Health Sector Play Broader Roles?

    Directory of Open Access Journals (Sweden)

    Omokhoa Adedayo Adeleye

    2010-01-01

    Full Text Available Many strategic challenges impeding the success of primary health care are rooted in weak strategic inputs, including intersectoral collaboration. Some encouraging evidence from programmes, projects, and studies suggests that intersectoral collaboration is feasible and useful. The strategy has the potential to fast-track the attainment of Millenium Development Goals. However, the strategy is not commonly utilised in developing countries. The health sector expects inputs from other sectors which may not necessarily subscribe to a shared responsibility for health improvement, whereas the public expects ‘‘health’’ from the health sector. Yet, the health sector rarely takes on initiatives in that direction. The sector is challenged to mobilise all stakeholders for intersectoral collaboration through advocacy and programming. Pilot projects are advised in order to allow for cumulative experience, incremental lessons and more supportive evidence.

  17. CPC Initiative - Participating Primary Care Practices

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen...

  18. 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...... 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...... 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...

  19. Fortalecimento da atenção primária à saúde: estratégia para potencializar a coordenação dos cuidados Strengthening primary health care: a strategy to maximize coordination of care

    Directory of Open Access Journals (Sweden)

    Patty Fidelis de Almeida

    2011-02-01

    semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. RESULTS: Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision, as well as improving articulation between surveillance and care actions. CONCLUSIONS: The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumerdriven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.

  20. Strengthening emergency obstetric care in Ayacucho, Peru.

    Science.gov (United States)

    Kayongo, M; Esquiche, E; Luna, M R; Frias, G; Vega-Centeno, L; Bailey, P

    2006-03-01

    With support from the Averting Maternal Death and Disability (AMDD) Program, CARE began the FEMME Project in 2000 to increase access and utilization of emergency obstetric care (EmOC) services for the approximately 48,000 pregnant women in the northern provinces of Ayacucho. The project targeted 5 facilities with a comprehensive package of interventions designed to improve capacity to provide quality EmOC services and to promote a human rights approach in health care. Key program activities included improvements in infrastructure, human resources capacity development, development of service standards and protocols, quality improvement activities, and promoting a rights-based approach to health. By the end of the project, northern Ayacucho had 6 functioning EmOC facilities: 3 comprehensive (including a non-FEMME project facility) and 3 basic. This exceeds the UN minimum recommendation of 5 EmOC facilities per 500,000 population. Other changes in the UN process indicators indicate an increase in quality and utilization of EmOC services. Met need for EmOC increased significantly from 30% in 2000 to a high of 84% in 2004. Case fatality rates declined and the number of maternal deaths in the entire region declined. CARE's work in Ayacucho made an impact on policies and programs related to EmOC throughout the region. Within CARE, project experiences have supported maternal health programs particularly in the Latin American/Caribbean region.

  1. [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.

  2. 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.

  3. Incorporating shared savings programs into primary care: from theory to practice

    NARCIS (Netherlands)

    Hayen, A.P.; Berg, M.J. van den; Meijboom, B.R.; Struijs, J.N.; Westert, G.P.

    2015-01-01

    BACKGROUND: In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate

  4. Incorporating shared savings programs into primary care : From theory to practice

    NARCIS (Netherlands)

    Hayen, A.P.; van den Berg, M.J.; Meijboom, B.R.; Struijs, J.N.; Westert, G.P.

    2015-01-01

    Background In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate

  5. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

    ... strengthen free-standing primary care capacity by testing a model of comprehensive, accountable primary care... solicitation is directed to public and private health care payers who will respond individually to the... innovative payment and service delivery models that reduce spending under Medicare, Medicaid or CHIP, while...

  6. in primary care

    African Journals Online (AJOL)

    Claire van Deventer

    Keywords: child HIV, doctor involvement, primary health care, quality improvement. Introduction. The national guidelines for the management of children on antiretroviral therapy (ART) in South Africa have been revised three times in the last five years.1–3. This indicates a rapid responsiveness to evidence emerging from ...

  7. Measuring primary care expenses.

    Science.gov (United States)

    Krist, Alex H; Cifuentes, Maribel; Dodoo, Martey S; Green, Larry A

    2010-01-01

    Significant investments and effort are being devoted to health care reform, yet little is known about the costs of improvements. Practical tools are needed to allow for systematic assessment of practice expenses. We report here a field trial of a standardized expenditure data collection instrument. Combining economic and primary care practice consultation, an expenditure data collection instrument was created. The instrument underwent observed feasibility testing and was fielded by 10 practice-based research networks in 30 practices conducting 10 different health behavior change interventions. Start-up and operating expenses were successfully collected for 87% and 97% of the practices, respectively. Data collection time and effort were considerable but acceptable. Three elements were necessary to collect expenditure data: (1) an intervention-specific data collection instrument, (2) a field guide, and (3) economic oversight and assistance. Fully 90% of networks reported that they planned to collect expenditure data in the future and study participation increased the likelihood of their participation in a future expenditure study. It is feasible to systematically collect intervention-specific expenses in primary care using formal expenditure methods. However, most practices and researchers lack the knowledge, expertise, and resources to collect such data independently. Further assistance and education is necessary to obtain reliable information about the expenses to transform and improve primary care.

  8. [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.

  9. 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

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    com. +234 803 5837179. KEYWORDS. Disease surveillance, notification, resident doctors,. Edo State journal of. COMMUNITY HEALTH. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 107-115 ...

  11. Epigenetics and primary care.

    Science.gov (United States)

    Wright, Robert; Saul, Robert A

    2013-12-01

    Epigenetics, the study of functionally relevant chemical modifications to DNA that do not involve a change in the DNA nucleotide sequence, is at the interface between research and clinical medicine. Research on epigenetic marks, which regulate gene expression independently of the underlying genetic code, has dramatically changed our understanding of the interplay between genes and the environment. This interplay alters human biology and developmental trajectories, and can lead to programmed human disease years after the environmental exposure. In addition, epigenetic marks are potentially heritable. In this article, we discuss the underlying concepts of epigenetics and address its current and potential applicability for primary care providers.

  12. Applying principles of health system strengthening to eye care

    Directory of Open Access Journals (Sweden)

    Karl Blanchet

    2012-01-01

    Full Text Available Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

  13. A snapshot of the organization and provision of primary care in Turkey

    NARCIS (Netherlands)

    Kringos, Dionne S.; Boerma, Wienke G. W.; Spaan, Ernst; Pellny, Martina

    2011-01-01

    This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. The WHO Primary Care Evaluation Tool was

  14. A snapshot of the organization and provision of primary care in Turkey.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Spaan, E.; Pellny, M.

    2011-01-01

    Background: This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods: The WHO Primary Care

  15. Integrating Primary Oral Health Care into Primary Care.

    Science.gov (United States)

    Isman, Robert E.

    1993-01-01

    Primary oral health care, and the scope of services it includes, are defined. The proposed scope of services is a set of basic dental services used by the Indian Health Service. Policy recommendations for improving the integration of primary oral health services with primary health care and delivery are offered. (Author/MSE)

  16. 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......-sectional telephone survey. SETTING: All municipal health centres in Finland. SUBJECTS: Health centres where both the head physician and the senior nursing officer responded. MAIN OUTCOME MEASURES: Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension...... that no agreements on recording target blood pressure in patient records existed. A similar discrepancy was seen in recording cardiovascular risk (64% vs. 44%, p executives agreed best on the calibration of sphygmomanometers and the provision of weight-control group counselling. CONCLUSIONS...

  17. 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.

  18. Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway.

    Science.gov (United States)

    Kongsvik, Trond; Halvorsen, Kristin; Osmundsen, Tonje; Gjøsund, Gudveig

    2016-08-30

    Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories. A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel. The LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers. As a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.

  19. Primary health care models

    Science.gov (United States)

    Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric

    2012-01-01

    Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904

  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. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Salchev, P.; Schäfer, W.; Boerma, W.; Groenewegen, P.

    2011-01-01

    Today, strengthening primary care is worldwide probably higher than ever on the agenda of scientist and policy makers (1). Primary care is expected to be an effective response to effects of the current economic crisis on health and health care. The policy strategy towards primary care reinforcement

  2. Strengthening the Creative Transformational Leadership of Primary School Teachers

    Science.gov (United States)

    Kallapadee, Yadapak; Tesaputa, Kowat; Somprach, Kanokorn

    2017-01-01

    This research and development aimed to: 1) study the components and indicators of creative transformational leadership of primary school teachers; 2) study the existing situation, and the desirable situation of creative transformational leadership of primary school teachers in the northeastern region of Thailand; 3) develop a program to strengthen…

  3. Strengthening "the Foundations" of the Primary School Curriculum

    Science.gov (United States)

    Duncombe, Rebecca; Cale, Lorraine; Harris, Jo

    2018-01-01

    The low status of the foundation subjects (e.g. Music and Physical Education (PE)) in English primary schools is well documented. Using PE as an illustrative example, a thematic analysis of 51 PE trainee students' assignments, based on their perceptions of a two-week experience in a primary school, highlighted a number of areas of concern (e.g.…

  4. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    Department of Community Medicine,. Ahmadu Bello University,Zaria. +234 803 705 3845. Email: firstmsibrahim@yahoo.com. Department of Community Medicine, Ahmadu Bello University, Zaria journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care.

  5. Chinese primary care physicians and work attitudes.

    Science.gov (United States)

    Shi, Leiyu; Hung, Li-Mei; Song, Kuimeng; Rane, Sarika; Tsai, Jenna; Sun, Xiaojie; Li, Hui; Meng, Qingyue

    2013-01-01

    China passed a landmark health care reform in 2009, aimed at improving health care for all citizens by strengthening the primary care system, largely through improvements to infrastructure. However, research has shown that the work attitudes of primary care physicians (PCPs) can greatly affect the stability of the overall workforce and the quality and delivery of health care. The purpose of this study is to investigate the relationship between reported work attitudes of PCPs and their personal, work, and educational characteristics. A multi-stage, complex sampling design was employed to select a sample of 434 PCPs practicing in urban and rural primary care settings, and a survey questionnaire was administered by researchers with sponsorship from the Ministry of Health. Four outcome measures describing work attitudes were used, as well as a number of personal-, work-, and practice-related factors. Findings showed that although most PCPs considered their work as important, a substantial number also reported large workloads, job pressure, and turnover intentions. Findings suggest that policymakers should focus on training and educational opportunities for PCPs and consider ways to ease workload pressures and improve salaries. These policy improvements must accompany reform efforts that are already underway before positive changes in reduced disparities and improved health outcomes can be realized in China.

  6. 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...

  7. The Development and Performance of After-Hours Primary Care in the Netherlands: A Narrative Review

    NARCIS (Netherlands)

    Smits, M.; Rutten, M.H.; Keizer, E.; Wensing, M.; Westert, G.P.; Giesen, P.H.

    2017-01-01

    In many Western countries, hospital emergency departments are overcrowded, leading to the desire to strengthen primary care, particularly after hours. To achieve this goal, an increasing number of Western nations are reorganizing their after-hours primary care systems into large-scale primary care

  8. 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.

  9. Primary health care: making Alma-Ata a reality.

    Science.gov (United States)

    Walley, John; Lawn, Joy E; Tinker, Anne; de Francisco, Andres; Chopra, Mickey; Rudan, Igor; Bhutta, Zulfiqar A; Black, Robert E

    2008-09-13

    The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and community health workers linked to strengthened primary-care facilities and first-referral services are needed. Furthermore, intersectoral action linking health and development is necessary, including that for better water, sanitation, nutrition, food security, and HIV control. Chronic diseases, mental health, and child development should be addressed. Progress should be measured and accountability assured. We prioritise research questions and suggest actions and measures for stakeholders both locally and globally, which are required to revitalise primary health care.

  10. 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

  11. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    2012-05-01

    May 1, 2012 ... Journal of Community Medicine and Primary Health Care. 27 (1) 27-36. KEYWORDS out-of-pocket payment, user fees, quality, tertiary health services;. Nigeria. .... and research committee of the Delta State .... Methods of funding and perceived satisfaction patient's waiting time, attitude of health care.

  12. Towards a more demand oriented health care: analyzing demand for local primary health care .

    NARCIS (Netherlands)

    Bakker, D.H. de; Zwaanswijk, M.; Zantinge, E.M.; Verhaak, P.F.M.

    2007-01-01

    One of the goals of the current health care reform in the Netherlands is to strengthen demand orientation. Community based primary health care provision should be tuned to local demand. Information on local demand is missing, however. Research goal is to provide local decision makers (patient

  13. 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.

  14. 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

  15. 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

  16. Phytotherapy in primary health care

    Directory of Open Access Journals (Sweden)

    Gisele Damian Antonio

    2014-06-01

    Full Text Available OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.

  17. Phytotherapy in primary health care.

    Science.gov (United States)

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

    2014-06-01

    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.

  18. Mohalla Clinics of Delhi, India: Could these become platform to strengthen primary healthcare?

    Science.gov (United States)

    Lahariya, Chandrakant

    2017-01-01

    The mohalla or community clinics in Delhi, India aims to provide basic health services to underserved population in urban settings. This article reviews and analyzes the strengths & limitations of the concept and explores the role these clinics can play in (1) reforming urban health service delivery, (2) addressing health inequities, and (3) strengthening primary health care. These clinics provide basic healthcare services to people, in underserved areas, in a responsive manner, have brought health higher on the political agenda and the governments of a number of Indian states have shown interest in adoption (of a variant) of this concept. Strengths notwithstanding, the limitations of these clinics are: curative or personal health services focus and relatively less attention on public/population health services. It is proposed that while setting up these clinics, the government should built upon existing health system infrastructure such as dispensaries, addressing the existing challenges. The new initiative need not to be standalone infrastructure, rather should aimed at health system strengthening. These need to have a functional linkage with existing programs, such as Urban Primary Health Centres (U-PHCs) under national urban health mission (NUHM) and could be supplemented with overall efforts for innovations and other related reforms. The author proposes a checklist 'Score-100' or 'S-100', which can be used to assess the readiness and preparedness for such initiative, should other state governments and/or major city in India or other countries, plan to adopt and implement similar concept in their settings. In last 18 months, the key contribution of these clinics has been to bring health to public and political discourse. Author, following the experience in Delhi, envisions that these clinics have set the background to bring cleanliness-health-education-sanitation-social sectors (C-H-E-S-S or CHESS) as an alternative to Bijli-Sadak-Paani (B-S-P) as electoral

  19. Incorporating Spirituality in Primary Care.

    Science.gov (United States)

    Isaac, Kathleen S; Hay, Jennifer L; Lubetkin, Erica I

    2016-06-01

    Addressing cultural competency in health care involves recognizing the diverse characteristics of the patient population and understanding how they impact patient care. Spirituality is an aspect of cultural identity that has become increasingly recognized for its potential to impact health behaviors and healthcare decision-making. We consider the complex relationship between spirituality and health, exploring the role of spirituality in primary care, and consider the inclusion of spirituality in existing models of health promotion. We discuss the feasibility of incorporating spirituality into clinical practice, offering suggestions for physicians.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    Early detection and treatment of these morbidities could prevent deterioration. The aim of the survey was to determine and compare the prevalence of ..... interventions. Increasing the detection rate of mental morbidity in the community is fundamental. The inclusion of mental health care as a component of primary health ...

  1. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Objective: The study aimed at involving adolescents in school-based health promotion activities as a strategy to improve ... Adolescents, perception of risk, sexual behaviour, active participation, health promotion. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE .... behaviour, importance of self esteem and.

  2. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    sexual intercourse under the influence of alcohol or adolescents and younger adults. psychoactive substances. Respondents were. Risky sexual behaviour among young people has categorized as engaging in risky sexual behaviour if. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 2 ...

  3. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    attitudes towards Basic Cardiopulmonary Resuscitation (CPR) among Community Nurses in Remo Area of. Ogun State, Nigeria with ... Knowledge of basic CPR amongst nurses at primary health care level is generally poor with the young ones having better performance. ..... Fetuga, B. Okeniyi, A. Neonatal. Knowledge and ...

  4. 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

  5. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    1,2. Organization, the community health worker was health system when the country adopted the PHC introduced into the health system for various strategy to achieve the goal of health for all. 76. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 25, NO 2, SEPTEMBER 2013. Correspondence to.

  6. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    determine the awareness, willingness and use of. Voluntary HIV testing and counseling services by. One of the priorities of national HTC students of Niger Delta University. programmes is to ensure that at least 80% of. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 25, NO 2, SEPTEMBER ...

  7. primary health care in nigeria

    African Journals Online (AJOL)

    user1

    2014-07-31

    Jul 31, 2014 ... The Alma Ata declaration on Primary Health Care (PHC) which was made in 1978 is meant to address the main health problems in communities by providing promotive, preventive, curative and rehabilitative services. Nigeria was among the 134 signatories to this invaluable idea. Subsequently, several ...

  8. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    population of the big cities live urban slums. our environment are diarrhea diseases, pneumonia,. Urban slums pose special health problems due to. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. 1. 1Department of Paediatrics, University of Nigeria Teaching Hospital, ...

  9. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    the stigmatization of people living with HIV/AIDS among traders in model markets in Lagos State. Methodology: ... traders, Pre- intervention and post- intervention. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 24, NO 1&2, MARCH 2013. 34 ..... Oladele J, Adeiga ZA, Ricketts F, Goodluck H.

  10. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    CHILDREN,. SCHOOL HEALTH. Correspondence to. Dr Kofoworola A Odeyemi. Department of Community Health, University of Lagos . Lagos. Nigeria. Email kofoodeyemi@yahoo.com. Journal of Community Medicine and Primary Health Care. 25 (1) 51-57. Background: Visual impairment is usually due to conditions that ...

  11. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    order words, it refers to any abusive treatment to women, thus violating the law of basic human ... JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 2, SEPTEMBER 2015. 20 journal of ... Some women victims, for the fear of repeated attacks by perpetrators, refused to even to report to. 3.

  12. 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.

  13. The Health Care Strengthening Act: The next level of integrated care in Germany.

    Science.gov (United States)

    Milstein, Ricarda; Blankart, Carl Rudolf

    2016-05-01

    The lack of integration of health-care sectors and specialist groups is widely accepted as a necessity to effectively address the most urgent challenges in modern health care systems. Germany follows a more decentralized approach that allows for many degrees of freedom. With its latest bill, the German government has introduced several measures to explicitly foster the integration of health-care services. This article presents the historic development of integrated care services and offers insights into the construction of integrated care programs in the German health-care system. The measures of integrated care within the Health Care Strengthening Act are presented and discussed in detail from the perspective of the provider, the payer, and the political arena. In addition, the effects of the new act are assessed using scenario technique based on an analysis of the effects of previously implemented health policy reforms. Germany now has a flourishing integrated care scene with many integrated care programs being able to contain costs and improve quality. Although it will be still a long journey for Germany to reach the coordination of care standards set by leading countries such as the United Kingdom, New Zealand or Switzerland, international health policy makers may deliberately and selectively adopt elements of the German approach such as the extensive freedom of contract, the strong patient-focus by allowing for very need-driven and regional solutions, or the substantial start-up funding allowing for more unproven and progressive endeavors to further improve their own health systems. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  14. Strengthening Primary Health Care in the municipalities in the Metropolitan Region of Porto Alegre, Brazil, after the introduction of the Mais Médicos (More Doctors) Program: an inter-municipal comparison.

    Science.gov (United States)

    Mendonça, Claunara Schilling; Diercks, Margarita Silva; Kopittke, Luciane

    2016-09-01

    This article aims to propose an adaptation of the methodology used by Starfield and Shy (2002) to assess the quality of health care in the municipalities which joined the Mais Médicos (More Doctors) Program. The indicators were adapted for each one of the nine criteria proposed in the methodology and were applied to medium and large municipalities in the Metropolitan Region of Porto Alegre before and after they were integrated in the Mais Médicos Program. In 2014, the municipalities were grouped into three groups according to their scores. An analysis concerning any correlations between the different group scores for the municipalities and the health indicators that were evaluated, did not reveal anything significant. However the averages of the evaluated indicators were better in the group of municipalities characterized through having the best APS scores. In relation to the income indicator, the highest amount of money spent per capita in health is related to the best APS performance in the municipalities. An adaption of this methodology may be able to provide a better understanding of the policies related to health care.

  15. 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.

  16. Phytotherapy in primary health care

    OpenAIRE

    Gisele Damian Antonio; Charles Dalcanele Tesser; Rodrigo Otavio Moretti-Pires

    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 ...

  17. Psychiatric consulting in primary care

    Directory of Open Access Journals (Sweden)

    Susana María Castro Pérez

    2013-04-01

    Full Text Available The psychiatric consultation is broadly defined as an educational relationship between a psychiatrist, a general practitioner and other professionals working in the area of Mental Health. Currently it is a fundamental tool to optimize the treatment of psychiatric patients in primary care, given the high prevalence of these conditions and limited access to hours of specialty. Psychiatric Consulting is centrally positioned because patients are generally reluctant to consult with specialists, either because of the stigma associated with psychiatric illness or the cost effectiveness of the specialty. This leads patients to consult in primary care. Therefore we were interested in reviewing the evidence supporting this activity and what are the benefits it delivers. After reviewing the literature we conclude that the Psychiatric Consultation helps to improve the diagnosis, treatment and monitoring of psychiatric disorders in primary care, particularly the management of depressive disorders and somatoform disorders, improving the resolution capabilities of general practitioners, thus lowering the associated healthcare costs of these conditions. There is no evidence to support the health benefits of training general practitioners.

  18. 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

  19. [Eating disorders in primary care].

    Science.gov (United States)

    Bjørnelv, Sigrid

    2004-09-23

    Early diagnosis and treatment are important for the prognosis in eating disorders and will also reduce the burden on the patient as well as n his or her family. On the other hand, community studies show that less than half of clinical cases of eating disorders are identified in primary care; hence, better skills among general practitioners in this field are very important. On the basis of the literature and clinical experience, this article discusses various problems related to identifying, evaluating and treating patients with eating disorders in primary care. The most important tool for the general practitioner is an understanding of the nature of the disorder, but tools for identification and treatment are also useful. Attending the patient and collaboration with hospitals and outpatient clinics could be a challenge. There are guidelines for the treatment of eating disorders in specialised health care, including indications for hospitalisation, but no guidelines for referral to outpatient treatment or for the coordination between the general practitioner and specialised units. The proposed British guidelines might serve as a basis for Norwegian guidelines.

  20. 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)

  1. Primary Care Clinics and Accountable Care Organizations

    Directory of Open Access Journals (Sweden)

    Judith Ortiz PhD

    2015-10-01

    Full Text Available Background: The Accountable Care Organization (ACO is one of the new models of health care delivery in the United States. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so. Methods: A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs in 9 states. Two dependent variables—participation in ACOs and willingness to join ACOs—were created and analyzed using a generalized estimating equation approach. Results: A total of 257 RHCs responded to the survey. A small percentage (5.2% of the respondent clinics reported that they were participating in ACOs. Rural Health Clinics in isolated areas were 78% less likely to be in ACOs (odds ratio = 0.22, P = .059. Nonprofit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B = 1.271, P = .054. There is a positive relationship between RHC size and willingness to join an ACO (B = 0.402, P = .010. Conclusion: At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers’ limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs.

  2. 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...

  3. Oral anticoagulation in primary care.

    Science.gov (United States)

    Altirriba, J; Aparicio, P

    2017-06-01

    Oral anticoagulant therapy is currently widespread in the population and primary care plays an important role in its control in Spain. Younger populations, such as those in prisons, often require this treatment for reasons other than atrial fibrillation, often in relation to valvular or congenital or acquired hypercoagulability situations. The possibility of obtaining the INR by portable coagulometers has allowed primary care physicians to tackle the indication of this therapy and the control of these patients in coordination with haematology services. The emergence of new therapeutic alternatives (Dabigatran, Rivaroxaban, Apixaban and Edoxaban, the so called "ACOD") has permitted the expansion of options for oral anticoagulation in some cases, since they do not require systematic monitoring of their effect and interact with far fewer drugs than their predecessors, although there are still restrictions by the health authorities on their widespread use. This article reviews the different indications of oral anticoagulant therapy according to the new recommendations as well as the clinical scenarios in which it should be used.

  4. Buprenorphine retention in primary care.

    Science.gov (United States)

    Stein, Michael D; Cioe, Patricia; Friedmann, Peter D

    2005-11-01

    This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist. Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after the adoption of buprenophine/naloxone by a primary care practice in Rhode Island. Practice policy precluded patient discharges due to continuing drug use. Patients (n=41) had a mean duration of opioid use of 15.7 years and most had a history of heroin use (63.4%). Thirty-nine percent of patients transferred from methadone maintenance. At 24 weeks, 59% remained in treatment. Nearly half of dropouts occurred in the first 30 days. Participants with opiate-positive toxicologies at week 1 were more likely to drop out of the program (Pbuprenorphine maintenance practice reflect those reported in clinical trials. Abstinence during the first week of treatment and receipt of counseling were critical to patient retention.

  5. Primary care multidisciplinary teams in practice: a qualitative study.

    Science.gov (United States)

    Leach, Brandi; Morgan, Perri; Strand de Oliveira, Justine; Hull, Sharon; Østbye, Truls; Everett, Christine

    2017-12-29

    Current recommendations for strengthening the US healthcare system consider restructuring primary care into multidisciplinary teams as vital to improving quality and efficiency. Yet, approaches to the selection of team designs remain unclear. This project describes current primary care team designs, primary care professionals' perceptions of ideal team designs, and perceived facilitating factors and barriers to implementing ideal team-based care. Qualitative study of 44 health care professionals at 6 primary care practices in North Carolina using focus group discussions and surveys. Data was analyzed using framework content analysis. Practices used a variety of multidisciplinary team designs with the specific design being influenced by the social and policy context in which practices were embedded. Practices overwhelmingly located barriers to adopting ideal multidisciplinary teams as being outside of their individual practices and outside of their control. Participants viewed internal organizational contexts as the major facilitators of multidisciplinary primary care teams. The majority of practices described their ideal team design as including a social worker to meet the needs of socially complex patients. Primary care multidisciplinary team designs vary across practices, shaped in part by contextual factors perceived as barriers outside of the practices' control. Facilitating factors within practices provide a culture of support to team members, but they are insufficient to overcome the perceived barriers. The common desire to add social workers to care teams reflects practices' struggles to meet the complex demands of patients and external agencies. Government or organizational policies should avoid one-size-fits-all approaches to multidisciplinary care teams, and instead allow primary care practices to adapt to their specific contextual circumstances.

  6. [Information system in primary health care].

    Science.gov (United States)

    Stevanović, Ranko; Stanić, Arsen; Varga, Sinisa

    2005-01-01

    The Croatian Ministry of Health started a health care system computerization project aimed at strengthening the collaboration among health care institutions, expert groups and individual health care providers. A tender for informatic system for Primary Health Care (PHC) general practice, pediatrics and gynecology, a vital prerequisite for project realization, has now been closed. Some important reasons for undertaking the project include rationalization of drug utilization, savings through a reduced use of specialists, consultants and hospitalization, then achievement of better cooperation, work distribution, result linking, data quality improvement (by standardization), and ensuring proper information-based decision making. Keeping non-standardized and thus difficult to process data takes too much time of the PHC team time. Since, however, a vast amount of data are collected on only a few indicators, some important information may remain uncovered. Although decisions made by health authorities should rely on evidence and processed information, the authorities spend most of the time working with raw data from which their decisions ultimately derive. The Informatic Technology (IT) in PHC is expected to enable a different approach. PHC teams should be relieved from the tedious task of data gathering and the authorities enabled to work with the information rather than data. The Informatics Communication Technology (ICT) system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. At the national level (National Public Health Informatics System), a software platform will be built for data collection, analysis and distribution. This data collection will be based on the International Classification of Primary Care (ICPC-2) standard to ensure the utilization of medical records and quality assessment. The system permits bi-directional data exchange between

  7. 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.

  8. Health transition in Africa: practical policy proposals for primary care.

    Science.gov (United States)

    Maher, D; Smeeth, L; Sekajugo, J

    2010-12-01

    Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example, age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa, they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition.

  9. Pediatric Primary Care as a Component of Systems of Care

    Science.gov (United States)

    Brown, Jonathan D.

    2010-01-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  10. 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

  11. Hypertension Management in Primary Care.

    Science.gov (United States)

    Weltermann, Birgitta; Kersting, Christine; Viehmann, Anja

    2016-03-11

    To improve hypertension control, this cluster randomized trial evaluated the effectiveness of physician manager education about hypertension management. After randomization at practice level, primary care physicians of the intervention arm, whose practices collaborated with a university department, participated in a three-session education on evidence-based hypertensiology and practice implementation strategies. The primary outcome was blood pressure (BP) control (ambulatory blood pressure [ABP] hypertension management. Following an intention-to-treat approach, data analyses included crude and adjusted generalized mixed models and sensitivity analyses. These took into account sex, age, ≥ hypertension-related disease and resistant hypertension (RH). The analysis included 103 of 169 patients from 22 practices. Overall, BP decrease was -8.2 systolic and -4.1 mmHg diastolic. The intervention had no effect on BP control (odds ratio 0.84 [95% CI 0.29-2.43]) and BP changes (interventional effect: systolic -2.48 mmHg [95% CI -7.24 to 2.29], diastolic -0.25 mmHg [95% CI 3.31 to 2.82]). Sensitivity analysis indicated effect modification in patients with RH. Intervention practices requested educational input on difficult cases, and newly implemented 3 practice strategies (14.5±2.6 versus 11.4±2.2; P=0.005). After the short follow-up of 5 months, the intervention had no impact on BP control but improved the use of practice strategies.

  12. 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.

  13. [Critical view and argumentation on chronic care programs in Primary and Community Care].

    Science.gov (United States)

    Minué-Lorenzo, Sergio; Fernández-Aguilar, Carmen

    2018-02-01

    The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care. Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date. Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  14. 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.

  15. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation. PMID:27563348

  16. 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

  17. 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...

  18. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    systems deteriorated in parallel with the deepening the gross inequalities in health care system, many economic crisis, while the subsequent introduction countries adopted the National Health Insurance of user fees further impeded access to care and. Scheme (NHIS) as a way of health care financing. 1 aggravated inequity ...

  19. Exploring patient safety culture in primary care

    NARCIS (Netherlands)

    Verbakel, N.J.; van Melle, M.; Langelaan, M.; Verheij, T.J.; Wagner, C.; Zwart, D.L.

    2014-01-01

    Objective. To explore perceptions of safety culture in nine different types of primary care professions and to study possible differences. Design. Cross-sectional survey. Setting. Three hundred and thirteen practices from nine types of primary care profession groups in the Netherlands. Participants.

  20. 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

  1. Primary Medical Care and Children's Learning Problems.

    Science.gov (United States)

    McGrath, P J; Feldman, W; Rosser, W

    1989-02-01

    The authors describe the major learning problems that confront the primary-care physician. They discuss why they believe that the primary-care physician has an important role in case finding, referral, case management, and advocacy for the child with learning problems and his or her family.

  2. 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.

  3. 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

  4. 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.

  5. Primary Health Care and Narrative Medicine.

    Science.gov (United States)

    Murphy, John W

    2015-01-01

    Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery.

  6. Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment

    Directory of Open Access Journals (Sweden)

    Sarah Fredsted Villadsen

    2014-01-01

    Full Text Available Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals. Conclusions. Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health.

  7. Depression in primary care: assessing suicide risk

    Science.gov (United States)

    Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

    2017-01-01

    Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care. PMID:28210741

  8. Nurses are central to primary care.

    Science.gov (United States)

    Hargadon, Judy

    1995-11-22

    Your story about our primary healthcare conference seems to imply that the nursing profession is being left out of the process of developing primary care services in London, 'Nurses side-stepped in capital's primary healthcare plans' (News November 8). Nothing could be further from the truth.

  9. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    ABSTRACT. Background: The well-being of women and children is one of the major determinants of the health of any nation and can ... preconception care, the result showed that majority (65.9%, n=247) of the respondents have not sought the care before pregnancy ... women have optimal health in order to give birth to.

  10. 1st National Conference on Family Medicine and Primary Care: A Journey Toward Stronger Primary Care in India

    Science.gov (United States)

    Kumar, Raman

    2013-01-01

    Academy of Family Physicians of India organized the first National Conference on Family Medicine and Primary Care (FMPC) on 20-21 April 2013 at India International Centre New Delhi. The conference was a major success towards positioning of requirement for a distinct academic discipline (family medicine) within the medical and nursing education system as a means for strengthening of primary care in India. The event gained its prominence in the times when universal health coverage is being debated. A generalist approach in development of human resource prominently figured in the discussions. The deliberations and talks of the Indian as well as international experts were recorded and released as the report of national consultation on family medicine programme. PMID:26664831

  11. Communication between primary care physicians and consultants.

    Science.gov (United States)

    Epstein, R M

    1995-05-01

    Optimal communication between primary care physicians and consultants includes transfer of relevant clinical information, including the patient's perspectives and values, and provides a means of collaboration to provide meaningful and health-promoting interventions. Communication difficulties arise because of lack of time, lack of clarity about the reason for referral, patient self-referral, and unclear follow-up plans. Also, primary care physicians and consultants may have different core values and may have little day-to-day contact with each other. Poor communication leads to disruptions in continuity of care, delayed diagnoses, unnecessary testing, and iatrogenic complications. Changes in the health care system offer the opportunity for improved collaboration between physicians by creating smaller administrative units within large health care systems that facilitate contact between primary care physicians and consultants; incorporation of discussions of uncertainty, patient preferences, and values into referral letters; adoption of a friendlier consultant letter format; and the improvement of the transfer of clinical data.

  12. Primary health care and child survival in India.

    Science.gov (United States)

    Lahariya, Chandrakant; Khanna, Rajesh; Nandan, Deoki

    2010-03-01

    The Primary Health Care (PHC) has been globally promoted as a comprehensive approach to achieve optimal health status and 'Health for all'. The PHC approach, although, initially received the attention but failed to meet the expectations of the people in India. The child health programs in India had been started for long as verticals programs, which later on integrated and had been planned in a way to deliver the services through the PHC systems. Nevertheless, the last decade has witnessed many new initiatives for improving child health, specially; a number of strategies under National Rural Health Mission have been implemented to improve child survival--Skilled Birth Attendant and Emergency Obstetric Care, Home Based Newborn Care, Sick newborn care units, Integrated Management of Neonatal and Childhood Illnesses, strengthening Immunization services, setting up Nutritional rehabilitation centers etc. However, for a large proportion of rural population, an effective and efficient PHC system is the only way for service delivery, which still needs more attention. The authors note that although there have been improvements in infrastructure, community level health workers, and availability of the funding etc., the areas like community participation, district level health planning, data for action, inter-sectoral coordination, political commitment, public private partnership, accountability, and the improving health work force and need immediate attention, to strengthen the PHC system in the country, making it more child friendly and contributory in child survival, in India.

  13. 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.

  14. 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

  15. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    to improving mood and helping to manage stress . physical activity a day at least five times a week . Sedentary lifestyle is associated with obesity, Greater health benefits can be experienced with. KEYWORDS. Practice,. Exercise,. Leisure,. Work- related,. Overweight,. Obesity. Journal of Community Medicine and Primary ...

  16. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    on the patients and families for self-care and the leading to more effective counselling and better clinical decision-making responsibilities it .... about body image because of their weight. The responsibility of administering .... in the individual a negative effect on self- history of diabetes and were skipping meals as a esteem.

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    replaced in January 2000, with free health service, which involves supplying free drugs from the state medical store to local government areas. This study aimed to ... The drug revolving fund initiative as a strategic opportunity to support local ... Iwajowa Local Government in symbols of quality care to consumers; in Nigeria,.

  18. 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 ... health policy makers. Irrespective of the option, the choice of health care financing should mobilize resources for health and provide financial protection. 1 ..... Opportunities for Sub-Saharan African.

  19. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Background. The availability of drugs on a continuous basis is paramount to the success of any health care system. The Bamako Initiative (BI) had provision of essential drugs as one of its key thrusts in order to improve the utilization of health facilities. This study compared the perceived availability of essential drugs and ...

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Methodology. A cross-sectional survey of patients at the antiretroviral clinic of the Federal Medical Centre,. Makurdi, Nigeria, was conducted between June and August 2008. An adapted version of the RAND. Patient Satisfaction Questionnaire Long Form was used to assess seven dimensions of care: general satisfaction ...

  1. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    2013-09-02

    Sep 2, 2013 ... Background. Disease pattern in Nigeria is changing from communicable diseases to non-communicable diseases. However, the approach to patient care has not changed; neither has the expectations of the general public for quick recovery. These have resulted in poorer treatment outcome and patients'.

  2. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    campaigns; use of cigarette (nicotine). Information was collected on socio- substitutes and alternative approaches like demographic characteristics of respondents, acupuncture, aromatherapy, hypnosis and knowledge and attitude of the health care. 9-12 herbs. Often times, combinations of workers about smoking cessation ...

  3. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    microeconomic costs data are useful in assessing. 12 for treatment. the ability of individuals and households to afford health care services. Nigeria receives donor support for malaria control. Global Fund is currently its largest funding partner. This study was conducted to assess the direct cost. Through the Global Fund, SFH ...

  4. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    Nigeria has one of the largest stocks of. In all situations, volunteers add to the quality and human resources for ... profit making enterprise by the partners the health care objectives, including the involved.Rather, it is a health ..... Investing in volunteerism: The impact of service initiatives in selected state agencies. Austin, TX: ...

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    catastrophic health expenditures (CHE) and risk of being impoverished as a result of cost of care were assessed. Statistical ... Study found a high prevalence of catastrophic health expenditure and near absence of financial risk protection for patients with long term ... services especially for the target group in Nigeria.

  6. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    on the patients and families for self-care and the leading to more effective counselling and better clinical decision-making responsibilities .... T2DM were females aged 14 and 16 years diagnosis of diabetes. With regard to acute respectively and ... about body image because of their weight. The responsibility of administering ...

  7. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    2013-09-02

    Sep 2, 2013 ... Incidence and reasons for Discharge Against Medical Advice in a tertiary health care facility in Port Harcourt, south-south Nigeria. Ordinioha B. Community Medicine Department. University of Port Harcourt Teaching Hospital,Port Harcourt. Email: ruralhealthforum@yahoo.com. +2348037075300.

  8. Primary Care Providers' Perspectives on Errors of Omission.

    Science.gov (United States)

    Poghosyan, Lusine; Norful, Allison A; Fleck, Elaine; Bruzzese, Jean-Marie; Talsma, AkkeNeel; Nannini, Angela

    2017-01-01

    Despite recent focus on patient safety in primary care, little attention has been paid to errors of omission, which represent significant gaps in care and threaten patient safety in primary care but are not well studied or categorized. The purpose of this study was to develop a typology of errors of omission from the perspectives of primary care providers (PCPs) and understand what factors within practices lead to or prevent these omissions. A qualitative descriptive design was used to collect data from 26 PCPs, both physicians and nurse practitioners, from the New York State through individual interviews. One researcher conducted all interviews, which were audiotaped, transcribed verbatim, and analyzed in ATLAS.ti, Berlin by 3 researchers using content analysis. They immersed themselves into data, read transcripts independently, and conducted inductive coding. The final codes were linked to each other to develop the typology of errors of omission and the themes. Data saturation was reached at the 26th interview. PCPs reported that omitting patient teaching, patient followup, emotional support, and addressing mental health needs were the main categories of errors of omission. PCPs perceived that time constraints, unplanned patient visits and emergencies, and administrative burden led to these gaps in care. They emphasized that organizational support and infrastructure, effective teamwork and communication, and preparation for the patient encounter were important safeguards to prevent errors of omission within their practices. Errors of omission are common in primary care and could threaten patient safety. Efforts to eliminate them should focus on strengthening organizational attributes of practices, improving teamwork and communication, and assigning manageable workload to PCPs. Practice and policy change is necessary to address gaps in care and prevent them before they result in patient harm. © Copyright 2017 by the American Board of Family Medicine.

  9. Strengthening the Late-Life Care Process: Effects of Two Forms of a Care-Receiver Efficacy Intervention

    Science.gov (United States)

    Cox, Enid O.; Green, Kathy E.; Hobart, Katharine; Jang, Li-Ju; Seo, Honglan

    2007-01-01

    Purpose: The primary goal of the Care-Receiver Efficacy Intervention (CREI) was to increase the capacity of cognitively able elderly care receivers to effectively manage their own care and optimize relationships with caregivers. To accomplish this, two forms of the CREI were created: an individual and a small-group form. The purpose of this study…

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

    Science.gov (United States)

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

    2013-12-01

    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, economy, prevailing values, and type of healthcare system are all important factors that influence the development of strong PC. Wealthier countries are associated with a weaker PC structure and lower PC accessibility, while Eastern European countries seemed to have used their growth in national income to strengthen the accessibility and continuity of PC. Countries governed by left-wing governments are associated with a stronger PC structure, accessibility and coordination of PC. Countries with a social-security based system are associated with a lower accessibility and continuity of PC; the opposite is true for transitional systems. Cultural values seemed to affect all aspects of PC. It can be concluded that strengthening PC means mobilising multiple leverage points, policy options, and political will in line with prevailing values in a country. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Diverticular Disease in the Primary Care Setting

    OpenAIRE

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-01-01

    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 ...

  12. Primary mental health care: Indications and obstacles

    Directory of Open Access Journals (Sweden)

    Y.G. Pillay

    1992-09-01

    Full Text Available This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health to its fruition are seldom addressed.

  13. Improving interprofessional collaboration in primary care: position paper of the European Forum for Primary Care.

    NARCIS (Netherlands)

    Samuelson, M.; Tedeschi, P.; Aarendonk, D.; Cuesta, C. de la; Groenewegen, P.

    2012-01-01

    Primary care is the central pillar of health care. The increasingly complex health needs of the population and individual patients in a changing society can only be met by promoting interprofessional collaboration (IpC) within primary care teams. The aim of this Position Paper of the European Forum

  14. 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.

  15. Millennial transformation for primary care.

    Science.gov (United States)

    Cowan, Michael

    2010-06-01

    We do not need a crystal ball to see the future. Our web-based future has already arrived in all other aspects of our lives--even our mobile phones. The tools for progress--Personal Health Records, Social Networks, and Online medical information--are widely available. The demand is at hand--Millennials are flexing consumer muscles as they enter the healthcare market. Real "Health Care Reform" requires fundamental changes in practice--which in turn requires effective use of information technologies and adaption to changing consumer expectations. The VHA and the MHS are uniquely capable of leveraging political, academic and technological forces to help move American health care through this millennial transformation. Federal health systems are positioned to demonstrate the value of innovation as America seeks healthcare reform.

  16. 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

  17. Flipping primary health care: A personal story.

    Science.gov (United States)

    Mate, Kedar S; Salinas, Gilbert

    2014-12-01

    There is considerable interest in ideas borrowed from education about "flipping the classroom" and how they might be applied to "flipping" aspects of health care to reach the Triple Aim of improved health outcomes, improved experience of care, and reduced costs. There are few real-life case studies of "flipping health care" in practice at the individual patient level. This article describes the experience of one of the authors as he experienced having to "flip" his primary health care. We describe seven inverted practices in his care, report outcomes of this experiment, describe the enabling factors, and derive lessons for patient-centered primary care redesign. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Worksite primary care clinics: a systematic review.

    Science.gov (United States)

    Shahly, Victoria; Kessler, Ronald C; Duncan, Ian

    2014-10-01

    Despite levels of health spending that are higher per capita and as share of gross domestic product than any country worldwide, the US health care system is fragmented, technology and administration heavy, and primary care deficient. Studies of regional variations in US health care show similar "disconnects" between higher spending and better health outcomes. Faced with rising health benefit costs and suboptimal workforce health amid economic downturn, concerned US employers have implemented innovative payment and health care delivery strategies such as consumer-driven health plans and targeted prevention programs. The former may impose undue cost shifting, prohibitive out-of-pocket expenses, and health literacy challenges, while the latter have shown inconsistent near-term economic returns and long-term clinical efficacy. Employers have begun exploring more comprehensive health delivery platforms such as integrated worksite primary care clinics that have potential to cost-effectively address several pressing problems with current US health care: the growing primary care physician shortage, poor access to routine care, lack of coordinated and patient-centered treatment models, low rates of childhood immunizations, and "quality-blind" fee-for-service payment mechanisms. Such on-site medical clinics exploit one of the rare comparative strengths of the US health care system-its plentiful supply of highly skilled registered nurses-to offer workers and their dependents convenient, high-quality, affordable care. A relatively recent health care paradigm, worksite clinics must yet develop consistent reporting strategies and credible demonstration of outcomes. This review explores available evidence regarding worksite primary care clinics, including current rationale, historical trends, prevalence and projected growth, expected health and financial benefits, challenges, and future research directions.

  19. Eating Disorders in the Primary Care Setting.

    Science.gov (United States)

    Sangvai, Devdutta

    2016-06-01

    Eating disorders are a complex set of illnesses most commonly affecting white adolescent girls and young women. The most common eating disorders seen in the primary care setting are anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment in the primary care environment ideally involves a physician, therapist, and nutritionist, although complex cases may require psychiatric and other specialist care. Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

    Directory of Open Access Journals (Sweden)

    Gertrude Namazzi

    2015-03-01

    Full Text Available Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST, aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with

  1. 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.

  2. 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.

  3. 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...

  4. Rainbows: a primary health care initiative for primary schools.

    Science.gov (United States)

    Munns, Ailsa; Forde, Karen A; Krouzecky, Miriam; Shields, Linda

    2015-01-01

    Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care centred approach, embracing the social contexts of health and wellbeing. Recent research investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents. The results of this qualitative study indicate that all participants regard Rainbows as effective, with many perceived benefits to students and their families.

  5. Accessibility to primary health care services in the state of Goiás

    Directory of Open Access Journals (Sweden)

    Juliana Pires Ribeiro

    2015-09-01

    Full Text Available The objective of this study was to evaluate accessibility to primary health care services in the state of Goiás. A descriptive cross-sectional study was conducted based on secondary data from the National Program to Improve Access to and Quality of Primary Health Care. The study sample was composed of health professionals from 1,216 primary health care units. Results showed that 68.5% of the health units miss a screening room, thus considerably damaging prompt decision-making by professionals. The lack of medical offices in 2% of the sites hinders the primary health care services accessibility in Goiás. As regards opening hours and work shifts, 86% of the units are open five days a week in eight-hour shifts, which does not favor accessibility for users. This study confirms the lack of accessibility to health services and the need for additional investments to strengthen primary health care.

  6. 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.

  7. 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.

  8. 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.

  9. Primary health care practitioners' tools for mental health care.

    Science.gov (United States)

    Hyvonen, S; Nikkonen, M

    2004-10-01

    The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.

  10. 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.

  11. [Promotion of research in primary care].

    Science.gov (United States)

    2008-03-01

    To identify what can be done to promote research and development (R+D) in primary care. To find the main lines of primary care R+D in the Community of Valencia, Spain. Qualitative research based on consensus group. Concretely, the Phillips technique, modified for the number attending, was employed. Primary care. Twenty-four primary care professionals in the Community of Valencia (75% of 32 invited): physicians, pharmacists, teaching or research unit professionals, medical managers, and researcher-doctors leading primary care R+D projects. Four questions were asked: concerning barriers to research, how to make it easier to take part in competitive R+D contests, how to disseminate results and what topics are of most interest today. Problems identified were: lack of time, need for technical support, and need for day-schools and prizes to promote investigation. It was suggested that research should be given value in job contests, it should be made a requirement to finish training (MIR), funds for projects in health areas should be created and finance for emerging groups should be provided. In summary, it was proposed to create research units in every department/area with professionals given time off to lead projects and with administrative support to gain resources. Doctors should be encouraged to take part by the recognition of research for job contests, in their professional careers and in productivity indicators.

  12. Primary Care Physicians' Dementia Care Practices: Evidence of Geographic Variation

    Science.gov (United States)

    Fortinsky, Richard H.; Zlateva, Ianita; Delaney, Colleen; Kleppinger, Alison

    2010-01-01

    Purpose: This article explores primary care physicians' (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states. Design and Methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in…

  13. 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.

  14. Homelessness: a problem for primary care?

    Science.gov (United States)

    Riley, Anthony J; Harding, Geoffrey; Underwood, Martin R; Carter, Yvonne H

    2003-06-01

    Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness.

  15. Moral sensitivity in Primary Health Care nurses.

    Science.gov (United States)

    Nora, Carlise Rigon Dalla; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida M

    2017-04-01

    to characterize the profile and describe the moral sensitivity of primary health care nurses. this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis. the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning. the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.

  16. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania.

    Science.gov (United States)

    Maluka, Stephen Oswald

    2011-01-01

    Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader

  17. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania

    Directory of Open Access Journals (Sweden)

    Stephen Maluka

    2011-11-01

    Full Text Available Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority

  18. Prenatal Care for Adolescents and attributes of Primary Health Care

    Directory of Open Access Journals (Sweden)

    Maria Cristina Barbaro

    2014-01-01

    Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.

  19. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe

    2015-01-01

    increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3...... and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included...... in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems...

  20. 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.

  1. Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment.

    NARCIS (Netherlands)

    Aantjes, C.J.; Quinlan, T.K.C.; Bunders-Aelen, J.G.F.

    2014-01-01

    In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. Our aim was to assess the position of civil society-led community home based care programmes (CHBC),

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

    Science.gov (United States)

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

    2014-01-01

    Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. 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. 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). 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.

  3. 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

  4. 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

  5. Management of asthma in primary care

    NARCIS (Netherlands)

    Honkoop, Pieter Jacob

    2016-01-01

    Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of ‘Controlled asthma’, which means patients experience hardly any

  6. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

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

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...

  7. Psychiatric emergencies, a primary care perspective

    African Journals Online (AJOL)

    Repro

    mood and anxiety disorders. He is mar- ried with two sons. Psychiatric emergencies, a primary care perspective. Psychiatric emergencies can be stressful and ... In teenagers the trigger is often relationships or the lack thereof, problems at school or parental expectat i o n s. In middle- age the concerns are divorce and.

  8. 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

  9. Registered Nurses’ Patient Education in Everyday Primary Care Practice

    Directory of Open Access Journals (Sweden)

    Anne-Louise Bergh

    2015-08-01

    Full Text Available Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoretical-based pedagogical competence development needs to be strengthened.

  10. Registered Nurses’ Patient Education in Everyday Primary Care Practice

    Science.gov (United States)

    Bergh, Anne-Louise; Friberg, Febe; Persson, Eva; Dahlborg-Lyckhage, Elisabeth

    2015-01-01

    Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoretical-based pedagogical competence development needs to be strengthened. PMID:28462314

  11. The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams.

    Science.gov (United States)

    Noël, Polly Hitchcock; Lanham, Holly J; Palmer, Ray F; Leykum, Luci K; Parchman, Michael L

    2013-01-01

    Recent research from a complexity theory perspective suggests that implementation of complex models of care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams. Our primary aim was to assess the extent to which practice member perceptions of relational coordination and reciprocal learning were associated with the presence of CCM elements in community-based primary care practices. We used baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM and improve risk factor control for patients with Type 2 diabetes in small primary care practices. Practice members (i.e., physicians, nonphysician providers, and staff) completed baseline assessments, which included the Relational Coordination Scale, Reciprocal Learning Scale, and the Assessment of Chronic Illness Care (ACIC) survey, along with items assessing individual and clinic characteristics. To assess the association between Relational Coordination, Reciprocal Learning, and ACIC, we used a series of hierarchical linear regression models accounting for clustering of individual practice members within clinics and controlling for individual- and practice-level characteristics and tested for mediation effects. A total of 283 practice members from 39 clinics completed baseline measures. Relational Coordination scores were significantly and positively associated with ACIC scores (Model 1). When Reciprocal Learning was added, Relational Coordination remained a significant yet notably attenuated predictor of ACIC (Model 2). The mediation effect was significant (z = 9.3, p < .01); 24% of the association between Relational Coordination and ACIC scores was explained by Reciprocal Learning. Of the individual- and practice-level covariates included in Model 3, only the presence of an electronic medical record was significant; Relational Coordination and Reciprocal Learning remained significant

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

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, AB; Olesen, Frede

    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...... sectors.METHOD. A number of focus group interviews were conducted with three types of subgroups: 1) Bereaved relatives, 2) GPs and 3) Various health-care-professionals, namely community nurses, hospital physicians and GPs. The interviews were transcribed and analysed according to a phenomenological......) The primary sector needs easy access to specialist advise, supervision and empowerment. 4) Better and easier communication pathways are important, both within the primary sector and across the sectors to improve accessibility.CONCLUSION. Our study shows a need for improvements in palliative home care...

  13. 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.

  14. Advanced nurse roles in UK primary care.

    Science.gov (United States)

    Sibbald, Bonnie; Laurant, Miranda G; Reeves, David

    2006-07-03

    Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.

  15. Primary health care organizations - through a conceptual and a political lens.

    Science.gov (United States)

    Sturmberg, Joachim P

    2011-06-01

    Governments around the world are looking at means to improve health care services and health outcomes for their communities within a sustainable expenditure framework. There is a general agreement that strengthening primary health care is the way for the future. Primary health care organizations (PHCOs) are seen as a means to achieving more effective and efficient health care. This paper proposes a complex adaptive framework for PHCOs, taking account of health and illness being subjective experiences, health care being 'whole person'-focused, and PHCOs focusing on all of a community's health determinants and community-based health care needs. Such approach would foster building healthy local communities as much as seamless integration of health services for all. However, despite the expressed intensions towards patient-centred health care reform the bureaucratic mindset of Australian health policy makers risks true reform by imposing highly structured - rather than 'simple'- policy and operational rules. © 2011 Blackwell Publishing Ltd.

  16. Translating an evidence-based lifestyle intervention program into primary care: lessons learned.

    Science.gov (United States)

    Blonstein, Andrea C; Yank, Veronica; Stafford, Randall S; Wilson, Sandra R; Rosas, Lisa Goldman; Ma, Jun

    2013-07-01

    The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluated the feasibility and potential effectiveness of translating an evidence-based lifestyle intervention for the management of obesity and related risk factors in a primary care setting. Delivered by allied health care providers, the intervention promoted at least 7% weight loss and at least 150 minutes per week of moderate-intensity physical activity through gradual, sustainable lifestyle changes. Activities included interactive group lessons, food tasting, guided physical activity, and technology-mediated self-monitoring and behavioral counseling. This article discusses insights and potential areas for improvement to strengthen program implementation for dissemination of the E-LITE program to other primary care settings. We focus on (a) the role of allied health professionals in program delivery, (b) strengthening program integration within a primary care clinic, and (c) the use of information technology to extend the reach and impact of the program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care setting. Challenges remain, and we offer possible solutions to overcome them.

  17. 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.

  18. Primary health care services for effective health care development in ...

    African Journals Online (AJOL)

    This is an empirical study of 7 communities among the O-kun Yoruba of Ijumu, Kogi State, Nigeria. The general objective of the study was to investigate the prioritizing pattern of the various Primary Health Care services (PHC) in the study area. Data for the study were generated mainly through multi-stage sampling ...

  19. The PAMINO-project: evaluating a primary care-based educational program to improve the quality of life of palliative patients.

    NARCIS (Netherlands)

    Rosemann, T.J.; Hermann, K.; Miksch, A.; Engeser, P.; Szecsenyi, J.

    2007-01-01

    BACKGROUND: The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To

  20. [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.

  1. 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...... separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson's chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out...

  2. 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.

  3. A snapshot of the organization and provision of primary care in Turkey

    Science.gov (United States)

    2011-01-01

    Background This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskişehir) in Turkey in 2007/08. The Tool consists of three parts: a national questionnaire concerning the organisation and financing of primary care; a questionnaire for family doctors; and a questionnaire for patients who visit a family health centre. Results Primary care has just recently become an official health policy priority with the introduction of a family medicine scheme. Although the supply of family doctors (FDs) has improved, they are geographically uneven distributed, and nationwide shortages of primary care staff remain. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by FDs. Conclusions The study provides an overview of the current state of PC in Turkey for two provinces with newly introduced family medicine, by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a "good" service delivery system (as being accessible, comprehensive, coordinated and continuous). PMID:21542904

  4. Treatment of Obesity in Primary Care.

    Science.gov (United States)

    Tsai, Adam G; Remmert, Jocelyn E; Butryn, Meghan L; Wadden, Thomas A

    2018-01-01

    This article outlines some of the behavioral, pharmacologic, and surgical interventions available to primary care physicians (PCPs) to help their patients with weight management. Studies on lifestyle modification, commercial weight loss programs, and medical and surgical options are reviewed. Several clinical suggestions on obesity management that PCPs can take back and use immediately in office practice are offered. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Pharmacotherapy for Insomnia in Primary Care

    OpenAIRE

    Smith, Emily; Narang, Puneet; Enja, Manasa; Lippmann, Steven

    2016-01-01

    Pharmacotherapy for insomnia in primary care settings can be challenging. Frequently, there are multiple coexisting medical and psychiatric conditions, drug interactions, concern regarding use of habit-forming sleep aids, and paucity of time in office visits to discuss management of sleep difficulties. This article reports the results of a literature search related to pharmacotherapy for insomnia and presents 4 clinical vignettes with corresponding treatment options.

  6. Barriers and facilitators of adolescent behavioral health in primary care: Perceptions of primary care providers.

    Science.gov (United States)

    Bitar, George W; Springer, Paul; Gee, Robert; Graff, Chad; Schydlower, Manuel

    2009-12-01

    Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary care providers are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been described in the literature, few studies have investigated these issues from the first-person perspective of front-line providers. The purpose of this study, therefore, is to provide an in-depth description of primary care providers' attitudes and perceptions of adolescent behavioral health care across a diversity of primary care settings (i.e., Federally Qualified Health Center [FQHC], FQHC-Look Alike, school-based, military). Sixteen focus groups were conducted at 5 primary care clinics. Thematic analysis was used to analyze the focus group data. Obstacles to integration are presented as well as strategies to overcome these challenges, using training and education, working groups, and community collaboratives.

  7. Operational integration in primary health care: patient encounters and workflows.

    Science.gov (United States)

    Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Markaki, Adelais; Kritikos, Kyriakos; Petelos, Elena; Lionis, Christos

    2017-11-29

    Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web

  8. 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. 

  9. Shoulder pain in primary care: frozen shoulder.

    Science.gov (United States)

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.

  10. A sustainable primary care system: lessons from the Netherlands.

    Science.gov (United States)

    Faber, Marjan J; Burgers, Jako S; Westert, Gert P

    2012-01-01

    The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving care in the primary care practice in which they are registered. Financial incentives support the transfer of care from hospital specialists to primary care physicians, and task delegation from primary care physicians to practice nurses. Regional collaborative care groups of primary care practices offer disease management programs. The quality assessment system and the electronic medical record system are predominantly driven by health care professionals. Bottom-up and top-down activities contributed to a successful Dutch primary care system.

  11. Role of primary health care in ensuring access to medicines.

    Science.gov (United States)

    Sambala, Evanson Z; Sapsed, Susan; Mkandawire, Mercy L

    2010-06-01

    To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization.

  12. Implementing multimodal pain rehabilitation in primary care - a health care professional perspective.

    Science.gov (United States)

    Stenberg, Gunilla; Stålnacke, Britt-Marie; Enthoven, Paul

    2017-10-01

    To explore professional perspectives on how to start and work with multimodal pain rehabilitation within primary healthcare. Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their experiences of starting and working with multimodal pain. Interviews were transcribed and analyzed by qualitative content analysis. This study was part of a larger project, which aimed at evaluating multimodal pain rehabilitation in primary care. The analysis resulted in six categories. Two categories were about management engagement: putting the focus on rehabilitation and creating appropriate conditions. Three were about professional engagement: importance of driving spirits, creating a program - a process, and good teamwork - not a coincidence. The last category was about professional gain from multimodal rehabilitation (MMR): team work is enriching. To enable implementation of MMR in primary care, managers on all organizational levels must take responsibility for allowing rehabilitation to be a priority. A driving spirit among the professionals facilitates the start, but the entire team is important when processing a program. Creating good teamwork requires hard work, e.g., negotiations for consensus about rehabilitation, and assumption of responsibility by each team member. Collaboration between professionals was perceived to strengthen and enhance knowledge about the patients. Implications for rehabilitation Much can be gained from conducting multimodal pain rehabilitation in primary care. Front line managers and those at other organizational levels must prioritize and create appropriate conditions to facilitate multimodal pain rehabilitation in primary care. Creation of an effective multimodal rehabilitation team requires that each team member takes responsibility, drops the focus on individual rehabilitation, seek member consensus about the content of the rehabilitation, and confer equal worth to each team member. The process of creating a

  13. [Palliative care in Primary Care: presentation of a case].

    Science.gov (United States)

    Álvarez-Cordovés, M M; Mirpuri-Mirpuri, P G; Gonzalez-Losada, J; Chávez-Díaz, B

    2013-10-01

    We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  14. Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

    Science.gov (United States)

    Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

    2015-12-21

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

  15. 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

  16. The link between income inequality and health in Europe, adding strength dimensions of primary care to the equation.

    Science.gov (United States)

    Detollenaere, Jens; Desmarest, Ann-Sophie; Boeckxstaens, Pauline; Willems, Sara

    2018-03-01

    Income inequality has been clearly associated with reduced population health. A body of evidence suggests that a strong primary care system may mitigate this negative association. The aim of this study is to assess the strength of the primary care system's effect on the inverse association between income inequality and health in Europe. Health is operationalised using four cross-sectional outcomes: self-rated health, life expectancy, mental well-being, and infant mortality. Strength of the primary care system is measured using the framework of the Primary Health Care Activity Monitor Europe, and income inequality by the Gini coefficient. Multiple regression models with interaction terms were used. The results confirm that especially the structure and continuity dimension of primary care strength can buffer the inverse association between income inequality and health. European policymakers should therefore focus on strengthening primary care systems in order to reduce inequity in health. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care.

    Science.gov (United States)

    Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A

    2017-10-01

    Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO ® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

  18. Contribution of primary care to health: an individual level analysis from Tibet, China.

    Science.gov (United States)

    Wang, Wenhua; Shi, Leiyu; Yin, Aitian; Mao, Zongfu; Maitland, Elizabeth; Nicholas, Stephen; Liu, Xiaoyun

    2015-11-30

    There have been significant improvements in health outcomes in Tibet, health disparities between Tibet and the rest of China has been greatly reduced. This paper tests whether there was a positive association between good primary care and better health outcomes in Tibet. A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 1386 patients aged over 18 years old accessing primary care. Self-rated health (SRH) was employed to measure health outcomes. A multiple binary logistic regression model was used to explore the association between primary care quality and self-rated health status after controlling for socio-demographic and lifestyle variables. This study found that primary care quality had a significant positive association with self-rated health status. Among the nine domains of PCAT-T, family centeredness domain had the highest Odds Ratio (OR = 1.013) with SRH. Patients located in rural area, with higher education levels, without depression, and less frequent drinking were more likely to self-rate as "good health" compared with the reference group. In Tibet, higher quality primary care was associated with better self-rated health status. Primary care should be much strengthened in future health system reform in Tibet.

  19. A possibility for strengthening family life and health: Family members' lived experience when a sick child receives home care in Sweden.

    Science.gov (United States)

    Castor, Charlotte; Landgren, Kajsa; Hansson, Helena; Kristensson Hallström, Inger

    2018-03-01

    Families often prefer home care to hospital care, and home-care services for ill children are increasing worldwide with limited knowledge of families' needs during curative and palliative home care. The aim of this study was to elucidate family members' lived experience when a sick child received home care from county-based primary healthcare services. A descriptive qualitative design was chosen and 12 families including sick children receiving home care and their mothers, fathers and siblings in the south of Sweden were interviewed between December 2015 and January 2017. The transcribed interviews were analysed using a hermeneutic phenomenological approach. The family members' lived experience was described in three essential themes: "Strengthening family life" relates to how home care induced freedom and luxury in a strained period of life and supported the families' everyday life. Usual social activities and relations were maintained as time and energy was saved when receiving home care. "Promoting health" relates to how the family members' burden of illness decreased as the child's signs of illness alleviated and the well-being of the whole family increased when the child received care in the home. This provided a peaceful respite for family members' psychosocial recovery. The third theme, "Creating alliances," relates to the importance of creating trustful alliances for communicating participation in care. If trustful alliances were not created, parents felt an overwhelming responsibility and family members became anxious. The findings suggest that care in the family's home is a useful complement to hospital care. Home care should be given with close attention to family members' needs and conditions, as positive effects of home care might be jeopardised when expectations and possibilities are not successfully shared. © 2017 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

  20. 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.

  1. Preparing primary care for the future - perspectives from the Netherlands, England, and USA.

    Science.gov (United States)

    Erler, Antje; Bodenheimer, Thomas; Baker, Richard; Goodwin, Nick; Spreeuwenberg, Cor; Vrijhoef, Hubertus J M; Nolte, Ellen; Gerlach, Ferdinand M

    2011-01-01

    All modern healthcare systems need to respond to the common challenges posed by an aging population combined with a growing number of patients with (complex) chronic conditions and rising patient expectations. Countries with 'stronger' primary care systems (e.g. the Netherlands and England) seem to be better prepared to address these challenges than countries with 'weaker' primary care (e.g. USA). The role of primary care in a health care system is strongly related to its organisation and funding, thus determining the starting point and the possibilities for change. We selected the Netherlands, England, and USA as examples for the diversity of approaches to organise and finance health care. We analysed the main problems for primary care and reviewed strategies and practice models used to meet the challenges described above. The Netherlands aim to strengthen prevention for chronic diseases, while England strives to improve the management of patients with multimorbidity, prevent hospital admissions to contain costs, and to satisfy the increased demand of patients for access to primary care. Both countries seek to reorganise care around the patient and place their needs at the centre. The USA has to provide sufficient workforce, organisation, and funding for primary care to ensure better access, prevention, and provision of chronic care for its population. Strategies to improve (trans-sectoral) cooperation and care coordination, a main issue in all three countries, include the implementation of standards of care and bundled payments for chronic diseases in the Netherlands, GP commissioning, federated and group practice models in England, and the introduction of the Patient-Centred Medical Home and accountable care organisations in the USA. Organisation and financing of health care differ widely in the three countries. However, the necessity to improve coordination and integration of chronic disease care remains a common and core challenge. Copyright © 2011. Published

  2. Occupational therapists in primary care health management

    Directory of Open Access Journals (Sweden)

    Paula Giovana Furlan

    2017-03-01

    Full Text Available Introduction: The expansion of the working field of occupational therapists in non-hospital environments and asylums in the last few decades, which came along with the territorial health practices in the National Health System, shows the relationship between the possibilities of professional performance and the existing public policies, including management functions and services. Objectives: To characterize the role of occupational therapists in the management of primary health care in the Distrito Federal and the professional knowledge used in this practice. Method: This was a qualitative research with production and analysis of data carried out through ethnography. Data were produced with aid of observations, field diary, semi-structured interviews and literature review. The study subjects were two occupational therapists from the State Secretariat of Health of the Distrito Federal who work in the management of primary health care. Results: The expansion of the concept of health has resulted in the incorporation of different professionals to compose the management of service and programs. The role of occupational therapists depends on their knowledge about management, collective projects and integral health care. Occupational therapists of this study work on central management and welfare programs to specific populations. Conclusion: The research made it possible to analyze the expansion of the working space of occupational therapists, contributing to future discussions on professional training. It was evident that the formation of the professional core provides subsidies for a larger management practice, such as skills for group and team work, and the work with socially excluded people.

  3. Evaluation of the organization and provision of primary care in Kazakhstan: a survey-based project in the regions of Almaty and Zhambyl.

    NARCIS (Netherlands)

    Boerma, W.; Wiegers, T.A.; Kringos, D.S.; Baltag, V.; Zhylkaidarova, A.

    2011-01-01

    Although the strengthening of primary care services is a health reform priority in many countries of the WHO European Region, the background for such reform varies. In western Europe, primary care is emphasized to help address rising costs and changing demand that result from demographic and

  4. Beyond the consultation room: Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers.

    Science.gov (United States)

    Berenguera, Anna; Pons-Vigués, Mariona; Moreno-Peral, Patricia; March, Sebastià; Ripoll, Joana; Rubio-Valera, Maria; Pombo-Ramos, Haizea; Asensio-Martínez, Angela; Bolaños-Gallardo, Eva; Martínez-Carazo, Catalina; Maderuelo-Fernández, José Ángel; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta

    2017-10-01

    Primary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities. To identify proposals to approach HP in the context of primary care according to health-care users aged 45-75 years, key community informants and primary care centre (PCC) workers. Descriptive-interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out. Participants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person-centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness. According to a socio-ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  5. [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.

  6. [Functional geriatric assessment in primary health care].

    Science.gov (United States)

    Muñoz Silva, Carolina Andrea; Rojas Orellana, Pedro Antonio; Marzuca-Nassr, Gabriel Nasri

    2015-05-01

    The functional assessment of moderately or severely dependent older people encompasses social, psychological and biological aspects that may influence their quality of life and their degree of independence. This paper reviews the global geriatric assessment that should be performed in primary health care (PHC) for moderately or severely dependent older people. Since 2012 in PHC in Chile, the norm establishes that the degree of independence of older people should be assessed using the Barthel scale and caregiver stress should be evaluated using Zarit scale. People with severe disability should receive home care. We recommend to evaluate also cognitive aspects using the Mini-Mental State Examination (MMSE) to Barthel Index or using the Functional Independence Measure (FIM), since they are closely associated with functional capacity.

  7. Facial cosmetic surgery: a primary care perspective.

    Science.gov (United States)

    Landis, B J

    1994-11-01

    Primary care providers are often the source of information regarding health matters including elective cosmetic surgery. Practitioners should know about the more common cosmetic surgical procedures to assist their clients in making informed decisions regarding these operations. This article describes facial cosmetic surgical procedures performed to modify the signs of aging, which includes rhytidectomy ("face lift"), blepharoplasty ("eyelid surgery"), chemical peels, and dermabrasion. Issues discussed include preoperative considerations, expected outcomes, length of recovery period, costs, and complications (hemorrhage, necrosis, nerve injury, psychologic sequelae). Because facial cosmetic surgery usually has a positive impact on one's self-esteem, there has been an overall increase in facial cosmetic procedures during the past decade.

  8. Competencies for psychology practice in primary care.

    Science.gov (United States)

    McDaniel, Susan H; Grus, Catherine L; Cubic, Barbara A; Hunter, Christopher L; Kearney, Lisa K; Schuman, Catherine C; Karel, Michele J; Kessler, Rodger S; Larkin, Kevin T; McCutcheon, Stephen; Miller, Benjamin F; Nash, Justin; Qualls, Sara H; Connolly, Kathryn Sanders; Stancin, Terry; Stanton, Annette L; Sturm, Lynne A; Johnson, Suzanne Bennett

    2014-01-01

    This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

  9. Patients’ experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care

    Science.gov (United States)

    Chung, Vincent CH; Yip, Benjamin HK; Griffiths, Sian M; Yu, Ellen LM; Liu, Siya; Ho, Robin ST; Wu, Xinyin; Leung, Albert WN; Sit, Regina WS; Wu, Justin CY; Wong, Samuel YS

    2015-01-01

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services. PMID:26686267

  10. 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

  11. 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 ...

  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. [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.

  14. 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.

  15. Prevalence of obesity recorded in Primary Care.

    Science.gov (United States)

    Gutiérrez Angulo, María Luisa; Amenabar Azurmendi, Miren Dolores; Cuesta Solé, María Lourdes; Prieto Esteban, Irene; Mancebo Martínez, Sara; Iglesias Alonso, Amparo

    2014-11-01

    To ascertain the prevalence of obesity and overweight recording in primary care (PC) clinical records. A descriptive, cross-sectional study. The study was conducted in three urban, primary care centers in Gipuzkoa. 620 computerized clinical records randomly selected from a population of 63,820. Patient age older than 14 years was the only inclusion criterion. Recording of the clinical episode referring to obesity and/or overweight. Other variables included age, sex, body mass index (BMI), waist circumference, comorbidity (diabetes, hypertension, heart failure, among others), and variability of the record made by healthcre professionals at each center. Statistical analysis included a Chi-square test or a Fisher's test for low frequencies. A value of P<.05 was considered significant. Analysis was performed using SPSS(®) v.21 software. Prevalence of recorded obesity was 6%, and 78.4% of those with recorded obesity were women. Overweight was recorded in 3% of subjects, of which 33.2% were women. BMI was recorded in 170 cases (27%). At least one comorbidity was found in 241 subjects (39%). Association of BMI with presence of comorbidity was statistically significant (P=.0001). Recording of obesity was associated to presence of comorbidity (P =.0002). This study confirmed that prevalence of obesity is underestimated, mainly because it is inadequately recorded in clinical histories; that prevalence increases in the presence of other risk factors; and that there is a significant variability in data collection between healthcare professionals. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  16. A training course for experts in diabetology in primary care

    NARCIS (Netherlands)

    Hart, Huberta E.; Rutten, Guy E H M

    2015-01-01

    In the Netherlands so-called Diabetes Care Groups organize the primary diabetes care centrally with delegation to different health care providers. A training course for general practitioners who would like to become experts in diabetology in the primary care setting meets the need to guide the

  17. 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

  18. Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq.

    Science.gov (United States)

    Shukor, Ali R; Klazinga, Niek S; Kringos, Dionne S

    2017-08-23

    This study presents a descriptive synthesis of Kurdistan Region of Iraq's (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises. The descriptive analysis used a framework operationalizing Starfield's classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data. The descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI's public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises. The convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI's primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further

  19. Between-Visit Workload in Primary Care

    Science.gov (United States)

    Galpin, Kevin; Jones-Taylor, Cedrella; Anander, Steven; Demosthenes, Charles; Platt, Susan; Ponkshe, Sanjay

    2010-01-01

    Background The time spent and complexity of work done by primary internal medicine physicians between office visits has not been well studied. Objective To measure the time and complexity of this care. Design Cross-sectional study. Setting General internists practicing on primary care teams with electronic medical records at a tertiary Veterans Health Administration Medical Center. Participants Ten physicians. Main Measures The project was designed to measure physician work between office visits. The electronic record was used to record the number and complexity of work events by physicians for 1 month. Complexity of work was measured on five levels ranging from Level I with no change in management, Level II with change in management of one disease, Level III of two diseases, Level IV of three diseases, and Level V of four or more diseases. Time sampling was done over 5 days to determine the time spent by level of complexity. Total time per physician was calculated by multiplying the number of events each physician captured by the average time for that physician for that level of complexity. Key Results Physicians worked a median of 7.9 h per week between office visits. Work was apportioned among Level I (18.3%), Level II (38.3%), Level III (36.5%), Level IV (4.6%), and Level V (2.3%). Limitations Single VA population and self-reported data. Findings may not be generalizable to other practice settings. Conclusion Primary internists spent a median of 7.9 h per week in work between office visits with 82% of the time involved in changes in management. PMID:20700665

  20. 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.

  1. Primary care physician turnover in HMOs.

    Science.gov (United States)

    Kerstein, J; Pauly, M V; Hillman, A

    1994-01-01

    OBJECTIVE. We assess whether physician turnover stems from incorrect physician expectations about the practice environment or from actual constraints or rewards in that environment. DATA SOURCES. Our primary data source contains information about individual HMOs' primary care physicians incentive mechanisms and general HMO characteristics. Our secondary data source is the area resource file (ARF), which contains countywide information about the HMOs' market areas, including physician characteristics, population characteristics, and other market characteristics. DATA COLLECTION. Our primary data source is from a nationwide survey of all HMOs in operation in 1987-1988, as reported to Interstudy. PRINCIPAL FINDINGS. We find that turnover is higher on the part of physicians whose HMO enrollment comprises a greater percentage of their total practice. Our results further indicate that physicians whose compensation is dependent on the behavior of a group of other physicians are more likely to leave the plan than those who bear the risk (and control it) more directly. On the other hand, turnover is increased by basing bonuses on individual productivity and by not sharing surpluses among a group. Market characteristics also are significant in explaining physician turnover in HMOs. CONCLUSIONS. It appears that physicians accurately forecast how they will react to individual financial risk, although they dislike restrictions imposed by HMOs. PMID:8163378

  2. 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

  3. 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.

  4. Primary Health Care: care coordinator in regionalized networks?

    Science.gov (United States)

    Almeida, Patty Fidelis de; Santos, Adriano Maia Dos

    2016-12-22

    To analyze the breadth of care coordination by Primary Health Care in three health regions. This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde. Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia. A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de servi

  5. Civilian primary care prescribing psychologist in an army medical center.

    Science.gov (United States)

    Shearer, David S

    2012-12-01

    The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.

  6. An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

    Directory of Open Access Journals (Sweden)

    Chan Brian T

    2011-10-01

    Full Text Available Abstract Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv effective strategies for HIV/AIDS care in other settings should be

  7. [Levers in Primary Health Care - Identifying Strategic Success Factors for Improved Primary Care in Upper Austria].

    Science.gov (United States)

    Kriegel, J; Rebhandl, E; Reckwitz, N; Hockl, W

    2016-12-01

    Current and projected general practitioner (GP) and primary care in Austria shows structural and process inadequacies in the quality as well as assurance of healthcare supply. The aim is therefore to develop solution- and patient-oriented measures that take patient-related requirements and medical perspectives into account. Using an effect matrix, subjective expert and user priorities were ascertained, cause and effect relationships were examined, and an expanded circle of success for the optimization of GP and primary care in Upper Austria was developed. Through this, the relevant levers for target-oriented development and optimization of the complex system of GP and primary care in Upper Austria were identified; these are training to become general practitioners, entrepreneurs as well as management and coordination. It is necessary to further adapt the identified levers conceptually and operationally in a targeted approach. This is to be achieved by means of the primary health care (PHC) concept as well as management tools and information and communication technologies (ICT) associated with it. © Georg Thieme Verlag KG Stuttgart · New York.

  8. 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.

  9. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

    Directory of Open Access Journals (Sweden)

    Van den Berg Michael J

    2011-10-01

    Full Text Available Abstract Background The QUALICOPC (Quality and Costs of Primary Care in Europe study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design of the QUALICOPC study is described. Methods/design QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey and in Australia, Israel and New Zealand. This study uses a three level approach of data collection: the system, practice and patient. Surveys will be held among general practitioners (GPs and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight in the professional behaviour of GPs and the expectations and actions of their patients. An important aspect of this study is that each patient's questionnaire can be linked to their own GP's questionnaire. To gather data at the structure or national level, the study will use existing data sources such as the System of Health Accounts and the Primary Health Care Activity Monitor Europe (PHAMEU database. Analyses of the data will be performed using multilevel models. Discussion By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will advance the state of the art in primary care research and contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development.

  10. 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.

  11. Multiple somatic symptoms in primary care

    DEFF Research Database (Denmark)

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

    2016-01-01

    ) 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......-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability. Conclusion Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms...... without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care. © 2016 Elsevier Inc....

  12. [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.

  13. [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.

  14. [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.

  15. 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

  16. Tools for primary care management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-01-01

    Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians...... affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD...... is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently...

  17. Physician′s self-perceived abilities at primary care settings in Indonesia

    Directory of Open Access Journals (Sweden)

    Wahyudi Istiono

    2015-01-01

    Full Text Available Background: Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians′ standard of abilities. Materials and Methods: This was a multiple-case study that explored physicians′ self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC, which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs, and clinical observations. Results: This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited  patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Discussions and Conclusions: Strengthening primary health care in Indonesia requires upscaling doctors′ abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians′ performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

  18. Physician's self-perceived abilities at primary care settings in Indonesia.

    Science.gov (United States)

    Istiono, Wahyudi; Claramita, Mora; Ekawati, Fitriana Murriya; Gayatri, Aghnaa; Sutomo, Adi Heru; Kusnanto, Hari; Graber, Mark Alan

    2015-01-01

    Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities. This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

  19. Primary health eye care knowledge among general practitioners ...

    African Journals Online (AJOL)

    2010-05-10

    May 10, 2010 ... Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9% of them would attend such courses. Also, 82% of GPs felt that primary care doctors, not optometrists, should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health ...

  20. Toward More Equitable Primary Health Care in Argentina and Latin ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Toward More Equitable Primary Health Care in Argentina and Latin America through Intersectoral Approaches. Improving primary health care for everyone requires an effort that extends beyond the formal health sector. This project will examine the value of intersectoral collaborations at the primary healthcare level to ...

  1. 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

  2. Ophthalmic Skills Assessment of Primary Health Care Workers at ...

    African Journals Online (AJOL)

    Ophthalmic Skills Assessment of Primary Health Care Workers at Primary Health Care Facilities in Rural Communities in Cross River State, Nigeria. ... The workers attributed the high failure rate/low score to lack of follow-up and inadequate duration of training on eye care, which was just for one day. The ophthalmic skills ...

  3. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Lewin, Simon; Lavis, John N; Oxman, Andrew D; Bastías, Gabriel; Chopra, Mickey; Ciapponi, Agustín; Flottorp, Signe; Martí, Sebastian García; Pantoja, Tomas; Rada, Gabriel; Souza, Nathan; Treweek, Shaun; Wiysonge, Charles S; Haines, Andy

    2008-09-13

    Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

  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. 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.

  6. How primary care networks can help integrate academic and service initiatives in primary care.

    Science.gov (United States)

    Thomas, Paul; Graffy, Jonathan; Wallace, Paul; Kirby, Mike

    2006-01-01

    Theory of effective network operation in primary care is underdeveloped. This study aimed to identify how primary care networks can best integrate academic and service initiatives. We performed a comparative case study of 4 primary care research networks in North London, England, for the years 1998-2002. Indicators were selected to assess changes in (1) research capacity, (2) multidisciplinary collaboration, and (3) research productivity. We compared the profiles of network outcome with descriptions of their contexts and organizational types from a previous evaluation. Together, the networks supported 133 viable projects and 30 others; 399 practitioners, managers, and academics participated in the research teams. How the networks organized themselves was influenced by the circumstances in which they were formed. Different ways of organizing were associated with different outcome profiles. Shared projects and learning spaces helped participants to develop trusted relationships. A top-down, hierarchical approach based on institutional alliances and academic expertise attracted more funding and appeared to be stable. The bottom-up, individualistic network with research practices was good at reflecting on practical primary care concerns. Whole-system methods brought together stakeholder contributions from all parts of the system. Networks can help integrate academic research and service development initiatives by facilitating interorganizational interactions and in shared leadership of projects. Researchers and practitioners stand to gain considerably from an integrated approach in both the short and the long term. Success requires agreement about a set of pathways, learning spaces, and feedback mechanisms to harness the insights and efforts of stakeholders throughout the whole system.

  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. Nursing contributions to chronic disease management in primary care.

    Science.gov (United States)

    Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Tranmer, Joan

    2014-02-01

    As the prevalence of chronic diseases continues to increase, emphasis is being placed on the development of primary care strategies that enhance healthcare delivery. Innovations include interprofessional healthcare teams and chronic disease management strategies. To determine the roles of nurses working in primary care settings in Ontario and the extent to which chronic disease management strategies have been implemented. We conducted a cross-sectional survey of a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, in Ontario between May and July 2011. Nurses in primary care reported engaging in chronic disease management activities but to different extents depending on their regulatory designation (licensure category). Chronic disease management strategy implementation was not uniform across primary care practices where the nurses worked. There is the potential to optimize and standardize the nursing role within primary care and improve the implementation of chronic disease management strategies.

  9. Supporting primary healthcare professionals to care for people with intellectual disability: a research agenda.

    Science.gov (United States)

    Lennox, Nicholas; Van Driel, Mieke L; van Dooren, Kate

    2015-01-01

    The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and well-being of people with intellectual disability. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for this group. The present authors updated the existing review by searching the international literature for developments and evaluations of multinational models of care. Based on our review, we present three strategies to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. Many people with intellectual disability have poor health. The authors reviewed what has been written by other researchers about how to improve the health of people with intellectual disability. In the future, people who support adults with intellectual disability should continue doing what they do well, think of other ways to improve health, and do more research about health. At all times, the needs of people with intellectual disability should be the

  10. Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses.

    NARCIS (Netherlands)

    Gaal, S.; Laarhoven, E. van; Wolters, R.J.; Wetzels, R.; Verstappen, W.H.J.M.; Wensing, M.J.P.

    2010-01-01

    RATIONALE, AIMS AND OBJECTIVES: Scientific definitions of patient safety may be difficult to apply in routine health care delivery. It is unknown what primary care workers consider patient safety. This study aimed to clarify the concept of patient safety in primary care. METHODS: We held 29

  11. Training teachers of day care centres for primary ear care.

    Science.gov (United States)

    Abraham, V J; Balraj, Vinohar; Shankar, N; Job, Anand; Joseph, A

    2003-04-01

    The feasibility of training teachers of day care centres for children (balwadi teachers) to recognize and manage common ear problems was studied so that they could provide primary care for ear related morbidity in the community. A training module was designed, piloted on grass root level workers and used to train 19 balwadi teachers. Their knowledge, skills and technique of examination was assessed following training. Pathways for referral were established between the balwadis, secondary and tertiary hospitals. The knowledge score of the balwadi teachers increased from a mean of 28.4% to 86%; they scored an average of 75% in an assessment of their examination technique. Their sensitivity in identifying overall ear related morbidity was 75%, and 96% in identifying children with ear discharge, specifically. Age, education and experience did not affect the outcome of their training. While it may be premature to comment on the impact of the training, periodic supervision, close monitoring and review sessions would sharpen the skills of the balwadi teachers and improve their efficiency.

  12. 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.

  13. Using Evidence to Strengthen Health Systems in Africa and the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The project is timely for Lebanon, a country that is working to strengthen its primary health care system to respond to current priorities such as the emerging crisis of Syrian refugees. Timely access to information The project will strengthen institutional and individual abilities to conduct and use systematic and rapid reviews to ...

  14. [Comprehensive primary care and segmented health systems in South America].

    Science.gov (United States)

    Giovanella, Ligia; Almeida, Patty Fidelis de

    2017-10-02

    The article analyzes recent reforms in primary health care in the South American countries, discussing the scope and challenges for establishing comprehensive primary health care in the region's health systems. The data sources were case studies conducted in 12 countries, and the analytical lines were the strategic components in the design and implementation of primary health care: national policy approaches, characteristics of financing, organization and provision, and the workforce in primary health care. The crosscutting analysis from a comparative perspective provides an overview of primary health care in the region's countries and highlights convergences and asymmetries. A common trait is the recovery of the expanded definition of primary health care with family and community components, a territorial base, multidisciplinary team, incorporation of community health workers, and social participation. Implementation revealed heterogeneities in the advances and contradictions in the models. Insufficient supply of physicians, difficulties in provision and physician retention in remote and peripheral areas, as well as in primary health care itself, precarious employment relations, and absence of career plans are common problems, and there have been recent initiatives in government intervention to direct the workforce to the public system. Segmentation of the supply of primary health care converges with the segmentation of social protection in the various countries, through maintenance of social insurance or selective and targeted insurance or coverage by private health insurance, and persistent exclusion of populations from the right to health. The article argues that implementation of comprehensive primary health care is conditioned by the prevailing modalities of social protection in health.

  15. Coordination and integration of primary care in Western Europe.

    OpenAIRE

    Riet-Paap, J.C. van; Boerma, W.; Kringos, D.S.

    2010-01-01

    Background: Due to ageing a larger proportion of the population suffers from multiple and complex health problems that need treatment from more than one health care provider. Fragmentation of care is a critical development that all health care systems in Europe need to cope with. To improve the responsiveness of patient care there is a need for coherent and well coordinated provision of health care services. Methods: On the basis of a systematic review of the literature on primary care (PC) a...

  16. 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.

  17. Re-orienting a remote acute care model towards a primary health care approach: key enablers.

    Science.gov (United States)

    Carroll, Vicki; Reeve, Carole A; Humphreys, John S; Wakerman, John; Carter, Maureen

    2015-01-01

    The objective of this study was to identify the key enablers of change in re-orienting a remote acute care model to comprehensive primary healthcare delivery. The setting of the study was a 12-bed hospital in Fitzroy Crossing, Western Australia. Individual key informant, in-depth interviews were completed with five of six identified senior leaders involved in the development of the Fitzroy Valley Health Partnership. Interviews were recorded and transcripts were thematically analysed by two investigators for shared views about the enabling factors strengthening primary healthcare delivery in a remote region of Australia. Participants described theestablishment of a culturally relevant primary healthcare service, using a community-driven, 'bottom up' approach characterised by extensive community participation. The formal partnership across the government and community controlled health services was essential, both to enable change to occur and to provide sustainability in the longer term. A hierarchy of major themes emerged. These included community participation, community readiness and desire for self-determination; linkages in the form of a government community controlled health service partnership; leadership; adequate infrastructure; enhanced workforce supply; supportive policy; and primary healthcare funding. The strong united leadership shown by the community and the health service enabled barriers to be overcome and it maximised the opportunities provided by government policy changes. The concurrent alignment around a common vision enabled implementation of change. The key principle learnt from this study is the importance of community and health service relationships and local leadership around a shared vision for the re-orientation of community health services.

  18. Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education.

    Science.gov (United States)

    Hallinan, Christine M; Hegarty, Kelsey L

    2016-01-01

    educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.

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

    Directory of Open Access Journals (Sweden)

    Pim P. Valentijn

    2013-03-01

    Full Text Available Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care.Methods:  The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework.Results: The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration, meso (professional and organisational integration and macro (system integration level. Functional and normative integration ensure connectivity between the levels.Discussion:  The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

  20. 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.

  1. Diagnostic accuracy of spirometry in primary care

    Directory of Open Access Journals (Sweden)

    Dinant Geert-Jan

    2009-07-01

    Full Text Available Abstract Background To evaluate the sensitivity, specificity and predictive values of spirometry for the diagnosis of chronic obstructive pulmonary disease (COPD and asthma in patients suspected of suffering from an obstructive airway disease (OAD in primary care. Methods Cross sectional diagnostic study of 219 adult patients attending 10 general practices for the first time with complaints suspicious for OAD. All patients underwent spirometry and structured medical histories were documented. All patients received whole-body plethysmography (WBP in a lung function laboratory. The reference standard was the Tiffeneau ratio (FEV1/VC received by the spirometric maneuver during examination with WBP. In the event of inconclusive results, bronchial provocation was performed to determine bronchial hyper-responsiveness (BHR. Asthma was defined as a PC20 fall after inhaling methacholine concentration ≤ 16 mg/ml. Results 90 (41.1% patients suffered from asthma, 50 (22.8% suffered from COPD, 79 (36.1% had no OAD. The sensitivity for diagnosing airway obstruction in COPD was 92% (95%CI 80–97; specificity was 84% (95%CI 77–89. The positive predictive value (PPV was 63% (95%CI 51–73; negative predictive value (NPV was 97% (95%CI 93–99. The sensitivity for diagnosing airway obstruction in asthma was 29% (95%CI 21–39; specificity was 90% (95%CI 81–95. PPV was 77% (95%CI 60–88; NPV was 53% (95%CI 45–61. Conclusion COPD can be estimated with high diagnostic accuracy using spirometry. It is also possible to rule in asthma with spirometry. However, asthma can not be ruled out only using spirometry. This diagnostic uncertainty leads to an overestimation of asthma presence. Patients with inconclusive spirometric results should be referred for nitric oxide (NO – measurement and/or bronchial provocation if possible to guarantee accurate diagnosis.

  2. The Empirical Foundations of Telemedicine Interventions in Primary Care.

    Science.gov (United States)

    Bashshur, Rashid L; Howell, Joel D; Krupinski, Elizabeth A; Harms, Kathryn M; Bashshur, Noura; Doarn, Charles R

    2016-05-01

    This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.

  3. Advanced nurse roles in UK primary care.

    NARCIS (Netherlands)

    Sibbald, B.; Laurant, M.G.H.; Reeves, D.

    2006-01-01

    Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected

  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. Designing A Mixed Methods Study In Primary Care

    OpenAIRE

    Creswell, John W.; Fetters, Michael D.; Ivankova, Nataliya V.

    2004-01-01

    BACKGROUND Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations.

  6. Patient-Focused Quality Improvement in Primary Health Care ...

    African Journals Online (AJOL)

    UNIBEN

    84. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 29, NO 2, SEPTEMBER 2017. Patient-Focused Quality Improvement in Primary Health Care: Opportunities with the Patient Evaluation Scale. Ogaji DS. Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt.

  7. The European primary care monitor: structure, process and outcome indicators

    NARCIS (Netherlands)

    Kringos, Dionne S.; Boerma, Wienke G. W.; Bourgueil, Yann; Cartier, Thomas; Hasvold, Toralf; Hutchinson, Allen; Lember, Margus; Oleszczyk, Marek; Pavlic, Danica Rotar; Svab, Igor; Tedeschi, Paolo; Wilson, Andrew; Windak, Adam; Dedeu, Toni; Wilm, Stefan

    2010-01-01

    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

  8. Exploring patient safety culture in Dutch primary care.

    NARCIS (Netherlands)

    Verbakel, N.J.; Melle, M. van; Langelaan, M.; Verheij, T.J.M.; Wagner, C.; Zwart, D.L.M.

    2014-01-01

    Objective: To explore perceptions of safety culture in nine different types of primary care professions and to study possible differences. Design Cross-sectional survey: Setting: Three hundred and thirteen practices from nine types of primary care profession groups in the Netherlands. Participants:

  9. How Do Students Learn on a Primary Nursing Care Unit?

    Science.gov (United States)

    Hall, Mary Barbera

    1977-01-01

    When a unit's staff changed from a team nursing to a primary nursing approach to care, the role of students gaining experience there changed to that of associate nurse, who is accountable for providing continuity of care to the primary nurses' patients. (Editor/TA)

  10. Primary care for asylum seekers in the Netherlands.

    NARCIS (Netherlands)

    Oort, M. van; Devillé, W.; Bakker, D. de

    2004-01-01

    In 2000 policymakers decided that primary care for asylum seekers should be organized as it is for Dutch residents. Nurses of the Community Health Services organize selection and referral to primary care. General practitioners have practice in the different Centres of Asylum Seekers or in their own

  11. 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,

  12. 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

  13. 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,

  14. 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 ...

  15. Factors affecting the referral of primary health care doctors toward ...

    African Journals Online (AJOL)

    Background: Few eligible candidates are referred from primary care for bariatric surgery in spite of improvement in its safety and efficacy. Objective: The aim of this study was to identify factors affecting primary care physicians' (PCPs) referral to bariatric surgery in morbid obesity. Methods: This study is a cross-sectional ...

  16. 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.

  17. A sustainable primary care system: lessons from the Netherlands.

    NARCIS (Netherlands)

    Faber, M.J.; Burgers, J.S.; Westert, G.P.

    2012-01-01

    The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving

  18. In Defence of Care: Gilligan's Relevance for Primary Education

    Science.gov (United States)

    Adams, Paul

    2015-01-01

    In the main, writing about care seems to contrast the ethics of justice with the ethics of care. Whilst the former deploys objectivity, the latter holds that individuals are connected. Problematically, contemporary primary education seemingly holds a-personal, justice conceptions as its basis and rationale. In turn, primary education, in parts,…

  19. Enhancing Primary Health Care Services for Adults with Intellectual Disabilities

    Science.gov (United States)

    Melville, C. A.; Finlayson, J.; Cooper, S.-A.; Allan, L.; Robinson, N.; Burns, E.; Martin, G.; Morrison, J.

    2005-01-01

    Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training…

  20. Primary health care financing in Nigeria via privatization using ...

    African Journals Online (AJOL)

    A survey using shareholders' contribution mechanism of primary health care financing was conducted in the Eastern part of Nigeria. The willingness of the shareholders in private and public corporations to offer a part or whole of their annual dividend in financing primary health care programme was assessed. The research ...

  1. Assessing breast cancer risk in a primary care setting.

    Science.gov (United States)

    Kiely, Deirdre; Schwartz, Shira

    2014-10-15

    Individuals who are given a preventive exam by a primary care provider are more likely to agree to cancer screening. The provider recommendation has been identified as the strongest factor associated with screening utilization. This article provides a framework for breast cancer risk assessment for an advanced practice registered nurse working in primary care practice.

  2. Providing Perinatal Mental Health Services in Pediatric Primary Care

    Science.gov (United States)

    Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

    2009-01-01

    After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

  3. 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…

  4. 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

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

    African Journals Online (AJOL)

    Methods: This study was carried out in all primary health care centers in Kuwait. All nurses who were currently working in these centers during the ... primary care nurses had poor knowledge regarding DV. Although female nurses are somewhat more knowledgeable about DV, many more educational activities are needed.

  6. Obstetric emergencies in primary midwifery care In The Netherlands

    NARCIS (Netherlands)

    Smit, Marrit

    2014-01-01

    In this thesis, the primary aim was to gain insight into management of obstetric emergencies occurring in primary midwifery care in the Netherlands. Secondly, we aimed to develop preventative strategies and tools to optimise care in case of an obstetric emergency. From 2008-2010, a unique dataset of

  7. 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.

  8. 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...... in primary care patients with clinical and radiographic confirmed hip OA. METHODS: Primary care patients with unilateral clinical and radiographic hip OA living on the island of Funen, Denmark were recruited from primary care to participate in a randomized clinical trial. At baseline, patients recorded pain...... intensity using an 11-box numeric rating scale and the distribution of hip pain using a manikin displaying three separate views: front, back and lateral. Pain drawings were analysed using a template to determine the most frequent pain locations and distribution of pain. RESULTS: Pain drawings were completed...

  9. Primary health care research in Bolivia: systematic review and analysis.

    Science.gov (United States)

    Alvarez, Francisco N; Leys, Mart; Mérida, Hugo E Rivera; Guzmán, Giovanni Escalante

    2016-02-01

    Bolivia is currently undergoing a series of healthcare reforms centred around the Unified Family, Community and Intercultural Health System (SAFCI), established in 2008 and Law 475 for Provision of Comprehensive Health Services enacted in 2014 as a first step towards universal health coverage. The SAFCI model aims to establish an intercultural, intersectoral and integrated primary health care (PHC) system, but there has not been a comprehensive analysis of effective strategies towards such an end. In this systematic review, we analyse research into developing PHC in Bolivia utilizing MEDLINE, the Virtual Health Library and grey literature from Pan American Health Organization/World Health Organization's internal database. We find that although progress has been made towards implementation of a healthcare system incorporating principles of PHC, further refining the system and targeting improvements effectively will require increased research and evaluation. Particularly in the 7 years since establishment of SAFCI, there has been a dearth of PHC research that makes evaluation of such key national policies impossible. The quantity and quality of PHC research must be improved, especially quasi-experimental studies with adequate control groups. The infrastructure for such studies must be strengthened through improved financing mechanisms, expanded institutional capacity and setting national research priorities. Important for future progress are improved tracking of health indicators, which in Bolivia are often out-of-date or incomplete, and prioritization of focused national research priorities on relevant policy issues. This study aims to serve as an aid towards PHC development efforts at the national level, as well as provide lessons for countries globally attempting to build effective health systems accommodating of a multi-national population in the midst of development. © The Author 2015. Published by Oxford University Press in association with The London School

  10. 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

  11. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  12. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Science.gov (United States)

    Si, Damin; Bailie, Ross; Cunningham, Joan; Robinson, Gary; Dowden, Michelle; Stewart, Allison; Connors, Christine; Weeramanthri, Tarun

    2008-01-01

    Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages – facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design

  13. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory - use of the Chronic Care Model.

    Science.gov (United States)

    Si, Damin; Bailie, Ross; Cunningham, Joan; Robinson, Gary; Dowden, Michelle; Stewart, Allison; Connors, Christine; Weeramanthri, Tarun

    2008-05-28

    Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence - strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages - facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management - promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support - facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design - strengthened by provision of transport for

  14. Learning from primary care meaningful use exemplars.

    Science.gov (United States)

    Ornstein, Steven M; Nemeth, Lynne S; Nietert, Paul J; Jenkins, Ruth G; Wessell, Andrea M; Litvin, Cara B

    2015-01-01

    Submission of clinical quality measures (CQMs) data are 1 of 3 major requirements for providers to receive meaningful use (MU) incentive payments under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Some argue that CQMs are the most important component of MU. Developing an evidence base for how practices can successfully use electronic health records (EHRs) to achieve improvement in CQMs is essential and may benefit from the study of exemplars who have successfully implemented EHRs and demonstrated high performance on CQMs. Conducted in PPRNet, a national primary care practice-based research network, this study used a multimethod approach combining an EHR-based CQM performance assessment, a provider survey, and focus groups among high CQM performers. Practices whose providers had attested for stage 1 MU were eligible for the study. Performance on 21 CQMs included in the 2014 MU CQM set and a summary measure was assessed as of October 1, 2013, through an automated data extract and standard analytic procedures. A web-based provider survey, conducted in November to December 2013, assessed provider agreement, staff education, use of EHR reminders, standing orders, and EHR-based patient education related to the 21 CQMs. The survey also had more general questions about the practices' use of EHR functionality and quality improvement (QI) strategies. Statistical analyses using general linear mixed models assessed the associations between responses to the survey and CQM performance, adjusted for several practice covariates. Three focus groups, held in early 2014, provided an opportunity for clinicians to provide their perspectives on the validity of the statistical analyses and to provide context-specific examples from their practice that supported their assessment. Seventy-one practices completed the study, and 319 (92.1%) of their providers completed the survey. There was wide variability in performance on the 21 CQMs among the

  15. Bariatric Surgery: A Brief Primer for Primary Care Physicians

    OpenAIRE

    Frichtel, Christina M

    2004-01-01

    Bariatric surgery is on the rise as treatment for the increasing number of obese patients in the US population. As this procedure becomes more common, primary care physicians are assuming increased responsibility not only for preoperative selection and education of bariatric surgery candidates but also for their postoperative care and monitoring—two factors necessary for a successful surgical outcome. This article highlights some issues relevant for primary care physicians and reports an illu...

  16. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

    OpenAIRE

    Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care pr...

  17. Factors interfering with the attribute longitudinality in the primary health care: an integrative review

    Directory of Open Access Journals (Sweden)

    Cristiane Cardoso de Paula

    2015-12-01

    Full Text Available Our objective was to assess the evidence available in the literature about factors interfering with the primary health care attribute longitudinality. This is an integrative review, developed in May of 2014, on the following electronic databases: LILACS, PubMed and Scopus. We used the descriptors “primary health care” and “continuity of patient care”. In total, 16 articles were fully assessed. We organized the data in accordance with care aspects longitudinality (structure and performance and we divided the identified factors in accordance with the attribute interference (favoring or disfavoring. The evidence offer aids to compose a global panorama of interfering factors on longitudinality, reinforcing the value of its interpersonal relationships and minimizing gaps in the organization of health services. The prevalence of descriptive studies suggests the need to strengthen the construction of knowledge with studies of higher evidence level.

  18. 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

  19. Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience.

    Science.gov (United States)

    Takach, Mary

    2016-10-01

    Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes-all core attributes of a medical home. This qualitative study looked at 4 different PHCO models-3 from the United States and 1 from Australia-with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system.

  20. Molding to the Children: Primary Caregiving and Continuity of Care

    Science.gov (United States)

    Theilheimer, Rachel

    2006-01-01

    The author describes the practices of primary caregiving and continuity of care as necessary components of a high quality child care setting. Yet recent evidence suggests that continuity of care is rare for infants and toddlers because young children are often moved from room to room as they grow. The author describes the benefits of primary…

  1. Using Quality Experts from Manufacturing to Transform Primary Care

    Science.gov (United States)

    Steiner, Rose M.; Walsworth, David T.

    2010-01-01

    Introduction: Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality…

  2. Primary Care-Mental Health Integration in the VA: Shifting Mental Health Services for Common Mental Illnesses to Primary Care.

    Science.gov (United States)

    Leung, Lucinda B; Yoon, Jean; Escarce, José J; Post, Edward P; Wells, Kenneth B; Sugar, Catherine A; Yano, Elizabeth M; Rubenstein, Lisa V

    2018-04-01

    Primary care-mental health integration (PC-MHI) aims to increase access to general mental health specialty (MHS) care for primary care patients thereby decreasing referrals to non-primary care-based MHS services. It remains unclear whether new patterns of usage of MHS services reflect good mental health care. This study examined the relationship between primary care clinic engagement in PC-MHI and use of different MHS services. This was a retrospective longitudinal cohort study of 66,638 primary care patients with mental illnesses in 29 Southern California Veterans Affairs clinics (2008-2013). Regression models used clinic PC-MHI engagement (proportion of all primary care clinic patients who received PC-MHI services) to predict relative rates of general MHS visits and more specialized MHS visits (for example, visits for serious mental illness services), after adjustment for year and clinic fixed effects, other clinic interventions, and patient characteristics. Patients were commonly diagnosed as having depression (35%), anxiety (36%), and posttraumatic stress disorder (22%). For every 1 percentage point increase in a clinic's PC-MHI engagement rate, patients at the clinic had 1.2% fewer general MHS visits per year (pPrimary care clinics with greater engagement in PC-MHI showed reduced general MHS use rates, particularly for patients with depression, without accompanying reductions in use of more specialized MHS services.

  3. Patients' socioeconomic status and their evaluations of primary care in Hong Kong.

    Science.gov (United States)

    Owolabi, Onikepe; Zhang, Zhenzhen; Wei, Xiaolin; Yang, Nan; Li, Haitao; Wong, Samuel Y S; Wong, Martin C S; Yip, Winnie; Griffiths, Sian M

    2013-11-25

    Strengthening primary care is key to Hong Kong's ongoing health system reform. Primary care remains unregulated, private sector dominated and financed mainly out-of-pocket. This study sought to examine the association between patients' socioeconomic status (SES), source of health payments and the quality of primary care they accessed to inform policy discussions. Data was collected from 1,994 respondents in a stratified random telephone survey with a 68% response rate, using the validated primary care assessment tool (PCAT). Education, household-income and type of housing were selected as indicators of SES. Multivariable ordinal logistic regression models were created to examine associations between indicators of SES and scores of quality. Higher household-income was most significantly associated with better experiences of quality. Respondents with HK$ 15000-39999 (USD1934-5158) and HK$ 40000 (USD5159) and above were 47% (OR 1.47, 95% CI 1.10-1.96) and 2 times (OR 2.07, 95% CI 1.38-3.09) more likely to experience better quality than the lowest-income group respectively. Income group HK$ 40000 (USD5159) and above was 84% more likely to have better utilization (OR 1.84, 95% CI (1.21-2.78), and 2 times more likely to receive better comprehensiveness (OR 1.90, 95% CI 1.26-2.87). Patients who used only private insurance were 80% (OR 1.80, 95% CI 1.20-2.68) more likely to experience better quality than those who paid out-of-pocket. Our results show that the quality of primary care experienced in HK tended to be higher for those who had higher income and private insurance, and were able to pay out-of-pocket for the care. This indicated that the inequality in primary care is likely to be related with the private dominated primary care system in Hong Kong. More public responsibility on primary health care should be sought for in HK and similar contexts to reduce the inequality in primary care.

  4. Patients’ socioeconomic status and their evaluations of primary care in Hong Kong

    Science.gov (United States)

    2013-01-01

    Background Strengthening primary care is key to Hong Kong’s ongoing health system reform. Primary care remains unregulated, private sector dominated and financed mainly out-of-pocket. This study sought to examine the association between patients’ socioeconomic status (SES), source of health payments and the quality of primary care they accessed to inform policy discussions. Methods Data was collected from 1,994 respondents in a stratified random telephone survey with a 68% response rate, using the validated primary care assessment tool (PCAT). Education, household-income and type of housing were selected as indicators of SES. Multivariable ordinal logistic regression models were created to examine associations between indicators of SES and scores of quality. Results Higher household-income was most significantly associated with better experiences of quality. Respondents with HK$ 15000–39999 (USD1934-5158) and HK$ 40000 (USD5159) and above were 47% (OR 1.47, 95% CI 1.10-1.96) and 2 times (OR 2.07, 95% CI 1.38-3.09) more likely to experience better quality than the lowest-income group respectively. Income group HK$ 40000 (USD5159) and above was 84% more likely to have better utilization (OR 1.84, 95% CI (1.21-2.78), and 2 times more likely to receive better comprehensiveness (OR 1.90, 95% CI 1.26-2.87). Patients who used only private insurance were 80% (OR 1.80, 95% CI 1.20-2.68) more likely to experience better quality than those who paid out-of-pocket. Conclusions Our results show that the quality of primary care experienced in HK tended to be higher for those who had higher income and private insurance, and were able to pay out-of-pocket for the care. This indicated that the inequality in primary care is likely to be related with the private dominated primary care system in Hong Kong. More public responsibility on primary health care should be sought for in HK and similar contexts to reduce the inequality in primary care. PMID:24274660

  5. Telepaediatrics, primary health care and developing countries

    African Journals Online (AJOL)

    appropriate care to be given in PHC facilities without transfer. Currently paediatric surgery ... necessary information. International outreach via telemedicine aids training in ... Telepaediatrics, which has the potential to improve paediatric care if expert knowledge is not locally available, involves transfer of information between ...

  6. Demand Management: The Primary Care Role at Ireland Army Community Hospital (IACH)

    National Research Council Canada - National Science Library

    Hall, Bonnie J

    2005-01-01

    .... Several factors contributing to this concern are the variability of primary care managers, deficiencies in the continuity of care, the lack of internal policies governing primary care practices...

  7. Holistic wound assessment in primary care.

    Science.gov (United States)

    Cornforth, Amber

    2013-12-01

    Wound care is expensive and can cause immeasurable stress and inconvenience to patients and their significant others. It is therefore in the best interest of the patient, their significant others and the NHS as a whole that wounds are expertly assessed, managed and healed in the quickest timeframe possible. Nurses play a pivotal role in the process of accurate holistic wound assessment, evaluation and treatment. This article aims to help further develop and enhance both professional and clinical wound care assessment and evaluation skills. Pertinent wound care literature is critically reviewed and the crucial nature and important components of comprehensive wound assessment for facilitating the highest possible quality wound care to patients are presented alongside recommendations regarding how the enhanced knowledge and skills could be applied into everyday wound care practice.

  8. Healthy Business and Creative Partnerships Strengthen Quality Early Care and Education

    Science.gov (United States)

    Schlueter, Heidi H.

    2010-01-01

    First Children's Finance is a national nonprofit organization located in Minneapolis, Minnesota, whose work strives to break the cycle of poverty, starting with those who care for and educate the nation's youngest citizens--child care businesses. First Children's Finance asks the question: How do Americans talk about providing quality child care…

  9. Primary care nurses' performance in motivational interviewing: a quantitative descriptive study.

    Science.gov (United States)

    Östlund, Ann-Sofi; Kristofferzon, Marja-Leena; Häggström, Elisabeth; Wadensten, Barbro

    2015-07-25

    Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing. The study was based on twelve primary care nurses' audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1. None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in "percent open questions" was the summary score that fewest achieved. Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.

  10. Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study.

    Science.gov (United States)

    Maarsingh, Otto R; Henry, Ykeda; van de Ven, Peter M; Deeg, Dorly Jh

    2016-08-01

    Although continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak. To investigate whether continuity of care in general practice is associated with better survival in older people. Data were derived from the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people in the Netherlands. The study sample consisted of 1712 older adults aged ≥60 years, with 3-year follow-up cycles up to 17 years (1992-2009), and mortality follow-up until 2013. Continuity of care was defined as the duration of the ongoing therapeutic relationship between patient and GP. The Herfindahl-Hirschman Index was used to calculate the continuity of care (COC). A COC index value of 1 represented maximum continuity. COC index values 0-0.500) showed significantly greater mortality than those in the maximum COC category (hazard ratio (HR) = 1.20, 95% CI = 1.01 to 1.42). There were no confounders that affected this HR. This study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care. © British Journal of General Practice 2016.

  11. Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members.

    Science.gov (United States)

    Edwards, Samuel T; Rubenstein, Lisa V; Meredith, Lisa S; Schmidt Hackbarth, Nicole; Stockdale, Susan E; Cordasco, Kristina M; Lanto, Andrew B; Roos, Philip J; Yano, Elizabeth M

    2015-09-01

    Unclear roles in interdisciplinary primary care teams can impede optimal team-based care. We assessed perceived task allocation among primary care providers (PCPs) and staff during implementation of a new patient-centered care model in Veterans Affairs (VA) primary care practices. We performed a cross-sectional survey of PCPs and primary care staff (registered nurses (RNs), licensed practical/vocational nurses (LPNs), and medical assistants/clerks (MAs)) in 23 primary care practices within one VA region. We asked subjects whether PCPs performed each of 14 common primary care tasks alone, or relied upon staff for help. Tasks included gathering preventive service history, disease screening, evaluating patients and making treatment decisions, intervening on lifestyle factors, educating patients about self-care activities and medications, refilling prescriptions, receiving and resolving patient messages, completing forms, tracking diagnostic data, referral tracking, and arranging home health care. We then performed multivariable regression to determine predictors of perceived PCP reliance on staff for each task. 162 PCPs and 257 staff members responded, a 60% response rate. For 12/14 tasks, fewer than 50% of PCPs reported relying on staff for help. For all 14 tasks, over 85% of RNs reported they were relied upon. For 12/14 tasks, over 50% of LPNs reported they were relied on, while for 5/14 tasks a majority of MAs reported being relied upon. Nurse practitioners and physician assistants (NP/PAs) reported relying on staff less than physicians. Early in the implementation of a team-based primary care model, most PCPs perceived they were solely responsible for most clinical tasks. RNs, and LPNs felt they were relied upon for most of the same tasks, while medical assistants/clerks reported being relied on for fewer tasks. Better understanding of optimal inter-professional team task allocation in primary care is needed. Published by Elsevier Inc.

  12. 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.

  13. Management commitments and primary care: another lesson from Costa Rica for the world?

    Science.gov (United States)

    Soors, Werner; De Paepe, Pierre; Unger, Jean-Pierre

    2014-01-01

    Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than a decade, management commitments have been part of Costa Rican health reform. We assessed the effect of the Costa Rican management commitments on access and quality of care and on compliance with their intended objectives. We constructed seven hypotheses on opinions of primary care providers. Through a mixed qualitative and quantitative approach, we tested these hypotheses and interpreted the research findings. Management commitments consume an excessive proportion of consultation time, inflate recordkeeping, reduce comprehensiveness in primary care consultations, and induce a disproportionate consumption of hospital emergency services. Their formulation relies on norms in need of optimization, their control on unreliable sources. They also affect professionalism. In Costa Rica, management commitments negatively affect access and quality of care and pose a threat to the public service delivery system. The failures of this pay-for-performance-like initiative in an otherwise well-performing health system cast doubts on the appropriateness of pay-for-performance for health systems strengthening in less advanced environments.

  14. Antenatal care strengthening for improved health behaviours in Jimma, Ethiopia, 2009-2011

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe

    2016-01-01

    INTRODUCTION: health systems in low-income settings are not sufficiently reaching the poor, and global disparities in reproductive health persist. The frequency and quality of health education during antenatal care is often low. Further studies are needed on how to improve the performance of health...... systems in low income settings to improve maternal and child health. OBJECTIVES: to assess the effectiveness of a participatory antenatal care intervention on health behaviours and to illuminate how the different socioeconomic groups responded to the intervention in Jimma, Ethiopia. SETTING, INTERVENTION...... facility delivery are encouraging and underline the need to scale up priority of antenatal care in the effort to reduce maternal and child health inequity....

  15. Revitalizing primary health care and family medicine/primary care in India--disruptive innovation?

    Science.gov (United States)

    Biswas, Rakesh; Joshi, Ankur; Joshi, Rajeev; Kaufman, Terry; Peterson, Chris; Sturmberg, Joachim P; Maitra, Arjun; Martin, Carmel M

    2009-10-01

    India has rudimentary and fragmented primary health care (PHC) and family medicine systems, yet it also has the policy expectation that PHC should meet the needs of extremely large populations with slums and difficult to reach groups, rapid social and epidemiological transition from developing to developed nation profiles. Historically, the system has lacked impetus to achieve PHC. To provide an overview of PHC approaches and the current state of PHC and family medicine in India in order to assess the opportunities for their revitalization. A narrative review of the published and grey literature on PHC, family medicine, Web2.0 and health informatics key papers and policy documents, pertinent to India. A conceptual framework and recommendations for policy makers and practitioner audiences. PHC is constructed through systems of local providers who address individual, family and local community basic health needs with strong community participation. Successful PHC is a pre-eminent strategy for India to address the determinants of health and the almost chaotic of massive social transition in its institutions and health care sector. There is a lack of an articulated comprehensive framework for the publicly stated goals of improving health and implementing PHC. Also, there exists a very limited education and organization of a medical and PHC workforce who are trained and resourced to address individual, family and local community health and who have become increasingly specialized. However, emerging technology, Health2.0 and user generated health care informatics, which are largely conducted through mobile phones, are co-evolving patient-driven health systems, and potentially enhance PHC and family medicine workforce development. In order to improve health outcomes in an equitable manner in India, there is a pressing need for a framework for implementing PHC. The co-emergence of information technologies accessible to the mass population and user-driven health care

  16. 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

  17. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    Directory of Open Access Journals (Sweden)

    McDermott Robyn

    2010-05-01

    Full Text Available Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE project has facilitated the implementation of modern Continuous Quality Improvement (CQI approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1 explore the factors associated with variation in clinical performance; 2 examine specific strategies that have been effective in improving primary care clinical performance; and 3 work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers, the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary

  18. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples.

    Science.gov (United States)

    Bailie, Ross; Si, Damin; Shannon, Cindy; Semmens, James; Rowley, Kevin; Scrimgeour, David J; Nagel, Tricia; Anderson, Ian; Connors, Christine; Weeramanthri, Tarun; Thompson, Sandra; McDermott, Robyn; Burke, Hugh; Moore, Elizabeth; Leon, Dallas; Weston, Richard; Grogan, Haylene; Stanley, Andrew; Gardner, Karen

    2010-05-19

    Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange

  19. E-business in health care: does it contribute to strengthen consumer interest?

    Science.gov (United States)

    Kertzman, Ed; Janssen, Richard; Ruster, Marijn

    2003-04-01

    One of the goals of the reforms in the European health-care systems over the last two decades has been to make the health-care system more demand-oriented. There is not much known about the possible impact of E-business like approaches on this goal. This paper describes the concept of E-business. Two cases are introduced to illustrate the use of a simple E-business approach in a health-care setting. On the basis of these case studies, we aspect a reduction of the information disadvantages of patients. In our analysis, we also apply new institutional economy concepts, namely agency theory and transaction costs economics to focus on the position of the patient. Concluded is that it is more probable that preferences of demanders are answered by the suppliers of health care.

  20. 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

  1. 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

    2018-02-01

    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.

  2. Primary Care of the Solid Organ Transplant Recipient.

    Science.gov (United States)

    Wong, Christopher J; Pagalilauan, Genevieve

    2015-09-01

    Solid organ transplantation (SOT) is one of the major advances in medicine. Care of the SOT recipient is complex and continued partnership with the transplant specialist is essential to manage and treat complications and maintain health. The increased longevity of SOT recipients will lead to their being an evolving part of primary care practice, with ever more opportunities for care, education, and research of this rewarding patient population. This review discusses the overall primary care management of adult SOT recipients. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Physicians' accounts of frontline tensions when implementing pilot projects to improve primary care.

    Science.gov (United States)

    Mansfield, Elizabeth; Bhattacharyya, Onil; Christian, Jennifer; Naglie, Gary; Steriopoulos, Vicky; Webster, Fiona

    2018-03-19

    Purpose Canada's primary care system has been described as "a culture of pilot projects" with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

  4. 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

  5. Can the use of urgent care clinics improve access to care without undermining continuity in primary care?

    Science.gov (United States)

    Villaseñor, Sally; Krouse, Helene J

    2016-06-01

    There is a niche for urgent care clinics as an alternate source of health care in the United States. This systematic review examines whether the use of urgent care clinics can improve access to care or if these facilities undermine continuity of primary care. Databases used were Cumulative Index for Nursing and Allied Health (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE). Articles from 2004 to 2014 were searched using keywords-access, barriers, continuity of care, nurse practitioner (NP), urgent care, retail clinic, emergency, and primary care. Urgent care clinics can improve access to care, but may also negatively impact continuity of care, preventative services, and ongoing management of chronic conditions. Barriers to primary care and benefits of urgent care are inversely related. Insufficient knowledge regarding navigation of the healthcare system, perceived urgency of medical need, and deflection of care contribute to use of urgent care over primary care. NPs are frontline healthcare providers essential to developing and maintaining successful communication and collaboration among providers across healthcare settings. In both primary care and urgent care facilities, NPs can ensure continuity of care, decreased healthcare costs, and optimized health outcomes for patients. ©2015 American Association of Nurse Practitioners.

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

    Science.gov (United States)

    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

    2014-10-01

    Assessment of prevalence of health promotion programs in primary health care units within Brazil's health system. 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. 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. 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.

  7. 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.

  8. Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal.

    Science.gov (United States)

    Acharya, Bibhav; Tenpa, Jasmine; Thapa, Poshan; Gauchan, Bikash; Citrin, David; Ekstrand, Maria

    2016-09-19

    Globally, access to mental healthcare is often lacking in rural, low-resource settings. Mental healthcare services integration in primary care settings is a key intervention to address this gap. A common strategy includes embedding mental healthcare workers on-site, and receiving consultation from an off-site psychiatrist. Primary care provider perspectives are important for successful program implementation. We conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal. We asked participants about their concerns and recommendations for an integrated mental healthcare delivery program. They were also asked about current practices in seeking referral for patients with mental illness. We collected data using structured notes and analyzed the data by template coding to develop themes around concerns and recommendations for an integrated program. Participants noted that the current referral system included sending patients to the nearest psychiatrist who is 14 h away. Participants did not think this was effective, and stated that integrating mental health into the existing primary care setting would be ideal. Their major concerns about a proposed program included workplace hierarchies between mental healthcare workers and other clinicians, impact of staff turnover on patients, reliability of an off-site consultant psychiatrist, and ability of on-site primary care providers to screen patients and follow recommendations from an off-site psychiatrist. Their suggestions included training a few existing primary care providers as dedicated mental healthcare workers, recruiting both senior and junior mental healthcare workers to ensure retention, recruiting academic psychiatrists for reliability, and training all primary care providers to appropriately screen for mental illness and follow recommendations from the psychiatrist. Primary care providers in rural Nepal reported the failure of the current system of referral, which

  9. Leveraging quality improvement through use of the Systems Assessment Tool in Indigenous primary health care services: a mixed methods study.

    Science.gov (United States)

    Cunningham, Frances C; Ferguson-Hill, Sue; Matthews, Veronica; Bailie, Ross

    2016-10-18

    Assessment of the quality of primary health care health delivery systems is a vital part of continuous quality improvement (CQI) processes. The Systems Assessment Tool (SAT) was designed to support Indigenous PHC services in assessing and improving their health care systems. It was based on the Assessment of Chronic Illness Care scale, and on practical experience with applying systems assessments in quality improvement in Indigenous primary health care. We describe the development and application of the SAT, report on a survey to assess the utility of the SAT and review the use of the SAT in other CQI research programs. The mixed methods approach involved a review of documents and internal reports relating to experience with use of the SAT since its development in 2002 and a survey of key informants on their experience with using the SAT. The paper drew from documents and internal reports to describe the SAT development and application in primary health care services from 2002 to 2014. Survey feedback highlighted the benefit to the whole primary health care team from participating in the SAT, bringing to light issues that might not emerge with separate individual tool completion. A majority of respondents reported changes in their health centres as a result of using the SAT. Good organisational and management support assisted with ensuring allocation of time and resources for SAT conduct. Respondents identified the importance of having a skilled, external facilitator. Originally designed as a measurement tool, the SAT rapidly evolved to become an important development tool, assisting teams in learning about primary health care system functioning, applying best practice and contributing to team strengthening. It is valued by primary health care centres as a lever in implementing improvements to strengthen centre delivery systems, and has potential for further adaptation and wider application in Australia and internationally.

  10. Evaluating the effect of the Practical Approach to Care Kit on teaching medical students primary care: Quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Robert Mash

    2017-01-01

    Full Text Available Background: South Africa is committed to health reforms that strengthen primary health care. Preparing future doctors to work in primary care teams with other professionals is a priority, and medical schools have shifted towards community-based and decentralised training of medical students.Aim: To evaluate the effect on student performance of the Practical Approach to Care Kit (PACK (an integrated decision-making tool for adult primary care during the final phase of medical student training at Stellenbosch University.Setting: Clinical rotations in family medicine at clinics in the Western Cape.Methods: Mixed methods involving a quasi-experimental study and focus group interviews. Student examination performance was compared between groups with and without exposure to the PACK during their clinical training. Student groups exposed to PACK were interviewed at the end of their rotations.Results: Student performance in examinations was significantly better in those exposed to the PACK. Students varied from using the PACK overtly or covertly during the consultation to checking up on decisions made after the consultation. Some felt that the PACK was more suitable for nurses or more junior students. Although tutors openly endorsed PACK, very few modelled the use of PACK in their clinical practice.Conclusion: The use of PACK in the final phase of undergraduate medical education improved their performance in primary care. Students might be more accepting and find the tool more useful in the earlier clinical rotations. Supervisors should be trained further in how to incorporate the use of the PACK in their practice and educational conversations.

  11. Incorporating shared savings programs into primary care: from theory to practice.

    Science.gov (United States)

    Hayen, Arthur P; van den Berg, Michael J; Meijboom, Bert R; Struijs, Jeroen N; Westert, Gert P

    2015-12-30

    In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate incentives for taking on this new role. Under a so-called shared savings program physicians are instead incentivized to take accountability for spending and quality, as the program lets them share in cost savings when quality targets are met. We provide a structured approach to designing a shared savings program for primary care, and apply this approach to the design of a shared savings program for a Dutch chain of primary care providers, which is currently being piloted. Based on the literature, we defined five building blocks of shared savings models that encompass the definition of the scope of the program, the calculation of health care expenditures, the construction of a savings benchmark, the assessment of savings and the rules and conditions under which savings are shared. We apply insights from a variety of literatures to assess the relative merits of alternative design choices within these building blocks. The shared savings program uses an econometric model of provider expenditures as an input to calculating a casemix-corrected benchmark. The minimization of risk and uncertainty for both payer and provider is pertinent to the design of a shared savings program. In that respect, the primary care setting provides a number of unique opportunities for achieving cost and quality targets. Accountability can more readily be assumed due to the relatively long-lasting relationships between primary care physicians and patients. A stable population furthermore improves the confidence with which savings can be attributed to changes in population management. Challenges arise from the institutional context. The Dutch health care system has a fragmented structure and providers are typically

  12. Tailor-made finance versus tailor-made care. Can the state strengthen consumer choice in healthcare by reforming the financial structure of long-term care?

    Science.gov (United States)

    Grit, K; de Bont, A

    2010-02-01

    Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare. The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets. Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions. With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of 'need' is transformed into the principle of 'economic demand'. Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

  13. Telepaediatrics, primary health care and developing countries ...

    African Journals Online (AJOL)

    Telepaediatrics, which has the potential to improve paediatric care if expert knowledge is not locally available, involves transfer of information between two or more locations, to aid diagnosis or management and/or to allow continuing professional development and education. Developed nations first introduced telemedicine ...

  14. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal provinces, South Africa.

  15. Knowledge and attitude of primary health care providers regarding ...

    African Journals Online (AJOL)

    Knowledge and attitude of primary health care providers regarding domestic violence. A validation study. Shaikha S Al-Hajeri, Eman Y Al-Otibie, Tahani K Habib, Medhat El-Shazly, Mohamed I Kamel, Thuraya AA Ghayath ...

  16. [Increase of attractiveness of primary care during undergraduate medical education].

    Science.gov (United States)

    Schaufelberger, Mireille

    2013-03-13

    The importance of primary care in medical education is recognized internationally. This medical speciality offers a lot of different and attractive aspects. Beyond the milestones of primary care in medical education is the teaching of medical assessment, skills and practical approach. Thus, primary care will get more interesting and attractive. In medical education, primary care should be thought mainly through clerkships, courses and tutorials. Clerkships should be offered during the whole period of medical school. For medical students, GP surgery should become a «place for apprenticeship». Innovative teaching methods like courses with simulated patients and blended learning, may increase the attractivity. Preceptors must be aware of their function as role models.

  17. Urine sampling techniques in symptomatic primary-care patients

    DEFF Research Database (Denmark)

    Holm, Anne; Aabenhus, Rune

    2016-01-01

    in primary care. The aim of this study was to determine the accuracy of urine culture from different sampling-techniques in symptomatic non-pregnant women in primary care. Methods: A systematic review was conducted by searching Medline and Embase for clinical studies conducted in primary care using...... a randomized or paired design to compare the result of urine culture obtained with two or more collection techniques in adult, female, non-pregnant patients with symptoms of urinary tract infection. We evaluated quality of the studies and compared accuracy based on dichotomized outcomes. Results: We included...... seven studies investigating urine sampling technique in 1062 symptomatic patients in primary care. Mid-stream-clean-catch had a positive predictive value of 0.79 to 0.95 and a negative predictive value close to 1 compared to sterile techniques. Two randomized controlled trials found no difference...

  18. Patient Telephone Appointment System for High Volume Primary Care Sites

    National Research Council Canada - National Science Library

    Worthington, Francine

    2000-01-01

    The purpose of this research is to design a patient telephone appointment system for use in the Naval Medical Center San Diego's high volume Primary Care sites, which will reduce variation and ensure...

  19. Patient safety in primary health care: a systematic review

    Directory of Open Access Journals (Sweden)

    Simone Grativol Marchon

    2014-09-01

    Full Text Available The aim of this study was to identify methodologies to evaluate incidents in primary health care, types of incidents, contributing factors, and solutions to make primary care safer. A systematic literature review was performed in the following databases: PubMed, Scopus, LILACS, SciELO, and Capes, from 2007 to 2012, in Portuguese, English, and Spanish. Thirty-three articles were selected: 26% on retrospective studies, 44% on prospective studies, including focus groups, questionnaires, and interviews, and 30% on cross-sectional studies. The most frequently used method was incident analysis from incident reporting systems (45%. The most frequent types of incidents in primary care were related to medication and diagnosis. The most relevant contributing factors were communication failures among member of the healthcare team. Research methods on patient safety in primary care are adequate and replicable, and they will likely be used more widely, thereby providing better knowledge on safety in this setting.

  20. [Work features of the psychologist in the primary health care centers of the public health care system in Chile].

    Science.gov (United States)

    Scharager Goldenberg, Judith; Molina Aguayo, María Loreto

    2007-09-01

    recommendations, the primary health care psychologists in Chile's public health care system are dedicating most of their time to individual counseling and therapy, rather than community activities designed to strengthen and promote mental health. In addition, a funding plan that supports NPMHP priorities is needed.

  1. Primary Health Care (phc): Back to the Past?

    OpenAIRE

    Alvaro Franco-Giraldo

    2012-01-01

    Primary health care is analyzed as the alternative throughwhich health systems will recover the role they had during thelate twentieth century: working with other sectors to implementhealth promotion actions to improve the users’ quality of lifeand equity. A renewal is presented in recognition of the effortsduring the final century to establish primary care policies andprograms as the core of the health systems, emphasizing thereorientation of health services. This paper discusses the princip...

  2. 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.

  3. Innovations in primary care: Implications for hypertension detection and treatment

    OpenAIRE

    Lewanczuk, Richard

    2006-01-01

    The majority of hypertension detection and management in Canada is provided by family physicians. Although various organizations have called attention to the poor rates of hypertension detection and control on a worldwide basis, the tools and infrastructure that allow for better hypertension management have generally been lacking in primary care. Recent advances in the fields of primary care and chronic disease management have led to the development of frameworks wherein chronic diseases such...

  4. Integration of mental health into primary care in Kenya

    OpenAIRE

    JENKINS, RACHEL; KIIMA, DAVID; NJENGA, FRANK; OKONJI, MARX; KINGORA, JAMES; KATHUKU, DAMMAS; LOCK, SARAH

    2010-01-01

    Integration of mental health into primary care is essential in Kenya, where there are only 75 psychiatrists for 38 million population, of whom 21 are in the universities and 28 in private practice. A partnership between the Ministry of Health, the Kenya Psychiatric Association and the World Health Organization (WHO) Collaborating Centre, Institute of Psychiatry, Kings College London was funded by Nuffield Foundation to train 3,000 of the 5,000 primary health care staff in th...

  5. [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.

  6. 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

  7. 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.

  8. 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.

  9. Do primary care physicians coordinate ambulatory care for chronic disease patients in Canada?

    Science.gov (United States)

    Katz, Alan; Martens, Patricia; Chateau, Dan; Bogdanovic, Bodgan; Koseva, Ina

    2014-08-30

    Adults with chronic disease are the most frequent users of the primary healthcare system. In Manitoba, patients are allowed to seek ambulatory (outpatient) care from the provider of their choosing (primary care physician or specialist), with referrals to specialists preferred but not always required. Some patients receive their routine care from specialists. We conducted this study to determine the patterns by which adults with chronic disease access ambulatory care as a prelude to exploring the impact these patterns may have on the quality of care received. Physician claims for all visits between 2007/8-2009/10 were extracted from the Data Repository at the Manitoba Centre for Health Policy. Patients included in the analysis made at least four ambulatory visits to a primary care physician or specialist within the study period, and met the definition criteria for at least one of six chronic diseases: diabetes mellitus; congestive heart failure; mood disorders; ischemic heart disease; total respiratory morbidity; and/or hypertension. Patients were "assigned" to the physician they visited most regularly. Physician visit patterns were assessed by dividing visits into nine visit types based on the type of physician patients visited (assigned primary care physician, other primary care physician, or specialist) and whether or not they received a referral. 347,606 patients with 7,662,411 physician visits were included in the analysis. Most visits were to the patients' assigned primary care physician. About 50% of the visits to specialists were by referral from the assigned primary care physician. However, 26-29% of all visits to a primary care physician were not to the assigned primary care physician, and non-assigned physicians were more likely to refer patients to specialists than assigned primary care physicians. The findings suggest that the current primary care system in Manitoba may not adequately support coordination of ambulatory care. Ambulatory visits to a

  10. 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

  11. Establishing an integrated human milk banking approach to strengthen newborn care.

    Science.gov (United States)

    DeMarchis, A; Israel-Ballard, K; Mansen, Kimberly Amundson; Engmann, C

    2017-05-01

    The provision of donor human milk can significantly reduce morbidity and mortality among vulnerable infants and is recommended by the World Health Organization as the next best option when a mother's own milk is unavailable. Regulated human milk banks can meet this need, however, scale-up has been hindered by the absence of an appropriate model for resource-limited settings and a lack of policy support for human milk banks and for the operational procedures supporting them. To reduce infant mortality, human milk banking systems need to be scaled up and integrated with other components of newborn care. This article draws on current guidelines and best practices from human milk banks to offer a compilation of universal requirements that provide a foundation for an integrated model of newborn care that is appropriate for low- and high-resource settings alike.

  12. Developing a response to family violence in primary health care: the New Zealand experience.

    Science.gov (United States)

    Gear, Claire; Koziol-McLain, Jane; Wilson, Denise; Clark, Faye

    2016-08-20

    Despite primary health care being recognised as an ideal setting to effectively respond to those experiencing family violence, responses are not widely integrated as part of routine health care. A lack of evidence testing models and approaches for health sector integration, alongside challenges of transferability and sustainability, means the best approach in responding to family violence is still unknown. The Primary Health Care Family Violence Responsiveness Evaluation Tool was developed as a guide to implement a formal systems-led response to family violence within New Zealand primary health care settings. Given the difficulties integrating effective, sustainable responses to family violence, we share the experience of primary health care sites that embarked on developing a response to family violence, presenting the enablers, barriers and resources required to maintain, progress and sustain family violence response development. In this qualitative descriptive study data were collected from two sources. Firstly semi-structured focus group interviews were conducted during 24-month follow-up evaluation visits of primary health care sites to capture the enablers, barriers and resources required to maintain, progress and sustain a response to family violence. Secondly the outcomes of a group activity to identify response development barriers and implementation strategies were recorded during a network meeting of primary health care professionals interested in family violence prevention and intervention; findings were triangulated across the two data sources. Four sites, representing three PHOs and four general practices participated in the focus group interviews; 35 delegates from across New Zealand attended the network meeting representing a wider perspective on family violence response development within primary health care. Enablers and barriers to developing a family violence response were identified across four themes: 'Getting started', 'Building effective

  13. Training in child and adolescent psychiatry for primary health care ...

    African Journals Online (AJOL)

    Objective — To obtain feedback from primary care nurses who attended two study days in child and adolescent mental health. The study days aimed to equip nurses with basic assessment and intervention skills for the most common problems in child and adolescent psychiatric nursing. Method — All 144 and 68 primary ...

  14. Health care, the California primary, and the 1992 election.

    Science.gov (United States)

    Blendon, R J; Szalay, U S; Altman, D E; Chervinsky, G

    1992-01-01

    Voters in the June 2 last-in-the-nation California primary indicated that candidates' character, experience, and leadership ability have become more significant than their stands on such issues as health reform. However, among substantive campaign issues, health care ranked second, behind the economy. That is consistent with previous poll results from New Hampshire, the nation's first primary state.

  15. Drug interactions in primary health care in the George subdistrict ...

    African Journals Online (AJOL)

    Drug interactions in primary health care in the George subdistrict, South Africa: a cross-sectional study. PA Kapp, AC Klop, LS Jenkins. Abstract. Objectives: To investigate the prevalence of potential drug-drug interactions in primary healthcare clinics in the George subdistrict, to determine which drugs were involved, and to ...

  16. 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 ...

  17. Do trained practice nurses apply motivational interviewing techniques in primary care consultations?

    Science.gov (United States)

    Noordman, Janneke; van Lee, Inge; Nielen, Mark; Vlek, Hans; van Weijden, Trudy; van Dulmen, Sandra

    2012-12-01

    Reducing the prevalence of unhealthy lifestyle behaviour could positively influence health. Motivational interviewing (MI) is used to promote change in unhealthy lifestyle behaviour as part of primary or secondary prevention. Whether MI is actually applied as taught is unknown. Practice nurses' application of motivational interviewing in real-life primary care consultations was examined. Furthermore, we explored if (and to what extent) practice nurses adjust their motivational interviewing skills to primary versus secondary prevention. Thirteen Dutch practice nurses, from four general practices, trained in motivational interviewing participated, 117 adult patients visiting the practice nurse participated, 117 practice nurse-patient consultations between June and December 2010 were videotaped. Motivational interview skills were rated by two observers using the Behaviour Change Counselling Index (BECCI). Data were analyzed using multilevel regression. Practice nurses use motivational interviewing techniques to some extent. Substantial variation was found between motivational interviewing items. No significant differences in the use of motivational interviewing between primary and secondary prevention was found. Motivational interviewing skills are not easily applicable in routine practice. Health care providers who want to acquire motivational interview skills should follow booster sessions after the first training. The training could be strengthened by video-feedback and feedback based on participating observation. A possible explanation for the lack of differences between the two types of prevention consultations may be the gain to help patients in primary consultations by preventing complications equals the necessity to help the disease from aggravating in secondary prevention.

  18. Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors.

    Science.gov (United States)

    Gurung, Dristy; Upadhyaya, Nawaraj; Magar, Jananee; Giri, Nir Prakash; Hanlon, Charlotte; Jordans, Mark J D

    2017-01-01

    Service user and caregiver involvement has become an increasingly common strategy to enhance mental health outcomes, and has been incorporated in the mental healthpolicies of many developed nations. However, this practice is non-existent or fragmented in low and middle income countries (LMICs). Instances of service user and caregiver involvement have been rising slowly in a few LMICs, but are rarely described in the literature. Very little is known about the context of user and caregiver participation in mental health system strengthening processes in a low-income, disaster- and conflict-affected state such as Nepal. This study explores (a) the extent and experiences of service user and caregiver involvement in policy making, service planning, monitoring, and research in Nepal; (b) perceived barriers to such involvement; and (c) possible strategies to overcome barriers. Key Informant Interviews (n = 24) were conducted with service users and caregivers who were either affiliated to a mental health organization or receiving menta health care integrated within primary care. Purposive sampling was employed. Data collection was carried out in 2014 in Chitwan and Kathmandu districts of Nepal. Data analysis was carried out in NVivo10 using a framework approach. The involvement of service users affiliated to mental health organizations in policy development was reported to be 'tokenistic'. Involvement of caregivers was non-existent. Perceived barriers to greater involvement included lack of awareness, stigma and discrimination, poor economic conditions, the centralized health system, and lack of strong leadership and unity among user organizations. Increased focus on reducing public as well as self-stigma, improved policy frameworks and initiatives, and decentralization of care are some strategies that may facilitate service user and caregiver involvement. The study highlighted need for user and caregiver networks free from competing interests and priorities. Improved

  19. 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

  20. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    DR Marwa

    Abstract. Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in.

  1. Knowledge of Health Insurance Among Primary Health-Care ...

    African Journals Online (AJOL)

    Background: The National Health Insurance Scheme (NHIS) was formally launched in Nigeria in 2005 as an option to help bridge the evident gaps in health care financing, with the expectation of it leading to significant improvement in the country's dismal health status indices. Primary Health Care (PHC) is the nation's ...

  2. Primary care for young adult cancer survivors: an international perspective.

    NARCIS (Netherlands)

    Holge-Hazelton, B.; Blake-Gumbs, L.; Miedema, B.; Rijswijk, E. van

    2010-01-01

    PURPOSE: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement. METHODS: Comparative descriptions and literature review. RESULTS: Cancer among YAs is rare and

  3. 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 ...

  4. 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.

  5. Ophthalmic Skills Assessment of Primary Health Care Workers at ...

    African Journals Online (AJOL)

    The aim of the study was to assess the ability of the primary health care workers to provide basic ophthalmic .... Material resources for eye-care delivery in urban South eastern Nigeria. OJM. 2004; 16: .... However, in a country that is not technologically advanced, coupled with the challenges of scarce resources, it may be ...

  6. Determinants of increased primary health care use in cancer survivors.

    NARCIS (Netherlands)

    Heins, M.; Schellevis, F.; Rijken, M.; Hoek, L. van der; Korevaar, J.

    2012-01-01

    Purpose: The number of cancer survivors is increasing, and patients with cancer often experience long-lasting consequences of cancer and its treatment. Because of the variety of health problems and high prevalence of comorbidity, primary care physicians (PCPs) seem obvious candidates to take care of

  7. Patient Satisfaction and Factor of Importance in Primary Health Care ...

    African Journals Online (AJOL)

    Primary health care involves a sustained partnership between patients and providers that addresses the majority of a population's health needs over time. Lengthy waiting time, poor access, lack of information and healthy relationship with healthcare workers in outpatient clinics remain a challenge to quality care.

  8. Pain management in primary care – current perspectives | Meyer ...

    African Journals Online (AJOL)

    Pain management in primary care – current perspectives. ... Part of the problem lies with some health-care providers who have failed to keep up with the advances in pain medicine and ... The modern paradigm of pain management has moved from this biomedical to the broader biopsychosocial approach, where pain ...

  9. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in two districts of ...

  10. 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 ...

  11. 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 ...

  12. 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.

  13. Drug prescriptions in Danish out-of-hours primary care

    DEFF Research Database (Denmark)

    Christensen, Morten Bondo; Nørøxe, Karen Busk; Moth, Grete

    2016-01-01

    OBJECTIVE: General practitioners are the first point of contact in Danish out-of-hours (OOH) primary care. The large number of contacts implies that prescribing behaviour may have considerable impact on health-care expenditures and quality of care. The aim of this study was to examine the prevail......OBJECTIVE: General practitioners are the first point of contact in Danish out-of-hours (OOH) primary care. The large number of contacts implies that prescribing behaviour may have considerable impact on health-care expenditures and quality of care. The aim of this study was to examine...... data. MAIN OUTCOME MEASURES: Prescriptions were categorised according to Anatomical Therapeutic Chemical Classification (ATC) codes and stratified for patient age, gender and contact type (telephone consultation, clinic consultation or home visit). Prescription rates were calculated as number...

  14. Cross-cultural aspects of depression management in primary care.

    Science.gov (United States)

    Hails, Katherine; Brill, Charlotte D; Chang, Trina; Yeung, Albert; Fava, Maurizio; Trinh, Nhi-Ha

    2012-08-01

    Major depressive disorder (MDD) is a prevalent illness in minority populations. Minority patients with MDD are often unrecognized and untreated. This review examines promising interventions to address MDD in primary care settings, where minority groups are more likely to seek care. Since 2010, eleven interventions have been developed to address patient-specific and provider-specific barriers, many of which are adaptations of the collaborative care model. Other promising interventions include cultural tailoring of the collaborative care model, as well as the addition of telepsychiatry, motivational interviewing, cultural consultation, and innovations in interpreting. Overall, collaborative care was found feasible and improved satisfaction and treatment engagement of depressed minority patients in primary care. It remains inconclusive whether these newer intervention models improve MDD treatment outcomes. Future research will be needed to establish the effectiveness of these intervention models in improving the treatment outcomes of minority populations with MDD.

  15. Changes in Family Life and Challenges in Primary Care

    Science.gov (United States)

    Shorter, Edward

    1991-01-01

    Fragmentation of the postmodern family affects several aspects of primary care. In prevention, the physician-patient relationship is most important in forestalling abuse. In morbidity and diagnosis, single or socially isolated patients are more vulnerable to diseases, such as total allergy syndrome. In acute care, fragmentation increases the number of elderly patients in hospital. And in rehabilitation, the two-career family is no longer able to supplement hospital nursing care as it once did. PMID:21229053

  16. 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

  17. 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

  18. Using focus groups and social marketing to strengthen promotion of group prenatal care.

    Science.gov (United States)

    Vonderheid, Susan C; Carrie, S Klima; Norr, Kathleen F; Grady, Mary Alice; Westdahl, Claire M

    2013-01-01

    Centering Pregnancy, an innovative group model of prenatal care, shows promise to reduce persistent adverse maternal-infant outcomes and contain costs. Because this innovation requires systemwide change, clinics reported needing support enrolling women into groups and obtaining organizational buy-in. This study used the 3-step social marketing communication strategy to help clinic staff identify key customers and customer-specific barriers to adopting or supporting Centering Pregnancy. They developed targeted information to reduce barriers and built skills in communicating with different customers through role-playing. Findings provide practical information for others to use this communication strategy to improve implementation of Centering Pregnancy.

  19. Value and the medical home: effects of transformed primary care.

    Science.gov (United States)

    Gilfillan, Richard J; Tomcavage, Janet; Rosenthal, Meredith B; Davis, Duane E; Graham, Jove; Roy, Jason A; Pierdon, Steven B; Bloom, Frederick J; Graf, Thomas R; Goldman, Roy; Weikel, Karena M; Hamory, Bruce H; Paulus, Ronald A; Steele, Glen D

    2010-08-01

    The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 different primary care practices. The goals were to improve the quality, efficiency, and patient experience of care. To evaluate the ability of a medical home model to improve the efficiency of care for Medicare beneficiaries. Observational study using regression modeling based on preintervention and postintervention data and a propensity-selected control cohort. Four years of claims data for Medicare patients at 11 intervention sites and 75 control groups were analyzed to compute hospital admission and readmission rates, and the total cost of care. Regression modeling was used to establish predicted rates and costs in the absence of the intervention. Actual results were compared with predicted results to compute changes attributable to the PHN model. ProvenHealth Navigator was associated with an 18% (P Investing in the capabilities of primary care practices to serve as medical homes may increase healthcare value by improving the efficiency of care. This study demonstrates that the PHN model is capable of significantly reducing admissions and readmissions for Medicare Advantage members.

  20. [Geriatric assessment in the primary care].

    Science.gov (United States)

    Díaz, Violeta; Díaz, Inés; Rojas, Graciela; Novogrodsky, David

    2003-08-01

    A good medical care program for the elderly requires a thorough assessment of the functional capacity and limitations of the consulting patients. To perform a geriatric assessment to elderly subjects consulting in a public outpatient clinic. A cross sectional assessment of subjects over 60 years old, beneficiaries of the public health care system and consulting in 4 outpatient clinics of a poor community of Metropolitan Santiago. Evaluation included a complete medical history, the Katz score for activities of daily living (ADL), Lawton score for instrumental activities for daily living (IADL) and Folstein Mini Mental state examination. During the study period 1,023 subjects, 73% female, aged 74 +/- 7 years, were assessed. Thirteen percent were illiterate, 78% elementary school, 8% had high school and 0.2% university education. Eighty eight percent lived with relatives, 79% did not participate in community groups and 7% smoked. The most common chronic disease detected was high blood pressure in 61%, followed by obesity in 32%, osteoarthritis in 22%, diabetes mellitus in 17%, depression in 11%, cardiac diseases in 8%, hypothyroidism in 3% and epilepsy in 1%. ADL score showed partial dependency in 11% and total dependency in 2%. IADL score showed partial dependency in 41% and total dependency in 4%. Mini Mental score was abnormal in 31% of subjects. High blood pressure, osteoarthritis, depression and cognitive impairment are the most common health problems in this sample of elderly subjects. ADL score showed a low rate of dependency.

  1. 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.

  2. Learning to listen in primary care: some educational challenges.

    Science.gov (United States)

    Cocksedge, Simon

    2016-11-01

    Effective clinician listening and communicating directly affects patients' health, satisfaction with healthcare, and complaints. This influences healthcare policy and clinician training/assessment. Listening skills and consultation frameworks underpin training but are often poorly used in everyday clinical work. Primary care doctors provide continuity of care using listening skills to develop long term relationships. Additionally, they listen to patients and colleagues in other ways such as surveys, participation groups, and significant event reviews. All these factors challenge educators to offer systematic training which ensures that future primary care clinicians/leaders develop conscious competence in listening at different levels and in differing contexts.

  3. [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.

  4. 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.

  5. 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.

  6. Strengthening emergency obstetric care in Nepal: The Women's Right to Life and Health Project (WRLHP).

    Science.gov (United States)

    Rana, T G; Chataut, B D; Shakya, G; Nanda, G; Pratt, A; Sakai, S

    2007-09-01

    The Women's Right to Life and Health Project contributes to Nepal's National Safe Motherhood Program and maternal mortality reduction efforts by working to improve the availability, quality and utilization of emergency obstetric care services in public health facilities. The project upgraded 8 existing public health facilities through infrastructure, equipment, training, data collection, policy advocacy, and community information activities. The total cost of the project was approximately US$1.6 million. In 5 years, 3 comprehensive and 4 basic emergency obstetric care (EmOC) facilities were established in an area where adequate EmOC services were previously lacking. From 2000 to 2004, met need for EmOC improved from 1.9 to 16.9%; the proportion of births in EmOC project facilities increased from 3.8 to 8.3%; and the case fatality rate declined from 2.7 to 0.3%. While the use of maternity services is still low in Nepal, improving availability and quality of EmOC together with community empowerment can increase utilization by women with complications, even in low-resource settings. Partnerships with government and donors were key to the project's success. Similar efforts should be replicated throughout Nepal to expand the availability of essential life-saving services for pregnant women.

  7. Action research to strengthen women weavers' self-care in North-East Thailand.

    Science.gov (United States)

    Nilvarangkul, Kessarawan; Srithongchai, Niramol; Saensom, Donwiwat; Smith, John F; Supornpan, Ausa; Tumnong, Chuanpit

    2013-05-01

    The objective of this research was to improve self-care and work safety practices among women weavers in North-East Thailand. Action research was used with a sample of 107 weavers and 15 community and local government stakeholders from six rural villages. Formative and summative evaluation was carried out over 10 months following initial implementation of five action plans, and after 5 years. Qualitative data were collected via focus groups, formal and informal interviews and research field notes. Women's self-care issues and safety problems, and weaving-related environmental pollution emerged from the content analyses. Five action plans were created. Results showed that through action research the women were empowered to identify personal and work-related health issues, environmental contamination concerns, and lack of social and community support systems. Over time they developed capacity for working collectively to address these. Five year follow-up revealed many of the changes made were ongoing, and well-integrated into community life. The study reaffirmed the potential for public health or community nurses and other health personnel for enhancing community health status via action research with vulnerable populations; in this case, rural village women weavers in North-East Thailand. © 2012 Wiley Periodicals, Inc.

  8. The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review.

    Science.gov (United States)

    Stephen, Catherine; McInnes, Susan; Halcomb, Elizabeth

    2018-02-01

    To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Integrative review guided by the work of Whittemore and Knafl (). Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base. © 2017 John Wiley & Sons Ltd.

  9. 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...... for proposed decision rules in ICD-11 PHC, were administered to 1488 participants. Results A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients...... 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...

  10. Primary health care research--essential but disadvantaged.

    Science.gov (United States)

    Yallop, Julie J; McAvoy, Brian R; Croucher, Joanne L; Tonkin, Andrew; Piterman, Leon

    2006-07-17

    Primary health care is the foundation of effective, sustainable population health and is associated with higher patient satisfaction and reduced aggregate health spending. Although improving patient care requires a sound evidence base, rigorously designed studies remain under-represented in primary care research. The pace of research activity in general practice and the rate and quality of publications do not match the pace of structural change or the level of funding provided. Recruitment difficulties are a major impediment, fuelled by general practitioners' time constraints, lack of remuneration, non-recognition, and workforce shortages. Radical reform is required to redress imbalances in funding allocation, including: funding of GP Research Network infrastructure costs; formalising relationships between primary care researchers and academic departments of general practice and rural health; and mandating that research funding bodies consider only proposals that include in the budget nominal payments for GP participation and salaries for dedicated research nurses.

  11. The role of the primary care physician in the Israeli health care system as a 'gatekeeper'--the viewpoint of health care policy makers.

    Science.gov (United States)

    Tabenkin, H; Gross, R

    2000-06-01

    The aim of the study was to determine the attitudes of policy makers in the health care system in Israel to a change in the role of primary care physicians (PCP) and to ascertain the conditions under which they would be ready to adopt the model of PCP as gatekeeper. The study design was qualitative, with analyses of in-depth structured interviews of 20 policy makers from the Ministry of Health, the Sick Funds' central administrations and the Israel Medical Association (IMA) central office. The majority of the respondents claim that they want highly trained PCPs (family physicians, pediatricians and internals) to play a central role in the health care system. They should be co-ordinators, highly accessible and should be able to weigh cost considerations. However, only about half of the respondents support a full gatekeeper model and most of them think that the gatekeeper concept has a negative connotation. They also feel that it would be difficult to implement regulations regarding primary care. The barriers to implementation of the gatekeeper model, as cited by the respondents include loss of faith in PCPs by the general population, dearth of PCPs with adequate training, low stature, lack of availability on a 24-h basis, resistance by specialists, strong competition between the sick funds including promises of direct access to specialists, the medical care habits of the general population many of whom do not settle for only one opinion, and a declared anti-gatekeeper policy by one of the sick funds. Ways to overcome these obstacles include implementation of fundholding clinics, patient education on the importance of having a personal physician, appropriate marketing by family medicine and primary care advocates, and continued training in primary care. Israeli health care policy makers have an ambivalent attitude to strengthening the role of primary care. In theory, they profess support for placing primary care physicians in a central role in the health care system

  12. Towards the effective introduction of physical activity interventions in primary health care

    NARCIS (Netherlands)

    Huijg, Johanna Maria

    2014-01-01

    Despite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical activity, the introduction of physical activity interventions in routine daily primary health care

  13. Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

    Science.gov (United States)

    Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

    2008-01-01

    Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

  14. Socio-economic improvements and health system strengthening of maternity care are contributing to maternal mortality reduction in Cambodia.

    Science.gov (United States)

    Liljestrand, Jerker; Sambath, Mean Reatanak

    2012-06-01

    Maternal mortality has been falling significantly in Cambodia since 2005 though it had been stagnant for at least 15 years before that. This paper analyzes the evolution of some major societal and health system factors based on recent national and international reports. The maternal mortality ratio fell from 472 per 100,000 live births in 2000-2005 to 206 in 2006-2010. Background factors have included peace and stability, economic growth and poverty reduction, improved primary education, especially for girls, improved roads, improved access to information on health and health services via TV, radio and cellphones, and increased ability to communicate with and within the health system. Specific health system improvements include a rapid increase in facility-based births and skilled birth attendance, notably investment in midwifery training and numbers of midwives providing antenatal care and deliveries within an expanding primary health care network, a monetary incentive for facility-based midwives for every live birth conducted, and an expanding system of health equity funds, making health care free of cost for poor people. Several major challenges remain, including post-partum care, family planning, prevention and treatment of breast and cervical cancer, and addressing sexual violence against women, which need the same priority attention as maternity care. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  15. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

    Science.gov (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

    2013-01-01

    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

  16. 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...... diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action planning...

  17. Chronic kidney disease: identification and management in primary care.

    Science.gov (United States)

    Fraser, Simon Ds; Blakeman, Tom

    2016-01-01

    Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end-stage kidney disease for most people with CKD. CKD also predisposes to acute kidney injury - a major cause of morbidity and mortality worldwide. Although only a small proportion of people with CKD progress to end-stage kidney disease, renal replacement therapy (dialysis or transplantation) represents major costs for health care systems and burden for patients. Efforts in primary care to reduce the risks of cardiovascular disease, acute kidney injury, and progression are therefore required. Monitoring renal function is an important task, and primary care clinicians are well placed to oversee this aspect of care along with the management of modifiable risk factors, particularly blood pressure and proteinuria. Good primary care judgment is also essential in making decisions about referral for specialist nephrology opinion. As CKD commonly occurs alongside other conditions, consideration of comorbidities and patient wishes is important, and primary care clinicians have a key role in coordinating care while adopting a holistic, patient-centered approach and providing continuity. This review aims to summarize the vital role that primary care plays in predialysis CKD care and to outline the main considerations in its identification, monitoring, and clinical management in this context.

  18. Chronic disease management in primary care: from evidence to policy.

    Science.gov (United States)

    Dennis, Sarah M; Zwar, Nicholas; Griffiths, Rhonda; Roland, Martin; Hasan, Iqbal; Powell Davies, Gawaine; Harris, Mark

    2008-04-21

    To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were classified according to which elements were addressed: community resources, health care organisation, self-management support, delivery system design, decision support and/or clinical information systems. Our major findings were discussed with policymakers and key stakeholders in relation to current and emerging health policy in Australia. The interventions most likely to be effective in the context of Australian primary care were engaging primary care in self-management support through education and training for general practitioners and practice nurses, and including self-management support in care plans linked to multidisciplinary team support. The current Practice Incentives Payment and Service Incentives Payment programs could be improved and simplified to encourage guideline-based chronic disease management, integrating incentives so that individual patients are not managed as if they had a series of separate chronic diseases. The use of chronic disease registers should be extended across a range of chronic illnesses and used to facilitate audit for quality improvement. Training should focus on clear roles and responsibilities of the team members. The Chronic Care Model provides a useful framework for understanding the impact of chronic disease management interventions and highlights the gaps in evidence. Consultation with stakeholders and policymakers is valuable in shaping policy options to support the implementation of the National Chronic Disease Strategy in primary care.

  19. Electronic health records and support for primary care teamwork

    Science.gov (United States)

    Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

    2015-01-01

    Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

  20. Electronic health records and support for primary care teamwork.

    Science.gov (United States)

    O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

    2015-03-01

    Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  1. Coordinating Mental Health Care across Primary Care and Schools: ADHD as a Case Example

    Science.gov (United States)

    Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual…

  2. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    Science.gov (United States)

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  3. The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

    Science.gov (United States)

    Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

    2018-02-27

    Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

  4. Multidisciplinary collaboration in primary care: through the eyes of patients.

    Science.gov (United States)

    Cheong, Lynn H; Armour, Carol L; Bosnic-Anticevich, Sinthia Z

    2013-01-01

    Managing chronic illness is highly complex and the pathways to access health care for the patient are unpredictable and often unknown. While multidisciplinary care (MDC) arrangements are promoted in the Australian primary health care system, there is a paucity of research on multidisciplinary collaboration from patients' perspectives. This exploratory study is the first to gain an understanding of the experiences, perceptions, attitudes and potential role of people with chronic illness (asthma) on the delivery of MDC in the Australian primary health care setting. In-depth semi-structured interviews were conducted with asthma patients from Sydney, Australia. Qualitative analysis of data indicates that patients are significant players in MDC and their perceptions of their chronic condition, perceived roles of health care professionals, and expectations of health care delivery, influence their participation and attitudes towards multidisciplinary services. Our research shows the challenges presented by patients in the delivery and establishment of multidisciplinary health care teams, and highlights the need to consider patients' perspectives in the development of MDC models in primary care.

  5. A primary care approach for adolescent care and counseling services.

    Science.gov (United States)

    Nair, M K C; Chacko, D S; Indira, M S; Siju, K E; George, Babu; Russell, P S

    2012-01-01

    Adolescents can have mental, emotional, and behavior problems that are a source of stress for the child as well as the family, school and community. These may disrupt the adolescent's ability to function normally. Adolescents also have reproductive concerns especially at menarche. Considering the extent of problems of adolescents and the lack of adolescent care and counseling services, it was felt that community adolescent care counseling services should be made available. This article describes the steps involved in the setting up of Taluk model of adolescent care and counseling services. Following steps were involved in setting up a Taluk model of adolescent care counseling service delivery system. Step I: Focus Group Discussions (FGDs) among Stakeholders. Step II: Conceptualization and Strategy planning for service delivery. III: Finalization of service delivery model Step IV: Workshops for finalization of TSQ-T 2008 version the tool to be used for assessing the adolescents in the ARSH clinics. Step V: Training Programme for Medical/Paramedical health staff. Step VI: Awareness programs for mothers of adolescents. Step VII: Setting up of ACS/ARSH clinics at Taluk hospitals. Step VIII: Evaluation of the utilization of services at Taluk hospitals. The clinic has been well utilized with 1,588 adolescents being seen in 2 years. Medical and Reproductive problems among adolescent girls were anemia, underweight, dysmenorrhoea, menstrual irregularities and symptoms of Polycystic Ovarian Syndrome, whereas among boys problems were mostly related to concerns about masturbation and its perceived ill effects. The psychosocial problems ranged from minor anxieties, sadness and adjustment problems to psychiatric disorders. Scholastic problems included poor concentration, poor study habits and low intelligence quotient. The success of the clinics in these five hospitals can be replicated in other parts of the state as well as the country. These will go a long way to ameliorate

  6. Primary Care Endocrinology in the Adult Woman.

    Science.gov (United States)

    Thomas, Celeste C; Zeytinoglu, Meltem

    2016-06-01

    Diabetes mellitus, thyroid disorders, and osteoporosis are endocrine conditions affecting a significant proportion of women presenting to the obstetrician-gynecologist. Obstetrician-gynecologists are often the first health-care providers that young women see in adulthood, and thus, have a critical opportunity to identify women at risk for gestational and overt diabetes and manage the condition in those who have developed it. The obstetrician-gynecologist should be aware of the appropriate therapeutic options and treatment goals (eg, hemoglobin A1c) for women with diabetes. Thyroid disorders often present with menstrual irregularities or infertility, can affect pregnancy outcomes, and contribute to cardiovascular and bone disorders as women age. Finally, osteoporosis and low bone mineral density affect a substantial proportion of older women and some younger women with risk factors for secondary osteoporosis. The morbidity and mortality of osteoporotic fractures is substantial. There are many lifestyle interventions and therapeutic options available for these conditions, and the gynecologist plays a key role in optimizing risk factor assessment, screening, and providing treatment when appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Primary care for young adult cancer survivors: an international perspective

    DEFF Research Database (Denmark)

    Hølge-Hazelton, Bibi; Blake-Gumbs, Lyla; Miedema, Baujke

    2010-01-01

    PURPOSE: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement. METHODS: Comparative descriptions and literature review. RESULTS: Cancer among YAs is rare...... issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited. CONCLUSIONS: YACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care...

  8. Strengthening emergency obstetric care in Thanh Hoa and Quang Tri provinces in Vietnam.

    Science.gov (United States)

    Otchere, S A; Binh, H T

    2007-11-01

    Save the Children/USA and the Ministry of Health of Vietnam undertook a project between 2001 and 2004 to improve the availability of, access to, quality and utilization of emergency obstetric care (EmOC) services at district and provincial hospitals in two provinces in Vietnam. The project improved the functional capacity of 3 provincial and 1 district hospitals providing comprehensive EmOC services, and upgraded 1 district hospital providing basic EmOC into a comprehensive EmOC facility through training, infrastructure and quality improvement. Data presented in this paper focus on only the 2 district hospitals even though the UN process indicators showed increases in utilization of EmOC in all 5 hospitals. In the case of Hai Lang, the proportion of births increased from 13% at baseline to 31% at the end of 2004, and met need increased significantly from 16% to 87% largely due to increased capacity of the hospital and staff. Met need in Hoang Hoa hospital more than doubled (17% at baseline versus 54% in 2004) and the proportion of births increased slightly from 19% in 2001 to 22% in 2004. Case fatality rates for the two hospitals remarkably remained at zero. Lessons from this project have been incorporated into national policy and guidelines. Improvements in the capacity of existing health facilities to treat complications in pregnancy and childbirth can be realized in a relatively short period of time and is an essential element in reducing maternal mortality.

  9. Magnetic resonance imaging use by primary care physicians.

    Science.gov (United States)

    Baldor, R A; Quirk, M E; Dohan, D

    1993-03-01

    Magnetic resonance imaging (MRI) has recently been introduced in the United States as an imaging technique for clinical use. Initially used by neurologists to view the brain stem, its indications have rapidly expanded to include spine, pelvis, bone marrow, and joints. This has raised concerns over the appropriate, cost-effective use of such an expensive technology. This paper examines MRI scanning patterns that have developed over time in central Massachusetts and surveys primary care knowledge, attitudes, and patterns of utilization. The two MRI centers in central Massachusetts were surveyed for information about the number and types of scans ordered and the specialties of the physicians who ordered the scans. Questionnaires were sent to primary care physicians in Worcester County to assess knowledge and attitudes about MRI and utilization. The data demonstrate changing patterns of MRI utilization over time. Orthopedics has been the specialty with the greatest increase in use, now slightly surpassing neurology in the total number of scans ordered. Primary care physician use has doubled over this same period. Not all primary care physicians utilize MRI, but those who have used the technology have familiarized themselves with its indications and problems and have a better knowledge about its costs. Utilization patterns of MRI have changed considerably in a short time, with primary care physicians requesting use of this new technology much more frequently than when it was first introduced.

  10. Epistemology and uncertainty in primary care: an exploratory study.

    Science.gov (United States)

    Evans, Lance; Trotter, David R M

    2009-05-01

    Primary care is an endeavor marked by breadth, complexity, and more clinical uncertainty than all non-primary care specialties except psychiatry. This is significant, as uncertainty is associated with a variety of troublesome economic and clinical indicators. Researchers have identified the three types of cognitive resources needed to combat uncertainty (technical, personal, or conceptual), as well as the affective stress reactions physicians have when confronted with uncertainty. In this study, we explored the relationship between primary care physicians' stress reactions to uncertainty and the conceptual resource of epistemology. Using Likert-type measures of epistemology and stress reactions to uncertainty, we conducted a cross-sectional survey with 78 board-certified and resident physicians in primary care. A simple bivariate regression analysis was performed to identify the relationship between epistemology and stress reactions to uncertainty (Model 1), and a multivariate regression analysis was performed to test for the independent effect of epistemology on stress reactions to uncertainty while controlling for gender, specialty, and professional development status (Model 2). Physician epistemology and stress reactions to uncertainty were significantly related in both models. Among primary care physicians, a biopsychosocial epistemology is associated with less stress reactions to uncertainty, and a biomedical epistemology is associated with more stress reactions to uncertainty.

  11. Designing a mixed methods study in primary care.

    Science.gov (United States)

    Creswell, John W; Fetters, Michael D; Ivankova, Nataliya V

    2004-01-01

    Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research.

  12. Retail clinics versus traditional primary care: Employee satisfaction guaranteed?

    Science.gov (United States)

    Lelli, Vanessa R; Hickman, Ronald L; Savrin, Carol L; Peterson, Rachel A

    2015-09-01

    To examine if differences exist in the levels of autonomy and job satisfaction among primary care nurse practitioners (NPs) employed in retail clinics versus traditional primary care settings. Data were collected from 310 primary care NPs who attended the American Association of NP's 28th Annual Conference in June 2013. Participants completed a demographic form, the Misener NP Job Satisfaction Scale, and the Dempster Practice Behavior Scale. Overall, there were no differences in job satisfaction or autonomy among NPs by practice setting. Retail NPs felt less valued and were less satisfied with social interaction, but more satisfied with benefits compared to NPs in traditional settings. NPs working in retail clinics were less likely to have intentions to leave current position compared to NPs in traditional practice settings. The results of this study enhance our current understanding of the linkages between levels of autonomy, job satisfaction, and practice setting among primary care NPs. The findings of this descriptive study offer valuable insights for stakeholders devoted to the development of the primary care workforce and identify modifiable factors that may influence retention and turnover rates among NPs. ©2015 American Association of Nurse Practitioners.

  13. Clinical productivity of primary care nurse practitioners in ambulatory settings.

    Science.gov (United States)

    Xue, Ying; Tuttle, Jane

    Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. A picture tells 1000 words: learning teamwork in primary care.

    Science.gov (United States)

    Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun; Foley, Tony

    2013-04-01

    Teamwork and patient centredness are frequently articulated concepts in medical education, but are not always explicit in the curriculum. In Ireland, recent government policy emphasises the importance of a primary care team approach to health care. We report on an appraisal of a newly introduced community-based student attachment, which focused on teamwork. To review students' experience of teamwork following a community clinical placement by examining student assignments: essays, poetry, music and art. Year-2 graduate-entry students (n = 45) spent 2 weeks with a primary care team. Attachments comprised placements with members of the primary care team, emphasising team dynamics, at the end of which students submitted a representative piece of work, which captured their learning. Essays (n = 22) were analysed using a thematic content analysis. Artwork consisted of painting, collage, photography, poetry and original music (n = 23). These were analysed using Gardner's entry points. Three core themes emerged in both written and visual work: patient centredness; communication; and an improved appreciation of the skills of other health care professionals. Students identified optimal team communication occurring when patient outcomes were prioritised. Metaphors relating to puzzles, hands and inter-connectedness feature strongly. The poems and artwork had a high impact when they were presented to tutors. Primary care team placements focus student attention on teamwork and patient centredness. Student artwork shows potential as a tool to evaluate student learning in medical education. © Blackwell Publishing Ltd 2013.

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

    Science.gov (United States)

    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

  16. Spatial accessibility of primary care: concepts, methods and challenges

    Directory of Open Access Journals (Sweden)

    Guagliardo Mark F

    2004-02-01

    Full Text Available Abstract Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S. For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care – travel impedance to nearest provider and supply level within bordered areas – lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas. This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

  17. Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.

    Science.gov (United States)

    Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

    2013-08-01

    Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

  18. Patients' and health professionals' perceptions of teamwork in primary care.

    Science.gov (United States)

    Pullon, Susan; McKinlay, Eileen; Stubbe, Maria; Todd, Lindsay; Badenhorst, Christopher

    2011-06-01

    Effective teamwork in primary care settings is integral to the ongoing health of those with chronic conditions. This study compares patient and health professional perceptions about teams, team membership, and team members' roles. This study aimed to test both the feasibility of undertaking a collaborative method of enquiry as a means of investigating patient perceptions about teamwork in the context of their current health care, and also to compare and contrast these views with those of their usual health professionals in New Zealand suburban general practice settings. Using a qualitative methodology, 10 in-depth interviews with eight informants at two practices were conducted and data analysed using inductive thematic analysis. The methodology successfully elicited confidential interviews with both patients and the health professionals providing their care. Perceptions of the perceived value of team care and qualities facilitating good teamwork were largely concordant. Patient and health professionals differed in their knowledge and understanding about team roles and current chronic care programmes, and had differing perceptions about health care team leadership. This study supports the consensus that team-based care is essential for those with chronic conditions, but suggests important differences between patient and health professional views as to who should be in a health care team and what their respective roles might be in primary care settings. These differences are worthy of further exploration, as a lack of common understanding has the potential to consistently undermine otherwise well-intentioned efforts to achieve best possible health for patients with chronic conditions.

  19. Development and validation of the primary care team dynamics survey.

    Science.gov (United States)

    Song, Hummy; Chien, Alyna T; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Hacker, Karen; Rosenthal, Meredith B; Singer, Sara J

    2015-06-01

    To develop and validate a survey instrument designed to measure team dynamics in primary care. We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. We administered the survey between September 2012 and March 2013. Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). © Health Research and Educational Trust.

  20. Development and Validation of the Primary Care Team Dynamics Survey

    Science.gov (United States)

    Song, Hummy; Chien, Alyna T; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Hacker, Karen; Rosenthal, Meredith B; Singer, Sara J

    2015-01-01

    Objective To develop and validate a survey instrument designed to measure team dynamics in primary care. Data Sources/Study Setting We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. Study Design We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. Data Collection We administered the survey between September 2012 and March 2013. Principal Findings Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71–0.91), and discriminant validity (average factor correlations: 0.49). Conclusions It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). PMID:25423886

  1. Building teams in primary care: A practical guide.

    Science.gov (United States)

    Ghorob, Amireh; Bodenheimer, Thomas

    2015-09-01

    Primary care is changing to a team-based model. A number of high-performing primary-care practices in the United States have succeeded in making the transition to team-based care. Site visits were conducted to 29 high-performing primary-care practices. Observations made in these practices were summarized for common elements exhibited by care teams. A limited literature search was done to review corroborating evidence. Teams observed in the 29 practices were found to exhibit 9 elements: a stable team structure, colocation, a culture shift in progress from physician-driven to team-based care, defined roles with training and skill checks to reinforce those roles, standing orders and protocols, defined workflows and workflow mapping, staffing ratios adequate to facilitate new roles, ground rules, and modes of communication, including team meetings, huddles, and minute-to-minute interaction. These 9 elements may be helpful to practices making the transition to team-based care. (c) 2015 APA, all rights reserved).

  2. Expanded programme on immunization and primary health care.

    Science.gov (United States)

    Basu, R N

    1982-09-01

    The ultimate objective of the Expanded Program on Immunication, better known as EPI, is to reduce the morbidity of the diseases for which vaccine is available. The EPI is a key component of the country effort to provide Health for All by the year 2000. It is planned that by 1990 immunization services will be available for all infants against diphtheria, whooping cough, tetanus, tuberculosis, and poliomyelitis and for all school children for diptheria, tetanus, and typhoid, and for all pregnant women against tetanus. The immunization services will be a part of the comprehensive health care and will be integrated with all hospitals and dispensaries in urban areas and primary health centers/subcenters in the rural areas. Outreach operations are encouraged to bring these services as close to the mother and children as possible. Steps have already been taken to make the country self-sufficient in the production of different quality vaccines to meet the program requirements. New vaccines will be added where found to be epidemiologically necessary and administratively feasible. The vaccination program is effective only if given at the right age. A national immunization schedule has been prepared which emphasizes vaccination of all infants with 1 dose of BCG, 3 doses of DPT and polio at a minimum interval of 1 month, by the 1st birthday. School entrants are given a booster dose of DT and 2 doses of typhoid vaccine at an interval of 1 month. The children leaving primary school and leaving high school are given 1 booster dose of tetanus toxoid. In case of history of tetanus toxoid immunization in the earlier preganancy, 1 booster dose is adequate. Important components of management of EPI are cold chain maintenance, record keeping and evaluation, uniform vaccination coverage standards, and communication with the public through various media. A table gives the number of children/women proposed to be covered with full course of vaccine during each year of the 6th Plan. Disease

  3. Collaborative care psychiatrists’ views on treating bipolar disorder in primary care: a qualitative study

    Science.gov (United States)

    Cerimele, Joseph M.; Halperin, Abigail C.; Spigner, Clarence; Ratzliff, Anna; Katon, Wayne J.

    2014-01-01

    Objective To understand collaborative care psychiatric consultants’ views and practices on making the diagnosis of and recommending treatment for bipolar disorder in primary care using collaborative care. Method We conducted a focus group at the University of Washington in December 2013 with nine psychiatric consultants working in primary care-based collaborative care in Washington State. A grounded theory approach with open coding and the constant comparative method revealed categories where emergent themes were saturated and validated through member checking, and a conceptual model was developed. Results Three major themes emerged from the data including the importance of working as a collaborative care team, the strengths of collaborative care for treating bipolar disorder, and the need for psychiatric consultants to adapt specialty psychiatric clinical skills to the primary care setting. Other discussion topics included gathering clinical data from multiple sources over time, balancing risks and benefits of treating patients indirectly, tracking patient care outcomes with a registry, and effective care. Conclusion Experienced psychiatric consultants working in collaborative care teams provided their perceptions regarding treating patients with bipolar illness including identifying ways to adapt specialty psychiatric skills, developing techniques for providing team-based care, and perceiving the care delivered through collaborative care as high quality. PMID:25174762

  4. Collaborative care psychiatrists' views on treating bipolar disorder in primary care: a qualitative study.

    Science.gov (United States)

    Cerimele, Joseph M; Halperin, Abigail C; Spigner, Clarence; Ratzliff, Anna; Katon, Wayne J

    2014-01-01

    To understand collaborative care psychiatric consultants' views and practices on making the diagnosis of and recommending treatment for bipolar disorder in primary care using collaborative care. We conducted a focus group at the University of Washington in December 2013 with nine psychiatric consultants working in primary-care-based collaborative care in Washington State. A grounded theory approach with open coding and the constant comparative method revealed categories where emergent themes were saturated and validated through member checking, and a conceptual model was developed. Three major themes emerged from the data including the importance of working as a collaborative care team, the strengths of collaborative care for treating bipolar disorder and the need for psychiatric consultants to adapt specialty psychiatric clinical skills to the primary care setting. Other discussion topics included gathering clinical data from multiple sources over time, balancing risks and benefits of treating patients indirectly, tracking patient care outcomes with a registry and effective care. Experienced psychiatric consultants working in collaborative care teams provided their perceptions regarding treating patients with bipolar illness including identifying ways to adapt specialty psychiatric skills, developing techniques for providing team-based care and perceiving the care delivered through collaborative care as high quality. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Experienced continuity of care in patients at risk for depression in primary care

    NARCIS (Netherlands)

    Uijen, Annemarie A.; Schers, Henk J.; Schene, Aart H.; Schellevis, Francois G.; Lucassen, Peter; van den Bosch, Wil J. H. M.

    2014-01-01

    Existing studies about continuity of care focus on patients with a severe mental illness. Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Explorative study comparing patients at risk

  6. Experienced continuity of care in patients at risk for depression in primary care

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.L.; Bosch, W.J.H.M. van den

    2014-01-01

    Abstract Background: Existing studies about continuity of care focus on patients with a severe mental illness. OBJECTIVES: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. METHODS:

  7. Experienced continuity of care in patients at risk for depression in primary care

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.; van den Bosch, W.J.H.M.

    2014-01-01

    Background: Existing studies about continuity of care focus on patients with a severe mental illness. Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Methods: Explorative

  8. Experienced continuity of care in patients at risk for depression in primary care.

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.; Bosch, W.J.H.M. van den

    2014-01-01

    Background: Existing studies about continuity of care focus on patients with a severe mental illness. Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Methods: Explorative

  9. CAN PRIMARY CARE CLINIC RUN MMT SERVICE WELL?

    Directory of Open Access Journals (Sweden)

    KHALIJAH MY

    2010-01-01

    Full Text Available Methadone Maintenance Therapy (MMT for opiate dependence was first started in Malaysia in 2005. The service was initially provided by psychiatric clinics in hospitals and primary care clinics. Handling patients with opiate dependency especially in a primary care clinic is very challenging due to various constraints hence the success is doubtful. 143 patients from Tampin Health Clinic were recruited from November 2006 until March 2009. Retention rate in the program was high. Significant improvement was seen in the World Health Organization Quality Of Life score (WHOQOL-BREF in all 4 domains done atbaseline, 1st year and 2nd year in the program. After joining the program, there were no new blood borne virus infection for HIV and Hepatitis B and only 1 had Hepatitis C. Minimal number of patients were involved in new drug related offences while in the MMT program. Existing primary care clinics can be empowered to scale up this service in Malaysia.

  10. Primary health care staff's perception of childhood tuberculosis

    DEFF Research Database (Denmark)

    Bjerrum, Stephanie; Rose, Michala Vaaben; Bygbjerg, Ib Christian

    2012-01-01

    Background: Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study...... explored primary health care staff’s perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania. Methods: We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health...... staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis. Results: Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely...

  11. Improving access to oral surgery services in primary care.

    Science.gov (United States)

    Kendall, Nick

    2009-10-01

    This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

  12. Predicting recovery from whiplash injury in the primary care setting.

    Science.gov (United States)

    Ferrari, Robert

    2014-08-01

    The effect of expectation of recovery on the recovery rate of whiplash patients in the primary care setting is not known. Whiplash patients were assessed in a primary care setting within 1 week of their collision for their expectations of recovery and were re-examined 3 months later for recovery. Initial expectations of recovery predicted recovery. According to adjusted odds ratios, subjects who expected 'to get better slowly' had a recovery rate that was nearly 1.9 times that of subjects with poor recovery expectations. Subjects who expected 'to get better soon' had a recovery rate that was 2.6 times greater than either of those with poor recovery expectations. In the primary care setting, asking patients with whiplash about their expectations of recovery is a useful predictor of their outcome.

  13. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial.

    Science.gov (United States)

    Adair, Richard; Wholey, Douglas R; Christianson, Jon; White, Katie M; Britt, Heather; Lee, Suhna

    2013-08-06

    Improving the quality and efficiency of chronic disease care is an important goal. To test whether patients with chronic disease working with lay "care guides" would achieve more evidence-based goals than those receiving usual care. Parallel-group randomized trial, stratified by clinic and conducted from July 2010 to April 2012. Patients were assigned in a 2:1 ratio to a care guide or usual care. Patients, providers, and persons assessing outcomes were not blinded to treatment assignment. (ClinicalTrials.gov: NCT01156974). 6 primary care clinics in Minnesota. Adults with hypertension, diabetes, or heart failure. 2135 patients were given disease-specific information about standard care goals and asked to work toward goals for 1 year, with or without the help of a care guide. Care guides were 12 laypersons who received brief training about these diseases and behavior change. The primary end point for each patient was change in percentage of goals met 1 year after enrollment. The percentage of goals met increased in both the care guide and usual care groups (changes from baseline, 10.0% and 3.9%, respectively). Patients with care guides achieved more goals than usual care patients (82.6% vs. 79.1%; odds ratio, 1.31 [95% CI, 1.16 to 1.47]; P care patients; and improved more than usual care patients in meeting several individual goals, including not using tobacco. Estimated cost was $286 per patient per year. Providers' usual care may have been influenced by contact with care guides. Last available data in the electronic health record were used to assess end points. Adding care guides to the primary care team can improve care for some patients with chronic disease at low cost.

  14. Strengthening care teams to improve adherence in cystic fibrosis: a qualitative practice assessment and quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Gardner AJ

    2017-04-01

    Full Text Available Allison J Gardner,1 Alice L Gray,2 Staci Self,3 Jeffrey S Wagener4 1Med-IQ, LLC, Baltimore, MD, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, 3Division of Pediatric Pulmonology, University of Alabama at Birmingham, Birmingham, AL, 4Department of Pediatrics, University of Colorado Medical School, Aurora, CO, USA Background: Treatment regimens for patients with cystic fibrosis (CF are complex, time consuming, and burdensome, and adherence to CF treatment is suboptimal. CF care teams play a critical role in supporting patients’ chronic self-management skills, but there is no uniform method for assessing patients’ adherence to treatment or standard interventions to help patients improve when necessary.Methods: Between May 2015 and March 2016, care team members from 10 CF centers in the USA participated in a practice assessment and quality improvement (QI initiative. The intervention included a baseline practice assessment survey, personalized continuing medical education (CME-certified Webconferences with expert study faculty, targeted reinforcement of key practice points, and follow-up online survey and telephone interviews to evaluate the benefits and limitations of the intervention.Results: Responses to the baseline practice assessment survey were received from 50 multidisciplinary care team members representing 10 CF centers. Primary barriers to adherence-related aspects of care in their clinics were motivating patients and caregivers to improve adherence and obtaining accurate information about adherence from patients. At the conclusion of the initiative, participants reported improvements in communication within their care team, implementation of new approaches to asking about adherence, and a renewed commitment to asking patients and caregivers about adherence at each clinic visit.Conclusion: Structured QI interventions that bring multidisciplinary care teams together to

  15. 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

  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

    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

  17. Improving Health Care Management in Primary Care for Homeless People: A Literature Review

    Science.gov (United States)

    Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

    2018-01-01

    Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. PMID:29439403

  18. Improving Health Care Management in Primary Care for Homeless People: A Literature Review.

    Science.gov (United States)

    Jego, Maeva; Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

    2018-02-10

    Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community's health. Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.

  19. Computer use in primary care practices in Canada.

    Science.gov (United States)

    Anisimowicz, Yvonne; Bowes, Andrea E; Thompson, Ashley E; Miedema, Baukje; Hogg, William E; Wong, Sabrina T; Katz, Alan; Burge, Fred; Aubrey-Bassler, Kris; Yelland, Gregory S; Wodchis, Walter P

    2017-05-01

    To examine the use of computers in primary care practices. The international Quality and Cost of Primary Care study was conducted in Canada in 2013 and 2014 using a descriptive cross-sectional survey method to collect data from practices across Canada. Participating practices filled out several surveys, one of them being the Family Physician Survey, from which this study collected its data. All 10 Canadian provinces. A total of 788 family physicians. A computer use scale measured the extent to which family physicians integrated computers into their practices, with higher scores indicating a greater integration of computer use in practice. Analyses included t tests and 2 tests comparing new and traditional models of primary care on measures of computer use and electronic health record (EHR) use, as well as descriptive statistics. Nearly all (97.5%) physicians reported using a computer in their practices, with moderately high computer use scale scores (mean [SD] score of 5.97 [2.96] out of 9), and many (65.7%) reported using EHRs. Physicians with practices operating under new models of primary care reported incorporating computers into their practices to a greater extent (mean [SD] score of 6.55 [2.64]) than physicians operating under traditional models did (mean [SD] score of 5.33 [3.15]; t 726.60 = 5.84; P computer use across provinces. Most family physicians in Canada have incorporated computers into their practices for administrative and scholarly activities; however, EHRs have not been adopted consistently across the country. Physicians with practices operating under the new, more collaborative models of primary care use computers more comprehensively and are more likely to use EHRs than those in practices operating under traditional models of primary care. Copyright© the College of Family Physicians of Canada.

  20. Nursing competency standards in primary health care: an integrative review.

    Science.gov (United States)

    Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

    2016-05-01

    This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Integrative review. A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content

  1. Health profiles of foreigners attending primary care clinics in Malaysia.

    Science.gov (United States)

    Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

    2016-06-14

    The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care. Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters. More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public

  2. Improving Obesity Prevention and Management in Primary Care in Canada.

    Science.gov (United States)

    Campbell-Scherer, Denise; Sharma, Arya Mitra

    2016-09-01

    Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve.

  3. Overweight and Obesity and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    The standard economic model for the demand for health care predicts that unhealthy behaviour such as being overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether overweight......-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight and obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent classes...... and show that being obese or overweight does not increase the demand for primary physician care among infrequent users but does so among frequent users....

  4. The unique requirements of primary health care in Southern Africa

    Directory of Open Access Journals (Sweden)

    D. P. Knobel

    1986-03-01

    Full Text Available The critical need for primary health care in Southern Africa with special reference to the demands of the heterogenous population is measured against the background of the declaration of Alma Ata at the WHO/UNICEF conference in 1978. In particular the provision of primary health care to the Third World communities of the RSA as an essential part of the security power base of the State is underlined and it is analised in terms of how shortcomings in this service can be exploited in a subversive revolutionary onslaught.

  5. Team effectiveness in primary care networks in Alberta.

    Science.gov (United States)

    Drew, Peter; Jones, Brad; Norton, Douglas

    2010-01-01

    Primary care networks (PCNs) are interdisciplinary programs in a geographical area that are designed to improve patient care, team collaboration and appropriate resource allocation. They are one of government's approaches to delivering quality healthcare with finite resources. The primary objective of this study was to explore the level of perceived team effectiveness in PCNs within three former health regions in Alberta. A descriptive, cross-sectional, exploratory, semi-structured questionnaire study design was employed. Respondents identified five themes for strategies to improve team effectiveness. Although many factors and strategies were identified, more work is needed to explore the study's findings.

  6. Understanding the body-mind in primary care

    DEFF Research Database (Denmark)

    Davidsen, Annette Sofie; Guassora, Ann Dorrit; Reventlow, Susanne

    2016-01-01

    which could readily fit both bodily and mental categories. In this article we discuss theoretical models that have attempted to overcome this challenge: The psychosomatic approach could be called holistic in the sense of taking an anti-dualistic stance. Primary care theorists have formulated integrative...... views but these have not gained a foothold in primary care medicine. McWhinney introduced a new metaphor, ‘the body–mind’, and Rudebeck advocated cultivating ‘bodily empathy’. These views have much in common with both phenomenological thinking and mentalization, a psychological concept for understanding...

  7. Economies of scope in Danish primary care practices

    DEFF Research Database (Denmark)

    Kristensen, Troels; Rose Olsen, Kim

    2011-01-01

    Aim: We analyze total operating costs and activities in Danish General Practice units to assess whether there are unexploited economies of scope in the production of primary care services. Methods: We apply stochastic frontier analysis to derive cost functions and associated cost complementarities...... between GP services and overall economies of scope. Data: Cross-section data for a sample of 331 primary care practices with 1-8 GPs from the year 2006. This is a unique combined dataset consisting of survey and register data. Results: We find a trend towards cost complementarities between the production...

  8. African primary care research: Performing surveys using questionnaires

    Directory of Open Access Journals (Sweden)

    Indiran Govender

    2014-01-01

    Full Text Available The aim of this article is to provide practical guidance on conducting surveys and the use of questionnaires for postgraduate students at a Masters level who are undertaking primary care research. The article is intended to assist with writing the methods section of the research proposal and thinking through the relevant issues that apply to sample size calculation, sampling strategy, design of a questionnaire and administration of a questionnaire. The articleis part of a larger series on primary care research, with other articles in the series focusing on the structure of the research proposal and the literature review, as well as quantitative data analysis.

  9. African primary care research: performing surveys using questionnaires.

    Science.gov (United States)

    Govender, Indiran; Mabuza, Langalibalele H; Ogunbanjo, Gboyega A; Mash, Bob

    2014-04-25

    The aim of this article is to provide practical guidance on conducting surveys and the use of questionnaires for postgraduate students at a Masters level who are undertaking primary care research. The article is intended to assist with writing the methods section of the research proposal and thinking through the relevant issues that apply to sample size calculation, sampling strategy, design of a questionnaire and administration of a questionnaire. The articleis part of a larger series on primary care research, with other articles in the series focusing on the structure of the research proposal and the literature review, as well as quantitative data analysis.

  10. Primary care providers' lived experiences of genetics in practice.

    Science.gov (United States)

    Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

    2018-04-26

    To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

  11. Identifying Areas of Primary Care Shortage in Urban Ohio

    Directory of Open Access Journals (Sweden)

    Hsin-Chung Liao

    Full Text Available ABSTRACT: This study considers both spatial and a-spatial variables in examining accessibility to primary healthcare in the three largest urban areas of Ohio (Cleveland, Columbus, and Cincinnati. Spatial access emphasizes the importance of geographic barriers between individuals and primary care physicians, while a-spatial variables include non-geographic barriers or facilitators such as age, sex, race, income, social class, education, living conditions and language skills. Population and socioeconomic data were obtained from the 2000 Census, and primary care physician data for 2008 was provided by the Ohio Medical Board. We first implemented a two-step method based on a floating catchment area using Geographic Information Systems to measure spatial accessibility in terms of 30-minute travel times. We then used principal component analysis to group various socio-demographic variables into three groups: (1 socioeconomic disadvantages, (2 living conditions, and (3 healthcare needs. Finally, spatial and a-spatial variables were integrated to identify areas with poor access to primary care in Cleveland, Columbus, and Cincinnati. KEYWORDS: Geographic information systems, healthcare access, spatial accessibility, primary care shortage areas

  12. INSOMNIA AND CORRELATION WITH PSYCHOSOCIAL FACTORS IN PRIMARY HEALTH CARE

    OpenAIRE

    Made Gede Cahyadi Permana

    2013-01-01

    Insomnia is regarded as sleep disorder that most often affects people in the world, both in primary and in the presence of comorbid conditions. Based on those facts, insomnia could be a serious problem at the level of primary health care. General Practitioner should be able to diagnose insomnia and able to perform the appropriate treatment for the patient. Psychosocial factors may related to the degree of severity of insomnia, among others are health status, depression, dysfunctional beliefs ...

  13. Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

    Science.gov (United States)

    Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

    2017-04-01

    Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (pclinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

  14. The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Lewis Martyn

    2007-05-01

    Full Text Available Abstract Background Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM. Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be. Methods Aims and objectives To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care. Study design Face-to-face interview-based survey. Setting Three general practices in North Staffordshire. Participants Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year. Results 138 interviews were completed. 116 participants (84% had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80% had used conventional treatment. 95 (69% were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively. Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used. Conclusion We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine

  15. The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain.

    Science.gov (United States)

    Artus, Majid; Croft, Peter; Lewis, Martyn

    2007-05-04

    Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM). Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be. To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care. Face-to-face interview-based survey. Three general practices in North Staffordshire. Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year. 138 interviews were completed. 116 participants (84%) had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80%) had used conventional treatment. 95 (69%) were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used. We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and assess safety. The observation that most users of conventional medicine also used CAM

  16. Skill mix in primary care : patient, professional and management perpectives

    OpenAIRE

    Branson, Christine

    2007-01-01

    Aim: This research is a study into the organisation and management of health services in Torbay Care Trust. It takes an overview of skill mix in primary care, considering the topic from the perspective of service recipients (patients), providers (professionals) and shapers and resourcers (management). The topic focuses on delegation and service diversification involving general practitioners, their directly employed team and community nurses attached to practices. Between an...

  17. Competencies for engaging high-needs patients in primary care.

    Science.gov (United States)

    Yedidia, Michael J

    2017-12-04

    Patients who heavily utilize hospitals and emergency departments frequently have complex needs requiring services spanning medical, behavioral, and social service sectors. This study identifies essential competencies for caring for high-needs patients and highlights their importance to primary care delivery. Transcripts of in-depth interviews with 30 clinical and administrative staff at 23 complex care programs across the United States were analyzed using standard qualitative techniques. Selected programs had several years of experience in serving patients with multiple chronic conditions, serious mental illness, substance use disorders, severe poverty, and homelessness. These programs exemplified diverse models (assertive community treatment, housing first, behavioral health, high utilizer), and all of them shared the common element of integrating primary care into their services. Competencies, including those known and taught in other fields, have distinctive application to informing delivery of high quality primary care to populations with complex needs, including: motivational interviewing for establishing patients' priorities and helping them improve their health on their own terms; trauma-informed care for modifying primary care procedures to mitigate the ill-effects of prior trauma prevalent in this population; and harm reduction for altering medical regimens to accommodate constraints on what patients are able or willing to do. Other capabilities, cultivated by these programs, include empathizing with patients, promoted by exposure to simulations of patient experiences (e.g., hearing voices); as well as withholding judgment and counteracting patient passivity to foster open discussion of treatment plans. Absence of deliberate attention to equipping providers with specific competencies for caring for high-needs patients may contribute to lack of patient engagement and sub-optimal outcomes, ultimately undermining the success of programs serving these

  18. Essential attributes and qualifiers of primary health care

    OpenAIRE

    Andréa Silvia Walter de Aguiar; Pollyanna Martins

    2012-01-01

    Historically, the primary health care (PHC) has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country.Several theoretical and conceptual landmarks proposed approaches and indicators to assess and ch...

  19. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

    Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

  20. Contributions of Physical Therapists to Primary Preventive Health Care.

    Science.gov (United States)

    Nomura, Takuo

    2016-01-01

    The limitations of what physical therapists can differ from country to country. In Japan, physical therapists are national licensed health care professionals who can help patients improve or restore their mobility. Most Japanese physical therapists provide care for people in health care facilities, medical-welfare transitional facilities, and welfare facilities for the elderly. Currently, physical therapists are unable to sufficiently contribute to primary preventive health care in Japan. However, there are many health problems that physical therapists could help alleviate. For example, low back pain (LBP) more likely than any other condition prevents people from working; thus, making the establishment of effective measures to prevent and reduce LBP vital. An estimated 20,500,000 Japanese individuals have diabetes mellitus (DM) or are at a high risk of developing the disease. DM commonly accompanies stroke and/or heart disease, and is characterized by complications that result from chronic hyperglycemia. Evidence-based physical therapy is effective for the prevention and treatment of LBP and DM. The Japanese Physical Therapy Association established the Japanese Society of Physical Therapy (JSPT) in June 2013. The JSPT has 12 departmental societies and 10 sections. We believe that the JSPT will advance the study of the potential role of physical therapists in primary preventive health care. In the future, it is expected that Japanese physical therapists will contribute to primary preventive health care.

  1. Children's health care assistance according to their families: a comparison between models of Primary Care

    Directory of Open Access Journals (Sweden)

    Vanessa Bertoglio Comassetto Antunes de Oliveira

    2015-02-01

    Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.

  2. Care Coordination for Youth With Mental Health Disorders in Primary Care.

    Science.gov (United States)

    Hobbs Knutson, Katherine; Meyer, Mark J; Thakrar, Nisha; Stein, Bradley D

    2018-01-01

    Many children are treated for mental health disorders in primary care settings. The system of care (SOC) provides a framework for collaboration among pediatric mental health providers, but it is unclear if youth treated for mental health disorders in primary care receive such coordination. At the South Boston Community Health Center from September /2012 to August 2013 for 74 individuals ≤18 years, the odds of contact with SOC agencies (mental health, education, child protective services, juvenile justice and developmental disabilities) were compared for mental health treatment in primary versus specialty care. The odds of SOC contact within primary care were lower compared to specialty care (OR = 0.43, 95% CI = 0.29-0.66), specifically for mental health (OR = 0.54, 95% CI = 0.25-1.2), education (OR = 0.12, 95% CI = 0.050-0.28), and child protective services (OR = 0.64, 95% CI = 0.22-1.9). As care coordination may improve health outcomes, increased support and education for care coordination specific to youth treated for mental health disorders in primary care settings may be warranted.

  3. Primary care quality among different health care structures in Tibet, China.

    Science.gov (United States)

    Wang, Wenhua; Shi, Leiyu; Yin, Aitian; Mao, Zongfu; Maitland, Elizabeth; Nicholas, Stephen; Liu, Xiaoyun

    2015-01-01

    To compare the primary care quality among different health care structures in Tibet, China. A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics. The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status. This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development.

  4. Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

    Science.gov (United States)

    Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Kay Johnson, N.; Shanette Granstaff, U.; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.

    2013-01-01

    Objectives. We compared homeless patients’ experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the “Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P homelessness. PMID:24148052

  5. [Heart failure in primary care: Attitudes, knowledge and self-care].

    Science.gov (United States)

    Salvadó-Hernández, Cristina; Cosculluela-Torres, Pilar; Blanes-Monllor, Carmen; Parellada-Esquius, Neus; Méndez-Galeano, Carmen; Maroto-Villanova, Neus; García-Cerdán, Rosa Maria; Núñez-Manrique, M Pilar; Barrio-Ruiz, Carmen; Salvador-González, Betlem

    2017-06-23

    To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. Cross-sectional and multicentre study. Primary Care. Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R 2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  6. eDiagnostics: a promising step towards primary mental health care.

    Science.gov (United States)

    Dijksman, Ies; Dinant, Geert-Jan; Spigt, Mark G

    2013-12-01

    There is a growing interest in eHealth applications in daily health care. Considering that a psychological examination, to a large extent, consists of filling out questionnaires, the use of the Internet seems logical. We evaluated an eDiagnostic system for mental health disorders that has recently been introduced in primary care in the Netherlands. We monitored the diagnoses produced by the system. Evaluation questionnaires from both GPs/practice nurses (PNs) and patients were collected. In addition, we compared the advice produced by the GPs/PNs and the advice produced by the system. The most prevalent disorders were mood, anxiety and somatoform disorders (n = 353). Patients (n = 242; 74% response rate) were moderately enthusiastic about the eHealth approach, and GPs/PNs (n = 49, 72% response rate per practice) were very enthusiastic. Patients showed no clear preference for a face-to-face consultation with a psychologist over an eDiagnostic system. GPs/PNs felt strengthened in their control function. In most cases, the system gave a different echelon advice (i.e. referral to primary or secondary mental health care) than the GPs/PNs (κ = 0.13, P = 0.003). Nevertheless, GPs/PNs accept the results of the examination and the advice given. Using the Internet to diagnose mental health problems in primary care seems very promising. This system of using eDiagnostics before referral to a mental health institution may change the management of mental health care. Further research should investigate whether this tool is valid, reliable and (cost) effective.

  7. Multimorbidity and quality of preventive care in Swiss university primary care cohorts.

    Directory of Open Access Journals (Sweden)

    Sven Streit

    Full Text Available Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings.We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator.Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%.In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.

  8. 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 and recommendations were 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 nine 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. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  9. Utilization of Routine Primary Care Services Among Dancers.

    Science.gov (United States)

    Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth

    2016-01-01

    This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior.

  10. Trends in antenatal care attendance and health facility delivery following community and health facility systems strengthening interventions in Northern Uganda.

    Science.gov (United States)

    Ediau, Michael; Wanyenze, Rhoda K; Machingaidze, Simba; Otim, George; Olwedo, Alex; Iriso, Robert; Tumwesigye, Nazarius M

    2013-10-18

    Maternal morbidity and mortality remains high in Uganda; largely due to inadequate antenatal care (ANC), low skilled deliveries and poor quality of other maternal health services. In order to address both the demand and quality of ANC and skilled deliveries, we introduced community mobilization and health facility capacity strengthening interventions. Interventions were introduced between January 2010 and September 2011. These included: training health workers, provision of medical supplies, community mobilization using village health teams, music dance and drama groups and male partner access clubs. These activities were implemented at Kitgum Matidi health center III and its catchment area. Routinely collected health facility data on selected outcomes in the year preceding the interventions and after 21 months of implementation of the interventions was reviewed. Trend analysis was performed using excel and statistical significance testing was performed using EPINFO StatCal option. The number of pregnant women attending the first ANC visit significantly increased from 114 to 150 in the first and fourth quarter of 2010 (OR 1.72; 95% CI 1.39-2.12) and to 202 in the third quarter of 2011(OR 11.41; 95% CI 7.97-16.34). The number of pregnant women counselled, tested and given results for HIV during the first ANC attendance significantly rose from 92 (80.7%) to 146 (97.3%) in the first and fourth quarter of 2010 and then to 201 (99.5%) in the third quarter of 2011. The number of male partners counseled, tested and given results together with their wives at first ANC visit rose from 13 (16.7%) in the fourth quarter of 2009 to 130 (89%) in the fourth quarter of 2010 and to 180 (89.6%) in the third quarter of 2011. There was a significant rise in the number of pregnant women delivering in the health facility with provision of mama-kits (delivery kits), from 74 (55.2%) to 149 (99.3%) in the second and fourth quarter of 2010. Combined community and facility systems

  11. An interactive, all-payer, multidomain primary care performance dashboard.

    Science.gov (United States)

    Ward, Charlotte E; Morella, Lisa; Ashburner, Jeffrey M; Atlas, Steven J

    2014-01-01

    Engaging physicians and practice leaders through regular performance reporting is a key goal of patient-centered medical home improvement efforts. We developed and implemented an interactive, Web-based performance dashboard for primary care practices with input from provider focus groups. Adapting a business software application, individual physician and practice-level reports included information on visit-based and panel productivity, patient panel demographics, and outcome measures (quality of care, patient experience of care, and resource utilization). User training occurred prior to dissemination. Over 2 rounds of reporting, 69% to 77% of users viewed their report within 30 days and 79% of users found the report informative.

  12. Cancer Survivorship Care in Advanced Primary Care Practices: A Qualitative Study of Challenges and Opportunities.

    Science.gov (United States)

    Rubinstein, Ellen B; Miller, William L; Hudson, Shawna V; Howard, Jenna; O'Malley, Denalee; Tsui, Jennifer; Lee, Heather Sophia; Bator, Alicja; Crabtree, Benjamin F

    2017-12-01

    Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a

  13. Collaboration of midwives in primary care midwifery practices with other maternity care providers.

    Science.gov (United States)

    Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

    2017-12-01

    Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with

  14. Service quality perceptions in primary health care centres in Greece

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2012-01-01

    Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

  15. Service quality perceptions in primary health care centres in Greece.

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2014-04-01

    The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

  16. Knowledge and attitude of primary care doctors towards ...

    African Journals Online (AJOL)

    Knowledge and attitude of primary care doctors towards management of postmenopausal symptoms. ... The correct answers regarding 10 statements related to theWomenHealth Initiative finding were ranging from 2.8% to 78.9% which indicated low level of knowledge. Regarding the effectiveness of hormonal replacement ...

  17. The concept and attitudes of primary health care workers towards ...

    African Journals Online (AJOL)

    Evil spirit possession and native charm/juju were incorrectly mentioned by half of the respondents as causes of mental illness while alcohol/drug abuse, emotional problems and marijuana smoking were correctly implicated by more than 70% of respondents. Although 90% of the primary health care workers preferred ...

  18. Participatory action research in the training of primary health care ...

    African Journals Online (AJOL)

    Background: The aim of this study was to understand and be part of a process of change in the training of primary health care nurses in Venda. Methods:Because participatory action research (PAR), which is an emancipatory-critical paradigm, to a great extent shares the same worldview as adult education and sustainable ...

  19. Job Satisfaction: Rural Versus Urban Primary Health Care Workers ...

    African Journals Online (AJOL)

    BACKGROUND: Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one's efforts. Several factors affect job satisfaction. OBJECTIVE: To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. METHODS: A cross ...

  20. Primary care management of food allergy and food intolerance.

    Science.gov (United States)

    Garzon, Dawn Lee; Kempker, Tara; Piel, Pamela

    2011-12-16

    The incidence of food allergies is steadily increasing. Due to potentially life-threatening complications, it is important that primary care providers recognize and appropriately manage these disorders. This article includes a discussion of the current evidence-based guidelines for the diagnosis, screening, and management of food allergies.

  1. Technology Mediated Information Sharing (Monitor Sharing) in Primary Care Encounters

    Science.gov (United States)

    Asan, Onur

    2013-01-01

    The aim of this dissertation study was to identify and describe the use of electronic health records (EHRs) for information sharing between patients and clinicians in primary-care encounters and to understand work system factors influencing information sharing. Ultimately, this will promote better design of EHR technologies and effective training…

  2. Knowledge of primary care nurses regarding domestic violence

    African Journals Online (AJOL)

    Nagham N. Alsafy

    2011-06-12

    Jun 12, 2011 ... KEYWORDS. Domestic violence;. Primary care nurses;. Knowledge. Abstract Introduction: Domestic violence (DV) against women has been identified as a serious ... mate partner.1 DV, also known as intimate partner violence. (IPV), is ..... mate partner violence (IPV) from India, Bangladesh, Thailand,.

  3. The European Primary Care Monitor: structure, process and outcome indicators.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Bourgueil, Y.; Cartier, T.; Hasvold, T.; Hutchinson, A.; Lember, M.; Oleszczyk, M.; Pavlick, D.R.; Svab, I.; Tedeschi, P.; Wilson, A.; Windak, A.

    2010-01-01

    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

  4. Primary health eye care knowledge among general practitioners ...

    African Journals Online (AJOL)

    Primary health eye care knowledge among general practitioners working in the Cape Town metropole. M Van Zyl, N Fernandes, G Rogers, N Du Toit. Abstract. Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and ...

  5. Drugs with anticholinergic side-effects in primary care | Yayla ...

    African Journals Online (AJOL)

    Background: Anticholinergic drugs in elderly people have been associated with some serious side.effects. Patients in Turkey tend to attend primary care centers to have prescriptions of the drugs they chronically use. However, very little are known about how frequent that these drugs are prescribed and their side-effects in ...

  6. Toward More Equitable Primary Health Care in Argentina and Latin ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The team will build a virtual Latin American community of practice focused on intersectoral collaborations for health. Findings will be integrated into course curricula for a master's in health systems and services management and a certificate in intersectoral primary health care management offered by Rosario University.

  7. Attitude of Primary Health Care Nurses in Kuwait Towards Domestic ...

    African Journals Online (AJOL)

    Background: Domestic violence against women is an important public health problem. Battered women attend primary health care centers seeking for both medical treatment and support. Nurses with a positive attitude play a key role to deal with victimized women. Objectives: The current study was formulated to reveal ...

  8. Knowledge of Primary Care Physicians Regarding Domestic Violence.

    African Journals Online (AJOL)

    Introduction: Domestic violence (DV) is considered as one of the most frequent forms of gender-based violence. Since primary care physicians frequently are the first in the community to encounter the battered woman, they must be equipped with the necessary knowledge, training and experience. Objective: The aim of this ...

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

    African Journals Online (AJOL)

    Introduction: Domestic violence (DV) against women has been identified as a serious public health problem. Primary care nurses usually play an important role in managing battered women. They must be equipped with the necessary knowledge, training and experience. Objective: The aim of this work was to study the ...

  10. The Complexity of Primary Care Psychology: Theoretical Foundations

    NARCIS (Netherlands)

    Smit, E.H.; Derksen, J.J.L.

    2015-01-01

    How does primary care psychology deal with organized complexity? Has it escaped Newtonian science? Has it, as Weaver (1991) suggests, found a way to 'manage problems with many interrelated factors that cannot be dealt by statistical techniques'? Computer simulations and mathematical models in

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

    African Journals Online (AJOL)

    Keywords: Motivational interviewing, behaviour change, communication skills, primary care, consultation skills. Abstract. Background: ... They had mixed experiences with skills for agenda setting and reducing resistance. The use of specific ... accompanied by support from colleagues and management. Future research on ...

  12. Determinants of nutrition guidance practices of primary-care physicians

    NARCIS (Netherlands)

    Hiddink, G.J.

    1996-01-01


    The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants

  13. Suicide Attempts among Depressed Adolescents in Primary Care

    Science.gov (United States)

    Fordwood, Samantha R.; Asarnow, Joan R.; Huizar, Diana P.; Reise, Steven P.

    2007-01-01

    Although depression is strongly associated with suicide attempts and suicide deaths, most depressed youth do not make an attempt, indicating the need to identify additional risk factors. We examined suicide attempts among 451 depressed primary care patients, 13 to 21 years of age. In bivariate analyses, youth classified as suicide attempters…

  14. Global health strategies versus local primary health care priorities ...

    African Journals Online (AJOL)

    Global health strategies versus local primary health care priorities - a case study of national immunisation days in Southern Africa. ... should, therefore, focus its attention on diminishing the negative side-effects of NIDs and on getting the positive sideeffects incorporated in the integrated health services in a sustainable way.

  15. Journal of Community Medicine and Primary Health Care - Vol 26 ...

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... Disasters in Nigeria: A Public Health Perspective · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT ... Awareness of Breast Cancer and Practice of Breast Self-Examination among Rural Women in Ife-North Local Government Area, Osun State, South-West ...

  16. Accuracy and Quality of Spirometry in Primary Care Offices.

    Science.gov (United States)

    Hegewald, Matthew J; Gallo, Heather M; Wilson, Emily L

    2016-12-01

    Spirometry is necessary for the optimal management of patients with respiratory disease. The quality of spirometry performed in the primary care setting has been inconsistent. We aimed to evaluate spirometer accuracy, determine the clinical significance of inaccurate spirometers, and assess the quality of spirograms obtained in primary care offices. We tested 17 spirometers used in primary care offices with a waveform generator; accuracy and precision were assessed using American Thoracic Society criteria. The clinical significance of inaccurate instruments was determined by applying the FEV 1 /FVC error from an obstructed waveform to a clinical data set. Spirogram quality was determined by grading spirograms using acceptability and repeatability criteria. The relationship between the number of tests performed by a clinic and test quality was assessed. Only 1 of 17 spirometers met accuracy criteria, with mean errors for FVC, FEV 1 , and FEV 1 /FVC ranging from 1.7 to 3.1%. Applying the percentage error to a clinical data set resulted in 28% of tests being recategorized from obstructed to nonobstructed. Of the spirograms reviewed, 60% were considered acceptable for clinical use. There was no association between the number of tests performed by a clinic and spirometry quality. Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients. Our results raise concerns regarding the utility of spirometry obtained in primary care offices without greater attention to quality assurance and training.

  17. Gender difference of knowledge and attitude of primary health care ...

    African Journals Online (AJOL)

    Saadoon F. Alazmy

    2011-09-07

    Sep 7, 2011 ... Knowledge;. Attitude gender difference. Abstract Background: Cultural and traditional norms in the community can have an impact on gender equity. This can be ... manipulative behavior, and physical and sexual assault, to rape and even ..... Malaysia: a survey on the primary health care providers. Asia.

  18. Depression in primary care: the knowledge, attitudes and practice of ...

    African Journals Online (AJOL)

    Background: Depression contributes significantly to the global burden of disease in developing countries. Poor case detection and inadequate numbers of mental health staff have been associated with increased morbidity among individuals with depression presenting to primary care. In Nigeria, as in most developing ...

  19. Comparison of Attitude of Primary Health Care Physicians and ...

    African Journals Online (AJOL)

    Background: Domestic violence (DV) against women has increased during the past few years and became an important public health problem. Personal values and beliefs of primary health care workers can affect both diagnostic and management procedures adopted to deal with battered women. Objectives: The current ...

  20. Abstract: Promotion of Primary Health Care Philosophy in a ...

    African Journals Online (AJOL)

    Learning experiences in community-based settings provide the students with opportunities to learn by means of being actively engaged in primary health care associated activities to under-resourced communities (Mtshali, 2009, 2005; World Health Organization ,2011a; World Health Organization, 2011b). International ...