Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care

2004 ◽  
Vol 19 (5) ◽  
pp. 250-257 ◽  
Author(s):  
Katrin Barkow ◽  
Reinhard Heun ◽  
T. Bedirhan Üstün ◽  
Mathias Berger ◽  
Isaac Bermejo ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
General Health ◽  
Depressive Disorders ◽  
Somatic Symptoms ◽  
Anxiety Symptoms ◽  
Primary Health ◽  
The World ◽  
Detection Of Depression

AbstractSomatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview—Primary Health Care Version (CIDI—PHC) can improve the detection of depression as compared to the General Health Questionnaire—12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI—PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and—to a smaller extent—diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.

Brazilian National Household Health Survey and PCAT: the case of Mato Grosso do Sul, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F Pinto ◽  
D Soranz ◽  
L J Santos ◽  
M S Paranhos ◽  
L S Malta ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Data Collection ◽  
Health Survey ◽  
Household Surveys ◽  
Mato Grosso ◽  
Primary Health ◽  
The World ◽  
Mato Grosso Do Sul

Abstract Brazil is divided into five administrative regions, 27 federation units and 5,570 municipalities. Mato Grosso do Sul is one of the states located in the Midwest region and has 1.6 million km2 and a resident population of 2.8 million inhabitants, that is, it has an even lower demographic density than its region - only 7.8 inhabitants/km2. Mato Grosso do Sul has part of the Pantanal, a biome considered the largest continuous floodplain in the world, rich in biodiversity. For this reason, displacements for data collection in household surveys combine roads and rivers. In 2019, the Brazilian National Institute of Geography and Statistics (Istituto Nazionale di Statistica del Brasile) in partnership with the Ministry of Health launched the world's largest household sample survey, the National Health Survey (PNS-2019), in which part of its questions included the use of Primary Care Assessment Tool (PCAT, adult version), created by professors Barbara Starfield and Leiyu Shi in the 2000s. IBGE interviewers visited more than 100,000 households across the country. In Mato Grosso do Sul, more than 3,000 households were surveyed. In this work, we present the data collection instrument used by IBGE and its multiple analysis possibilities in the scope of primary health care, crossing the variables from other questionnaire modules in order to compare the results from Brazil with the state of Mato Grosso do Sul and its capital, Campo Grande. Developing a baseline and measuring the attributes of primary health care in each of the Brazilian states is another step towards giving health policy accountability, towards strong primary care. IBGE's experience in household surveys and innovation in data collection in primary care is an example for the world that yes, it is possible to develop statistically representative national sample surveys and make them perennial in their regular household surveys, by the time World Health Organization (WHO) discusses universal health coverage. Key messages Evaluation of primary care using an internationally validated instrument is possible on national bases with random household sample surveys. A questionnaire elaborated academically can be used as an instrument of public policy to evaluate nationwide health services.

scholarly journals Correlation between Depression and Anxiety in Patients with Chronic Non-Malignant Pain

2021 ◽  
Vol 5 (1) ◽  
pp. 83-94
Author(s):  
Irena Kovačević ◽  
Sanja Ledinski Fičko ◽  
Boris Ilić ◽  
Adriano Friganović ◽  
Štefanija Ozimec Vulinec ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Chronic Pain ◽  
Primary Health Care ◽  
Cultural Differences ◽  
Ethnic Groups ◽  
Depression And Anxiety ◽  
Primary Health ◽  
Primary Care Patients ◽  
Detection Of Depression

Introduction. Two-thirds of primary care patients with depression also have somatic symptoms present, making detection of depression more difficult. Primary health care is the first level of screening for depression, and early detection is key to treatment success. Anxiety also has a high comorbidity rate with chronic pain conditions. Generalized anxiety disorder (GAD) is common among patients with “medically unexplained” chronic pain and chronic physical illness and is also a predictor of chronic musculoskeletal pain after trauma. Belonging to different ethnic groups and ignorance of these differences by primary care physicians can be an obstacle to good health care, especially early recognition of depressive symptoms. Aim. The aim of this proposed, systematic work was to draw conclusions from empirical research dealing with the processes involved in the examination of depression, anxiety, and chronic non malignant pain. The research question for this review paper was to examine the correlation of depression and anxiety with chronic non-malignant pain. The aim was to examine the role of primary health care in recognizing, preventing, and treating depression and anxiety in patients with chronic non-malignant pain, and whether there is a difference in the correlation between depression, anxiety, and chronic non-malignant pain according to ethnicity. Methods. Methods for identifying the study were derived from the Medline database (via PubMed). The analysis included all scientific papers in English, regardless of methodology, published since 2011. The papers dealt with the correlation between depression, anxiety, and chronic non-malignant pain, and included the population of primary care patients over 18 years of age who suffer from chronic nonmalignant pain and at the same time have symptoms of depression and anxiety present or are members of ethnic groups. 403 articles were found, original and review papers, of which, after a detailed reading, 10 were selected that meet the inclusion criteria for the purposes of this review. Results. Depression and anxiety are significantly more present in people with chronic pain (23%), compared to those who do not have chronic pain (12%). The most common is chronic musculoskeletal pain, with one-third of patients having depression. Depression and anxiety are significantly associated with the intensity and duration of pain. Chronic pain and depression also differ according to ethnic groups, with cultural differences and language barriers being a barrier to early detection of depression. Conclusion. Depression is the most common mental health disorder associated with chronic pain. It is extremely important to treat both depression and pain, in order to prevent the development of severe depression and chronic pain at an early stage. The integrated program at the level of primary health care is expected to have positive effects on both the physical and mental condition of patients. Cultural differences and ethnicity, which can significantly reduce the detection of depressive symptoms at the primary health care level, should certainly be taken into account.

Gender and cross-cultural differences in somatic symptoms associated with emotional distress. An international study in primary care

1997 ◽  
Vol 27 (2) ◽  
pp. 433-444 ◽  
Author(s):  
MARCO PICCINELLI ◽  
GREGORY SIMON
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cultural Differences ◽  
Emotional Distress ◽  
General Health ◽  
Somatic Symptoms ◽  
Cross Cultural ◽  
World Health ◽  
Cross Cultural Differences ◽  
The World

Background. Gender and cross-cultural differences in the association between somatic symptoms and emotional distress were investigated, using data from the World Health Organization Collaborative Project on Psychological Problems in General Health Care.Methods. Data were collected at 15 centres in 14 countries around the world. At each centre, a stratified random sample of primary care attenders aged 15–65 years was assessed using, among other instruments, the 28-item General Health Questionnaire and the Composite International Diagnostic Interview-Primary Health Care Version.Results. Females reported higher levels of somatic symptoms and emotional distress than males. A strong correlation between somatic symptoms and emotional distress was found in both sexes, with females reporting more somatic symptoms at each level of emotional distress. However, linear regression analysis showed that gender had no significant effect on level of somatic symptoms, when the effects of centre and emotional distress were controlled for. In both sexes, no specific pattern of association emerged between somatic symptom clusters and either anxiety or depression. Primary care attenders from less developed centres reported more somatic symptoms and showed greater gender differences than individuals from more developed centres, but inter-centre differences were small. Finally, gender was not a significant predictor of reason for consultation (somatic versus mental/behavioural symptoms), after controlling for levels of somatic symptoms and emotional distress as well as for centre effect.Conclusions. These data do not support the common belief that females somatize more than males or the traditional view that somatization is a basic orientation prevailing in developing countries. Instead, somatic symptoms and emotional distress are strongly associated in primary care attenders, with few differences between the two sexes and across cultures.

An Overview of Primary Health Care

1976 ◽  
Vol 6 (2) ◽  
pp. 309-314 ◽  
Author(s):  
John Fry
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
World Health Organization ◽  
Critical Analysis ◽  
World Health ◽  
Training And Education ◽  
Primary Health ◽  
The World ◽  
Health Organization

Primary health care has become a focus of interest from the World Health Organization down. The hopes that more emphasis on primary care will lead to less expensive and better care will not be realized unless a more critical analysis of its problems is undertaken and some of its defects and deficiencies put right. Its roles must be better defined and the work shared within a team; training and education must be more related to its needs; and much sharper research is required to decide what is useful and what is useless.

scholarly journals Primary health care and national household random sampling surveys: contributions from Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F Pinto ◽  
M R Gonçalves ◽  
N Katz ◽  
R S Silva ◽  
C A A Schmitz ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Systems ◽  
National Health ◽  
Health Survey ◽  
Health Surveys ◽  
Primary Health ◽  
The World ◽  
National Health Surveys

Abstract Primary health care has been considered by the World Health Organization (WHO) as the most efficient way of organizing health systems in order to achieve universal health coverage, preserving its attributes and focusing on people. Several countries in the world have developed instruments to measure access, use of services and lifestyles of their populations. In Europe, European Union members have validated the European Health Interview Survey (EHIS / Eurostat), which is in its third wave of application. Brazil, for over 20 years, has developed, through the Brazilian Institute of Geography and Statistics (IBGE) - the Brazilian Federal Statistics Bureau - in partnership with the Ministry of Health, a national household health survey throughout its territory, the so-called National Health Survey (PNS). PNS-2019 questionnaire innovated by including a module of questions that allows assessing the scores of the attributes proposed by Shi and Starfield in the 2000s. The Primary Care Assessment Tool (PCAT) was included in its brazilian statistically validated version for adult users and applied in more than 100,000 households in all five regions and 27 states in Brazil. Over a six-month period, a sample of approximately 10,000 adults was registered, according to the inclusion criteria of the PCAT considered (being 18 years old or older, having had more than one medical appointment in the last six months, having performed this appointment in a public primary health care facility). We consider it essential to use statistically validated instruments that allow cross-country comparisons and we encourage Governments all over the world to follow Brazilian example in incorporating in their national health surveys a module containing the validated version of the PCAT. This instrument has already been validated and used in the evaluation of primary care in regions of all five continents of the world, demonstrating, therefore, its capacity for cultural adaptation to each reality. Key messages PCAT's set of instruments remains current for the evaluation of primary health care services from the users' perspective nationwide. The importance of using National Health Surveys in each country, with random household sampling to assess health systems and conditions.

Primary Health Care and Person Centered Medicine

2015 ◽  
Vol 5 (2) ◽  
pp. 45-50
Author(s):  
Juan E Mezzich ◽  
James Appleyard ◽  
Michel Botbol ◽  
Tesfa Ghebrehiwet ◽  
Joanna Groves ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
World Health ◽  
Special Role ◽  
The Past ◽  
Primary Health ◽  
The World ◽  
Global Initiative ◽  
Health Organization

The popular usual meaning of primary care is health care at a basic rather than specialized level for people making an initial approach to a doctor or nurse for treatment. The concept of primary health care has evolved dramatically over the past four decades, particularly under the aegis of the World Health Organization with the additional participation of other institutional actors around the world. It is increasingly recognized as a fundamental concept and strategy for the advancement of health care and the promotion of health at national and international levels.Separately, as the programmatic global initiative on person centered medicine has been unfolding over the past decade, primary care, not surprisingly, is emerging as a prominent topic and concern for advancing person-centered medicine and health care. There are certainly conceptual and strategic reasons for such emergence. There have been as well institutional reasons for this. At the same time, person-centeredness is an open road for the optimization of primary care.Further understanding of the prominent position, special role, and particular challenges of primary care in person centered medicine is contributed by several of the papers published in the present issue of the International Journal of Person Centered Medicine.

scholarly journals Actual problems of outpatient pediatrics and their solutions (reflections and offers of the veteran)

2019 ◽  
Vol 19 (4) ◽  
pp. 249-254
Author(s):  
Antonina G. Gracheva
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Practical Experience ◽  
Primary Health ◽  
The World ◽  
Shortage Of Physicians ◽  
Primary Care Institutions ◽  
The City

There is presented the analysis of the state of ambulatory pediatrics and there are formulated proposals for the priority support for the development of outpatient pediatrics in the framework of improving primary health care for children for the prevention of the shortage ofpediatricians and providing the reduction in morbidity, disability and community-acquired mortality rate. To reduce the long-term shortage of physicians in ambulatory pediatrics author proposes to introduce a new specialty "general pediatrician", which is aimed to prepare a pediatrician at the postgraduate stage for the implementation ofprimary care across all the medicine of children age. The effectiveness of this solution has been proved by the World practice and domestic experiment in the city of Orenburg. It is moreover proposed to use a target distribution of graduates ofpediatric faculty, studied on a budgetary basis, to the outpatient primary care institutions. The organization of postgraduate specialization in ambulatory pediatrics according to the author opinion, should be implemented on the base of Departments of outpatient pediatrics possessing scientific and practical experience in the training of doctors specializing in ambulatory pediatrics.

scholarly journals Adaptation and reorganisation of primary care facility during COVID-19 pandemic: a perspective from primary health care corporation, Qatar

2020 ◽  
Vol 8 (1) ◽  
pp. 434
Author(s):  
Abdul Bari Shaik ◽  
Noor Fathima Shaik ◽  
Shawqiya Salman Al Majid ◽  
Sanaulla Sheik
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Healthcare Providers ◽  
Care Facility ◽  
Well Being ◽  
Safe Delivery ◽  
Primary Health ◽  
The World

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems across the world. It has had a devastating impact on peoples’ health, well-being and livelihood, crippling the economy, aviation, travel, hospitality and various other sectors. In order to curb its impact various governments had to take drastic measures to deal with this crisis. In Qatar, the major healthcare providers led by the MOPH responded swiftly by implementing major changes. They developed infrastructure, revisited public health policies, modified their operations and functioning which helped to cope with this evolving public health emergency. This paper reviews how a small health center in Qatar had to adapt its services, infrastructure and pathways to the changing needs and demands in a timely fashion leading to improved patient care and helping to contain the outbreak in both patients and staff alike. It also evaluates how Primary health care corporation at an organization level paved the transition in every aspect to ensure efficient and safe delivery of primary care services to everyone. As the world is preparing to overcome the pandemic, the paper highlights the value of teamwork in responding to the adversity by creating innovative ways of working and how good leadership can have a positive influence on healthcare and society in general.   

Classification of Somatization and Functional Somatic Symptoms in Primary Care

2005 ◽  
Vol 39 (9) ◽  
pp. 772-781 ◽  
Author(s):  
Per Fink ◽  
Marianne Rosendal ◽  
Frede Olesen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Somatic Symptoms ◽  
Physical Symptoms ◽  
Classification Systems ◽  
Medical Specialties ◽  
Diagnostic Categories ◽  
Primary Health

Objective: A substantial proportion of patients found in primary care complain of physical symptoms not attributable to any known conventionally defined disorder, that is, medically unexplained or functional somatic symptoms. The objective of this paper is to outline the problems with the current classification and propose a classification more suitable for primary health care. Method: We refer to and discuss relevant literature including papers on our own research on the topic in the light of our experiences from major projects on somatizing patients in primary health care. Results: Functional somatic symptoms may impose severe suffering on the patient and are costly for society because of high health-care utilization, lost working years and social expenses. At present, studies on functional somatic symptoms and disorders and their treatment are hampered by lack of a valid and reliable diagnostic classification. The diagnostic categories of somatoform disorders are overlapping. Thus, the present situation is that patients with identical symptoms and clinical pictures may receive different diagnostic labels depending on the focus of interests of the assessing physician. A particular problem in primary care is that the somatoform diagnostic categories only include persistent cases and do not offer the opportunity for classification of the patients with short-symptom duration found in this setting. We present a framework for a new descriptive classification of functional somatic symptoms and unfounded illness worrying, and outline a new classification that covers the whole spectrum of severity seen in clinical practice. Conclusion: A precondition for an appropriate management of patients with functional somatic symptoms is a valid taxonomy common for all medical specialties facilitating cooperative care. Classification systems as outlined in this paper may be a candidate for such a system, but it should be subject to further evaluation in research.

scholarly journals Primary care organizational model mix and avoidable hospitalization: an ecological study in Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Pinto ◽  
J V Santos ◽  
M Lobo ◽  
J Viana ◽  
J Souza ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Primary Healthcare ◽  
Pay For Performance ◽  
Care Quality ◽  
Organizational Model ◽  
Avoidable Hospitalizations ◽  
Primary Health ◽  
Age And Sex

Abstract Background In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patients within USF-B model and the rate of avoidable hospitalizations, as proxy of primary care quality. Methods We conducted a cross-sectional study considering the 55 ACES from mainland Portugal, in 2017. We used data from public hospitalizations to calculate the prevention quality indicator (avoidable hospitalizations) adjusted for age and sex, using direct standardization. The main independent variable was the proportion of patients in one ACES registered in the USF-B model. Unemployment rate, proportion of patients with family doctor and presence of Local Health Unit (different organization model) within ACES were also considered. The association was assessed by means of a linear regression model. Results Age-sex adjusted PQI value varied between 490 and 1715 hospitalizations per 100,000 inhabitants across ACES. We observed a significant effect of the proportion of patients within USF-B in the crude PQI rate (p = 0.001). However, using the age-sex adjusted PQI, there was not a statistical significant association (p = 0.504). This last model was also adjusted for confounding variables and the association remains non-significant (p = 0.865). Conclusions Our findings suggest that, when adjusting for age and sex, there is no evidence that ACES with more patients enrolled in a pay-for-performance model is associated with higher quality of PHC (using avoidable hospitalizations as proxy). Further studies addressing individual data should be performed. This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”. Key messages Adjusting PQI to sex and age seems to influence its value more than the type of organizational model of primary health care. Groups of primary healthcare centres with more units under the pay-for-performance scheme was not associated with different rate of avoidable hospitalizations.

Sign in / Sign up

Export Citation Format

Share Document