scholarly journals Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

2018 ◽  
Vol 20 ◽  
Author(s):  
Sabrina T. Wong ◽  
Julia M. Langton ◽  
Alan Katz ◽  
Martin Fortin ◽  
Marshall Godwin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Working Group ◽  
Scale Up ◽  
Data Sources ◽  
Knowledge Generation ◽  
Community Based ◽  
Primary Health ◽  
The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

scholarly journals Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

2010 ◽  
Vol 2 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Olawale O. Ogunsemi ◽  
Francis A. Oluwole ◽  
Festus Abasiubong ◽  
Adebayo R. Erinfolami ◽  
Olufemi E. Amoran ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Primary Health ◽  
Patient Health ◽  
The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

Models of community-based primary care for epilepsy in low- and middle-income countries

Neurology ◽  
2020 ◽  
Vol 94 (4) ◽  
pp. 165-175 ◽  
Author(s):  
Gagandeep Singh ◽  
Meenakshi Sharma ◽  
Anand Krishnan ◽  
Tarun Dua ◽  
Francesco d'Aniello ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Treatment Adherence ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Awareness ◽  
Primary Health ◽  
Low And Middle Income

ObjectiveTo review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries.MethodsA systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles.ResultsThe 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans.ConclusionsCost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.

Gender Makes a Difference in the Description of Dyspnoea in Patients with Chronic Heart Failure

2005 ◽  
Vol 4 (2) ◽  
pp. 117-121 ◽  
Author(s):  
Inger Ekman ◽  
Kurt Boman ◽  
Mona Olofsson ◽  
Nibia Aires ◽  
Karl Swedberg
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Care ◽  
Heart Disease ◽  
Primary Health Care ◽  
Chronic Heart Failure ◽  
Community Setting ◽  
Common Symptom ◽  
Primary Health ◽  
The Impact

Background: Dyspnoea is a common symptom of chronic heart failure (CHF). In the community setting, patients with CHF are most often women. Aim: To examine the impact of gender on the description of dyspnoea and to explore which clinical variables support a diagnosis of CHF. Methods: From four primary health care centres, 158 patients with CHF were included. Patients were examined with echocardiography and a cardiologist assessed the diagnosis of CHF. The patients filled in a questionnaire containing 11 descriptors of dyspnoea. Results: A diagnosis of CHF was confirmed in 87 (55%) patients (47 males and 40 females). One descriptor, I feel that I am suffocating, was significantly scored higher in CHF patients ( p=0.014) as compared to non-CHF patients. Three descriptors, My breath does not go in all the way ( p=0.006), I feel that I am suffocating ( p=0.040), and I cannot get enough air ( p=0.0327) were significantly scored higher among men with CHF, compared to no descriptor among women with CHF. Being male (OR=2.7; CI: 1.3–5.6, p=0.008), having diabetes (OR=5.6; CI: 1.7–18.2, p=0.004), IHD (OR=3.3; CI: 1.3–8.5, p=0.014), and a borderline significance for age (OR=1.04; CI: 0.99–1.08, p=0.058) predicted a confirmed diagnosis of CHF. Conclusion: Three descriptors of dyspnoea were associated with CHF among men, whereas no such association was found among women. Our results suggest that gender is an important factor and should—together with age, underlying heart disease, and diabetes—be taken into account when symptoms are evaluated in the diagnosis of CHF in primary care.

scholarly journals The Pacific primary health care workforce in New Zealand: What are the needs?

2009 ◽  
Vol 1 (2) ◽  
pp. 126 ◽  
Author(s):  
Luisa Ape-Esera ◽  
Vili Nosa ◽  
Felicity Goodyear-Smith
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Care Workforce ◽  
Pacific People ◽  
Advantages And Disadvantages ◽  
Pacific Population ◽  
Primary Health ◽  
The Impact

AIM: To scope future needs of the NZ Pacific primary care workforce. METHOD: Semi-structured interviews with key informants including Pacific primary care workers in both Pacific and mainstream primary health care organisations and managers at funding, policy and strategy levels. Qualitative thematic analysis using general inductive approach. RESULTS: Thirteen stakeholders interviewed (four males, nine females) in 2006. Included both NZ- and Island-born people of Samoan, Tongan, Niuean, Fijian and NZ European ethnicities; age 20–65 years. Occupations included general practitioner, practice nurse, community worker, Ministry of Health official and manager representing mainstream and Pacific-specific organisations. Key themes were significant differences in attributes, needs and values between ‘traditional’ and contemporary Pacific people; issues regarding recruitment and retention of Pacific people into the primary health care workforce; importance of cultural appropriateness for Pacific populations utilising mainstream and Pacific-specific primary care services and both advantages and disadvantages of ‘Pacific for Pacific’ services. CONCLUSION: Interviews demonstrated heterogeneity of Pacific population regarding ethnicity, age, duration of NZ residence and degree of immersion in their culture and language. Higher rates of mental disorder amongst NZ-born Pacific signpost urgent need to address the impact of Western values on NZ-born Pacific youth. Pacific population growth means increasing demands on health services with Pacific worker shortages across all primary health care occupations. However it is not possible for all Pacific people to be treated by Pacific organisations and/or by Pacific health workers and services should be culturally competent regardless of ethnicity of providers. KEYWORDS: Pacific Islands, New Zealand, manpower, ethnic groups, Oceanic Ancestry Group, primary health care

scholarly journals Artificial Intelligence in Primary Health Care: Perceptions, Issues, and Challenges

2019 ◽  
Vol 28 (01) ◽  
pp. 041-046 ◽  
Author(s):  
Harshana Liyanage ◽  
Siaw-Teng Liaw ◽  
Jitendra Jonnagaddala ◽  
Richard Schreiber ◽  
Craig Kuziemsky ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Medical Informatics ◽  
Panel Discussion ◽  
Healthcare Delivery ◽  
Primary Health ◽  
The Impact ◽  
Care Informatics

Background: Artificial intelligence (AI) is heralded as an approach that might augment or substitute for the limited processing power of the human brain of primary health care (PHC) professionals. However, there are concerns that AI-mediated decisions may be hard to validate and challenge, or may result in rogue decisions. Objective: To form consensus about perceptions, issues, and challenges of AI in primary care. Method: A three-round Delphi study was conducted. Round 1 explored experts’ viewpoints on AI in PHC (n=20). Round 2 rated the appropriateness of statements arising from round one (n=12). The third round was an online panel discussion of findings (n=8) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Results: PHC and informatics experts reported AI has potential to improve managerial and clinical decisions and processes, and this would be facilitated by common data standards. The respondents did not agree that AI applications should learn and adapt to clinician preferences or behaviour and they did not agree on the extent of AI potential for harm to patients. It was more difficult to assess the impact of AI-based applications on continuity and coordination of care. Conclusion: While the use of AI in medicine should enhance healthcare delivery, we need to ensure meticulous design and evaluation of AI applications. The primary care informatics community needs to be proactive and to guide the ethical and rigorous development of AI applications so that they will be safe and effective.

Undergraduate Medical Education towards Health for All: Progress, Pitfalls, Perspectives

1992 ◽  
Vol 5 (1) ◽  
pp. 17-31
Author(s):  
Antonio C. M. Carvalho
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Primary Health Care ◽  
Undergraduate Medical Education ◽  
Poor Quality ◽  
Sources Of Information ◽  
Community Based ◽  
Community Based Education ◽  
Primary Health ◽  
The Impact

I discuss aspects of undergraduate medical education related to primary health care and analyse innovative programmes, with emphasis on problem-based methods and community-based education. Assessing the impact of these programmes shows problem-based learning is an interesting didactic exercise but not a necessary or sufficient condition for the adequacy of programmes to the Health for All (HFA) policy. Community-based education is pressed by several obstacles inside and outside educational institutions that put at risk its effectiveness as a real agent of change. Amongst these obstacles are political difficulties in building linkages amongst teaching institutions, services, and community; logistical problems in facilitating faculty and student work in the community; reactions from faculties; poor research opportunities in primary health care; pressures for more socially, professionally, and economically rewarding careers; biases in training the present generation of teachers; attempts to fulfil the social, behavioural, epidemiological, and preventive knowledge requirements for medical education by adding to an already overloaded information base; and shortage of relevant and significant sources of information for the medical students. Building corporations representing ‘innovative’ programmes, on one side, and ‘conservative’, ‘traditional’ ones, on the other, is not helpful and probably false. Each Programme should be assessed in its strength and weaknesses in the light of political decisions committed to change in unequal, poor-quality health systems.

scholarly journals Impact of patient-perceived quality of primary health care on the patients' bypass behaviour in China

2020 ◽  
Author(s):  
WeiWei Zhang ◽  
Yuankai Huang ◽  
Gaojie Li ◽  
Hongjie Zhou ◽  
Xiaoyu Xi
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Assessment Tool ◽  
Perceived Quality ◽  
Health Care Facilities ◽  
Primary Health ◽  
Care Assessment ◽  
The Impact

Abstract Background Patient bypass often occurs under the loose gatekeeper system. Additionally, patients’ perceived quality of primary health care (PHC) is one of the important factors affecting bypass behaviour. Objective to explore individuals’ bypass behaviour in China and the associations between patients’ perceived quality of PHC and their bypass behaviour. MethodIn 2019, this study investigated Chinese bypass behaviour and the potential influencing factors. The questionnaire that was used assessed the following: the perceived quality of primary care using the Primary Care Assessment Tool; bypass experience; age; health insurance; and other factors. A logit regression model was used to analyse the impact of perceived quality of PHC on bypass behaviour. Results The data of 2070 residents in 706 health care facilities in China were collected. The results show that perceived quality of PHC is significantly associated with bypass behaviour in China. After adjustments were made for patients’ sociodemographic and other characteristics, an increase of one standard deviation (SD; odds ratio (OR) per 1-SD increase) in the PCAT scores led to a 2% decrease in bypass behaviour (OR 0.98, p<0.05). Gender, hukou and cold fee for PHC were negatively associated with bypass behaviour. Conclusion Patients' perceptions of PHC service quality play an active role in reducing their bypass behaviour, which may provide a new perspective for the design of PHC health policies.

scholarly journals Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

10.2196/23482 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e23482 ◽  
Author(s):  
Seung Min Han ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Antibiotic Prescribing ◽  
Remote Consultation ◽  
Face To Face ◽  
Primary Health ◽  
The Impact ◽  
Remote Consultations

Background There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

scholarly journals Capacity building and mentorship among pan-Canadian early career researchers in community-based primary health care

2020 ◽  
Vol 21 ◽  
Author(s):  
Kathryn Nicholson ◽  
Rebecca Ganann ◽  
Sue Bookey-Bassett ◽  
Lisa Garland Baird ◽  
Anna Garnett ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Capacity Building ◽  
Working Group ◽  
Core Competencies ◽  
Skills Training ◽  
Active Role ◽  
Early Career ◽  
Community Based ◽  
Primary Health

Abstract Aim: To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams. Background: In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group. Methods: After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature. Findings: Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation.

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