Why Primary Health Care Offers a more Comprehensive Approach to Tackling Health Inequities than Primary Care

2001 ◽  
Vol 7 (2) ◽  
pp. 57 ◽  
Author(s):  
Helen Keleher

As governments attempt to focus more intently on how to deal with alarming measures of health disadvantage and inequities, a reformist gaze seems to have settled on the primary care sector. Simultaneously, in literature about this area, whether intended or not, primary health care and primary care are terms that are increasingly interchanged. This article argues that the slippage in language is counter-productive, first because it disguises the transformative potential of strategies and approaches that can make the fundamental changes necessary to improve health status, and second because the structures and practices of the primary care sector are not necessarily compatible with notions of comprehensive primary health care. There is much to be lost if primary health care and health promotion are disguised as primary care, and not understood for their capacity to make a difference to health inequities although of course in some circumstances, comprehensive primary health care is interdependent with services provided by primary care. In this article, characteristics of primary care and primary health care are juxtaposed to show that if the strengths and limitations of each model are understood, they can be mobilised in collaborative partnerships to deal more effectively with health inequities, than our system has so far been able to do.

2001 ◽  
Vol 7 (1) ◽  
pp. 56 ◽  
Author(s):  
Jenny Adam ◽  
Rae Walker

In Victoria the primary health care sector is in a period of change intended to strengthen the integration of a complex service system through a process of partnership development based on collaboration. The partnerships are voluntary alliances of the primary care service providers, usually within a locality of two to three local government areas. Their purpose is to improve the health and wellbeing of the local population by strengthening inter-agency coordination in the areas of needs identification, planning and service delivery. Trust is a key issue in this process. This paper is a report of the first stage of a study to explore trust in the context of relationships between organisations in the primary care sector.


2009 ◽  
Vol 15 (4) ◽  
pp. 262 ◽  
Author(s):  
Julie McDonald ◽  
Gawaine Powell Davies ◽  
Mark Fort Harris

Improving collaboration and coordination in primary and community health is a national priority. Two major approaches have been taken: strengthening interorganisational and interprofessional collaboration. This paper reviews current and emerging models of partnerships: divisions of general practice and primary care partnerships (organisational models); and collaboration between general practitioners with practice nurses and with allied health professionals (interprofessional models). The models are reviewed in terms of the governance and formalisation of the partnership arrangements and the level of collaboration they achieve. The organisational models have had different purposes and taken different forms, the ‘hub and spoke’ model of divisions and decentralised ‘network’ relationships of primary care partnerships, both of which have broadly achieved their aims. Interprofessional collaboration involves a complex mix of allegiances and interests that influences the level of collaboration that is achieved. A combination of approaches is needed to achieve more coordinated and integrated primary health care. The implications for several current policy debates are discussed: the establishment of local integrated and comprehensive primary health care centres, regional level primary care organisations and alternative payment mechanisms.


Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 613
Author(s):  
Attà Negri ◽  
Claudia Zamin ◽  
Giulia Parisi ◽  
Anna Paladino ◽  
Giovanbattista Andreoli

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative–qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist’s profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization.


2011 ◽  
Vol 3 (1) ◽  
pp. 41 ◽  
Author(s):  
Sarah Lovell ◽  
Pat Neuwelt

INTRODUCTION: Reconciling the primary care sector’s traditional concern for individual health outcomes with a population health approach is integral to the implementation of New Zealand’s Primary Health Care Strategy, and a key challenge for health promotion in New Zealand. The purpose of this study was to examine the views of health promoters, their funders and managers toward the implementation of the Primary Health Care Strategy’s health promotion agenda. METHODS: Focus groups and interviews were carried out with 64 health promoters and 21 health sector managers and planners and funders over the 12 months beginning March 2008. Interview and focus group transcripts were analysed thematically. FINDINGS: Primary Health Organisations (PHOs) have been perceived as both an opportunity and a threat to health promotion. The opportunity was seen to lie in the development of health promotion responsive to the needs of communities. Yet the numerous PHOs that emerged spread funding and capacity for health promotion thin, particularly amongst smaller PHOs. CONCLUSION: The failure of the Ministry of Health to engage the health promotion workforce in the development and implementation of the Primary Health Care Strategy has led to a clear sense of vulnerability among health promoters. Ideological divisions between primary care and public health have been exacerbated by the restructuring of health promotion funding and delivery. Within non-governmental organisations and public health units concern continues to surround the legitimacy of health promotion approaches undertaken within the primary health care sector. KEYWORDS: Health promotion; primary health care; health policy; Primary Health Organisations; New Zealand; restructuring


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F Pinto ◽  
D Soranz ◽  
L J Santos ◽  
M S Paranhos ◽  
L S Malta ◽  
...  

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.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Pinto ◽  
J V Santos ◽  
M Lobo ◽  
J Viana ◽  
J Souza ◽  
...  

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.


2017 ◽  
Vol 12 (2) ◽  
pp. 431-440 ◽  
Author(s):  
Antônio Augusto Dall’Agnol Modesto ◽  
Marcia Thereza Couto

Erectile dysfunction (ED) is a common sexual problem and has been attracting growing interest from the field of medicine. The pharmaceutical industry works together with medical associations to popularize the theme, emphasizing individual enhancement and medication, besides reinforcing an idea of a male sexuality defined by the ability to have an erection and penetrate. Patients worried about erection problems search for general practitioners (GPs), frequently without a clear complaint, and a comprehensive primary health care (PHC) must be capable of dealing with these issues considering medicalization and disease mongering. This article discusses how PHC physicians take (and might take) care of men with erection problems, and how users perceive it and search for help in two cities in the State of São Paulo, Brazil. The qualitative research, performed in five PHC services, included semistructured interviews with 16 GPs and 15 adult male users. The adult male users were invited by their doctors during consultations where questions about prostate, ED, or other sexual problems arose. Interviews were transcribed and submitted for content analysis. In addition, the five participating services were observed with help of a specific script. Results indicate that ED is frequently a hidden agenda and that doctors have trouble approaching the problem, usually focusing on the biological aspects. Based on empirical data and literature, this work indicates some measures to qualify the care of men with ED in PHC which includes contemplating users’ questions, respecting their autonomy, avoiding an antidrug stance, and considering drug and nondrug approaches as a continuum of resources.


2021 ◽  
Vol 27 (1) ◽  
pp. 57
Author(s):  
Ailsa Munns

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers’ perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.


2010 ◽  
Vol 15 (1) ◽  
Author(s):  
Nomasonto B. Magobe ◽  
Sonya Beukes ◽  
Ann Müller

‘No member of [health] staff should undertake tasks unless they are competent to do so’ is stated in the Comprehensive Primary Health Care Service Package for South Africa (Department of Health 2001)document. In South Africa, primary clinical nurses (PCNs), traditionally known as primary health care nurses (PHCNs), function as ‘frontline providers’ of clinical primary health care (PHC) services within public PHC facilities, which is their extended role. This extended role of registered nurses(set out in section 38A of the Nursing Act 50 of 1978, as amended) demands high clinical competency training by nursing schools and universities.The objectives of the study were to explore and describe the perceptions of both clinical instructors and students, in terms of the reasons for poor clinical competencies. Results established that two main challenges contributed to students’ poor clinical competencies: challenges within the PHC clinical field and challenges within the learning programme (University).OpsommingDie primêre kliniese verpleegkundiges, tradisioneel bekend as primêre gesondheidsorg verpleegkundiges, funksioneer in Suid-Afrika as eerste-linie verskaffers van kliniese primêre gesondheidsorg (PGS) dienste binne die publieke PGS fasiliteite. Dit is hulle uitgebreide rol. Hierdie uitgebreide rol van die verpleegkundige (soos deur Wet op Verpleging,No 50 van 1978, artikel 38A voorgeskryf), vereis opleiding in kliniese vaardighede van hoë gehalte deur verpleegskole en universiteite.Die doelwitte van die navorsing was om die persepsies van beide kliniese dosente en leerders,met betrekking tot die redes vir swak kliniese vaardighede, repektiewelik te verken en te beskryf.Twee temas is deur die resultate as uitdagings (hoof redes) vir die swak vaardighede van leerders aangetoon, naamlik uitdagings in die PGS kliniese praktyk en die uitdagings in die leerprogram (universiteit).


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