scholarly journals Effects of a work-stress intervention in Swedish primary care versus treatment as usual: RCT-study

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Sandheimer ◽  
T Hedenrud ◽  
G Hensing ◽  
K Holmgren
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Collaborative Care ◽  
High Stress ◽  
Intervention Group ◽  
Treatment As Usual ◽  
Primary Health ◽  
Rehabilitative Measures

Abstract Background Work stress is an increasing burden in society. To identify early symptoms of work stress in primary health care (PHC) could result in earlier and better adjusted care. A work stress questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate if the use of WSQ, in combination with physician’s feedback, results in differences in health care visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU. Methods A two-armed RCT was conducted at seven primary health care centres (PHCC) in Region Västra Götaland, Sweden. One group received the WSQ-intervention and the controls received TAU. Employed not sick-listed persons aged 18-64 that sought care for mental and physical health complaints at the PHCCs participated. Register data on health care visits and treatments 12 months prior inclusion and 12 months after was obtained and analysed with Fisher’s exact test together with questionnaire data (WSQ and background features). Results A total of 271 participants were included in the study, 132 intervention and 139 controls. The proportion that visited psychologists/psychotherapists was higher among the intervention group with high stress (19.5%, n = 87) during follow-up compared to corresponding controls (7.2%, n = 97) (p = 0.048). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11.3%) (p = 0.048). Conclusions Significant differences were found between the WSQ intervention group and the controls reporting high stress in visits to psychologists and in amount of received collaborative care. This confirms our hypothesis that the WSQ can help physicians to identify work stress and give suitable rehabilitative measures at an earlier stage in the care process compared to TAU. Key messages The use of WSQ with physicians’ feedback generated more visits to psychologists and more received collaborative care compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary care and accommodate rehabilitative measures compared to treatment as usual.

scholarly journals Effect of implementation intention on walking in people with diabetes

2020 ◽  
Vol 54 ◽  
pp. 103
Author(s):  
Marco Antonio Vieira da Silva ◽  
Thaís Moreira São-João ◽  
Marilia Estevam Cornelio ◽  
Fábio Luiz Mialhe
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Leisure Time Physical Activity ◽  
Intervention Strategy ◽  
Intervention Group ◽  
Implementation Intention ◽  
Control Group ◽  
Primary Health ◽  
Significant Difference

OBJECTIVE: To evaluate the effect of implementation intentions as an intervention strategy to promote walking in adults with type 2 diabetes mellitus (T2DM). METHODS: We conducted a controlled and randomized trial, with 12 months of follow-up, involving 65 people with T2DM recruited from primary health care units and allocated them in the control group (CG, n = 32) and intervention group (IG, n = 33). The IG received the implementation intention strategy to promote walking and the CG remained in follow-up for conventional treatment in primary health care. The researchers were blinded by anthropometric measurements and the filling of the instruments. RESULTS: After twelve months of follow up, the IG presented a statistically significant increase in the leisure time physical activity when compared with the CG (p = 0.0413) and showed a significant decrease in waist circumference (p = 0.0061). No significant difference was observed regarding body mass index and glycated hemoglobin among groups. CONCLUSIONS: Implementation intention was effective in promoting walking and improving clinical indicators in adults with T2DM.

scholarly journals Measuring the performance of interprofessional primary health care teams: understanding the teams perspective

2019 ◽  
Vol 20 ◽  
Author(s):  
Catherine Donnelly ◽  
Rachelle Ashcroft ◽  
Amanda Mofina ◽  
Nicole Bobbette ◽  
Carol Mulder
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Performance Measurement ◽  
Collaborative Care ◽  
Performance Indicators ◽  
Interprofessional Collaboration ◽  
Health Care Teams ◽  
Primary Health ◽  
Care Models

Abstract Aim: The aim of the study was to describe practices that support collaboration in interprofessional primary health care teams, and identify performance indicators perceived to measure the impact of this collaboration from the perspective of interprofessional health providers. Background: Despite the surge of interprofessional primary health care models implemented across Canada, there is little evidence as to whether or not the intended outcomes of primary health care teams have been achieved. Part of the challenge is determining the most appropriate measures that can demonstrate the value of collaborative care. To date, little remains known about performance measurement from the providers contributing to the collaborative care process in interprofessional primary care teams. Having providers from a range of disciplinary backgrounds assist in the development of performance measures can help identify measures most relevant to demonstrate the value of collaborative care on the intended outcomes of interprofessional primary care models. Methods: A qualitative study; part of a larger mixed methods developmental evaluation to examine performance measurement in interprofessional primary health care teams. A stakeholder workshop was conducted at an annual association meeting of interprofessional primary health care teams in the province of Ontario, Canada. Six questions guided the workshop groups and participant responses were documented on worksheets and flip charts. All responses were collected and entered verbatim into a word document. Qualitative analytic strategies were applied to each question. Findings: A total of 283 primary health care providers from 14 health professions working in interprofessional primary health care teams participated. Top three elements of interprofessional collaboration (total n = 628) were communication (n = 146), co-treatment (n = 112) and patient-based conferences (n = 81). Top three performance indicators currently used to demonstrate the value of interprofessional collaboration (total n = 241) were patient experience (n = 71), patient health status (n = 35) and within team referrals (n = 30).

scholarly journals Does a brief work-stress intervention prevent sick-leave during the following 24 months? A randomized controlled trial in Swedish primary care

Work ◽  
2021 ◽  
pp. 1-10
Author(s):  
Jenny Hultqvist ◽  
Pernilla Bjerkeli ◽  
Gunnel Hensing ◽  
Kristina Holmgren
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Sick Leave ◽  
Early Identification ◽  
Controlled Trial ◽  
Intervention Group ◽  
Training Session ◽  
Control Group ◽  
Treatment As Usual ◽  
Primary Health

BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care. OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention. METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency. RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant. CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.

scholarly journals Profile Of Children Referred To Primary Health Care Physiotherapy: A Longitudinal Observational Study In Norway

2020 ◽  
Author(s):  
Kari Anne I Evensen ◽  
Siw Sellæg ◽  
Anne-Cath Stræte ◽  
Anne E. Hansen ◽  
Ingebrigt Meisingset
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Observational Study ◽  
Motor Development ◽  
Daily Activities ◽  
Child Health Care ◽  
Longitudinal Observational Study ◽  
Primary Health

Abstract Background Children are referred to primary care physiotherapy services for a variety of reasons, ranging from concerns for motor development to the need for extensive habilitation services. There is limited knowledge about their characteristics and outcome. The aim of this study was to describe the variation in baseline demographical and clinical characteristics as well as treatment outcome at follow-up six months after baseline. Methods Children referred to primary care physiotherapy in a municipality in Norway were invited to participate in this longitudinal observational study. The children’s demographics, causes of referral, functional diagnoses, influence on their daily activities, main goals and planned treatments were registered at baseline. Goal attainment and treatment compliance were registered at follow-up maximum six months after baseline. Results Baseline characteristics were registered for 148 children by the physiotherapist and for 101 (68.2%) children by their parents. Half of the children were referred from child health care centres due to concerns for motor development, asymmetry and orthopaedic conditions, and most of these children were below the age of one year. There was partly agreement between causes of referral and the physiotherapists’ functional diagnoses. The children’s daily activities were little affected by the problem or complaint for which they were referred. About a third of the children needed only examination. Follow-up data was registered for 64 children. The majority achieved their main treatment goal and the treatment was carried out as planned. Conclusions This study describes the profile of a broad spectrum of children referred to physiotherapy in primary health care in Norway. Our findings may guide further interdisciplinary collaboration and knowledge transfer between professionals involved in child health care with the goal to balance the use of resources to the need for physiotherapy. Trial registration: ClinicalTrials.gov Identifier: NCT03626389. Registered on August 13th 2018 (retrospectively registered).

scholarly journals Improving Insomnia in Primary Care Patients a Randomized Controlled Trial of Nurse-Led Group Treatment: A Literature Review

2020 ◽  
Vol 1 (1) ◽  
pp. 19-24
Author(s):  
Alwan Revai
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Group Treatment ◽  
Control Groups ◽  
Stockholm County ◽  
Treatment As Usual ◽  
Treatment Groups ◽  
Primary Health ◽  
Significant Difference

Introduction: Insomnia is generally defined as complaints of poor or unsatisfactory sleep, which can include difficulty initiating sleep, awakening after sleep onset, poor sleep quality, early morning awakenings, short sleep times, short total sleep times and daytime consequences. Chronic insomnia is a common problem in primary health care, affecting 10 - 19% of those seeking primary care. Method: Patient is a randomly selected sample of 165 people and divided into 2 groups, namely 90 treatment groups and 75 control groups in seven routine primary health care in Stockholm County, Sweden between August 2011 and June 2014. The intervention to be given was in the treatment group given the intervention consisting of a group treatment program for insomnia based on the CBT-I technique while the control group was free to undergo insomnia treatment as usual. Result: The formulation of the research problem is to compare how the effect of nurse-led group treatment with the effect of treatment as usual in routine primary health care in Stockholm County, Sweden. In this study, the researcher determined a sample of 165 people who met the research requirements, and divided respondents randomly (single-blinded) consisting of 90 treatment groups and 75 control groups. Conclusion: There was a significant difference between the treatment of insomnia with cognitive therapy and the treatment of insomnia with drugs. So that we can reduce the long-term effects of using drugs to treat insomnia.

scholarly journals Mental health specialist video consultations versus treatment-as-usual for patients with depression or anxiety disorders in primary care: A randomized controlled feasibility trial (Preprint)

2020 ◽  
Author(s):  
Justus Tönnies ◽  
Mechthild Hartmann ◽  
Michel Wensing ◽  
Joachim Szecsenyi ◽  
Frank Peters-Klimm ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Anxiety Disorder ◽  
Intervention Group ◽  
Control Group ◽  
Treatment As Usual ◽  
Mental Health Specialist ◽  
Randomized Controlled ◽  
Health Specialist

BACKGROUND Most people suffering from depression and anxiety disorders are solely treated by their primary care physician. Access to specialized mental health care is impeded by patients’ comorbidity and immobility in ageing societies and long waiting times on the providers’ end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in the primary care environment the patient is already familiar with. OBJECTIVE In an individually randomized controlled trial we aimed to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression and/or anxiety disorder. METHODS Participants were recruited by their primary care physicians during regular practice visits. Eligible patients were required to experience at least moderate symptoms of depression and/or anxiety disorder. Patients were randomized in two groups receiving either treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. Video consultations focused on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment and attendance at sessions. Effectiveness outcomes included depression (PHQ-9), anxiety (GAD-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale, SSD-12), recovery (Recovery Assessment Scale, RAS-G), and perception of chronic illness care (Patient Assessment of Chronic Illness Care, PACIC–Short Form) – which were measured at baseline and 16 weeks post-allocation by assessors blinded to group allocation. RESULTS Fifty patients with depression and/or anxiety disorder were randomized, 23 to the intervention group and 27 to the treatment-as-usual group. The recruitment yield (number randomized per number screened) and consent rate (number randomized per number eligible) were 50/73 (68.5%) and 50/58 (86.2%), respectively. Concerning acceptability, 20 (87.0%) of the 23 in the intervention group completed the intervention. Of 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 95.7% and 85.2% for the intervention and the control group, respectively. Change from baseline scores at post-measurement for the “No Domination by Symptoms” domain of recovery (RAS-G) were somewhat higher for the intervention group compared to the control group (Mann-Whitney U-Test: rank-biserial r = 0.19 [-0.09; 0.46], P = .18). We did not detect any notable differences between the intervention group and the control group for the other effectiveness outcomes. We did not observe any serious adverse events related to the trial. CONCLUSIONS The intervention and study procedures are feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate effectiveness in routine care. CLINICALTRIAL German Clinical Trials Register (registration no. DRKS00015812).

scholarly journals Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults

2005 ◽  
Vol 8 (7) ◽  
pp. 820-825 ◽  
Author(s):  
Daniela Saes Sartorelli ◽  
Elaine Cristina Sciarra ◽  
Laércio Joel Franco ◽  
Marly Augusto Cardoso
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Low Cost ◽  
Intervention Group ◽  
Saturated Fat ◽  
Nutritional Intervention ◽  
Primary Health Care Centre ◽  
Health Care Centre ◽  
Primary Health

AbstractObjectiveTo evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults.DesignRandomised clinical trial.SettingPrimary health-care centre in São José do Rio Preto, São Paulo State, Brazil.SubjectsWe randomly assigned 104 adults (83 women and 21 men aged 30–65 years, body mass index 24–35 kg m−2, non-diabetic) into two groups: nutrition counselling and control. Each subject in the intervention group received three individualised nutritional counselling sessions during the first 6 months aimed at increasing intakes of fruits, vegetables and olive oil, reducing saturated fat and improving physical activity. Body composition, biochemical indicators and lifestyle were assessed at baseline and at 6 months and 1 year in both groups.ResultsAfter 6 months of follow-up, body weight, waist circumference, diastolic blood pressure, fasting blood glucose, total and low-density lipoprotein cholesterol, total and saturated fat, and dietary energy and cholesterol levels showed a more significant decrease among subjects in the intervention group than in the control group (P<05). Moreover, the intervention group showed significantly greater improvement in each intervention goal, such as reduced intake of saturated fat and increased intakes of fruits, vegetables, fibre and olive oil (P<0.05). After 12 months of follow-up, most of the outcomes were maintained.ConclusionsThe low-cost nutritional intervention programme improved serum lipids profile and weight control, and appeared to be feasible for use at a primary health-care centre in a developing country.

scholarly journals Evolution of a Cohort of COVID-19 Infection Suspects Followed-Up from Primary Health Care

2021 ◽  
Vol 11 (6) ◽  
pp. 459
Author(s):  
Valle Coronado-Vázquez ◽  
Maria del Valle Ramírez-Durán ◽  
Juan Gómez-Salgado ◽  
María Silvia Dorado-Rabaneda ◽  
Elena Benito-Alonso ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Hospital Admission ◽  
Health Care Professionals ◽  
Clinical Deterioration ◽  
Primary Health ◽  
Patients With Diabetes ◽  
Immunosuppressed Patients

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p < 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission.

scholarly journals Barriers, Facilitators, and Proposals for Improvement in the Implementation of a Collaborative Care Program for Depression: A Qualitative Study of Primary Care Doctor and Nurse Experiences

2021 ◽  
Author(s):  
Enric Aragonès ◽  
Germán López-Cortacans ◽  
Narcís Cardoner ◽  
Catarina Tomé-Pires ◽  
Daniel Porta-Casteràs ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Qualitative Study ◽  
Collaborative Care ◽  
Health Care Professionals ◽  
Care Program ◽  
Primary Health ◽  
Primary Health Care Centers ◽  
Health Care Centers

Abstract Background: Primary care plays a central role in the treatment of depression. Nonetheless, shortcomings in its management and suboptimal outcomes have been identified. Collaborative care models improve processes for the management of depressive disorders and associated outcomes. We developed a strategy to implement the INDI collaborative care program for the management of depression in primary health care centers across Catalonia. The aim of this qualitative study was to evaluate a trial implementation of the program to identify barriers, facilitators, and proposals for improvement. Methods: One year after the implementation of the INDI program in 18 public primary health care centers we performed a qualitative study in which the opinions and experiences of 23 primary care doctors and nurses from the participating centers were explored in focus groups. We performed thematic content analysis of the focus group transcripts. Results: The results were organized into three categories: facilitators, barriers, and proposals for improvement as perceived by the health care professionals involved. The most important facilitator identified was the perception that the INDI collaborative care program could be a useful tool for reorganizing processes and improving the management of depression in primary care, currently viewed as deficient. The main barriers identified were of an organizational nature: heavy workloads, lack of time, high staff turnover and shortages, and competing demands. Additional obstacles were inertia and resistance to change among health care professionals. Proposals for improvement included institutional buy-in to guarantee enduring support and the organizational changes needed for successful implementation.Conclusions: The INDI program is perceived as a useful, viable program for improving the management of depression in primary care. Uptake by primary care centers and health care professionals, however, was poor. The identification and analysis of barriers and facilitators will help refine the strategy to achieve successful, widespread implementation.Trial registration: ClinicalTrials.gov identifier: NCT03285659; Registered 18th September, 2017.

scholarly journals Profile of Children Referred to Primary Health Care Physiotherapy: A Longitudinal Observational Study in Norway

2020 ◽  
Author(s):  
Kari Anne I Evensen ◽  
Siw Sellæg ◽  
Anne-Cath Stræte ◽  
Anne E. Hansen ◽  
Ingebrigt Meisingset
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Services ◽  
Daily Activities ◽  
Care Services ◽  
Longitudinal Observational Study ◽  
Primary Health ◽  
Primary Health Care Services

Abstract Background: Physiotherapy services are an important part of the primary health care services for children, serving a broad spectrum of children referred from different sources and for a variety of reasons. There is limited knowledge about their characteristics and outcome. The aim of this study was to describe the profile, i.e. referral patterns, baseline demographical and clinical characteristics, as well as treatment outcome at follow-up six months after baseline in children receiving physiotherapy in primary care. Methods: Children referred to primary care physiotherapy in a municipality in Norway were invited to participate in this longitudinal observational study. The children’s demographics, referral source, causes of referral, functional diagnoses, influence on their daily activities, main goals and planned treatments were registered at baseline. Goal attainment and treatment compliance were registered at follow-up maximum six months after baseline. Results: The physiotherapists registered baseline characteristics for 148 children. Parent-reported data at baseline were available for 101 (68.2%) of these children. Children were mainly referred from child health care centres (n=74; 50.0%), hospital (n=25; 16.9%) and kindergarten (n=22; 14.9%). The most frequent causes of referral were concerns for motor development (n=50; 33.8%), asymmetry (n=40; 27.0%) and orthopaedic conditions (n=25; 16.9%). Eighty-one (54.7%) children were below the age of one year. There was partly agreement between causes of referral and the physiotherapists’ functional diagnoses. Parents of 69 (71.1%) children reported that their child’s daily activities were little to not at all influenced by the problem or complaint for which they were referred. Follow-up data was registered for 64 children. The main treatment goal was achieved in 37 (57.8%) and partly achieved in 26 (40.6%) children and the treatment was carried out as planned in 55 (87.3%) children. Conclusions: The large variation in the profile of children receiving primary health care physiotherapy in Norway shows how primary health care PT’s can contribute to fulfil the broad purpose of the primary health care services.Trial registration: ClinicalTrials.gov Identifier: NCT03626389. Registered on August 13th 2018 (retrospectively registered).

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