scholarly journals P0619POINT OF CARE CREATININE FOR EARLY DIAGNOSIS OF COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN NIGERIA. TECHNOLOGY EVALUATION AND DESIGN OF QUALITY IMPROVEMENT PROJECT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dimitrios Poulikakos ◽  
Ibi Erekosima ◽  
Pedro Emem-Chioma ◽  
Prelador Fakrogha ◽  
R I Oko-Jaja ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Primary Health Care ◽  
Early Diagnosis ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Kidney Injury ◽  
Improvement Project ◽  
Primary Health ◽  
Port Harcourt

Abstract Background and Aims Acute Kidney Injury (AKI) in low- and middle-income countries is mostly a community-acquired potentially reversible syndrome and has high morbidity and mortality. Due to limited laboratory infrastructure diagnosis of AKI is often delayed until life threatening complications have developed and dialysis treatment is largely unavailable. Decisions for hospital referral from primary health care centers and triage decisions for hospital admission are not based on laboratory results in Port Harcourt Nigeria. To address the need for early diagnosis and treatment of AKI we established a collaboration between the Renal Unit of the University of Port Harcourt Teaching Hospital, Primary Health Care Board Rivers State and the Renal Department of Salford Royal NHS Foundation Trust, aiming at the evaluation of the use of point of care (POC) Creatinine (Cr) for early detection and management of community acquired AKI. Method The first stage of the project evaluated the accuracy of POC Cr technology. Following informed consent patients underwent concurrent measurement of Cr using the central laboratory (Lab) assay (Jaffe) from a venous sample and a point of care Cr measurement using a capillary sample (fingerstick) with the NOVA Stasensor Xpress Cr analyser. Pearson Correlation and Bland-Altman plots were used to assess correlation and agreement between the two methods. During the second stage, the results were discussed at a focused AKI workshop and guidance for the use of POC Cr was developed. Results During the first phase 96 concurrent POC Cr capillary and venous Lab Cr samples were analysed. Mean age was 49±14 years and 66 subjects were females. POC Cr values were 127±122 umol/l and Lab Cr values were 100 ±85 umol/L, mean positive bias of 27.2±47.94 umol/L. Overall, correlation between POC Cr and Lab Cr was very good, with Pearson correlation r=0.956) Figure 1A. All 4 out of 96 values that were outside the limits of agreement (set at mean ±2 standard deviations) were for Lab Cr values >200 umol/L. A Bland-Altman Plot is presented for paired samples with Lab Cr values <200 umol/L (Figure 1B).

scholarly journals Risk for acute kidney injury in primary health care

2018 ◽  
Vol 71 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Maria Célia Laranjeira Rigonatto ◽  
Marcia Cristina da Silva Magro
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Primary Health Care ◽  
Renal Injury ◽  
Kidney Injury ◽  
Total Sample ◽  
Diabetic Patients ◽  
Primary Health ◽  
Spearman Test

ABSTRACT Objective: To identify hypertensive and diabetic patients at risk for developing acute kidney injury in the primary health care setting. Method: Observational, longitudinal, prospective study. Sample of 56 diabetic and hypertensive individuals. A semi-structured questionnaire was adopted for data collection. For the description of results, were calculated dispersion measures and the Spearman test was used for statistical analysis. The result was considered significant when p <0.05. Results: Of the total sample, 23.2% of users evolved with renal impairment, of which 19.6% with risk for renal injury, and 3.6% with kidney injury itself. Age and body mass index were associated with worsening of renal function (p = 0.0001; p = 0.0003), respectively. Conclusion: A quarter of the health system users, hypertensive and diabetic, evolved with impaired renal function, more specifically to stages of risk for renal injury and kidney injury according to the RIFLE classification.

scholarly journals Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

2014 ◽  
Vol 32 (4) ◽  
pp. 241-247 ◽  
Author(s):  
Staffan Nilsson ◽  
Agneta Andersson ◽  
Magnus Janzon ◽  
Jan-Erik Karlsson ◽  
Lars-Åke Levin
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Setting ◽  
Troponin T ◽  
Point Of Care ◽  
Health Care Setting ◽  
Primary Health Care Setting ◽  
Primary Health

scholarly journals Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

2019 ◽  
Vol 11 (13) ◽  
pp. 158
Author(s):  
Nkosinothando Chamane ◽  
Tivani Phosa Mashamba-Thompson
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Experiential Learning ◽  
Service Delivery ◽  
Point Of Care ◽  
Service Improvement ◽  
Quality Service ◽  
Resource Limited Settings ◽  
Primary Health ◽  
Resource Limited

BACKGROUND: Despite impressive progress that has been made in the provision of health care services to all, the issue of quality service delivery still remains a challenge particularly for point-of-care (POC) diagnostics in resource-limited-settings. Poor competency of primary health care workers in these settings has been shown to be amongst the main contributors to poor quality service delivery. FINDINGS: Participatory-based continuous professional development (CPD) strategies to support technology advancements in health care are recommended. Experiential learning approaches have been shown to be efficient in supplementing traditional teaching methods for both health care students and professionals. These approaches have been shown to further contribute towards continuous skills development and lifelong learning. CONCLUSION: This review therefore provided an overview of literature on experiential learning as one of CPD approaches in relation to health care service improvement in resource-limited setting. In addition, this review has recommended a mobile-based experiential learning approach to help deliver a quality POC technology curriculum to Primary health care-based workers in resource-limited settings.

scholarly journals Understanding competing discourses as a basis for promoting equity in primary health care

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amélie Blanchet Garneau ◽  
Annette J. Browne ◽  
Colleen Varcoe
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Equity ◽  
Point Of Care ◽  
Health Inequities ◽  
Care Staff ◽  
Healthcare Organizations ◽  
Primary Health ◽  
Structural Inequities ◽  
Multiple Discourses

Abstract Background Globally, health inequities persist with effects on whole populations and the most profound effects on populations marginalized by poverty, discrimination and other forms of disadvantage. In the current neoliberal political-economic context, health inequities are produced and sustained by the inequitable distribution of social determinants of health and structural inequities such as discrimination and institutional racism. Even in the context of healthcare organizations with an explicit commitment to health equity, multiple intersecting discourses, such as ongoing efficiency discourses, and culturalist and racialized discourses, are in constant interaction with healthcare practices at the point of care and the organizational level, limiting providers’ and organizations’ capacities to address structural inequities. Attention to discourses that sustain inequities in health care is required to mitigate health inequities and related power differentials. In this paper, we present findings from a critical analysis of the relations among multiple discourses and healthcare practices within four Canadian primary health care clinics that have an explicit commitment to health equity. Methods Informed by critical theoretical perspectives and critical discourse analysis principles, we conducted an analysis of 31 in-depth interviews with clinic staff members. The analysis focused on the relations among discourses and healthcare practices, the ways in which competing discourses influence, reinforce, and challenge current practices, and how understanding these dynamics can be enlisted to promote health equity. Results We articulate the findings through three interrelated themes: equity-mandated organizations are positioned as the “other” in the health care system; discourses align with structures and policies to position equity at the margins of health care; staff and organizations navigate competing discourses through hybrid approaches to care. Conclusions This study points to the ways in which multiple discourses interact with healthcare organizations’ and providers’ practices and highlights the importance of structural changes at the systemic level to foster health equity at the point of care.

scholarly journals Workforce in the pharmaceutical services of the primary health care of SUS, Brazil

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Marselle Nobre Carvalho ◽  
Juliana Álvares ◽  
Karen Sarmento Costa ◽  
Augusto Afonso Guerra Junior ◽  
Francisco de Assis Acurcio ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Pearson Correlation ◽  
Pharmaceutical Services ◽  
Categorical Variables ◽  
Cross Sectional ◽  
Primary Health ◽  
Geographical Regions ◽  
Municipal Management ◽  
Workforce Composition

OBJECTIVE: To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS: This is a cross-sectional and quantitative study, with data from 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). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country’s regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables. RESULTS: We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions. CONCLUSIONS: The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health

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