Perspectives in Primary Care: Learning from Doing: Progression to Primary Health Care within a National Health Programme. A Case Study from Tanzania

1988 ◽  
Vol 34 (1) ◽  
pp. 4-11 ◽  
Author(s):  
G. J. Ebrahim ◽  
A Kaingo ◽  
A. Twaha
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
National Health ◽  
Primary Health ◽  
Health Programme

scholarly journals The Future of Health Care: Protocol for Measuring the Potential of Task Automation Grounded in the National Health Service Primary Care System (Preprint)

2018 ◽  
Author(s):  
Matthew Willis ◽  
Paul Duckworth ◽  
Angela Coulter ◽  
Eric T Meyer ◽  
Michael Osborne
Keyword(s):  
Machine Learning ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Care Staff ◽  
Primary Health ◽  
The Future

BACKGROUND Recent advances in technology have reopened an old debate on which sectors will be most affected by automation. This debate is ill served by the current lack of detailed data on the exact capabilities of new machines and how they are influencing work. Although recent debates about the future of jobs have focused on whether they are at risk of automation, our research focuses on a more fine-grained and transparent method to model task automation and specifically focus on the domain of primary health care. OBJECTIVE This protocol describes a new wave of intelligent automation, focusing on the specific pressures faced by primary care within the National Health Service (NHS) in England. These pressures include staff shortages, increased service demand, and reduced budgets. A critical part of the problem we propose to address is a formal framework for measuring automation, which is lacking in the literature. The health care domain offers a further challenge in measuring automation because of a general lack of detailed, health care–specific occupation and task observational data to provide good insights on this misunderstood topic. METHODS This project utilizes a multimethod research design comprising two phases: a qualitative observational phase and a quantitative data analysis phase; each phase addresses one of the two project aims. Our first aim is to address the lack of task data by collecting high-quality, detailed task-specific data from UK primary health care practices. This phase employs ethnography, observation, interviews, document collection, and focus groups. The second aim is to propose a formal machine learning approach for probabilistic inference of task- and occupation-level automation to gain valuable insights. Sensitivity analysis is then used to present the occupational attributes that increase/decrease automatability most, which is vital for establishing effective training and staffing policy. RESULTS Our detailed fieldwork includes observing and documenting 16 unique occupations and performing over 130 tasks across six primary care centers. Preliminary results on the current state of automation and the potential for further automation in primary care are discussed. Our initial findings are that tasks are often shared amongst staff and can include convoluted workflows that often vary between practices. The single most used technology in primary health care is the desktop computer. In addition, we have conducted a large-scale survey of over 156 machine learning and robotics experts to assess what tasks are susceptible to automation, given the state-of-the-art technology available today. Further results and detailed analysis will be published toward the end of the project in early 2019. CONCLUSIONS We believe our analysis will identify many tasks currently performed manually within primary care that can be automated using currently available technology. Given the proper implementation of such automating technologies, we expect considerable staff resources to be saved, alleviating some pressures on the NHS primary care staff. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11232

scholarly journals Measuring the quality of primary care in national health surveys: Lessons from Brazil

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Erno Harzheim ◽  
Luiz F. Pinto ◽  
Otávio P. D'Avila ◽  
Lisiane Hauser
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
National Health ◽  
Assessment Tool ◽  
Household Survey ◽  
Ministry Of Health ◽  
Primary Health ◽  
Care Assessment

Background: South Africa started to lead the cross-culturally validation and use of the Primary Care Assessment Tool (PCAT) in Africa, when Professor Bresick filled a gap, as this continent was until then the only one that had never used it in evaluation of primary health care facilities until 2015.Aim: The authors aim to demonstrate that after the consolidation of Bresick’s team to an African version of PCAT, it had been adapted to household survey in Brazil.Methods: In this letter, authors reflect on how Brazil had adapted PCAT to a national random household survey with Brazilian National Institute of Geography and Statistics (IBGE) – the Brazilian Census Bureau.Results: In the the beginning of 2019, Brazilian Ministry of Health brought back the PCAT as the official national primary health care assessment tool. Brazilian National Institute of Geography and Statistics (IBGE) included a new module (set of questions) in its National Health Survey (PNS-2019) and collected more than 100 000 households interviews in about 40% of the country’s municipalities. This module had 25 questions of the Brazilian validated version of the adult reduced PCAT.Conclusion: We believe that IBGE innovation with the Ministry of Health can encourage South Africa to establish a similar partnership with its National Institute of Statistics (Statistics South Africa) for the country to establish a baseline for future planning of primary health care, for decision-making based on scientific evidence.

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.

Impact of Budget Increase and Primary health care Performance in the Era of National Health Insurance: Case Study in the Buleleng District

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Kadek Suranugraha ◽  
Ni Made Sri Nopiyani ◽  
Pande Putu Januraga
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Negative Impact ◽  
Positive Impact ◽  
Primary Health ◽  
Budget Increase

Since 2014, there has been an increase in funds for primary health care (PHC) coming from the National Health Insurance (NHI) program capitation funds and the Health Operational Assistance Fund (HOAF). This study aimed to explore the effect of this budget increase on the health care services at PHC. The case study used a qualitative approach and interviews from 19 PHC health workers with the highest and lowest budget. Data were analyzed using thematic analysis and supported by quantitative data. The positive impact of the increasing PHC budget was felt by PHC staff due to the addition of operational equipment and incentives provided. Nevertheless, there was also a negative impact such as feeling overwhelmed due to an increase in the quantity of PHC activities and additional administrative affairs. It also triggered a negative interaction between staff due to the number of incentives received. The regulation on the use of budget empowers PHC to better arrange the schedule of activities and manage human resources. However, these regulations are considered restrictive and the administrative flow of funds is too long that hinder the optimal use of the budget.

scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Portugal

2020 ◽  
Vol 18 (3) ◽  
pp. 2043
Author(s):  
Nadine Ribeiro ◽  
Helder Mota-Filipe ◽  
Mara P. Guerreiro ◽  
Filipa A. Costa
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Community Pharmacy ◽  
National Health ◽  
Health Care Policy ◽  
Universal Coverage ◽  
Health Coverage ◽  
Primary Health ◽  
Clinical Records

The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes.

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 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.

A comprehensive public mental health programme in Guinea-Bissau: a useful model for African, Asian and Latin-American countries

1996 ◽  
Vol 26 (1) ◽  
pp. 97-108 ◽  
Author(s):  
Joop T. V. M. De Jong
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Workers ◽  
Public Mental Health ◽  
Diagnostic Sensitivity ◽  
Primary Health ◽  
Mental Health Programme ◽  
Care Workers ◽  
Health Programme

SynopsisFrom 1983–1994 a community mental health programme was set up in Guinea-Bissau. The first part of the programme concentrated on epidemiological aspects: rural and urban study areas were selected on socio-economic level and participation in the liberation war. A two-stage design was used to screen 351 adult consecutive general health care attenders and 100 children in a rural and an urban area for mental disorder. Psychiatric disorders have a morbidity of 12% among adults seen in Primary Health Care. Disorders were mainly neuroses (74%), but more psychoses were found than in other countries. No statistically significant difference in morbidity was found between rural-urban areas or between previous war and non-war zones. The diagnostic sensitivity of the Primary Health Care workers was 31%, their diagnostic specificity 88%. Thirteen per cent of the children showed neuropsychiatric disturbances. There were no sociocultural impediments to this public mental health approach. During the following intervention programme 850 Primary Health Care workers were trained and supervised nationwide. The diagnostic sensitivity of major mental disorders and epilepsy increased from 31% to an average of 85%. Before the training, their knowledge of the treatment of these disorders was nil whereas after training 82% of the patients received appropriate treatment. Moreover, this model programme shows a profitable cost/benefit ratio and a high sustainability over the last 10 years.

scholarly journals Cross-cultural adaptation of the primary health care satisfaction questionnaire

2014 ◽  
Vol 27 (5) ◽  
pp. 419-426 ◽  
Author(s):  
Elisabete Pimenta Araujo Paz ◽  
Pedro Miguel Santos Dinis Parreira ◽  
Alexandrina de Jesus Serra Lobo ◽  
Rosilene Rocha Palasson ◽  
Sheila Nascimento Pereira de Farias
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Cultural Adaptation ◽  
Care Service ◽  
Cross Cultural ◽  
Care Services ◽  
Primary Health

Objective To develop the cross-cultural validation and assessment of the psychometric properties of the Questionnaire about the quality and satisfaction dimensions of patients with primary health care. Methods Methodological cultural adaptation and assessment study of the psychometric properties, involving 398 users from a primary care service. The construct validity was verified through principal components factor analysis and internal consistency assessment as determined by Cronbach’s alpha, using SPSS. Results A factorial structure was identified that is equivalent to the original instrument, showing six factors that explain 70.81% of the total variance. All internal consistency coefficients were higher than 0.84, indicating appropriate psychometric properties. Conclusion The results show that the Brazilian Portuguese version of the instrument is culturally and linguistically appropriate to assess the satisfaction of users attended in primary care services.

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