scholarly journals Antibiotic overuse in the primary health care setting: a secondary data analysis of standardised patient studies from India, China and Kenya

2020 ◽  
Vol 5 (9) ◽  
pp. e003393
Author(s):  
Giorgia Sulis ◽  
Benjamin Daniels ◽  
Ada Kwan ◽  
Sumanth Gandra ◽  
Amrita Daftary ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Rural Areas ◽  
Secondary Data ◽  
Prevalence Ratio ◽  
Watery Diarrhoea ◽  
Healthcare Sector ◽  
Antibiotic Prescribing ◽  
Antibiotic Overuse ◽  
Primary Care Settings

IntroductionDetermining whether antibiotic prescriptions are inappropriate requires knowledge of patients’ underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions.MethodsSecondary analyses of data from nine SP studies were performed to estimate the proportion of SP–provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overprescribing by healthcare sector, location, provider qualification and case. The WHO Access–Watch–Reserve framework was used to categorise antibiotics based on their potential for selecting resistance. As richer data were available from India, we examined factors associated with antibiotic overuse in that country through hierarchical Poisson models.ResultsAcross health facilities, antibiotics were given inappropriately in 2392/4798 (49.9%, 95% CI 40.8% to 54.5%) interactions in India, 83/166 (50.0%, 95% CI 42.2% to 57.8%) in Kenya and 259/899 (28.8%, 95% CI 17.8% to 50.8%) in China. Prevalence ratios of antibiotic overuse in India were significantly lower in urban versus rural areas (adjusted prevalence ratio (aPR) 0.70, 95% CI 0.52 to 0.96) and higher for qualified versus non-qualified providers (aPR 1.55, 95% CI 1.42 to 1.70), and for presumptive TB cases versus other conditions (aPR 1.19, 95% CI 1.07 to 1.33). Access antibiotics were predominantly used in Kenya (85%), but Watch antibiotics (mainly quinolones and cephalosporins) were highly prescribed in India (47.6%) and China (32.9%).ConclusionGood-quality SP data indicate alarmingly high levels of antibiotic overprescription for key conditions across primary care settings in India, China and Kenya, with broad-spectrum agents being excessively used in India and China.

scholarly journals Parental Activation and Obesity-Related Health Behaviors Among a Racially and Ethnically Diverse Population of Low-Income Pediatric Patients: Protocol for a Cross-Sectional Survey Study (Preprint)

2017 ◽  
Author(s):  
Nakiya N Showell ◽  
Corinna Koebnick ◽  
Lisa R DeCamp ◽  
Margo Sidell ◽  
Tatiahna Rivera Rodriguez ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Care ◽  
Health Behaviors ◽  
Health Systems ◽  
Low Income ◽  
Screen Time ◽  
Aged Patients ◽  
Cross Sectional ◽  
Primary Care Settings

BACKGROUND Despite a recent decline in the obesity prevalence among preschool-aged children, obesity remains disproportionately high among children from low-income racial or ethnic minority families. Promoting healthy lifestyles (eg, obesity-preventative behaviors) in primary care settings is particularly important for young children, given the frequency of preventative health visits and parent-provider interactions. Higher adoption of specific health behaviors is correlated with increased patient activation (ie, skill, confidence, and knowledge to manage their health care) among adults. However, no published study, to date, has examined the relationship between parental activation and obesity-related health behaviors among young children. OBJECTIVE The goal of this study is to measure parental activation in low-income parents of preschoolers in 2 large health systems and to examine the association with diet, screen-time, and physical activity behaviors. METHODS We will conduct a cross-sectional study of parents of preschool-aged patients (2-5 years) receiving primary care at multiple clinic sites within 2 large health care systems. Study participants, low-income black, Hispanic, and white parents of preschool-aged patients, are being recruited across both health systems to complete orally administered surveys. RESULTS Recruitment began in December 2017 and is expected to end in May 2018. A total of 267 low-income parents of preschool-aged children have been enrolled across both clinic sites. We are enrolling an additional 33 parents to reach our goal sample size of 300 across both health systems. The data analysis will be completed in June 2018. CONCLUSIONS This protocol outlines the first study to fully examine parental activation and its relationship with parent-reported diet, physical activity, and screen-time behaviors among low-income preschool-aged patients. It involves recruitment across 2 geographically distinct areas and resulting from a partnership between researchers at 2 different health systems with multiple clinical sites. This study will provide new knowledge about how parental activation can potentially be incorporated as a strategy to address childhood obesity disparities in primary care settings. INTERNATIONAL REGISTERED REPOR RR1-10.2196/9688

scholarly journals Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0259065
Author(s):  
Yue Chang ◽  
Yuanfan Yao ◽  
Zhezhe Cui ◽  
Guanghong Yang ◽  
Duan Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Intervention Group ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Feedback Intervention ◽  
Primary Care Settings ◽  
Cluster Randomised ◽  
Prescription Rates

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.

Exploring the social ecology for appropriate antibiotic prescribing and stewardship in primary care: presenting the VALUE driven model of practice derived from qualitative analysis of public and private care settings in Singapore

2021 ◽  
Author(s):  
Huiling Guo ◽  
Zoe Jane-Lara Hildon ◽  
Victor Weng Keong Loh ◽  
Meena Sundram ◽  
Muhamad Alif Bin Ibrahim ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Care Delivery ◽  
Antibiotic Prescribing ◽  
Publicly Funded ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Optimal Care ◽  
Public And Private ◽  
Primary Care Settings

Abstract Background: Singapore’s healthcare system allows both antibiotic prescribing and dispensing across public and private primary care settings, presenting an ideal context to learn from systems where dispensing is closely tied to diverse operational models and funding mechanisms. Aim: To explore processes underpinning decision-making for antibiotic prescribing by primary care doctors in Singapore, by examining doctors’ experiences in different primary care settings. Methods: Thirty semi-structured interviews were conducted with 17 doctors working in publicly funded primary care clinics (polyclinics) and 13 doctors working in private general practitioner (GP) clinics (solo, small group and large group practices). Interviews were audio-recorded and transcribed verbatim. Data were analysed using applied thematic analysis. Results: Given the lack of National Guidelines for antibiotic prescribing in the Singapore context, this practice is currently non-standardised in both private and publicly funded primary care settings. Themes contributing to best practice narratives relate to having independent funding sources and control over drug formulary orders, and valuing reduction in antimicrobial resistance (AMR). The existence of trusting patient-doctor relationships, and reasonable patient loads were observed to allow joint participatory and informed decision-making that further enabled appropriate prescribing. The importance of monitoring and application of data/evaluations to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery.Conclusions: A model for appropriate antibiotic prescribing-related interventions needs to prioritise addressing and shaping organisational and personal Valuing of AMR reduction. These values have to also Align with wider systemic constraints experienced in publicly funded institutions, operational management of private clinics and interactions with patients at the interpersonal level. The overcoming of such constraints and allowing time for patient Liaison and trust building will crystalise these earlier initiatives. Use of data to monitor and Evaluate antibiotic prescribing, informing optimal delivery systems should be routinely shared for transparency and to improve prescribing practices. These dimensions are summarised in the VALUE model for appropriate antibiotic prescribing and stewardship in primary care, which is recommended as transferable to diverse contexts.

Implications of COVID-19 on Healthcare Seeking Behaviour of the Rural-Poor in Ido-Ekiti and Environs. Nigeria

2021 ◽  
Author(s):  
Ogadimma Arisukwu ◽  
Leke Enoch Olaoye ◽  
Chisaa Igbolekwu ◽  
Bamidele Rasak
Keyword(s):  
Rural Areas ◽  
Secondary Data ◽  
Conflict Theory ◽  
Healthcare Sector ◽  
Health Seeking ◽  
Southwestern Nigeria ◽  
Middle Income ◽  
Healthcare Seeking ◽  
General Decline ◽  
Tertiary Healthcare

Abstract Background: Coronavirus disease of 2019 (COVID-19) in low- and middle-income countries (LMICs) is raising serious concerns about effective pandemic response and preparedness in the context of background fragile health systems and especially in developing countries like Nigeria with alarming poverty indices. Aim: The study aimed to reveal the implication of the COVID-19 pandemic on the healthcare seeking behaviour of households experiencing (extreme) poverty and to also infer factors that influence the health-seeking behaviour in the areaMethods: A retrospective and comparative study using secondary data from the major tertiary healthcare centre which serves Ido-Ekiti; a town in southwestern Nigeria and its environs was utilized in this study; it comprises data before and during the pandemic.Results: There was general decline across the clinics (90%) with some clinics having up to 55%, 33% reduction in visits during COVID-19. There was a total 13% drop across board from January to December of 2020 as compared with 2019.Conclusion and Recommendation: The study suggests better enlightenment campaign and more investment in the healthcare sector especially in the rural areas. The conflict theory was adopted.

Scottish Psychiatrists in Primary Health-Care Settings

1988 ◽  
Vol 153 (5) ◽  
pp. 663-666 ◽  
Author(s):  
Ian M. Pullen ◽  
Alex J. Yellowlees
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Care Setting ◽  
Primary Care Setting ◽  
Health Care Settings ◽  
Primary Care Settings ◽  
Practice Experience ◽  
Primary Health ◽  
Similar Survey ◽  
Primary Health Care Settings

There has been a growing number of reports of psychiatrists moving out into primary-care settings. We report a survey of consultant psychiatrists to assess the extent of this practice in Scotland. Some time spent in the primary-care setting was reported by 56%, the figures being highest in rural areas. An equal number of non-consultant medical staff were involved. Most schemes were initiated by psychiatrists, over half of whom had had some postgraduate general-practice experience. A similar survey in England and Wales showed that only 19% of consultant psychiatrists spent time in primary-care settings, a smaller proportion of non-consultant staff being involved. The value of working in primary-care settings has yet to be assessed.

scholarly journals Primary Care Nurse Practitioners and Physicians in Low-Income and Rural Areas, 2010-2016

JAMA ◽  
2019 ◽  
Vol 321 (1) ◽  
pp. 102 ◽  
Author(s):  
Ying Xue ◽  
Joyce A. Smith ◽  
Joanne Spetz
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Low Income ◽  
Rural Areas ◽  
Care Nurse ◽  
Primary Care Nurse

Factor Structure of the Center for Epidemiologic Studies Depression Scale in Low- Income Women Attending Primary Care Clinics

2004 ◽  
Vol 20 (2) ◽  
pp. 106-115 ◽  
Author(s):  
Janet L. Thomas ◽  
Phillip J. Brantley
Keyword(s):  
Primary Care ◽  
Factor Structure ◽  
Low Income ◽  
Factor Model ◽  
Population Sample ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Low Income Women

Given the high rates of major depressive disorder in primary care settings, routine use of screening measures to assist in identifying depressed individuals is warranted. The Center for Epidemiologic Studies Depression Scale (CES-D) ( Radloff, 1977 ) is a self-rated measure of distress commonly used to screen for depression in primary care settings. The present study was undertaken to confirm the original four-factor model in a sample of low-income women attending primary care clinics (N = 179). Although the original four-factor structure has been replicated in a variety of population groups, internal validity of the measure has not been previously examined in this population sample. A series of confirmatory factor analytic procedures failed to replicate the original four-factor structure or a second-order model. An exploratory analysis, using principal components and a VARIMAX rotation yielded three factors: Depressed Affect/Somatic Symptoms, Positive Affect, and Interpersonal Difficulties. Results of this study add support to previous research documenting an increased somatic presentation of depression in low-income samples. Implications for the use of the CES-D as a screening tool to identify depression in similar primary care samples are discussed.

Challenges Faced by B.P.L. Population in Availing Public Healthcare – Analysing Government Initiatives, Technology and Cultural Barriers in Aligarh District, U.P

2021 ◽  
Vol 2 (5) ◽  
pp. 1-19
Author(s):  
Fahad Afzal ◽  
P.S. Raychaudhuri ◽  
Mohd Atif Afzal ◽  
Afaq Amir Ahmad
Keyword(s):  
Public Health ◽  
Data Analysis ◽  
Low Income ◽  
Rural Areas ◽  
Uttar Pradesh ◽  
Secondary Data ◽  
Survey Study ◽  
Public Healthcare ◽  
Cross Sectional Survey ◽  
Low Income Population

Public healthcare and government health initiative have always been in question regarding their availability, efficiency, and quality. This matter most for the poor section of society who have to go through various hurdles to avail the basic treatment, besides financial problems. The aim of this survey study was to analyze the present scenario of public healthcare system and the challenges in availing public healthcare faced by BPL (Below Poverty Line) and low-income population of Uttar Pradesh. A cross-sectional survey (direct interview) of 104 respondents was conducted in March 2021. Thematic analysis of generated qualitative data was done using ATLAS.ti (version 9.0.15). The quantitative data was analyzed by using SPSS (version 22.0.0.0). The respondents were from 2 rural areas near the Aligarh district in UP. The secondary data from published research articles and government sources were also analyzed. Analysis of data revealed there are various challenges faced by low-income population while availing public healthcare services. The nature of challenges has a considerable variation, from lack of information to documents’ unavailability, from technical issues in government schemes to cultural pressure. Data analysis revealed, the majority of respondents (59%) faced one or more types of challenges during treatment from public health facilities. Awareness level is identified as a significant problem among respondents. Analysis of secondary data and literature review revealed uneven resource allocation and discrepancies in government initiatives toward UHC (Universal Health Coverage). Results indicated the contrasting nature of healthcare in Uttar Pradesh. Data analysis revealed the disparity of ‘average OOP travelling expenditure’ for male and female. The correlation analysis revealed that there is negative correlation (y = -0.1377x + 11.119) of ‘age of respondent’ and ‘average satisfaction from public health service’ (r = -0.911; R² = 0.8301). This research article provides the evidence that there exists a communication gap between policymakers and end-users (BPL & low-income section). This article underscored some technical flaw in the UHC policies that act as a barrier for low socio economic and BPL population. This article suggests strategies to control various identified challenges.

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