scholarly journals Continuity of care and delivery of diabetes and hypertensive care among regular users of primary care services in Chile: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e027830
Author(s):  
Javiera Leniz ◽  
Martin C Gulliford
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Cross Sectional Study ◽  
Self Report ◽  
Secondary Outcome ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services

ObjectivesExplore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control.DesignCross-sectional study.SettingData from the Chilean Health National Survey 2009–2010.ParticipantsRegular users of primary care services aged 15 or older.Primary and secondary outcome measuresProportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression.Results3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8–12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients.ConclusionsContinuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.

Primary care services provided to adolescents in detention: a cross-sectional study using ICPC-2

2010 ◽  
Vol 99 (7) ◽  
pp. 1060-1064 ◽  
Author(s):  
DM Haller ◽  
P Sebo ◽  
B Cerutti ◽  
D Bertrand ◽  
A Eytan ◽  
...  
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services

scholarly journals Experiences of adult patients using primary care services in Poland – a cross-sectional study in QUALICOPC study framework

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Marek Oleszczyk ◽  
Anna Krztoń-Królewiecka ◽  
Willemijn L. A. Schäfer ◽  
Wienke G. W. Boerma ◽  
Adam Windak
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services

scholarly journals Prevalence and coprevalence of chronic comorbid conditions in patients with type 2 diabetes in Catalonia: a population-based cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031281 ◽  
Author(s):  
Manel Mata-Cases ◽  
Josep Franch-Nadal ◽  
Jordi Real ◽  
Marta Cedenilla ◽  
Didac Mauricio
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional

ObjectivesTo evaluate the prevalence and coprevalence of several chronic conditions in patients with type 2 diabetes in a Mediterranean region.DesignA cross-sectional study.SettingTwo hundred and eighty-six primary care teams of the Catalonian Health Institute (Catalonia, Spain).ParticipantsWe included patients aged ≥18 years with a diagnosis of type 2 diabetes by 31 December, 2016, who were registered in the Information System for the Development of Research in primary care (SIDIAP) database. We excluded patients with a diagnosis of type 1 diabetes, gestational diabetes mellitus and any other type of diabetes.Primary and secondary outcome measuresWe collected data on diabetes-related comorbidities (ie, chronic complications, associated cardiovascular risk factors and treatment complications). Diagnoses were based on the International Classification of Diseases, 10thRevision codes recorded in the database or, for some entities, on the cut-off points for a particular test result or a specific treatment indicated for that entity. The presence and stage of chronic kidney disease (CKD) were based on the glomerular filtration rate, the CKD Epidemiology Collaboration creatinine equation and the urine albumin-to-creatinine ratio.ResultsA total of 373 185 patients were analysed. 82% of patients exhibited ≥2 comorbidities and 31% exhibited ≥4 comorbidities. The most frequent comorbidities were hypertension (72%), hyperlipidaemia (60%), obesity (45%), CKD (33%), chronic renal failure (CRF)(28%) and cardiovascular disease (23%). The most frequently coprevalent pairs of chronic conditions were the combination of hypertension with hyperlipidaemia (45%), obesity (35%), CKD (28%), CRF (25%) or cardiovascular disease (19%), as well as the combination of hyperlipidaemia with obesity (28%), CKD (21%), CRF (18%) or cardiovascular disease (15%); other common pairs of comorbidities were obesity/CKD, obesity/CRF, hypertension/retinopathy, hypertension/albuminuria, hypertension/urinary tract infection, CVD/CRF and CVD/CKD, which were each present in more than 10% of patients.ConclusionPatients with type 2 diabetes have a high frequency of coprevalence of metabolic risk factors, cardiovascular disease and CKD and thus require an integrated management approach.

scholarly journals Public subsidies and the recommendation of child vaccines among primary care physicians: a nationwide cross-sectional study in Japan

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020923
Author(s):  
Yuta Sakanishi ◽  
Yosuke Yamamoto ◽  
Megumi Hara ◽  
Norio Fukumori ◽  
Yoshihito Goto ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Multiple Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
Childhood Vaccination ◽  
Secondary Outcome ◽  
Hpv Vaccines ◽  
Sectional Study ◽  
Cross Sectional ◽  
Public Subsidies

ObjectiveAlthough public subsidies and physician recommendations for vaccination play key roles in increasing childhood vaccination coverage, the association between them remains uncertain. This study aimed to identify the association between awareness of public subsidies and recommendations forHaemophilus influenzaetype b (Hib),Streptococcus pneumoniae(pneumococcal conjugate vaccine (PCV)) and human papillomavirus (HPV) vaccinations among primary care physicians in Japan.DesignThis is a cross-sectional study.SettingIn 2012, a questionnaire was distributed among 3000 randomly selected physicians who were members of the Japan Primary Care Association.ParticipantsFrom the questionnaire, participants were limited to physicians who administered childhood vaccinations.Primary and secondary outcome measuresThe primary measures were participants’ awareness of public subsidies and their recommendation levels for Hib, PCV and HPV vaccines. Multiple logistic regression analysis was performed to investigate the association between awareness and recommendation, with adjustment for possible confounders.ResultsThe response rate was 25.8% (743/2880). Of 743 physician respondents, 434 were included as analysis subjects. The proportions of those who recommended vaccinations were 57.1% for Hib, 54.1% for PCV and 58.1% for HPV. For each vaccine, multivariable analyses showed physicians who were aware of the subsidy were more likely to recommend vaccination than those who were not aware: the adjusted ORs were 4.21 (95% CI 2.47 to 7.15) for Hib, 4.96 (95% CI 2.89 to 8.53) for PCV and 4.17 (95% CI 2.00 to 8.70) for HPV.ConclusionsPrimary care physicians’ awareness of public subsidies was found to be associated with their recommendations for the Hib, PCV and HPV vaccines. Provision of information about public subsidies to these physicians may increase their likelihood to recommend vaccination.

scholarly journals Assessment of public oral healthcare services in Curitiba, Brazil: a cross-sectional study using the Primary Care Assessment Tool (PCATool)

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023283 ◽  
Author(s):  
Antonio Carlos Nascimento ◽  
Simone Tetü Moysés ◽  
Renata Iani Werneck ◽  
Marilisa Carneiro Leão Gabardo ◽  
Samuel Jorge Moysés
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Assessment Tool ◽  
Healthcare Services ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services ◽  
Care Assessment ◽  
Primary Care Assessment Tool

ObjectivesTo compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as ‘conventional’ healthcare (CHC), regarding the presence and extent of the attributes of ‘good’ primary healthcare (PHC). The null hypothesis of this study is that the attributes do not differ between the FHS and CHC.DesignCross-sectional.SettingPublic PHC services in Curitiba, the state capital of Paraná.ParticipantsPHC users of the public oral health network (n=900) and dentists active in this municipal network (n=203).Primary and secondary outcome measuresThe Primary Care Assessment Tool (PCATool)-Dentists and PCATool-Users were used to analyse the primary outcomes (‘essential’ attributes) and secondary outcomes (‘derived’ attributes) in the PHC.ResultsOverall, the primary care services in oral health were well evaluated, both by users and by dentists, with mean scores ascribed to PHC attributes mostly above the cut-off point (6.6). The exception for users were affiliation (6.36; 95% CI 6.11 to 6.60) and accessibility (5.83; 95% CI 5.78 to 5.89); and for dentists the accessibility (5.80; 95% CI 5.63 to 5.96). When comparing FHS and CHC, there was a superiority of the FHS model, which reached a general mean score of 7.53 (95% CI 7.48 to 7.58) among users and 7.56 (95% CI 7.45 to 7.67) among dentists; on the other hand, the CHC general mean score was of 6.61 (95% CI 6.49 to 6.73) and 6.68 (95% CI 6.56 to 6.80) respectively for users and dentists.ConclusionsThe results reveal a reasonable level of attainment of PHC attributes in the services investigated. Nevertheless, public health managers should make efforts to reduce the difficulties faced by users in accessing dental care. The more positive results achieved by FHS services indicate that the provision of oral healthcare under this strategy should be expanded.

scholarly journals Effect of involving certified healthcare assistants in primary care in Germany: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033325
Author(s):  
Jonas D Senft ◽  
Michel Wensing ◽  
Regina Poss-Doering ◽  
Joachim Szecsenyi ◽  
Gunter Laux
Keyword(s):  
Primary Care ◽  
Professional Education ◽  
Claims Data ◽  
Hospital Admissions ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Consultation Rate ◽  
Cross Sectional ◽  
Medication Costs

ObjectivesGrowing prevalence of chronic diseases and limited resources are the key challenges for future healthcare. As a promising approach to maintain high-quality primary care, non-physician healthcare professionals have been trained to broaden qualifications and responsibilities. This study aimed to assess the influence of involving certified healthcare assistants (HCAs, German: Versorgungsassistent/in in der Hausarztpraxis) on quality and efficacy of primary care in Germany.DesignCross-sectional study.SettingPrimary care.ParticipantsPatients insured by the Allgemeine Ortskrankenkasse (AOK) statutory health insurer (AOK, Baden-Wuerttemberg, Germany).InterventionsSince 2008 practice assistants in Germany can enhance their professional education to become certified HCAs.Primary and secondary outcome measuresClaims data related to patients treated in practices employing at least one HCA were compared with data from practices not employing HCAs to determine frequency of consultations, hospital admissions and readmissions. Economic analysis comprised hospitalisation costs, prescriptions of follow-on drugs and outpatient medication costs.ResultsA total of 397 493 patients were treated in HCA practices, 463 730 patients attended to non-HCA practices. Patients in HCA practices had an 8.2% lower rate of specialist consultations (p<0.0001), a 4.0% lower rate of hospitalisations (p<0.0001), a 3.5% lower rate of readmissions (p=0.0463), a 14.2% lower rate of follow-on drug prescriptions (p<0.0001) and 4.7% lower costs of total medication (p<0.0001). No difference was found regarding the consultation rate of general practitioners and hospital costs.ConclusionsFor the first time, this high-volume claims data analysis showed that involving HCAs in primary care in Germany is associated with a reduction in hospital admissions, specialist consultations and medication costs. Consequently, broadening qualifications may be a successful strategy not only to share physicians’ work load but to improve quality and efficacy in primary care to meet future challenges. Future studies may explore specific tasks to be shared with non-physician workforces and standardisation of the professional role.

scholarly journals Primary care doctor and nurse consultations among people who live in slums: a retrospective, cross-sectional survey in four countries

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e054142
Author(s):  
Keyword(s):  
Primary Care ◽  
Traditional Healers ◽  
Primary Care Doctor ◽  
Secondary Outcome ◽  
Health Seeking ◽  
Provider Type ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services

ObjectivesTo survey on the availability and use of primary care services in slum populations.DesignRetrospective, cross-sectional, household, individual and healthcare provider surveys.SettingSeven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh).ParticipantsResidents of slums and informal settlements.Primary and secondary outcome measuresPrimary care consultation rates by type of provider and facility.ResultsWe completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household’s monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%–78%) and service quality (31%–95%) being a reason for choosing a provider than fees (23%–43%). Demand was relatively inelastic with respect to both price of consultation and travel time.ConclusionsPeople in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.

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