Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

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Availability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda

South African Family Practice ◽

10.4102/safp.v63i1.5118 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Innocent K. Besigye ◽

Vicent Okuuny ◽

Mari Armstrong-Hough ◽

Anne R. Katahoire ◽

Nelson K. Sewankambo ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Point Of Care ◽

Primary Care Providers ◽

Health Facilities ◽

Health Providers ◽

Care Providers ◽

Tororo District ◽

Key Informant ◽

Care Facilities

Background: Early diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda.Methods: This was an explanatory sequential mixed-methods study combining a structured facility checklist and key informant interviews with primary care providers. The checklist was used to collect data on availability and functionality of BP machines within their organisational arrangements. Key informant interviews explored health providers’ access to BP machines.Results: The majority of health facilities reported at least one working BP machine. However, Health providers described limited access to machines because they are not located at each point of care. Health providers reported borrowing amongst themselves within their respective units or from other units within the facility. Some health providers purchase and bring their own BP machines to the health facilities or attempted to restore the functionality of broken ones. They are motivated to search the clinic for BP machines for some patients but not others based on their perception of the patient’s risk for hypertension.Conclusion: Access to BP machines at the point of care was limited. This makes hypertension screening selective based on health providers’ perception of the patients’ risk for hypertension. Training in proper BP machine use and regular maintenance will minimise frequent breakdowns.

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Who is not linked to primary care public health facilities for cardiovascular disease prevention, and why-not: A community based follow up study from urban slums in India

10.1101/2020.09.21.20198622 ◽

2020 ◽

Author(s):

Abhijit P Pakhare ◽

Ankur Joshi ◽

Rasha Anwar ◽

Khushbu Dubey ◽

Sanjeev Kumar ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Treatment Initiation ◽

Health Centre ◽

Health Facilities ◽

Community Based ◽

Public Health Facilities

We designed and conducted a community based longitudinal study in 16 urban slum clusters in context of a community health worker (CHW) led screening and preventive therapy initiation initiative for CVD prevention. Linkage to public health systems primary care facilities was a key outcome indicator for this initiative. In this paper, we have investigated predictors and barriers to non-linkage. CHWs screened all adults aged 30 years through for hypertension as well as diabetes. Referrals were advised and facilitated to nearby Urban Primary Health Centre (PHC) clinic for either treatment initiation or continuation or optimization. CHWs screened a total of 6174 individuals, and physicians identified 1449 participants (23.46%; 95% CI 22.42-24.54) as high-risk who required linkage to public-health facilities for pharmacotherapy . Out of these, 943(65%) attended health facilities with 801(55.2 %) being adherent to pharmacotherapy. Those who were not linked were young men belonging to low socio-economic position, living farther from UPHC, engaged late by CHW and identified to be in denial mode and reported lack of family support. This study highlights importance of early engagement through CHWs after positive screening, necessity to address denial of newly diagnosed and increase male participation in order to reduce detection to treatment initiation gap. Keywords- hypertension, diabetes, adherence, community health worker, cardio vascular diseases, population-based screening

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Professional Commitment and Its Associated Factors among Institutional Delivery Services Providers in Public Health Facilities, In Shone District, Southern Ethiopia

Women Health Care and Issues ◽

10.31579/2642-9756/102 ◽

2022 ◽

Vol 5 (1) ◽

pp. 01-08

Author(s):

Melaku Wolde Anshebo ◽

Tesfaye Gobeana Tessema ◽

Yosef Haile Gebremariam

Keyword(s):

Public Health ◽

Institutional Delivery ◽

Personal Characteristics ◽

Obstetric Care ◽

Health Facilities ◽

Professional Commitment ◽

Southern Ethiopia ◽

Care Providers ◽

Public Health Facilities ◽

Delivery Services

Background: There is paucity of information on level of commitment among health professionals attending delivery service in public health facilities of low-income countries including Ethiopia. Hence, the aim of this study is to assess the level and factors associated with professional commitment among institutional delivery services providers at public health facilities in Shone District, Southern Ethiopia. Methods: A facility-based cross-sectional study design was conducted at primary level public health facilities in Shone District. All health facilities (one primary hospital and 7 health centers) were included in the study. Five hundred three study participants who fulfilled inclusion criteria in proportion to obstetric care providers in each public health facilities were selected by applying simple random sampling method. Self-administered Likert scale type of questionnaire was used. Data were analyzed using SPSS version 20. Bivariate and multivariable logistic regression analyses were done to see the association between dependent and explanatory variables. Results: The magnitude of professional commitment for obstetric care providers working in public health facilities of Shone district was 69.4%. In this study, those who worked at hospital, those who had positive attitude toward organizational commitment, and those who had positive attitude toward personal characteristics were 2.4, 2.3 and 1.76 times more likely committed to profession compared with their counterparts respectively. Conclusion: The professional commitment among institutional delivery service provision was medium as compared to other study finding. All health professional should manage their own personal characteristics to behave in good way to be committed for their profession. Organizational commitment had great influence on professional commitment.

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Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101049 ◽

2018 ◽

Vol 10 (3) ◽

pp. 210-216 ◽

Cited By ~ 3

Author(s):

Lauren White ◽

Ali Azzam ◽

Lauren Burrage ◽

Clare Orme ◽

Barbara Kay ◽

...

Keyword(s):

Primary Care ◽

Secondary Care ◽

Transient Elastography ◽

Liver Stiffness ◽

Primary Care Providers ◽

Treatment Recommendation ◽

Care Providers ◽

Hcv Treatment ◽

Community Based

BackgroundAustralia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care.ObjectivesIn order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.DesignRetrospective analysis of a prospectively recorded HCV treatment database.InterventionsA nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care.Results327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38–56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%.ConclusionCommunity-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

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Redefining the Care Continuum to Create a Pipeline to Dementia Care for Minority Populations

Journal of Primary Care & Community Health ◽

10.1177/2150132720921680 ◽

2020 ◽

Vol 11 ◽

pp. 215013272092168

Author(s):

Tina R. Sadarangani ◽

Vanessa Salcedo ◽

Joshua Chodosh ◽

Simona Kwon ◽

Chau Trinh-Shevrin ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Primary Care ◽

Alzheimer's Disease ◽

Asian American ◽

Minority Groups ◽

Primary Care Providers ◽

Dementia Care ◽

Care Providers ◽

Community Based ◽

Community Based Organizations

Multiple studies show that racial and ethnic minorities with low socioeconomic status are diagnosed with Alzheimer’s disease and Alzheimer’s disease–related dementias (AD/ADRD) in more advanced disease stages, receive fewer formal services, and have worse health outcomes. For primary care providers confronting this challenge, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups. The New York University Center for the Study of Asian American Health, set out to culturally adapt and translate The Kickstart-Assess-Evaluate-Refer (KAER) framework created by the Gerontological Society of America to support earlier detection of dementia in Asian American communities and assist in this community-clinical coordinated care. We found that CBOs play a vital role in dementia care, and are often the first point of contact for concerns around cognitive impairment in ethnically diverse communities. A major strength of these centers is that they provide culturally appropriate group education that focuses on whole group quality of life, rather than singling out any individual. They also offer holistic family-centered care and staff have a deep understanding of cultural and social issues that affect care, including family dynamics. For primary care providers confronting the challenge of delivering evidence-based dementia care in the context of the busy primary care settings, community-based organizations can be key partners in supporting earlier identification of AD/ADRD and earlier entry into treatment, especially for minority groups.

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Is the Far West Mental Health Integration Project Making a Difference? The General Practitioner Perspective

Australian Journal of Primary Health ◽

10.1071/py05040 ◽

2005 ◽

Vol 11 (3) ◽

pp. 32 ◽

Cited By ~ 1

Author(s):

David Perkins ◽

David Lyle

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Primary Care Providers ◽

Care Staff ◽

Care Providers ◽

Community Based ◽

Mental Health Integration ◽

Integration Project ◽

The Impact

This paper reports on the evaluation of an Australian Government and NSW State funded Mental Health Integration Project in remote far western NSW. The project was part of the Mental Health Integration Program, developed from the Second National Mental Health Plan. The project implemented a model of community-based mental health services and used innovative financing arrangements to allow the provision of community-based specialist mental health teams to remote communities and to recruit visiting psychiatrists to support the local primary care providers. The evaluation strategy included a survey of general practitioners (GPs) in the Upper Western Sector and Broken Hill, designed to investigate their level and type of contact with psychiatrists and community-based specialist mental health care teams, their perceptions about the impact of the new services, and their interest in further professional development in mental health care.The project has shown that visiting specialists can be deployed in a primary care setting with a focus on meeting the needs of local GPs, primary health care staff and their patients.

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Lack of harms from community-based melanoma screening by primary care providers

Cancer ◽

10.1002/cncr.30194 ◽

2016 ◽

Vol 122 (20) ◽

pp. 3102-3105

Author(s):

Clara Curiel-Lewandrowski ◽

Susan M. Swetter

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Care Providers ◽

Community Based ◽

Melanoma Screening

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Public Health Detailing of Primary Care Providers: New York City’s Experience, 2003–2010

American Journal of Public Health ◽

10.2105/ajph.2011.300622 ◽

2012 ◽

Vol 102 (S3) ◽

pp. S342-S352 ◽

Cited By ~ 9

Author(s):

Michelle G. Dresser ◽

Leslie Short ◽

Laura Wedemeyer ◽

Victoria Lowerson Bredow ◽

Rachel Sacks ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

New York ◽

Primary Care Providers ◽

Care Providers

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Use of Pharmacotherapies in the Treatment of Alcohol Use Disorders and Opioid Dependence in Primary Care

BioMed Research International ◽

10.1155/2015/137020 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Jinhee Lee ◽

Thomas F. Kresina ◽

Melinda Campopiano ◽

Robert Lubran ◽

H. Westley Clark

Keyword(s):

Public Health ◽

Primary Care ◽

Substance Use ◽

Alcohol Use ◽

Opioid Dependence ◽

Alcohol Use Disorders ◽

Primary Care Providers ◽

Care Providers ◽

Addictive Disorders ◽

Care And Treatment

Substance-related and addictive disorders are chronic relapsing conditions that substantially impact public health. Effective treatments for these disorders require addressing substance use/dependence comprehensively as well as other associated comorbidities. Comprehensive addressing of substance use in a medical setting involves screening for substance use, addressing substance use directly with the patient, and formulating an appropriate intervention. For alcohol dependence and opioid dependence, pharmacotherapies are available that are safe and effective when utilized in a comprehensive treatment paradigm, such as medication assisted treatment. In primary care, substance use disorders involving alcohol, illicit opioids, and prescription opioid abuse are common among patients who seek primary care services. Primary care providers report low levels of preparedness and confidence in identifying substance-related and addictive disorders and providing appropriate care and treatment. However, new models of service delivery in primary care for individuals with substance-related and addictive disorders are being developed to promote screening, care and treatment, and relapse prevention. The education and training of primary care providers utilizing approved medications for the treatment of alcohol use disorders and opioid dependence in a primary care setting would have important public health impact and reduce the burden of alcohol abuse and opioid dependence.

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