A survey of the involvement of primary care doctors in HIV prevention and care in a low-prevalence, high-income setting

Abstract Background In high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong’s population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care. Methods A cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants’ level of involvement in HIV prevention and care and their demographics and medical practice characteristics. Results The response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50–59 age group (OR: 2.48, 95% CI: 1.12–5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4–7.12). Conclusions Overall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.

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“We Had to Keep Pushing”: Caregivers' Perspectives on Autism Screening and Referral Practices of Black Children in Primary Care

Intellectual and Developmental Disabilities ◽

10.1352/1934-9556-56.5.321 ◽

2018 ◽

Vol 56 (5) ◽

pp. 321-336 ◽

Cited By ~ 5

Author(s):

Sarah Dababnah ◽

Wendy E. Shaia ◽

Karen Campion ◽

Helen M. Nichols

Keyword(s):

Primary Care ◽

Primary Healthcare ◽

Racial Bias ◽

Healthcare Providers ◽

Black Children ◽

Autism Spectrum ◽

Theory Approach ◽

Early Intervention Services ◽

Primary Healthcare Providers

Abstract Black children with autism spectrum disorder (ASD) are diagnosed later than their White peers, are more likely to be misdiagnosed, and are less likely to receive early intervention services or a developmental evaluation by three years old. Using a grounded theory approach, we solicited the perspectives of parents and other primary caregivers of Black children with ASD on barriers and facilitators to ASD screening and referrals in primary care. A socioeconomically diverse sample of 22 female caregivers participated. Four themes emerged. First, while some caregivers noted their child's primary healthcare providers facilitated a timely ASD diagnosis, other participants reported these providers ignored early concerns about child developmental delays. Second, many participants felt racial bias negatively impacted caregiver-primary healthcare provider interactions. Third, legal/custodial issues slowed caregivers' abilities to follow up on referrals from their primary healthcare providers. Finally, caregivers described denial, shame, and stigma relating to ASD in the Black community as possible factors for delayed follow up to referrals. Differences based on socioeconomic status are discussed. Efforts to improve family-centered, culturally relevant care for all Black caregivers raising children with or at-risk for ASD are needed, particularly for those families experiencing the multiple effects of poverty.

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Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks

Medicine Access Point of Care ◽

10.1177/2399202620922507 ◽

2020 ◽

Vol 4 ◽

pp. 239920262092250

Author(s):

Natalie Kennie-Kaulbach ◽

Rachel Cormier ◽

Olga Kits ◽

Emily Reeve ◽

Anne Marie Whelan ◽

...

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Behavior Change ◽

Primary Healthcare ◽

Healthcare Providers ◽

Primary Care Providers ◽

System Level ◽

Care Providers ◽

Behavior Change Wheel ◽

Primary Healthcare Providers

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.

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Primary Care Doctors’ Role in Antenatal Detection and Management of Fetal Bilateral Pleural Effusions: A Report of 2 Cases

Journal of Community Health Research ◽

10.18502/jchr.v10i2.6585 ◽

2021 ◽

Author(s):

Chai Li Tay ◽

Noor Afiqah AW

Keyword(s):

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Healthcare Providers ◽

Hydrops Fetalis ◽

Pleural Effusions ◽

Maternal Complications ◽

Primary Care Doctors ◽

Antenatal Detection ◽

Primary Healthcare Providers

Introduction: Fetal pleural effusion is rarely seen in primary care setting. It is more commonly diagnosed among women with diabetes mellitus in pregnancy. Method: This report illustrates two patients with fetal bilateral pleural effusions, detected at 18-week and 24-week period of amenorrhea (POA) during routine antenatal scans by primary care doctors. Result: These two pregnancies were complicated with hydrops fetalis and resulted in fresh stillbirth and intra-uterine death. Conclusion: Primary healthcare providers play an important role in the early diagnosis of fetal congenital anomaly, counseling regarding the ultrasonography findings, neonatal outcome, and referral to obstetrician for further management and monitoring for maternal complications, such as polyhydramnios, preeclampsia, mirror syndrome, and depression as a result of hydrops fetalis.

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Lightweight Mobile Automated Assistant-to-physician for Global Lower-resource Areas

10.1101/2021.11.01.21265487 ◽

2021 ◽

Author(s):

Chao Zhang ◽

Hanxin Zhang ◽

Atif Khan ◽

Ted Kim ◽

Olasubomi Omoleye ◽

...

Keyword(s):

Primary Care ◽

Real Time ◽

Primary Healthcare ◽

Healthcare Providers ◽

Primary Care Providers ◽

Learning System ◽

Care Providers ◽

Wide Range ◽

Multiple Data Sets ◽

Primary Healthcare Providers

Importance: Lower-resource areas in Africa and Asia face a unique set of healthcare challenges: the dual high burden of communicable and non-communicable diseases; a paucity of highly trained primary healthcare providers in both rural and densely populated urban areas; and a lack of reliable, inexpensive internet connections. Objective: To address these challenges, we designed an artificial intelligence assistant to help primary healthcare providers in lower-resource areas document demographic and medical sign/symptom data and to record and share diagnostic data in real-time with a centralized database. Design: We trained our system using multiple data sets, including US-based electronic medical records (EMRs) and open-source medical literature and developed an adaptive, general medical assistant system based on machine learning algorithms. Main outcomes and Measure: The application collects basic information from patients and provides primary care providers with diagnoses and prescriptions suggestions. The application is unique from existing systems in that it covers a wide range of common diseases, signs, and medication typical in lower-resource countries; the application works with or without an active internet connection. Results: We have built and implemented an adaptive learning system that assists trained primary care professionals by means of an Android smartphone application, which interacts with a central database and collects real-time data. The application has been tested by dozens of primary care providers. Conclusions and Relevance: Our application would provide primary healthcare providers in lower-resource areas with a tool that enables faster and more accurate documentation of medical encounters. This application could be leveraged to automatically populate local or national EMR systems.

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