scholarly journals Implementation of HPV-based screening in Burkina Faso: lessons learned from the PARACAO hybrid-effectiveness study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keitly Mensah ◽  
Charles Kaboré ◽  
Salifou Zeba ◽  
Magali Bouchon ◽  
Véronique Duchesne ◽  
...  
Keyword(s):  
Primary Care ◽  
Burkina Faso ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Real Life ◽  
Limited Resource ◽  
Lessons Learned ◽  
Promising Alternative ◽  
Logistic Regression Models ◽  
Primary Healthcare Centers

Abstract Background Cervical cancer screening in sub-Saharan countries relies on primary visual inspection with acetic acid (VIA). Primary human papillomavirus (HPV)-based screening is considered a promising alternative. However, the implementation and real-life effectiveness of this strategy at the primary-care level in limited-resource contexts remain under explored. In Ouagadougou, Burkina Faso, free HPV-based screening was implemented in 2019 in two primary healthcare centers. We carried out a process and effectiveness evaluation of this intervention. Methods Effectiveness outcomes and implementation indicators were assessed through a cohort study of screened women, observations in participating centers, individual interviews with women and healthcare providers and monitoring reports. Effectiveness outcomes were screening completeness and women’s satisfaction. Logistic regression models and concurrent qualitative analysis explored how implementation variability, acceptability by women and the context affected effectiveness outcomes. Results After a 3-month implementation period, of the 350 women included in the cohort, 94% completed the screening, although only 26% had their screening completed in a single visit as planned in the protocol. The proportion of highly satisfied women was higher after result disclosure (95%) than after sampling (65%). A good understanding of the screening results and recommendations increased screening completeness and women’s satisfaction, while time to result disclosure decreased satisfaction. Adaptations were made to fit healthcare workers’ workload. Conclusion Free HPV-based screening was successfully integrated within primary care in Ouagadougou, Burkina Faso, leading to a high level of screening completeness despite the frequent use of multiple visits. Future implementation in primary healthcare centers needs to improve counseling and reduce wait times at the various steps of the screening sequence.

scholarly journals A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

2018 ◽  
Vol 8 (2) ◽  
pp. 145-163 ◽  
Author(s):  
Melita Sogomonjan ◽  
Tanel Kerikmäe ◽  
Pille Ööpik
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Behavioural Therapy ◽  
Real Life ◽  
Mental Health Disorders ◽  
Behavioural Therapy ◽  
Lessons Learned ◽  
Cognitive Behavioural ◽  
Health Disorders ◽  
Use Of Internet

AbstractIn the context of the EU’s Digital Single Market (eHealth) Strategy, the deployment of digital tools for patients’ empowerment and person-centred care is of high demand and importance. Shifting from treatment to health promotion and disease prevention, a variety of internet-based cognitive behavioural therapy programmes have been proven to be effective for managing common mental health disorders in secondary care even hough the effectiveness and the clinical use of internet-based cognitive behavioural therapy programmes alone in primary care have not been approved yet. Additionally, such interventions are neither included in the international clinical guidelines for treating common mental health disorders nor regulated by Member States as a healthcare service. Despite that, the UK National Health Service and the Swedish National Board of Health and Welfare endorse the use of internet-based cognitive behavioural therapy as a first treatment option. The aim of this research is to investigate the global experience of internet-based cognitive behavioural therapy programmes in controlled and real-life conditions in general practice and to evaluate the reliability of the results and concomitantly their compliance with the European Commission’s eHealth Strategy. A systematic review of quantitative studies was conducted from January 2007 to December 2017. The results indicated that unsupported internet-based cognitive behavioural therapy programmes alone are less effective than combined therapy options for treatment purposes, if no additional therapy is prescribed. Guided internet-based cognitive behavioural therapy may supplement traditional treatment methods resulting in improving the control of mental disorders, but are unable to demonstrate consistent quality or replace face-to-face therapy.

scholarly journals The effects of Enhanced Primary Healthcare interventions on primary care providers job satisfaction

2019 ◽  
Author(s):  
Wen Jun Wong ◽  
Aisyah Mohd Norzi ◽  
Swee Hung Ang ◽  
Chee Lee Chan ◽  
Faeiz Syezri Adzmin Jaafar ◽  
...  
Keyword(s):  
Primary Care ◽  
Job Satisfaction ◽  
Primary Healthcare ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Intervention Group ◽  
Well Being ◽  
Primary Care Providers ◽  
Care Providers ◽  
Post Intervention

Abstract Background In response to address the rising burden of cardiovascular risk factors, Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinics level. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs’ job satisfaction. However, studies evaluating HCPs’ job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs. Methods This is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all healthcare providers who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were distributed at baseline (April and May 2017) and post-intervention (March and April 2019). Difference-in-differences analysis was used in the multivariable linear regression model in which we adjusted for providers and clinics characteristics to detect the changes in job satisfaction following EnPHC interventions. Results A total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress and change in score between two groups was -0.14 (β= -0.139; 95% CI -0.266,-0.012; p =0.032). In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions (β= -0.223; 95% CI -0.419,-0.026; p =0.026). Additionally, the same group also responded that they were less likely to perceive their profession as well-respected at post-intervention (β= -0.175; 95% CI -0.331,-0.019; p =0.027). Conversely, allied health professionals from intervention group were more likely to report a good balance between work and effort (β= 0.386; 95% CI 0.033,0.738; p =0.032) after implementing EnPHC interventions. Conclusions Our findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs’ job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.

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

2018 ◽  
Vol 56 (5) ◽  
pp. 321-336 ◽  
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.

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

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.

Presenting primary care teams to the public: a qualitative exploration of general practice websites

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697049
Author(s):  
Helen Anderson ◽  
Joy Adamson ◽  
Yvonne Birks
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Nurse Practitioners ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Patient Choice ◽  
Healthcare Team ◽  
Sufficient Information ◽  
The Public ◽  
Professional Groups

BackgroundIncreasing demand and expanded primary care provision, coupled with a reduced GP workforce present challenges for primary care. New workforce models aim to reduce general practitioner workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.AimTo explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.MethodQualitative thematic analysis of a sample of general practice websites. 79 accessible websites from a district in England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.ResultsInformation about each group was incomplete, inconsistent and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.ConclusionLimited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. Potential for websites to disseminate information to the public is not being maximised.

scholarly journals Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to ‘act locally and think globally’

2019 ◽  
Vol 42 (3) ◽  
pp. e361-e368 ◽  
Author(s):  
Abla M Sibai ◽  
Martine Najem Kteily ◽  
Rana Barazi ◽  
Mia Chartouni ◽  
Maguy Ghanem ◽  
...  
Keyword(s):  
Primary Care ◽  
Intervention Program ◽  
Diabetes Management ◽  
Healthcare Providers ◽  
Monitoring And Evaluation ◽  
Study Groups ◽  
Lessons Learned ◽  
Host Community ◽  
Conflict Situations ◽  
And Control

ABSTRACT Background Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations. Methods Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness. Results Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines’ supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program. Conclusions Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more ‘local testing’ of modified interventions within such contexts. This can then inform ‘thinking globally’ on guidelines for the delivery of NCD care in crisis settings.

scholarly journals Presenting the primary care team to the public: a qualitative exploration of general practice websites

2018 ◽  
Vol 68 (668) ◽  
pp. e178-e186 ◽  
Author(s):  
Helen Anderson ◽  
Joy Adamson ◽  
Yvonne Birks
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Nurse Practitioners ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Patient Choice ◽  
Healthcare Team ◽  
Sufficient Information ◽  
The Public ◽  
Professional Groups

BackgroundIncreasing demand and expanded primary care provision, coupled with a reduced GP workforce, present challenges for primary care. New workforce models aim to reduce GP workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.AimTo explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.Design and settingQualitative thematic analysis of a sample of general practice websites.MethodIn total, 79 accessible websites from a metropolitan district in the north of England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.ResultsInformation about each group was incomplete, inconsistent, and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.ConclusionLimited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. The potential for websites to disseminate information to the public is not being maximised.

scholarly journals Stakeholder Perspectives to Inform Adaptation of a Hypertension Treatment Program in Primary Healthcare Centers in the Federal Capital Territory, Nigeria:  A Qualitative Study

2020 ◽  
Author(s):  
Rosemary CB Okoli ◽  
Gabriel Shedul ◽  
Lisa R Hirschhorn ◽  
Ikechukwu A Orji ◽  
Tunde M Ojo ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Primary Care Physicians ◽  
Health Workers ◽  
Blood Pressure Measurement ◽  
System Level ◽  
Evidence Based ◽  
Hypertension Treatment ◽  
Physician Health ◽  
Primary Healthcare Centers

Abstract Background: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. Methods: Purposive sampling in 8 PHCs identified patients (n=8), non-physician health workers (n= 12), administrators (n=3), and primary care physicians (n=6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. Results: Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment; (2) expansion of team-based care with additional training; (3) information systems to track patients and medication supply chain; and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: first contact accessibility, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could limit effectiveness of the HTN Program. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to raise awareness about the HTN Program and to train community members in blood pressure measurement. Conclusions: These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria with the ultimate aim of scaling it to other parts of the country.

scholarly journals Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Rosemary C. B. Okoli ◽  
Gabriel Shedul ◽  
Lisa R. Hirschhorn ◽  
Ikechukwu A. Orji ◽  
Tunde M. Ojo ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Primary Care Physicians ◽  
Health Workers ◽  
System Level ◽  
World Health ◽  
Evidence Based ◽  
Hypertension Treatment ◽  
Physician Health ◽  
Primary Healthcare Centers

Abstract Background Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. Methods Purposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. Results Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program. Conclusions These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country.

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