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.

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.

Innovative mobile-health led Participatory Approach to Comprehensive Screening and Treatment of Diabetes (IMPACT Diabetes): Rationale, Design and Baseline Characteristics (Preprint)

2021 ◽  
Author(s):  
Abhinav Bassi ◽  
Sumaiya Arfin ◽  
Oommen John ◽  
Devarsetty Praveen ◽  
Varun Arora ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Glucose ◽  
Community Health ◽  
Community Health Workers ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Health Workers ◽  
System Level ◽  
Elevated Blood

BACKGROUND India has 66 million people with diabetes, of which a large proportion do not receive adequate care. The Primary Health Centres across rural and urban areas serve as platforms for continuum of care and early detection of diabetes in the population. The untapped potential of frontline health care workforce can act as a means to bridge the gaps of service demands. OBJECTIVE We aim to develop and evaluate a technology-enabled system-level intervention based around the community health workers [Accredited Social Health Activists (ASHA)] and primary-care physicians, and mobile tablet-based clinical decision support system to improve the identification and management of individuals with diabetes and cardiovascular disease (CVD) in primary care settings in India. METHODS A cluster-randomized trial in sixteen villages/peri-urban areas in Andhra Pradesh and Haryana will test the preliminary effectiveness of this intervention. An independent evaluation will compare the difference in the proportion of participants with diabetes having a 0.5% reduction in HBA1c (measured at baseline and end-line) in intervention and usual-care arm. Qualitative interviews of physicians, ASHA, and community members will ascertain the intervention acceptability and feasibility. RESULTS A total of 1785 adults over 30 years (females: 53.2%; median age: 50 years) were screened. ASHAs achieved 100% completeness of data for all anthropometric, blood-pressure, and blood-glucose measures. At baseline, 63% of the participants were overweight/obese, 27.8% had elevated blood-pressure, 20.3% were at high-risk for CVD, and 21.3% had elevated blood-glucose. Half of the individuals with diabetes were newly diagnosed. CONCLUSIONS Transfers of simple clinical procedures from physicians to non-physician health workers, with the help of technology, can support the provision of healthcare in under-served communities. The preliminary findings suggest that community health workers can successfully screen and refer patients with diabetes and/or CVD to physicians in the Indian primary healthcare system. The proposed model can be adapted for larger trial sand tested for other commonly prevalent disease conditions. CLINICALTRIAL REF/2016/05/011275

scholarly journals Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044372
Author(s):  
Mat Nawi Zanaridah ◽  
Mohd Noor Norhayati ◽  
Zakaria Rosnani
Keyword(s):  
Primary Care ◽  
Evidence Based Medicine ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Sectional Study ◽  
Primary Care Practitioner ◽  
Cross Sectional ◽  
Primary Care Practitioners ◽  
Based Medicine

ObjectivesTo determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.SettingThis cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.ParticipantsThe study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.ResultsA total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.ConclusionsAlthough many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

scholarly journals Managing the Return to Football During the COVID-19 Pandemic: A Survey of the Head Team Physicians of the Football Bowl Subdivision Programs

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712199204
Author(s):  
Alexander D. Slabaugh ◽  
John W. Belk ◽  
Jonathan C. Jackson ◽  
Richard J. Robins ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
National Collegiate Athletic Association ◽  
College Football ◽  
Cross Sectional Study ◽  
Return To Play ◽  
World Health ◽  
Cross Sectional ◽  
Football Bowl Subdivision ◽  
Health Organization

Background: COVID-19 is a severe respiratory virus that spreads via person-to-person contact through respiratory droplets. Since being declared a pandemic in early March 2020, the World Health Organization had yet to release guidelines regarding the return of college or professional sports for the 2020-2021 season. Purpose: To survey the head orthopedic surgeons and primary care team physicians for the National Collegiate Athletic Association (NCAA) Football Bowl Subdivision (FBS) football teams so as to gauge the management of common COVID-19 issues for the fall 2020 college football season. Study Design: Cross-sectional study. Methods: The head team orthopaedic surgeons and primary care physicians for all 130 FBS football teams were surveyed regarding their opinions on the management of college football during the COVID-19 pandemic. A total of 30 questions regarding testing, return-to-play protocol, isolating athletes, and other management issues were posed via email survey sent on June 5, 2020. Results: Of the 210 team physicians surveyed, 103 (49%) completed the questionnaire. Overall, 36.9% of respondents felt that it was unsafe for college athletes to return to playing football during fall 2020. While the majority of football programs (96.1%) were testing athletes for COVID-19 as they returned to campus, only 78.6% of programs required athletes to undergo a mandatory quarantine period before resuming involvement in athletic department activities. Of the programs that were quarantining their players upon return to campus, 20% did so for 1 week, 20% for 2 weeks, and 32.9% quarantined their athletes until they had a negative COVID-19 test. Conclusion: While US Centers for Disease Control and Prevention guidelines evolve and geographic regions experience a range of COVID-19 infections, determining a universal strategy for return to socialization and participation in sports remains a challenge. The current study highlighted areas of consensus and strong agreement, but the results also demonstrated a need for clarity and consistency in operations, leadership, and guidance for medical professionals in multiple areas as they attempt to safely mitigate risk for college football players amid the COVID-19 pandemic.

scholarly journals Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

2020 ◽  
Author(s):  
Faith A. Okalebo ◽  
Eric M. Guantai ◽  
Aggrey O. Nyabuti
Keyword(s):  
Drug Use ◽  
Low Income ◽  
Primary Healthcare ◽  
Essential Medicines ◽  
World Health ◽  
Low Income Countries ◽  
Rational Use ◽  
Health Organization ◽  
Consultation Time ◽  
Primary Healthcare Centers

ABSTRACTBackgroundIrrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study set out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/ International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.MethodsTen PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three-hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.ResultsThe average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6– 1.8), percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%) and percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.ConclusionThe survey shows irrational drug use practices, particularly polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

scholarly journals Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians

2020 ◽  
Vol 11 ◽  
pp. 215013272090418 ◽  
Author(s):  
Garret A. Horton ◽  
Matthew T. W. Simpson ◽  
Michael M. Beyea ◽  
Jason A. Beyea
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
English Language ◽  
Family Physicians ◽  
Neck Surgery ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Evidence Based ◽  
The Cochrane Library ◽  
Cerumen Removal

Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

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