scholarly journals Update on advances in psychiatric treatment in primary care

2016 ◽  
Vol 22 (2) ◽  
pp. 99-107
Author(s):  
Christopher Dowrick
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Best Practice ◽  
Psychiatric Treatment ◽  
Antidepressant Medication ◽  
Mental Healthcare ◽  
Physical Symptoms ◽  
Care Quality ◽  
Middle Income ◽  
Care Assessment

SummaryThis article updates previous evidence on the role of primary care in the management of depression and related disorders, unexplained physical symptoms, and severe and enduring mental illness. Regarding depression and related disorders, there is now evidence for the benefits of non-medical interventions and collaborative care, providing alternatives to the simplistic over prescription of antidepressant medication. For severe and enduring illness, the emphasis in primary care is now on the effective management of comorbid physical health problems. The article also summarises best practice for the primary care assessment and management of dementia, including the need for holistic review of care quality and the potential benefits of collaborative care. Finally, it notes the growing emphasis on primary mental healthcare in low- and middle-income countries (LMIC).

scholarly journals Development and validation of the Vietnamese Primary Care Assessment Tool – provider version

2019 ◽  
Vol 20 ◽  
Author(s):  
Nguyen Thi Hoa ◽  
Anselme Derese ◽  
Jeffrey F. Markuns ◽  
Nguyen Minha Tam ◽  
Wim Peersman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Internal Consistency ◽  
Assessment Tool ◽  
Care Quality ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
The Impact ◽  
Primary Care Assessment Tool

Abstract Aim: To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Background: There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter. Method: Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. Findings: The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. Conclusion: The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.

scholarly journals PRIMARY CARE QUALITY FROM PROFESSIONALS’ PERSPECTIVE: HEALTH OF CHILDREN AND ADOLESCENTS WITH HIV

2017 ◽  
Vol 26 (2) ◽  
Author(s):  
Graziela Piovesan ◽  
Cristiane Cardoso de Paula ◽  
Luis Felipe Dias Lopes ◽  
Stela Maris de Mello Padoin ◽  
Raquel Einloft Kleinubing ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Children And Adolescents ◽  
Health Care Quality ◽  
Health Care Service ◽  
Care Quality ◽  
Integration Of Care ◽  
Primary Health ◽  
Care Assessment

ABSTRACT Objective: evaluate, based on the professionals’ experience, the primary health care quality in home cities of children and adolescents with HIV, treated at a specialized service. Method: cross-sectional study involving 527 professionals in 25 interior cities in Rio Grande do Sul, Brazil, in the first semester of 2014. The Primary Care Assessment Tool was applied. Pearson’s chi-square Test, the Mann Whitney Test and the Poisson Regression were used. Results: the Estratégia Saúde da Família and the primary health care service presented a high score related to the essential attributes: longitudinality (7.17 and 6.74), coordination-integration of care (6.87 and 7.03) and coordination-information systems (8.24 and 8.19); and a low score for the attribute access (3.96 and 3.8). The variables: female gender (0.009), education as general practitioner (<0.001), statutory staff (0.029), coordinator position (0.087) and not having another job (0.027) were also associated with the high score. Conclusion: the coverage of the Estratégia Saúde da Família needs to be expanded and structural and organizational shortages in the access need to be overcome.

scholarly journals Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers

2013 ◽  
Vol 9 (1) ◽  
pp. 84-87 ◽  
Author(s):  
Ramona S DeJesus ◽  
Kurt B Angstman ◽  
Stephen S Cha ◽  
Mark D Williams
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Antidepressant Medication ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Care Managers ◽  
Significant Difference ◽  
Depression Management ◽  
Treatment Improvement

Depression poses a significant economic and health burden, yet it remains underdiagnosed and inadequately treated. The STAR*D trial funded by the National Institute of Mental Health showed that more than one antidepressant medication is often necessary to achieve disease remission among patients seen in both psychiatric and primary care settings. The collaborative care model (CCM), using care managers, has been shown to be effective in numerous studies in achieving sustained outcomes in depression management compared to usual care. This model was adopted in a statewide depression treatment improvement initiative among primary care clinics in Minnesota, which was launched in March 2008. In this study, records of patients who were enrolled in CCM from March 2008 until March 2009 were reviewed and compared to those under usual care. Patients who were followed under the CCM had a significantly greater number of antidepressant medication utilizations when compared to those under usual care. After 6 months, mean PHQ-9 score of patients under CCM was statistically lower than those in usual care. There was no significant difference in both mean PHQ-9 scores at 6 months and antidepressant utilization between the 2 groups among patients aged 65 years and older.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Assessment Tool ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment

Abstract Background Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. This study used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. Methods Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. Results A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P < 0.001). The older users, more frequent users, and those in better health condition reported higher PCAT scores. Conclusions CHC users generally reported high quality primary care experience especially in the domain of first-contact (utilization), family centeredness, and comprehensiveness (services provided). That suburban and rural CHC residents reported better primary care experience than urban CHCs demonstrates the unique value of CHCs in relatively medical underserved areas.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

scholarly journals Primary Care Quality among Different Health Care Structures in Tibet, China

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Wenhua Wang ◽  
Leiyu Shi ◽  
Aitian Yin ◽  
Zongfu Mao ◽  
Elizabeth Maitland ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Human Resource Development ◽  
Assessment Tool ◽  
Care Quality ◽  
Health Centers ◽  
Healthy Population ◽  
Inpatient Service ◽  
Primary Care Quality ◽  
Care Assessment

Objective.To compare the primary care quality among different health care structures in Tibet, China.Methods.A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics.Results.The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status.Conclusions.This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development.

scholarly journals Integration of mental health into primary care in low- and middle-income countries: The PRIME mental healthcare plans

2016 ◽  
Vol 208 (s56) ◽  
pp. s1-s3 ◽  
Author(s):  
Crick Lund ◽  
Mark Tomlinson ◽  
Vikram Patel
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Healthcare ◽  
Design Evaluation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

SummaryThis supplement outlines the development and piloting of district mental healthcare plans from five low- and middle-income countries, together with the methods for their design, evaluation and costing. In this editorial we consider the challenges that these programmes face, highlight their innovations and draw conclusions.

scholarly journals Short-Term Medical Relief Trips to Help Vulnerable Populations in Latin America. Bringing Clarity to the Scene

2019 ◽  
Vol 16 (5) ◽  
pp. 745
Author(s):  
Melodyanne Cheng ◽  
Eunice Rodriguez
Keyword(s):  
Primary Care ◽  
Latin America ◽  
Best Practice ◽  
Assessment Tool ◽  
Short Term ◽  
Middle Income ◽  
Low Middle Income Countries ◽  
Medical Relief ◽  
Long Term Impact

Non-profit organizations provide international medical relief trips to low/middle-income countries (LMIC) in order to provide healthcare to medically underserved areas. Short-term medical relief trips (STMRT) take a large amount of time and resources, and arouse concerns about their actual effectiveness. Here we develop a novel tool for consistently assessing how U.S. organizations provide primary care to Latin America through short-term medical relief trips. First, in Part 1, we create a “Best Practice” (BP) framework focused on the efficacy, sustainability, and long-term impact of the organizations based on a review of the last 27 years of available literature published in peer-reviewed journals. Second, in Part 2, out of 581 total medical relief organizations in the US, we identify the 19 organizations currently providing short-term primary care services to Spanish-speaking countries in Latin America. We use the BP framework to analyze the website content and secondary sources of these 19 organizations. We find that only three of the 19 organizations met 80% or more of the criteria defining BP according to the framework and four out of the 19 did not perform well in any of the framework’s three aspects of efficacy, sustainability, and long-term impact. Because there exists no current standardized way of assessing the methods implemented and services offered by STMRT, we provide suggestions about using this novel framework as a self-assessment tool for STMRT organizations.

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