Scottish Psychiatrists in Primary Health-Care Settings

1988 ◽  
Vol 153 (5) ◽  
pp. 663-666 ◽  
Author(s):  
Ian M. Pullen ◽  
Alex J. Yellowlees
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Care Setting ◽  
Primary Care Setting ◽  
Health Care Settings ◽  
Primary Care Settings ◽  
Practice Experience ◽  
Primary Health ◽  
Similar Survey ◽  
Primary Health Care Settings

There has been a growing number of reports of psychiatrists moving out into primary-care settings. We report a survey of consultant psychiatrists to assess the extent of this practice in Scotland. Some time spent in the primary-care setting was reported by 56%, the figures being highest in rural areas. An equal number of non-consultant medical staff were involved. Most schemes were initiated by psychiatrists, over half of whom had had some postgraduate general-practice experience. A similar survey in England and Wales showed that only 19% of consultant psychiatrists spent time in primary-care settings, a smaller proportion of non-consultant staff being involved. The value of working in primary-care settings has yet to be assessed.

Screening Younger Individuals in a Primary Care Setting Flags Putative Dementia Cases and Correlates Gastrointestinal Diseases with Poor Cognitive Performance

2016 ◽  
Vol 43 (1-2) ◽  
pp. 15-28 ◽  
Author(s):  
Ilka M. Rosa ◽  
Ana Gabriela Henriques ◽  
Liliana Carvalho ◽  
Joana Oliveira ◽  
Odete A.B. da Cruz e Silva
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Gastrointestinal Disease ◽  
Gastrointestinal Diseases ◽  
Diagnostic Tools ◽  
Clinical Dementia Rating ◽  
Dementia Prevalence ◽  
Dementia Screening ◽  
Primary Care Settings

Background/Aims: Diagnosing dementia is challenging in many primary care settings, given the limited human resources and the lack of current diagnostic tools. With this in mind, a primary care-based cohort was established in the Aveiro district of Portugal. Methods: A total of 568 participants were evaluated using cognitive tests and APOE genotyping. Results: The findings revealed a dementia prevalence of 12%. A strong correlation between increasing Clinical Dementia Rating (CDR) scores and education was clearly evident. Other highly relevant risk factors were activities of daily living (ADL), instrumental ADL, aging, depression, gender, the APOE ε4 allele, and comorbidities (depression as well as gastrointestinal, osteoarticular, and neurodegenerative diseases). A hitherto unreported, significant correlation between gastrointestinal disease and high CDR score was clearly observable. Conclusions: This study shows the merit of carrying out a dementia screening on younger subjects. Significantly, 71 subjects in the age group of 50-65 years were flagged for follow-up studies; furthermore, these cases with a potentially early onset of dementia were identified in a primary care setting.

scholarly journals Chronic substance use and self-harm in a primary health care setting

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Elsie Breet ◽  
Jason Bantjes ◽  
Ian Lewis
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Substance Use ◽  
Primary Health Care ◽  
Emergency Departments ◽  
Service Utilisation ◽  
Health Care Settings ◽  
Primary Health ◽  
Self Harm ◽  
Primary Health Care Settings

Background: Chronic substance use (CSU) is associated with health problems, including selfharm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced.Aim: To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA.Methods: Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses.Results: Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio[OR] = 8.33, 95% confidence interval [CI] = 3.19–20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77–11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44–9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16–15.7, p < 0.001).Conclusion: The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patientswho present in primary health care settings.

scholarly journals Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: a systematic review

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Susan A. Rombouts ◽  
James H. Conigrave ◽  
Richard Saitz ◽  
Eva Louie ◽  
Paul Haber ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Models Of Care ◽  
Health Care Settings ◽  
Treatment Uptake ◽  
Primary Health ◽  
Intensity Of Care ◽  
Primary Health Care Settings

Abstract Background Pharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited. Primary care could be a key setting for identification and continuous care for AUD due to accessibility, low cost and acceptability to patients. We aimed to synthesise the literature regarding differential models of care for the management of AUD in primary health care settings. Methods We conducted a systematic review of articles published worldwide (1998-present) using the following databases; Medline, PsycINFO, Cochrane database of systematic reviews, Cochrane Central Register of Controlled Trials and Embase. The Grey Matters Tool guided the grey literature search. We selected randomised controlled trials evaluating the effectiveness of a primary care model in the management of AUD. Two researchers independently assessed and then reached agreement on the included studies. We used the Cochrane risk of bias tool 2.0 for the critical appraisal. Results Eleven studies (4186 participants) were included. We categorised the studies into ‘lower’ versus ‘higher’ intensity given the varying intensity of clinical care evaluated across the studies. Significant differences in treatment uptake were reported by most studies. The uptake of AUD medication was reported in 5 out of 6 studies that offered AUD medication. Three studies reported a significantly higher uptake of AUD medication in the intervention group. A significant reduction in alcohol use was reported in two out of the five studies with lower intensity of care, and three out of six studies with higher intensity of care. Conclusion Our results suggest that models of care in primary care settings can increase treatment uptake (e.g. psychosocial and/or pharmacotherapy) although results for alcohol-related outcomes were mixed. More research is required to determine which specific patient groups are suitable for AUD treatment in primary health care settings and to identify which models and components are most effective. Trial Registration PROSPERO: CRD42019120293.

scholarly journals Experiences of nurses working in a rural primary health-care setting in Mopani district, Limpopo Province

Curationis ◽  
2008 ◽  
Vol 31 (2) ◽  
Author(s):  
MP Mohale
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Setting ◽  
Limpopo Province ◽  
Health Care Setting ◽  
Health Care Settings ◽  
Primary Health Care Setting ◽  
Primary Health ◽  
Professional Nurses ◽  
Primary Health Care Settings

Professional nurses working in rural, primary health-care settings are experiencing burnout due to serious shortages of personnel. This is exacerbated by the brain drain of nurses leaving the country. Rural settings are resource constrained in terms of personnel and equipment. This results in dissatisfaction among nurses due to the unbearable working conditions which result in stress and frustration. A qualitative, explorative, descriptive study was conducted to explore and describe the experiences of nurses working in a rural primary health-care setting in the greater Letaba sub district in Limpopo Province. Purposive sampling was used to identify the participants. Data was collected in the form of in-depth interviews. The study revealed that nurses working in primary health-care settings were experiencing emotional and physical strain as a result of the shortage of human resources. It was recommended that policies that meet the health-care needs of rural communities be developed, and that strategies to retain professional nurses in primary health-care settings be formulated.

scholarly journals Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting

2018 ◽  
Vol 9 ◽  
pp. 215013271875921 ◽  
Author(s):  
Lisa A. Mueller ◽  
Alexa Sevin Valentino ◽  
Aaron D. Clark ◽  
Junan Li
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Time Frame ◽  
Primary Objective ◽  
Completion Rate ◽  
Primary Care Settings ◽  
Significant Difference ◽  
Referral Completion ◽  
Time Frames

Objectives: The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service. Methods: Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014–September 2015) and after (January 2016–October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist. Results: The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002). Conclusion: The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.

scholarly journals Facilitating Guideline Implementation in Primary Health Care Practices

2020 ◽  
Vol 11 ◽  
pp. 215013272091626
Author(s):  
Sanne Peters ◽  
André Bussières ◽  
Bart Depreitere ◽  
Stijn Vanholle ◽  
Julie Cristens ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Care Setting ◽  
Primary Care Setting ◽  
Guideline Implementation ◽  
Multidisciplinary Teams ◽  
Primary Health ◽  
Care Practices

Introduction: Many patients continue to receive suboptimal services, inappropriate, unsafe, and costly care. Underutilization of research by health professionals is a common problem in the primary care setting. Although many theoretical frameworks can be used to help address such evidence-practice gaps, health care professionals may not be aware of the benefits of frameworks or of the most appropriate ones for their context and thus, may be faced with the challenge of selecting and using the most relevant one. Aim: The aim of this article was to describe the process used to adapt a knowledge translation framework to meet the local needs of health professionals working in one large primary care setting. Methods: The authors developed a 5-step approach for guideline implementation. This approach was informed by prior research and the authors’ experiences in supporting multidisciplinary teams of health care professionals during the implementation of evidence-based clinical guidelines into primary care practices. To ensure that the 5-step approach was practical and suitable for the context of guideline implementation by multidisciplinary teams in primary health care, the implementation team adapted the “knowledge-to-action” framework using a multistep process. Results: The implementation approach consisted of the following 5 steps: identification, context analysis, development of implementation plan, evaluation, and sustainability. All 5 steps were described alongside details about a national low back pain project. Discussion: This article describes a collaborative, grassroots process that addressed an identified need in one complex context by adapting a knowledge translation framework to meet the local needs of health professionals working in primary care settings. Existing implementation frameworks may be too complex or abstract for use in busy clinical contexts. The 5-step approach presented in this paper resulted in practical steps that are more readily understood by health care professionals and staff on “the ground.”

Treatment of Neck Pain with Opioids in the Primary Care Setting: Trends and Geographic Variation

Pain Medicine ◽  
2020 ◽  
Author(s):  
Meghana Jami, ◽  
Majd Marrache ◽  
Varun Puvanesarajah ◽  
Micheal Raad ◽  
Niyathi Prasad ◽  
...  
Keyword(s):  
Primary Care ◽  
Neck Pain ◽  
Geographic Variation ◽  
Outpatient Clinic ◽  
Care Setting ◽  
Primary Care Setting ◽  
High Dose ◽  
Primary Care Visit ◽  
Primary Care Settings ◽  
First Time

Abstract Objective Neck pain is a leading cause of years lived with disability and is often managed with opioid medications in primary care settings, though this is contraindicated by national guidelines. The aim of this study was to determine the prevalence of opioid prescription for neck pain at a primary care visit and to analyze the geographic variation and trends in opioid prescriptions between 2011 and 2017. Methods Using a prescription drug claims database, we identified 591,961 adult patients who presented for neck pain in primary care settings between 2011 and 2017. Patients who had outpatient specialty visits within 1 year before presentation, a concomitant diagnosis of a non-musculoskeletal cause of neck pain, or preexisting chronic opioid use were excluded. Results The mean age of the patients was 45 ± 12 years, and 64% were female. Fifteen percent of patients were prescribed opioids within 30 days of their encounter. Eleven percent of patients were prescribed moderate- to high-dose opioids (&gt;20 morphine milligram equivalents). From 2011–2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions given to first time presenters to an outpatient clinic for neck pain was highest in Mississippi (20%) and lowest in New Mexico (6%) (P &lt; 0.001). In 2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions was highest in the Midwest (10.4%) and lowest in the Northeast (4.9%). The proportion of patients with filled opioid prescriptions declined between 2011 (19%) and 2017 (13%) (P &lt; 0.001), and the proportion of patients with moderate- to high-dose prescriptions declined from 2011 (13%) to 2017 (8%) (P &lt; 0.001). first-time presenters of neck pain to an outpatient clinic  Conclusions Opioid medication use for neck pain in the primary care setting is significant. Although opioid prescriptions are declining, there remains a need for further standardization in prescription practices.

scholarly journals Body Mass Index Assessment of Health Care Professionals in a Primary Care Setting in Portugal: a Cross Sectional Study

2014 ◽  
Vol 27 (5) ◽  
pp. 609 ◽  
Author(s):  
Inês Campos-Matos ◽  
André Peralta-Santos ◽  
Bernardo Gomes ◽  
Gustavo Borges ◽  
Pedro Aguiar
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Body Mass Index ◽  
Primary Health Care ◽  
Body Mass ◽  
Health Care Professionals ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cross Sectional ◽  
Primary Health

<p><strong>Introduction:</strong> Obesity is an important public health problem because it is a risk factor for numerous diseases and is associated with a higher death risk. Evidence concerning the prevalence of excess weight in health professionals is scarce and this group is often overlooked in weight interventions programs. This paper aims to estimate the prevalence of obesity and overweight among Portuguese primary health care professionals and to describe differences between occupational groups.<br /><strong>Material and Methods:</strong> This was a cross sectional study based on a primary care setting in Portugal in 2011. We collected data on occupation, age, sex and height of professionals from four primary care centers. We did a descriptive analysis of the main variables and an analysis of covariance to compare mean Body Mass Index.<br /><strong>Results:</strong> Our sample represented 52.8% of the total population of the four primary care centers, and 38.6% were overweight and 16.9% were obese. When adjusted for age and gender, health service personnel had the highest average Body Mass Index, followed by nurses, physicians, and superior technicians, in that order.<br /><strong>Discussion:</strong> Although we can’t ensure the generalisation of the results and cannot exclude the possibility of sampling bias, these results suggest high prevalence obesity and overweight in workers of primary health care in Portugal.<br /><strong>Conclusion:</strong> In this primary care setting more than half of the health care professionals were overweight or obese. Tailored interventions might be needed to tackle this issue.</p><p><br /><strong>Keywords:</strong> Body Mass Index; Health Personnel; Obesity; Portugal; Primary Health Care; Prevalence.</p>

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