scholarly journals Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1639 ◽  
Author(s):  
Dylan R.J. Collins ◽  
Tiina Laatikainen ◽  
Mekhri Shoismatuloeva ◽  
Isfandiyor Mahmudzoha ◽  
Zakriya Rahimov ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Clinical Decision Making ◽  
National Level ◽  
Clinical Decision ◽  
Ethical Review ◽  
Primary Health ◽  
Essential Interventions ◽  
The Republic ◽  
Soviet Legacy

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide and are a major burden in Tajikistan. The health system of Tajikistan is still shaped by the country's Soviet legacy and the pace of reform has been slow, with high patient out-of-pocket expenditure. The aim of this study is to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary health care in Tajikistan. Methods and analysis: A pragmatic, sequential mixed methods explanatory design, composed of quantitative and qualitative strands will be used with greater weighting of the quantitative strand. A single geographic district was nominated by the Ministry of Health and chosen for implementation. All primary health care centres in the district that meet inclusion criteria will be included; half will be randomly assigned to the intervention arm and half to the control arm. The overall process is organized into seven steps: (1) refresh clinical decision-making tools including open source WHO PEN and HEARTS resources; (2) update training package for primary health care workers; (3) collection of baseline data; (4) training staff in intervention clinics; (5) implementation of protocols and implementation coaching; (6) collection of follow-up data after 12 months; (7) evaluation of results and sharing experience. Ethics and dissemination: Ethical review and approval have been obtained. Findings will be disseminated at the participant level, national level through a national conference of key stakeholders, and internationally through publication in an open-access peer review journal.

scholarly journals Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons

2020 ◽  
Vol 18 (4) ◽  
pp. 2033
Author(s):  
Roxana De las Salas ◽  
Javier Eslava-Schmalbach ◽  
Claudia Vaca-González ◽  
Dolores Rodríguez ◽  
Albert Figueras
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Older Persons ◽  
Clinical Decision Making ◽  
Inappropriate Medication ◽  
Clinical Decision ◽  
Potentially Inappropriate Medication ◽  
Kappa Statistics ◽  
Primary Health

Objective: The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. Methods: We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity‏ ratio, item-level content validity, and Fleiss’ Kappa statistics was measured to establish reliability. The same voting method was used for round 2. Results: A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00). Conclusions: This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient’s and caregiver’s preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons’ medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.

scholarly journals Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data

2020 ◽  
Vol 21 ◽  
Author(s):  
Dylan Collins ◽  
Laura Inglin ◽  
Tiina Laatikainen ◽  
Angela Ciobanu ◽  
Ghenadie Curocichin ◽  
...  
Keyword(s):  
Health Care ◽  
Risk Factor ◽  
Primary Health Care ◽  
National Level ◽  
Noncommunicable Disease ◽  
Risk Factor Control ◽  
Republic Of Moldova ◽  
Primary Health ◽  
The Republic

SUMMARY Noncommunicable diseases (NCDs) are a growing challenge in the Republic of Moldova. A previously reported pilot cluster randomized controlled trial aimed to determine the feasibility of implementing and evaluating essential interventions for NCDs (e.g. cardiovascular risk scoring, hypertension management, statin treatment, etc.) in primary health care in the Republic of Moldova, with a view toward national scale up. One-year follow-up data (previously published) demonstrated modest improvements in NCD risk factor identification and management could be achieved. Herein, we report the second-year follow-up data and conclude that sustainable improvements in NCD risk factor control (e.g. hypertension control) can be achieved in primary health care in low resource settings by adapting existing resources (e.g. WHO PEN) and conducting focused clinical training and support. If scaled to a national level, these improvements in risk factor control could significantly translate to reductions in premature mortality from NCDs.

scholarly journals A systems approach to learning, practice and reflection in emergency primary health care: Student perspectives

2014 ◽  
Vol 11 (3) ◽  
Author(s):  
Daniel Mellifont ◽  
Nigel Barr ◽  
Peter Dunn
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Primary Health Care ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Systems Approach ◽  
Clinical Decision ◽  
Post Intervention ◽  
Learning And Teaching ◽  
Primary Health

IntroductionClinical decision making skills are essential for professional practice in primary emergency healthcare and are an intended outcome of clinical and professional programs. This article documents an interdisciplinary exploration of learning and teaching of clinical decision making and critical dialectical reflection (the systems approach) at The University of the Sunshine Coast (USC), Australia.MethodsUsing an online survey we explored students’ perspectives on how working with the systems approach impacted upon their confidence and capacity to engage in emergency clinical scenarios.ResultsUSC’s systems approach, integrated with a focus on critical reflection and case-based learning, is strongly associated with improved student confidence to engage in emergency primary health care scenarios. Most participants reported increased confidence post intervention and believed that the systems approach helped them to improve their capacity for other critical components.ConclusionThis study indicates the beneficial nature of a systems approach to the learning and teaching of clinical decision-making.  The tool could be further developed, to improve perceived ability to communicate more effectively.

scholarly journals The situation of nursing education in Latin America and the Caribbean towards universal health

2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Silvia Helena De Bortoli Cassiani ◽  
Lynda Law Wilson ◽  
Sabrina de Souza Elias Mikael ◽  
Laura Morán Peña ◽  
Rosa Amarilis Zarate Grajales ◽  
...  
Keyword(s):  
Health Care ◽  
Latin America ◽  
Primary Health Care ◽  
Nursing Education ◽  
Clinical Decision Making ◽  
Clinical Experiences ◽  
Cross Sectional ◽  
Primary Health ◽  
The Caribbean ◽  
Universal Health

Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.

scholarly journals District nurses’ experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study

2021 ◽  
Vol 22 ◽  
Author(s):  
Annica Lagerin ◽  
Lena Törnkvist ◽  
Johan Fastbom ◽  
Lena Lundh
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Primary Health Care ◽  
Decision Support ◽  
Clinical Decision Support System ◽  
Elderly Care ◽  
Medication Use ◽  
Clinical Decision ◽  
Primary Health ◽  
District Nurses

Abstract Aim: The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. Background: In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. Methods: Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts. Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

scholarly journals Legal limitations in the practice of the primary health care nurse

Curationis ◽  
1994 ◽  
Vol 17 (2) ◽  
Author(s):  
J. Bierman ◽  
M. Muller
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Empirical Investigation ◽  
Document Analysis ◽  
Care Nurse ◽  
Primary Health ◽  
The Republic ◽  
Year 2000

In this article the legal limitations in the practice of the primary health care nurse in the Republic of South Africa, having direct implications for the achievement of the goal: "Health for all by the year 2000", are explored and described The questions which had to be answered by means of the research are in relation to the nature and scope of the limitations obstructing the practice of the primary health care nurse. A legislative (document) analysis was performed and limitations in the legislation confirmed. It is recommended that an empirical investigation be done to verify the results after which amendments and clarification of the legislation may be requested.

Making Ethics Work in Collaborative Projects

2005 ◽  
Vol 11 (3) ◽  
pp. 101
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Research Ethics ◽  
Health Care Professionals ◽  
Ethics Committees ◽  
Research Process ◽  
Ethical Review ◽  
Ethical Research ◽  
Team Members ◽  
Primary Health

This article discusses problems a research team had managing their ethical obligations during a short project, and considers the implications of these problems for better understanding and carrying out ethical research in the future. Two key points will be proposed. Initially, it will be argued that the culture of ethical research as articulated within the research community may not be universally accepted within the primary health care sector. The nature of "ethical conduct" within clinical practice, service provision and research is not the same. Further, practical difficulties the researchers experienced while trying to gain approval from ethics committees and implement the proposed research plan highlight some ways in which institutional ethical review processes are structurally unsuited to the requirements of small collaborative projects. Understanding the different ways in which the term "ethics" is used will allow for a more expedient translation of concepts between different health professionals. Recognising the practical constraints ethical review places on the research process may help reduce some of the frustration primary health care professionals can experience when faced with the requirements of research ethics committees. Due to the history of, and cultural commitment to, ethical research within the university sector, those with formal academic training in research are well placed to assume responsibility for managing the ethics process when involved in cross-sectoral research. This responsibility may include the need to educate team members and study participants about the importance of research ethics.

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