Scope of practice in Primary Care: physicians and nurses in five health regions in Brazil

Abstract Objectives: The review on scopes of practice tends to gain importance in Human Resource in Health agenda in Brazil. The aim of this study was to investigate the scope of practice of physicians and nurses who work in the Atenção Primária em Saúde (APS) (Primary Healthcare) and their main barriers. Methods: this is an exploratory qualitative study conducted in 2015 and 2016, through interviews with 26 physicians and 26 nurses who work in the APS in 12 cities distributed in five Brazilian health regions. Results: physicians and nurses in the health region of the North and Northeast performed a great number of procedures, and those physicians who work in units located in rural areas. Both professional categories indicated that they knew how to carry out several procedures that were not performed in practice. The main barriers for not performing those procedures include, lack of access to exams, materials and inadequate infrastructure, protocols and city guides restrictions, legal restrictions and lack of training. Conclusions: the results suggests the need to ease the health professionals’ attributions, facilitate the integration between the professionals’ practices and optimizing their work, especially in remote and unassisted regions, in order to be in favor of expanding the access and problem solving in APS.

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How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas

Women s Health Issues ◽

10.1016/j.whi.2016.09.015 ◽

2017 ◽

Vol 27 (2) ◽

pp. 158-166 ◽

Cited By ~ 16

Author(s):

Diana N. Carvajal ◽

Deborah Gioia ◽

Estefania Rivera Mudafort ◽

Pamela Bohrer Brown ◽

Beth Barnet

Keyword(s):

Primary Care ◽

Decision Making ◽

Qualitative Study ◽

Primary Care Physicians

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Primary Care: The Future for Pediatric Education

PEDIATRICS ◽

10.1542/peds.86.5.653 ◽

1990 ◽

Vol 86 (5) ◽

pp. 653-659

Author(s):

Joel J. Alpert

Keyword(s):

Primary Care ◽

Rural Areas ◽

Primary Care Physicians ◽

Geographic Location ◽

Pediatric Care ◽

Past Century ◽

Inner Cities ◽

Critical Issues ◽

Definition Of ◽

Care Problems

There is a continuing crisis in primary care, characterized by inadequate numbers of appropriately trained primary care physicians and the failure to mount an effective and consistent graduate educational program for primary care. This paper reviews the history of the primary care crisis; revisits the definition of primary care; and, through identification of critical issues, presents a primary care educational agenda for the 1990s. Pediatrics is at a crossroads regarding primary care, as powerful social and economic forces are impacting on today's major pediatric care problems. Before the second World War there were more than 300 primary care physicians available for each 100 000 of our population. Today the ratio is 75 for 100 000. This is despite the fact that a shortage of 50 000 physicians 10 years ago no longer exists. The majority view is that a physician surplus of 70 000 will be present by the early 1990s.1 Whether there is a surplus is subject to interpretation and the surplus may end up as nonexistent. Moreover, the availability of primary care physicians varies with geographic location, and even a single figure for this nation provides a distorted picture. The shortage is especially serious in inner cities and in many rural areas. In addition, the use of overall numbers assumes that all primary care physicians are appropriately trained in the general disciplines. For the past century, physicians have cared for patients usually as family physicians. Today, however, the generalist has been replaced by the specialist. Is this a function of financial rewards and society's needs and values or the educational experience?

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Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

BMC Family Practice ◽

10.1186/1471-2296-10-39 ◽

2009 ◽

Vol 10 (1) ◽

Cited By ~ 27

Author(s):

Sharon Brez ◽

Margo Rowan ◽

Janine Malcolm ◽

Sheryl Izzi ◽

Julie Maranger ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Diabetes Care ◽

Primary Care Physicians

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The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study

Journal of Clinical Medicine ◽

10.3390/jcm10235656 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5656

Author(s):

Krzysztof Studziński ◽

Tomasz Tomasik ◽

Adam Windak ◽

Maciej Banach ◽

Ewa Wójtowicz ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Rural Areas ◽

Urban Areas ◽

Primary Care Physicians ◽

Primary Care Patient ◽

Care Patient ◽

Cross Sectional ◽

Therapeutic Goals ◽

Rural Primary Care

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (p = 43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.

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Who Should Play a Key Role in Preventing Common Mental Disorders that Affect Employees in the Workplace? Results of a Survey with Occupational Health Physicians, Primary Care Physicians, Psychotherapists, and Human Resource Managers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16081383 ◽

2019 ◽

Vol 16 (8) ◽

pp. 1383 ◽

Cited By ~ 2

Author(s):

Martina Michaelis ◽

Elisabeth Maria Balint ◽

Florian Junne ◽

Stephan Zipfel ◽

Harald Gündel ◽

...

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Occupational Health ◽

Health Professionals ◽

Primary Care Physicians ◽

Common Mental Disorders ◽

Human Resource Managers ◽

Insurance Agents ◽

Professional Groups ◽

Resource Managers

The rising burden of common mental disorders (CMDs) in employees requires strategies for prevention. No systematic data exist about how those involved perceive their roles, responsibilities, and interactions with other professional groups. Therefore, we performed a multi-professional standardized survey with health professionals in Germany. A self-administered questionnaire was completed by 133 occupational health physicians (OHPs), 136 primary care physicians (PCPs), 186 psychotherapists (PTs), and 172 human resource managers (HRMs). Inter alia, they were asked which health professionals working in the company health service and in the outpatient care or in the sector of statutory insurance agents should play a key role in the primary, secondary, and tertiary prevention of CMDs in employees. The McNemar test was used in order to compare the attributed roles among the professionals involved. With regard to CMDs, all the professional groups involved in this study declared OHPs as the most relevant pillar in the field of prevention. In primary prevention, HRMs regarded themselves, OHPs, and health insurance agents as equally relevant in terms of prevention. PTs indicated an important role for employee representatives in this field. In secondary prevention, PCPs were regarded as important as OHPs. HRMs indicated themselves as equally important as OHPs and PCPs. In tertiary prevention, only OHPs identified themselves as main protagonists. The other groups marked a variety of several professions. There is a common acceptance from the parties involved that might help the first steps be taken toward overcoming barriers, e.g., by developing a common framework for quality-assured intersectional cooperation in the field of CMD prevention in employees.

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1887. Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A Qualitative Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1543 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S540-S540

Author(s):

Rachel M Zetts ◽

Andrea Stoesz ◽

Andrea M Garcia ◽

Jason Doctor ◽

Jeffrey S Gerber ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Qualitative Study ◽

Antibiotic Stewardship ◽

Primary Care Physicians ◽

Attitudes And Perceptions

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Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp20x707849 ◽

2020 ◽

Vol 70 (691) ◽

pp. e102-e110 ◽

Cited By ~ 1

Author(s):

Verity Wainwright ◽

Lis Cordingley ◽

Carolyn A Chew-Graham ◽

Nav Kapur ◽

Jenny Shaw ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Qualitative Study ◽

Support Needs ◽

Structured Interviews ◽

Perceived Needs ◽

The North ◽

Suicide Bereavement ◽

Additional Support ◽

The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

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