scholarly journals Management of patients with obstructive lung disease in South India: a retrospective study of spirometry and bronchodilator use in an urban health centre

2019 ◽  
Vol 6 (7) ◽  
pp. 3061
Author(s):  
Niger David ◽  
Sajitha M. F. Rahman ◽  
Ruby Angeline Pricilla ◽  
Sunil Abraham ◽  
Kirubah V. David
Keyword(s):  
Primary Care ◽  
Retrospective Study ◽  
Urban Health ◽  
Primary Care Physicians ◽  
Respiratory Symptoms ◽  
Severe Disease ◽  
Health Centre ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Urban Health Centre

Background: Based on the burden of obstructive lung diseases program (BOLD), the global prevalence of chronic obstructive pulmonary disease (COPD) was 11.7% in which 90% of the deaths occur in low- and middle-income countries. India and China are estimated to account for 66% of total global COPD mortality. The Indian Chest Society (ICS) recommends spirometry to document irreversible airflow limitation in patients suspected of having COPD. However, the reported usage of spirometry among primary care physicians in India is only 10-20% as primary health care centers in India are not equipped with spirometry or inhaler devices.Methods: A retrospective study was done on patients treated for respiratory symptoms with bronchodilators at an urban health centre to document the practice pattern of primary care physicians with regards to use of spirometry in patients on bronchodilators.Results: Of the 1196 patients on bronchodilators, spirometry was documented in 15.5%. Patients on inhalers, using more than one therapy and males less than 55 years were more likely to undergo spirometry. About 52.4% of patients who underwent spirometry were found to have post bronchodilator forced expiratory volume at first second (FEV1)/ forced vital capacity (FVC) less than 0.7 of which 43% had severe disease and 44% had poor post-broncho-dilator reversibility.Conclusions: Besides diagnostic spirometry, management guidelines for COPD should be complemented by health education to change patients’ perception of respiratory symptoms, increase awareness of COPD in those with risk factors and change their health seeking behaviour along with continuous professional development activities for primary care physicians.

A strategy for improvement in diagnosis and treatment of bronchial asthma in primary care

2019 ◽  
Vol 29 (4) ◽  
pp. 457-467
Author(s):  
S. N. Avdeev ◽  
S. R. Aisanov ◽  
A. S. Belevskiy ◽  
A. V. Emel’yanov ◽  
O. M. Kurbacheva ◽  
...  
Keyword(s):  
Primary Care ◽  
Bronchial Asthma ◽  
Primary Care Physicians ◽  
Respiratory Symptoms ◽  
Respiratory Diseases ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
Asthma Diagnosis ◽  
Chronic Respiratory Diseases

Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.

Why Wait so Long for Child Care? An Analysis of Waits, Queues and Work in a South African Urban Health Centre

1997 ◽  
Vol 27 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Max O Bachmann ◽  
Peter Barron
Keyword(s):  
Primary Care ◽  
South African ◽  
Urban Health ◽  
Care Delivery ◽  
Waiting Times ◽  
Health Centre ◽  
Cross Sectional ◽  
Patient Dissatisfaction ◽  
Primary Care Delivery ◽  
Urban Health Centre

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

scholarly journals How different are COPD-specific patient reported outcomes, health status, dyspnoea and respiratory symptoms? An observational study in a working population

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025132 ◽  
Author(s):  
Koichi Nishimura ◽  
Toru Oga ◽  
Kazuhito Nakayasu ◽  
Miyoko Ogasawara ◽  
Yoshinori Hasegawa ◽  
...  
Keyword(s):  
Health Status ◽  
Respiratory Symptoms ◽  
Smoking Status ◽  
Fixed Ratio ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Working Population ◽  
Specific Patient ◽  
Patient Reported ◽  
D 12

ObjectivesWe hypothesised that chronic obstructive pulmonary disease (COPD)-specific health status measured by the COPD assessment test (CAT), respiratory symptoms by the evaluating respiratory symptoms in COPD (E-RS) and dyspnoea by Dyspnoea-12 (D-12) are independently based on specific conceptual frameworks and are not interchangeable. We aimed to discover whether health status, dyspnoea or respiratory symptoms could be related to smoking status and airflow limitation in a working population.DesignThis is an observational, cross-sectional study.Participants1566 healthy industrial workers were analysed.ResultsRelationships between D-12, CAT and E-RS total were statistically significant but weak (Spearman’s correlation coefficient=0.274 to 0.446). In 646 healthy non-smoking subjects, as the reference scores for healthy non-smoking subjects, that is, upper threshold, the bootstrap 95th percentile values were 1.00 for D-12, 9.88 for CAT and 4.44 for E-RS. Of the 1566 workers, 85 (5.4%) were diagnosed with COPD using the fixed ratio of the forced expiratory volume in one second/forced vital capacity <0.7, and 34 (2.2%) using the lower limit of normal. The CAT and E-RS total were significantly worse in non-COPD smokers and subjects with COPD than non-COPD never smokers, although the D-12 was not as sensitive. There were no significant differences between non-COPD smokers and subjects with COPD on any of the measures.ConclusionsAssessment of health status and respiratory symptoms would be preferable to dyspnoea in view of smoking status and airflow limitation in a working population. However, these patient-reported measures were inadequate in differentiating between smokers and subjects with COPD identified by spirometry.

scholarly journals Knowledge, attitude and practices of Ramadan fasting on health and disease among pregnant Muslim women in urban health centre of a medical college

2019 ◽  
Vol 7 (1) ◽  
pp. 289
Author(s):  
Muhammed Muntazeem G. ◽  
Varadaraja Rao B. A. ◽  
Mane Kusum S.
Keyword(s):  
Pregnant Women ◽  
Urban Health ◽  
Health Centre ◽  
Muslim Women ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Familial Support ◽  
Mother And Child ◽  
Urban Health Centre

Background: Fasting during the holy month of Ramadan entails abstinence from food, water, smoking and drugs from dawn to sunset. In Islamic religious rule fasting during Ramadan is not mandatory if there is any contraindication such as illness, old age, pregnancy, etc. Many studies have shown that most Muslim women choose to fast during pregnancy because of a sense of religious duty, familial support, positive views on fasting and difficulty in completing the missed fasts at another time.Methods: A cross sectional study was conducted on 124 pregnant Muslim women attending urban health centre for antenatal care during the month of Ramadan at Davanagere city. Data was entered in the Microsoft Excel and presented in the form of frequencies.Results: In this study majority of pregnant women believed that fasting during pregnancy is harmful to mother as well as child. Overall, 80.6% of pregnant women did not observed fasting during pregnancy.Conclusions: In this study majority of the pregnant women did not observed fasting during the month of Ramadan. Health education should be given to all pregnant women and family members regarding adverse effect of fasting on mother and child health.

scholarly journals Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study

2016 ◽  
Vol 23 (3) ◽  
pp. 580 ◽  
Author(s):  
Michelle Greiver ◽  
Kimberly Wintemute ◽  
Babak Aliarzadeh ◽  
Ken Martin ◽  
Shahriar Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Data Management ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Analytical Data ◽  
Data Repository ◽  
Chronic Obstructive ◽  
Care Organisation ◽  
Primary Care Organisation

Background Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.Methods Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.Results Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%–8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%–9.5%, p < 0.01).Conclusions Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

scholarly journals Early detection of asthma and chronic obstructive pulmonary disease in primary care patients

2013 ◽  
Vol 66 (1-2) ◽  
pp. 46-52 ◽  
Author(s):  
Marija Vukoja ◽  
Predrag Rebic ◽  
Zorica Lazic ◽  
Marija Mitic-Milikic ◽  
Branislava Milenkovic ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Primary Care Patients

Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. Material and Methods. In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. Results. There were 2074 patients, 38.4% men, their mean age being 54?15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (64.3%). The diagnosis of chronic obstructive pulmonary disease was confirmed by pulmonologists in 454 (21.9%) and asthma in 455 (21.9%) patients. The chronic obstructive pulmonary disease was newly diagnosed in 226 (10.9%) and asthma in 269 (13%) of the cases. There was a moderate agreement between the pulmonologists and general practitioners on the diagnosis of chronic obstructive pulmonary disease (kappa 0.41, 95%CI 0.36-0.46) and asthma (kappa 0.42, 95% CI 0.37-0.465). Conclusion. A significant number of patients seen in the general practitioner?s office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.

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