scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Indonesia

2020 ◽  
Vol 18 (3) ◽  
pp. 2085
Author(s):  
Andi Hermansyah ◽  
Luh Wulandari ◽  
Susi A. Kristina ◽  
Sherly Meilianti
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Pharmacy ◽  
Health Care Policy ◽  
Primary Care Providers ◽  
Good Evidence ◽  
Care Practice ◽  
Health Coverage ◽  
Care Providers ◽  
Care System

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

scholarly journals Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System

2018 ◽  
Vol 62 (8) ◽  
Author(s):  
Nathan R. Shively ◽  
Deanna J. Buehrle ◽  
Cornelius J. Clancy ◽  
Brooke K. Decker
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Health Care System ◽  
Primary Care Providers ◽  
Acute Respiratory Tract Infection ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Care System

ABSTRACT Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

scholarly journals A Systems-Wide Approach for Early Detection and Management of Dementia in Primary Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 346-346
Author(s):  
Annette Fitzpatrick ◽  
Basia Belza
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Signs And Symptoms ◽  
Primary Care Providers ◽  
Population Increase ◽  
Community Advisory Board ◽  
Care Practice ◽  
Care Providers ◽  
Cognitive Changes

Abstract Dementia is frequently unrecognized and under-reported by health care providers. The needs of an aging population increase the burden on an already over-worked primary care system that is often without the appropriate training, resources, and reimbursement to address the growing number of people with cognitive decline in the US. In this symposium we present a systems-wide approach within University of Washington (UW) Primary Care to increase awareness of early signs and symptoms, detection of cognitive impairment, and support of providers, patients and caregivers that will ultimately improve outcomes of care. This quality improvement (QI) program integrates stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA), into primary care practice. We describe content and logistics of a continuing education intervention for primary care providers and clinical staff to increase skills for evaluation and management of dementia. Working with UW clinic managers and information technology (IT), we have developed a pragmatic system for streamlining operations and documenting care utilizing newly developed interdisciplinary workflows and electronic health record order sets. Using input from our Community Advisory Board, we explain development of a web-based resource directory to be used in-clinic and at home to support providers, staff, patients, families, and caregivers across cognitive changes. Strategies presented here are aimed to help other health care systems initiate steps to integrate KAER and other tools into a practical QI program for improving detection and management of dementia through support of primary care.

scholarly journals Whom Should We Profile? Examining Diabetes Care Practice Variation among Primary Care Providers, Provider Groups, and Health Care Facilities

2002 ◽  
Vol 37 (5) ◽  
pp. 1159-1180 ◽  
Author(s):  
Sarah L Krein ◽  
Timothy P Hofer ◽  
Eve A Kerr ◽  
Rodney A Hayward
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Diabetes Care ◽  
Primary Care Providers ◽  
Practice Variation ◽  
Health Care Facilities ◽  
Care Practice ◽  
Care Providers ◽  
Care Facilities

scholarly journals A Pilot Assessment of Primary Care Providers’ Knowledge of Adrenal Insufficiency Diagnosis and Management

2019 ◽  
Vol 10 ◽  
pp. 215013271986216 ◽  
Author(s):  
Vinni Makin ◽  
Amy S. Nowacki ◽  
Colleen Y. Colbert
Keyword(s):  
Professional Development ◽  
Primary Care ◽  
Health Care ◽  
Needs Assessment ◽  
Adrenal Insufficiency ◽  
Health Care System ◽  
Primary Care Providers ◽  
Care Providers ◽  
Diagnosis And Management ◽  
Care System

Background and Objectives: Adrenal insufficiency (AI) is one of the most challenging diagnoses in primary care, and misdiagnosis is costly. The aim of this educational needs assessment was to assess primary care physicians’ (PCPs) knowledge of AI diagnosis and management as a preliminary step in developing a professional education module to address knowledge of practice gaps. Methods: We developed a 12-item needs assessment and pretested questionnaire items prior to use to gather validity evidence. The questionnaire contained 4 AI knowledge items, 4 needs assessment items, and 4 demographic items. It was administered to 100 PCPs across a single integrated health care system over a 6-month period. Results: Fifty-one of 100 questionnaires were returned. The majority of respondents believed their knowledge of AI diagnosis and management was “average” when compared with peers. Responses indicated that PCPs were fairly comfortable diagnosing, but not managing AI patients. There was no association between respondents’ clinical knowledge of AI and respondents’ roles as clinical instructors (ie, having trainees assigned to them). A total of 54% of respondents said they utilized online resources to enhance current knowledge of AI and 88% of respondents said they would use a new AI resource, if available. When asked to rank preferences for professional development modalities, 26/38 respondents ranked UpToDate, 21/38 respondents ranked traditional lecture, and 19/38 respondents ranked case discussion among their top 3 choices. Conclusion: Results of this needs assessment showed that PCPs within our health care system both needed and desired professional development targeting AI diagnosis and management. A faculty development session, which included a short lecture and case scenarios, was developed and delivered to PCPs at participating family health centers. Session materials are now available for use by other institutions to meet professional development needs on this important topic.

scholarly journals Quantification of the resilience of primary care networks by stress testing the health care system

2019 ◽  
Vol 116 (48) ◽  
pp. 23930-23935 ◽  
Author(s):  
Donald Ruggiero Lo Sardo ◽  
Stefan Thurner ◽  
Johannes Sorger ◽  
Georg Duftschmid ◽  
Gottfried Endel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Large Scale ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Physician Density ◽  
Care Systems ◽  
Care System

There are practically no quantitative tools for understanding how much stress a health care system can absorb before it loses its ability to provide care. We propose to measure the resilience of health care systems with respect to changes in the density of primary care providers. We develop a computational model on a 1-to-1 scale for a countrywide primary care sector based on patient-sharing networks. Nodes represent all primary care providers in a country; links indicate patient flows between them. The removal of providers could cause a cascade of patient displacements, as patients have to find alternative providers. The model is calibrated with nationwide data from Austria that includes almost all primary care contacts over 2 y. We assign 2 properties to every provider: the “CareRank” measures the average number of displacements caused by a provider’s removal (systemic risk) as well as the fraction of patients a provider can absorb when others default (systemic benefit). Below a critical number of providers, large-scale cascades of patient displacements occur, and no more providers can be found in a given region. We quantify regional resilience as the maximum fraction of providers that can be removed before cascading events prevent coverage for all patients within a district. We find considerable regional heterogeneity in the critical transition point from resilient to nonresilient behavior. We demonstrate that health care resilience cannot be quantified by physician density alone but must take into account how networked systems respond and restructure in response to shocks. The approach can identify systemically relevant providers.

Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health Care Utilization

2021 ◽  
pp. 102551
Author(s):  
Marianne Simonsen ◽  
Lars Skipper ◽  
Niels Skipper ◽  
Peter Rønø Thingholm
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Care Practice ◽  
Care Providers ◽  
Patient Health

scholarly journals Adolescents’ Views on Barriers to Health Care

2011 ◽  
Vol 3 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Sylvia W. Lim ◽  
Rosy Chhabra ◽  
Ayelet Rosen ◽  
Andrew D. Racine ◽  
Elizabeth M. Alderman
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Waiting Times ◽  
Primary Care Providers ◽  
Care Practice ◽  
Care Providers ◽  
Group Interviews ◽  
Key Barrier

Objectives: To determine from adolescents using health care their: 1) perceptions of barriers to obtaining health services, 2) views on how to overcome the barriers and 3) views on how to create an adolescent-friendly primary care practice. Design: Six focus group interviews. Methods: Adolescents 11-21 years old from three health centers in the Bronx were recruited. Main Outcome Measures: 1) barriers to accessing health care such as insurance, language barriers, transportation, making an appointment; 2) identifying barriers related to issues of consent and confidentiality; 3) exploring barriers to accessing mental health and related issues; and 4) their visions of an adolescent-friendly office. Results: Thirty-one adolescents, aged 11-21 years old, participated. The majority were Hispanic and 52% were female. Fifty percent of adolescents had a routine visit within the past month. Most adolescents reported experiencing barriers to making an appointment. Additionally, they complained about long waiting times to be seen by providers on the day of their scheduled appointment. Another key barrier was related to knowledge and perceptions about consent and confidentiality. Further, in regard to mental health, many adolescents from focus groups reported that they felt that their primary providers had little interest in this topic and limited knowledge about it. Most of the adolescents reported no barriers with insurance, language or transportation. Their visions of an adolescent-friendly office would include a separate adolescent waiting area equipped with entertainment units. Conclusion: In this study of adolescents who already have primary care providers and are seemingly well-connected to the health care system, there remained significant reported barriers to accessing necessary health services.

scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Portugal

2020 ◽  
Vol 18 (3) ◽  
pp. 2043
Author(s):  
Nadine Ribeiro ◽  
Helder Mota-Filipe ◽  
Mara P. Guerreiro ◽  
Filipa A. Costa
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Community Pharmacy ◽  
National Health ◽  
Health Care Policy ◽  
Universal Coverage ◽  
Health Coverage ◽  
Primary Health ◽  
Clinical Records

The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes.

Does behavioral health integration improve primary care providers' perceptions of health-care system functioning and their own knowledge?

2017 ◽  
Vol 46 ◽  
pp. 88-93 ◽  
Author(s):  
Leah Zallman ◽  
Robert Joseph ◽  
Colleen O'Brien ◽  
Emily Benedetto ◽  
Ellie Grossman ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Health Care System ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Health Integration ◽  
System Functioning ◽  
Care System
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