scholarly journals The use of Artificial Neural Networks in the diagnosis of manageable factors on Brazilian Primary Health Care

2021 ◽  
Vol 10 (1) ◽  
pp. e31010111740
Author(s):  
Kerla Fabiana Dias Cabral ◽  
Fábio Ribeiro Cerqueira ◽  
Rodrigo Siqueira-Batista ◽  
Marco Aurélio Marques Ferreira ◽  
Bruna Rodrigues de Freitas
Keyword(s):  
Neural Networks ◽  
Primary Care ◽  
Health Care ◽  
Artificial Neural Networks ◽  
Primary Health Care ◽  
Health Sector ◽  
Welfare Programs ◽  
Primary Health ◽  
The Social ◽  
Artificial Neural

The social determinants of health are relevant in the main strategies of Primary Health Care. However, it is known the difficulties of the health sector to overcome the factors that negatively interfere with the health of the population. Thus, it was aimed to create a computer model to present in detail the factors that somehow are related to the Primary Health Care, enabling public health managers to make decisions efficiently. Using artificial neural networks, it was possible to create a classifier model that could show which variables are related to the efficiency in Primary Care and which lead to inefficiency. Moreover, it was used the NICeSim simulator as a tool to evaluate the behavior of each variable identified as relevant to the efficiency in Primary Care of cities. The results demonstrate that the created model was superior to previously proposed models. Furthermore, our model has been demonstrated to be very effective in identifying variables that affect Primary Health. The created model shows that factors, such as illiteracy and welfare programs, considerably affect the efficiency of health care, reinforcing the argument that the focus of the public policies should be dealt in an intersectoral way, improving the factors that positively influence the population health.

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

2020 ◽  
pp. 152715442096553
Author(s):  
Sue Adams ◽  
Jenny Carryer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Nurse Practitioner ◽  
Central Government ◽  
Health Sector ◽  
District Health ◽  
Policy Context ◽  
Primary Health

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand’s strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a “hands-off” approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

scholarly journals Editorial

1995 ◽  
Vol 1 (1) ◽  
pp. 2
Author(s):  
Heather Gardner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Continuity Of Care ◽  
Health Sector ◽  
Community Health Services ◽  
Continuing Care ◽  
Australian Health ◽  
Primary Health

The advent of the Australian Journal of Primary Health - Interchange reflects the changes which are taking place in the Australian health sector and the increased and increasing importance of primary health care and community health services. The significant role of primary care in maintaining health and enhancing wellbeing is at last being recognised, and the relationships between primary care, continuing care, and acute care are being redefined and the connections made, so that improvement in continuity of care can be achieved.

scholarly journals Community oriented primary care in Tshwane District, South Africa: Assessing the first phase of implementation

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Hans-Friedemann Kinkel ◽  
Tessa Marcus ◽  
Shehla Memon ◽  
Nomonde Bam ◽  
Jannie Hugo
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Service Providers ◽  
Health Sector ◽  
Political Commitment ◽  
Care Providers ◽  
Primary Health

Background: Re-engineering primary health care is a cornerstone of the health sector reforminitiated nationally in South Africa in 2009. Using the concept of ward based NGO-run healthposts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011.Objectives: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district.Method: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health careproviders’ understanding, perception and experience of COPC.Results: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities.Conclusion: COPC touched a responsive nerve in the health care system, both nationallyand locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.

scholarly journals The health promotion shift into Primary Health Organisations: Implications for the health promotion workforce

2011 ◽  
Vol 3 (1) ◽  
pp. 41 ◽  
Author(s):  
Sarah Lovell ◽  
Pat Neuwelt
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Health Promotion ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Sector ◽  
Primary Health ◽  
Primary Care Sector ◽  
Care Health

INTRODUCTION: Reconciling the primary care sector’s traditional concern for individual health outcomes with a population health approach is integral to the implementation of New Zealand’s Primary Health Care Strategy, and a key challenge for health promotion in New Zealand. The purpose of this study was to examine the views of health promoters, their funders and managers toward the implementation of the Primary Health Care Strategy’s health promotion agenda. METHODS: Focus groups and interviews were carried out with 64 health promoters and 21 health sector managers and planners and funders over the 12 months beginning March 2008. Interview and focus group transcripts were analysed thematically. FINDINGS: Primary Health Organisations (PHOs) have been perceived as both an opportunity and a threat to health promotion. The opportunity was seen to lie in the development of health promotion responsive to the needs of communities. Yet the numerous PHOs that emerged spread funding and capacity for health promotion thin, particularly amongst smaller PHOs. CONCLUSION: The failure of the Ministry of Health to engage the health promotion workforce in the development and implementation of the Primary Health Care Strategy has led to a clear sense of vulnerability among health promoters. Ideological divisions between primary care and public health have been exacerbated by the restructuring of health promotion funding and delivery. Within non-governmental organisations and public health units concern continues to surround the legitimacy of health promotion approaches undertaken within the primary health care sector. KEYWORDS: Health promotion; primary health care; health policy; Primary Health Organisations; New Zealand; restructuring

scholarly journals Editorial

1996 ◽  
Vol 2 (2) ◽  
pp. 2
Author(s):  
Heather Gardner
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Health Sector ◽  
Primary Health ◽  
The Social ◽  
Improve Health ◽  
Meaningful Communication

Much of the material in this issue is concerned with communication, but communication is much more than simply a means whereby information and knowledge is transferred between people. It is influenced by culture and by the social and policy contexts in which it takes place. In the primary health care area, meaningful communication is possibly even more important and more difficult than in any other area of the health system. It is more difficult, for example, because of the principles of primary health care to which practitioners subscribe, including the empowerment of those who would seek access to the system, re-orienting the health sector, and intersectoral co-operation in attempting to improve health and health services. The contributors demonstrate that in primary health care and in thinking about what is health, what influences it, how is it perceived, and how is it to be improved, there are theoretical and practical ways of and approaching such issues.

Brazilian National Household Health Survey and PCAT: the case of Mato Grosso do Sul, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F Pinto ◽  
D Soranz ◽  
L J Santos ◽  
M S Paranhos ◽  
L S Malta ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Data Collection ◽  
Health Survey ◽  
Household Surveys ◽  
Mato Grosso ◽  
Primary Health ◽  
The World ◽  
Mato Grosso Do Sul

Abstract Brazil is divided into five administrative regions, 27 federation units and 5,570 municipalities. Mato Grosso do Sul is one of the states located in the Midwest region and has 1.6 million km2 and a resident population of 2.8 million inhabitants, that is, it has an even lower demographic density than its region - only 7.8 inhabitants/km2. Mato Grosso do Sul has part of the Pantanal, a biome considered the largest continuous floodplain in the world, rich in biodiversity. For this reason, displacements for data collection in household surveys combine roads and rivers. In 2019, the Brazilian National Institute of Geography and Statistics (Istituto Nazionale di Statistica del Brasile) in partnership with the Ministry of Health launched the world's largest household sample survey, the National Health Survey (PNS-2019), in which part of its questions included the use of Primary Care Assessment Tool (PCAT, adult version), created by professors Barbara Starfield and Leiyu Shi in the 2000s. IBGE interviewers visited more than 100,000 households across the country. In Mato Grosso do Sul, more than 3,000 households were surveyed. In this work, we present the data collection instrument used by IBGE and its multiple analysis possibilities in the scope of primary health care, crossing the variables from other questionnaire modules in order to compare the results from Brazil with the state of Mato Grosso do Sul and its capital, Campo Grande. Developing a baseline and measuring the attributes of primary health care in each of the Brazilian states is another step towards giving health policy accountability, towards strong primary care. IBGE's experience in household surveys and innovation in data collection in primary care is an example for the world that yes, it is possible to develop statistically representative national sample surveys and make them perennial in their regular household surveys, by the time World Health Organization (WHO) discusses universal health coverage. Key messages Evaluation of primary care using an internationally validated instrument is possible on national bases with random household sample surveys. A questionnaire elaborated academically can be used as an instrument of public policy to evaluate nationwide health services.

scholarly journals Primary care organizational model mix and avoidable hospitalization: an ecological study in Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Pinto ◽  
J V Santos ◽  
M Lobo ◽  
J Viana ◽  
J Souza ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Primary Healthcare ◽  
Pay For Performance ◽  
Care Quality ◽  
Organizational Model ◽  
Avoidable Hospitalizations ◽  
Primary Health ◽  
Age And Sex

Abstract Background In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patients within USF-B model and the rate of avoidable hospitalizations, as proxy of primary care quality. Methods We conducted a cross-sectional study considering the 55 ACES from mainland Portugal, in 2017. We used data from public hospitalizations to calculate the prevention quality indicator (avoidable hospitalizations) adjusted for age and sex, using direct standardization. The main independent variable was the proportion of patients in one ACES registered in the USF-B model. Unemployment rate, proportion of patients with family doctor and presence of Local Health Unit (different organization model) within ACES were also considered. The association was assessed by means of a linear regression model. Results Age-sex adjusted PQI value varied between 490 and 1715 hospitalizations per 100,000 inhabitants across ACES. We observed a significant effect of the proportion of patients within USF-B in the crude PQI rate (p = 0.001). However, using the age-sex adjusted PQI, there was not a statistical significant association (p = 0.504). This last model was also adjusted for confounding variables and the association remains non-significant (p = 0.865). Conclusions Our findings suggest that, when adjusting for age and sex, there is no evidence that ACES with more patients enrolled in a pay-for-performance model is associated with higher quality of PHC (using avoidable hospitalizations as proxy). Further studies addressing individual data should be performed. This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”. Key messages Adjusting PQI to sex and age seems to influence its value more than the type of organizational model of primary health care. Groups of primary healthcare centres with more units under the pay-for-performance scheme was not associated with different rate of avoidable hospitalizations.

The Social Audit Agenda - Primary Health Care in a Stakeholder Society

2000 ◽  
Vol 4 (1) ◽  
pp. 3-28 ◽  
Author(s):  
Philip Cotton ◽  
Ian A.M. Fraser ◽  
Wan Ying Hill
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Social Audit ◽  
Primary Health ◽  
The Social

scholarly journals Cross-cultural adaptation of the primary health care satisfaction questionnaire

2014 ◽  
Vol 27 (5) ◽  
pp. 419-426 ◽  
Author(s):  
Elisabete Pimenta Araujo Paz ◽  
Pedro Miguel Santos Dinis Parreira ◽  
Alexandrina de Jesus Serra Lobo ◽  
Rosilene Rocha Palasson ◽  
Sheila Nascimento Pereira de Farias
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Cultural Adaptation ◽  
Care Service ◽  
Cross Cultural ◽  
Care Services ◽  
Primary Health

Objective To develop the cross-cultural validation and assessment of the psychometric properties of the Questionnaire about the quality and satisfaction dimensions of patients with primary health care. Methods Methodological cultural adaptation and assessment study of the psychometric properties, involving 398 users from a primary care service. The construct validity was verified through principal components factor analysis and internal consistency assessment as determined by Cronbach’s alpha, using SPSS. Results A factorial structure was identified that is equivalent to the original instrument, showing six factors that explain 70.81% of the total variance. All internal consistency coefficients were higher than 0.84, indicating appropriate psychometric properties. Conclusion The results show that the Brazilian Portuguese version of the instrument is culturally and linguistically appropriate to assess the satisfaction of users attended in primary care services.

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