scholarly journals How Physicians Renew Electronic Prescriptions in Primary Care: Therapeutic Decision or Technical Task?

2021 ◽  
Vol 18 (20) ◽  
pp. 10937
Author(s):  
Taina Oravainen ◽  
Marja Airaksinen ◽  
Kaija Hannula ◽  
Kirsi Kvarnström
Keyword(s):  
Primary Care ◽  
Patient Involvement ◽  
Therapeutic Decision ◽  
Group Discussions ◽  
Primary Health ◽  
Interprofessional Cooperation ◽  
Two Phases ◽  
Physician’S Perspective ◽  
Electronic Prescriptions

In long-term pharmacotherapies, the renewal of prescriptions is part of the medication use process. Although the majority of medicines are used with renewed prescriptions, little research has focused on renewal practices. The aim of this study was to explore current renewal practices from a primary care physician’s perspective to identify system-based challenges and development needs related to the renewal practices. This qualitative study was conducted in two phases in public primary health care centres of Kirkkonummi, Finland. First, five physicians were shadowed on-site while they renewed prescriptions. The findings of the shadowing phase were further discussed in two focus group discussions with seven other physicians than in the shadowing phase. Inductive content analysis was used for data analysis utilizing Reason’s risk management theory as a theoretical framework. Due to problems in the renewal process, including impractical information systems, a lack of reconciled medication lists, and a lack of time allocated for renewing prescriptions, physicians felt that monitoring and reviewing each patients’ medications for renewal was complicated. Therefore, they felt that renewing, at times, became a technical task rather than a therapeutic decision. The physicians suggested information system improvements, enhanced interprofessional cooperation, and patient involvement as strategies to ensure rational pharmacotherapy and patient safety in the renewal of prescription medicines.

scholarly journals Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eveliina Heikkala ◽  
Ilona Mikkola ◽  
Jari Jokelainen ◽  
Markku Timonen ◽  
Maria Hagnäs
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Treatment Target ◽  
Adequate Treatment ◽  
Treatment Targets ◽  
Primary Health

Abstract Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

scholarly journals (In)visibility of children with special health needs and their families in primary care

2020 ◽  
Vol 73 (suppl 4) ◽  
Author(s):  
Sonia Silva Marcon ◽  
Beatriz Caroline Dias ◽  
Eliane Tatsch Neves ◽  
Maria Angelica Marcheti ◽  
Regina Aparecida Garcia de Lima
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Term Care ◽  
Healthcare Needs ◽  
Primary Health ◽  
Public Rehabilitation ◽  
Care Demands ◽  
Special Health

ABSTRACT Objectives: to discuss the (in)visibility of children with special healthcare needs and their families in the Primary Health Care scenario. Methods: experience report about the difficulties faced by researchers from different regions of Brazil to locate children with special healthcare needs in the scope of primary care. Results: the main reason for these children and their families to be “unknown” and, therefore, not assisted in PHC, is the fact that they are followed-up by institutions/outpatient clinics and specialized and/or public rehabilitation clinics, or even because they have private health insurance. Final Considerations: transferring care responsibility to the Primary Health Care teams to specialized and rehabilitation institutions may be related to the lack of knowledge of the care demands of this group, as well as to the relevance of care centered on rehabilitation and the specialty instead of the long-term care, one of the features of primary health care.

Five-year outcome of major depressive disorder in primary health care

2011 ◽  
Vol 44 (7) ◽  
pp. 1369-1379 ◽  
Author(s):  
K. A. Riihimäki ◽  
M. S. Vuorilehto ◽  
T. K. Melartin ◽  
E. T. Isometsä
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Depressive Disorder ◽  
Major Depressive ◽  
Full Remission ◽  
Primary Health ◽  
Co Morbidity ◽  
Primary Care Patients

BackgroundPrimary health care provides treatment for most patients with depression. Despite their importance for organizing services, long-term course of depression and risk factors for poor outcome in primary care are not well known.MethodIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients representing primary care patients in a Finnish city was screened for depression with the Primary Care Evaluation of Mental Disorders. SCID-I/P and SCID-II interviews were used to diagnose Axis I and II disorders. The 137 patients with DSM-IV depressive disorder were prospectively followed up at 3, 6, 18 and 60 months. Altogether, 82% of patients completed the 5-year follow-up, including 102 patients with a research diagnosis of major depressive disorder (MDD) at baseline. Duration of the index episode, recurrences, time spent in major depressive episodes (MDEs) and partial or full remission were examined with a life-chart.ResultsOf the MDD patients, 70% reached full remission, in a median time of 20 months. One-third had at least one recurrence. The patients spent 34% of the follow-up time in MDEs, 24% in partial remission and 42% in full remission. Baseline severity of depression and substance use co-morbidity predicted time spent in MDEs.ConclusionsThis prospective, naturalistic, long-term study of a representative cohort of primary care patients with depression indicated slow or incomplete recovery and a commonly recurrent course, which need to be taken into account when developing primary care services. Severity of depressive symptoms and substance use co-morbidity should be systematically evaluated in planning treatment.

scholarly journals Actual problems of outpatient pediatrics and their solutions (reflections and offers of the veteran)

2019 ◽  
Vol 19 (4) ◽  
pp. 249-254
Author(s):  
Antonina G. Gracheva
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Practical Experience ◽  
Primary Health ◽  
The World ◽  
Shortage Of Physicians ◽  
Primary Care Institutions ◽  
The City

There is presented the analysis of the state of ambulatory pediatrics and there are formulated proposals for the priority support for the development of outpatient pediatrics in the framework of improving primary health care for children for the prevention of the shortage ofpediatricians and providing the reduction in morbidity, disability and community-acquired mortality rate. To reduce the long-term shortage of physicians in ambulatory pediatrics author proposes to introduce a new specialty "general pediatrician", which is aimed to prepare a pediatrician at the postgraduate stage for the implementation ofprimary care across all the medicine of children age. The effectiveness of this solution has been proved by the World practice and domestic experiment in the city of Orenburg. It is moreover proposed to use a target distribution of graduates ofpediatric faculty, studied on a budgetary basis, to the outpatient primary care institutions. The organization of postgraduate specialization in ambulatory pediatrics according to the author opinion, should be implemented on the base of Departments of outpatient pediatrics possessing scientific and practical experience in the training of doctors specializing in ambulatory pediatrics.

Historical and medical aspects of the organization of medical and social services for the elderly and senile people in Russia in the late XX — early XXI centuries

2020 ◽  
pp. 49-57
Author(s):  
Lyudmila Kaspruk
Keyword(s):  
Health Care ◽  
Social Services ◽  
Social Protection ◽  
The Elderly ◽  
Primary Role ◽  
Primary Health ◽  
Geriatric Service ◽  
Delivery Of Medical Care ◽  
Older Citizens

When analyzing the historical and medical aspects of the organization of medical and social services for the elderly and senile people in Russia in the late XX — early XXI centuries not only obvious achievements in this sphere, but also a number of problems requiring solution were identified. The primary role in the delivery of medical care to geriatric patients is assigned to the primary health care sector. However the work of the geriatric service in the format of a single system for the provision of long-term medical and social care based on the continuity of patient management between differ- ent levels of the health care system and between the health and social protection services is not well organized. There is no clear coordination and interaction between health care and social protection institutions, functions of which include providing care to older citizens, and it significantly reduces the effectiveness of the provision of both medical and social services.

Evidence-Based Treatment for the Eating Disorders

2010 ◽  
pp. 451-451
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Evidence-Based Treatment for the Eating Disorders

2012 ◽  
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

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