Implementação de pictogramas para melhoria na adesão terapêutica em pacientes com baixo grau de escolaridade: um projeto de intervenção na atenção básica / Implementation of pictograms to improve therapeutic adherence in patients with low educational level: an intervention project in primary care

Introduction: Hypertension is a major public health concern and the leading cause of cardiovascular disease worldwide. Prevalence of adequate blood pressure control is low and it is mainly associated to poor antihypertensive drug adherence. We hypothesized that education through mobile phone text messaging (SMS) would improve antihypertensive drug adherence in hypertensive patients followed in a primary care setting. Methods: Recently diagnosed hypertensive patients receiving antihypertensive drug treatment for less than 6 months were randomised to receive SMS related to improve drug adherence and to follow a healthy life style or no messages. Exclusion criteria were history of stroke, heart failure, myocardial infarction and hemodialysis. Patients were recruited from 12 different primary care clinics in Santiago, Chile, where free antihypertensive drug therapy was provided. All patients signed an informed consent after which a survey was performed. Compliance was assessed using Morinsky- Green-Levine Questionnaire.Text messages were sent every 12± 2 days. After a 6-month follow-up, a new survey was applied. An Ordinary Least Squares regression model was used to analyse the net difference between the two groups. Results: A total of 314 subjects were recruited, mean age 60 ±10 years, 35% male, 67% with low or medium educational level (≤12 years). Mean drug pill number was 2.1 per day and the mean time of drug prescription was 4±1 months; 150 subjects were randomised to text messages. No statistical difference between the control and the intervention groups in regards to gender, age, educational level, blood pressure and baseline compliance was found. Eleven patients were lost of follow-up. Adherence in the control group decreased from to 59,7 % at baseline to 51,7% ( p<0,05) at 6 months. By contrast, in the intervention group, it increased from 50,9 % to 62,7 % ( p<0,05). The absolute difference in mean adherence rate between the two groups was 19,8 % (Standard error: 0.081, p: 0.015). Conclusion: This study shows that education through SMS in patients with recently prescribed antihypertensive drugs improved adherence to treatment. SMS could become a good and easy- to- use intervention tool to overcome low adherence to drug treatments in the community.

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Patient experience on self-management support among primary care patients with diabetes and hypertension

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzy252 ◽

2019 ◽

Vol 31 (7) ◽

pp. 37-43 ◽

Cited By ~ 3

Author(s):

Ming Tsuey Lim ◽

Yvonne Mei Fong Lim ◽

Xin Rou Teh ◽

Yi Lin Lee ◽

Siti Aminah Ismail ◽

...

Keyword(s):

Primary Care ◽

Patient Experience ◽

Educational Level ◽

Linear Regression Analysis ◽

Self Management ◽

Short Version ◽

Design Decision ◽

Management Support ◽

Cross Sectional Survey ◽

Primary Care Patients

Abstract Objective To determine the extent of self-management support (SMS) provided to primary care patients with type 2 diabetes (T2D) and hypertension and its associated factors. Design Cross-sectional survey conducted between April and May 2017. Setting Forty public clinics in Malaysia. Participants A total of 956 adult patients with T2D and/or hypertension were interviewed. Main Outcome Measures Patient experience on SMS was evaluated using a structured questionnaire of the short version Patient Assessment of Chronic Illness Care instrument, PACIC-M11. Linear regression analysis adjusting for complex survey design was used to determine the association of patient and clinic factors with PACIC-M11 scores. Results The overall PACIC-M11 mean was 2.3(SD,0.8) out of maximum of 5. The subscales’ mean scores were lowest for patient activation (2.1(SD,1.1)) and highest for delivery system design/decision support (2.9(SD,0.9)). Overall PACIC-M11 score was associated with age, educational level and ethnicity. Higher overall PACIC-M11 ratings was observed with increasing difference between actual and expected consultation duration [β = 0.01; 95% CI (0.001, 0.03)]. Better scores were also observed among patients who would recommend the clinic to friends and family [β = 0.19; 95% CI (0.03, 0.36)], when health providers were able to explain things in ways that were easy to understand [β = 0.34; 95% CI (0.10, 0.59)] and knew about patients’ living conditions [β = 0.31; 95% CI (0.15, 0.47)]. Conclusions Our findings indicated patients received low levels of SMS. PACIC-M11 ratings were associated with age, ethnicity, educational level, difference between actual and expected consultation length, willingness to recommend the clinic and provider communication skills.

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Racial/ethnic and educational-level differences in diabetes care experiences in primary care

Primary Care Diabetes ◽

10.1016/j.pcd.2007.11.002 ◽

2008 ◽

Vol 2 (1) ◽

pp. 39-44 ◽

Cited By ~ 15

Author(s):

George L. Jackson ◽

Morris Weinberger ◽

Natia S. Hamilton ◽

David Edelman

Keyword(s):

Primary Care ◽

Diabetes Care ◽

Educational Level ◽

Racial Ethnic

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Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care

Patient Education and Counseling ◽

10.1016/j.pec.2015.03.008 ◽

2015 ◽

Vol 98 (8) ◽

pp. 977-983 ◽

Cited By ~ 24

Author(s):

Roger Ruiz Moral ◽

Luis Angel Pérula de Torres ◽

Laura Pulido Ortega ◽

Margarita Criado Larumbe ◽

Ana Roldán Villalobos ◽

...

Keyword(s):

Primary Care ◽

Clinical Trial ◽

Motivational Interviewing ◽

Randomized Clinical Trial ◽

Chronic Diseases ◽

Therapeutic Adherence ◽

Cluster Randomized

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Cognitive screening test in primary care

Revista de Saúde Pública ◽

10.11606/s1518-8787.2018052000462 ◽

2018 ◽

Vol 52 ◽

pp. 88 ◽

Cited By ~ 2

Author(s):

Juliana Emy Yokomizo ◽

Katrin Seeher ◽

Glaucia Martins de Oliveira ◽

Laís dos Santos Vinholi e Silva Silva ◽

Laura Saran ◽

...

Keyword(s):

Primary Care ◽

Diagnostic Accuracy ◽

Educational Level ◽

High Sensitivity ◽

Cognitive Screening ◽

Operating Characteristics ◽

Predictive Values ◽

Brazilian Version ◽

Logistic Regressions ◽

State Examination

OBJECTIVE: To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS: Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS: Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS: The GPCOG-Br is clinically well-suited for use in primary care.

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Socio-demographic Analysis of An Early Psychosis intervention Programme

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1625 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S447-S447

Author(s):

C.M. Carrillo de Albornoz Calahorro ◽

J.A. Rodrigo Manzano ◽

B. Girela Serrano

Keyword(s):

Primary Care ◽

Educational Level ◽

Recovery Process ◽

Demographic Variables ◽

Initial Diagnosis ◽

Early Psychosis ◽

Intervention Programme ◽

Affective Psychosis ◽

Competing Interest ◽

Different Characteristics

IntroductionDuring the first 5 years of the onset of schizophrenia, the majority of the clinical and psychosocial deterioration takes place.This period of time is critical in terms of diagnosing the illness and providing effective psychosocial and pharmacological treatment.Objectives/aimsKnowing the demographic profile of users of an Early Psychosis intervention Programmeto adapt the intervention to their specific needs.MethodsA descriptive statistical analysis of the records of every patient on admission program during year 2014 was carried out. There have been various socio-demographic variables collected such as: sex, age, initial diagnosis, drug consumption, educational level, labor situation, referral source and origin.ResultsWe found an average age of 26, near the normal curve between 15 and 35 years distribution.Eighty percent of our simple were men.Eighty percent were non-affective psychosis as their initial diagnosis.Abuse toxic in 70%, in all cases cannabis or derivatives.Education level: 56% primary studies. Thirty percent reached secondary studies. Fourteen percent higher educational level.in terms of job-training situation: 30% were working, 40% unemployed and 30% studying.Sixty-five percent were referred from primary care centers, 20% from drug abuse centers and 15% from hospitalization units.Main nationalities were Spanish 65%, 30% were Moroccan, and 5% other came from other nationalities.ConclusionIt stresses the importance of intervening on dual diagnosis, the need for greater coordination with primary care to improve the detection of cases and the development of the training-labor area in the recovery process.It is also necessary to evaluate the different characteristics of immigrants included in the program.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Depression screening in primary care patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.759 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S543-S544

Author(s):

J. Ben Thabet ◽

M. Turki ◽

M. Mezghanni ◽

M. Maalej Bouali ◽

N. Charfi ◽

...

Keyword(s):

Primary Care ◽

Suicide Attempt ◽

Educational Level ◽

Functional Disability ◽

Common Mental Disorder ◽

School Level ◽

Tunisian Population ◽

Medical Patients ◽

Economic Level ◽

Prevalence Of Depression

IntroductionDepression is a common mental disorder that can be associated with more functional disability than most chronic medical illnesses and the increased reporting of medically unexplained somatic symptoms.AimTo assess the prevalence of depression in a Tunisian population, as well as the associated factors.MethodsWe conducted a cross-sectional, descriptive and analytic study, among 707 subjects consulting in 20 primary care units in Sfax and Tunis, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).ResultsThe mean age of participants was 39.84 years. Among them, 38.6% had a low educational level (illiterate or primary school level); 45.3% were professionally inactive and 92.9% had a low to medium socio economic level. Medical, psychiatric and suicide attempt histories were reported respectively in 51.2%, 7.6% and 1.8% of cases. According to BDI, a mild depression was noted in 22.9%; moderate 16.1%; severe 4.1%. Among those presenting a moderate to severe depression (MSD), only 16.8% were followed up in psychiatry, 4.2% were receiving antidepressant and 9.8% benzodiazepine. MSD was associated with low educational level (P < 0.001); low to medium socio economic level (P < 0.001); psychiatric histories (P < 0.001); suicide attempt histories (P < 0.001); somatic histories (P < 0.001).ConclusionOur study highlighted a high prevalence of depression that is still under diagnosed and therefore poorly managed. General practitioners should be made aware of the importance of screening for depression in medical patients because it not only complicates their overall medical treatments, but also impedes their physical and social functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The risk of emergency department visits in adults living in rural France

European Journal of Public Health ◽

10.1093/eurpub/ckz186.339 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

G Mercier ◽

Victor Rodwin ◽

Catherine Quantin ◽

Michael Chernew ◽

Michael Gusmano

Keyword(s):

Primary Care ◽

Emergency Department ◽

Rural Areas ◽

Educational Level ◽

Economic Status ◽

Emergency Department Visits ◽

Lower Educational Level ◽

Socio Economic Status ◽

Ed Visits ◽

Rural France

Abstract Background Individuals living in rural areas have poorer health outcomes due to complex causal pathways related to socio-economic status, health behaviors and lower use of primary care. Emergency department visits without inpatient admission (hereafter ED visits) are an indirect measure of access to primary care. Objective To analyze the determinants of ED visits among French adults living in rural areas. Methods We analyze survey data from the CONSTANCES cohort study, a representative sample of French adults aged 18-69 years. These data on individuals’ demographics, self-reported and physician-reported clinical indicators, and individual socio-economic status, are linked to France’s claims database (SNIIRAM). We analyze the risk of having at least one ED visit, in 2016, using a multivariate logistic regression model. Results Among 12,834 adults included in the study, 1,412 (11%) had at least one ED visit in 2016. After adjustment, the ED visit risk was associated negatively with female gender (OR = 0.87; p < 0.01), age (OR = 0.97; p < 0.01), secondary education (OR = 0.85; p = 0.03), higher use of GPs (OR = 0.99; p = 0.02); and positively associated with the number of comorbidities (OR = 1.1; p < 0.01), poorer self-reported health status (OR = 1.01; p = 0.02), a higher self-reported depression score (OR = 1.01; p = 0.02), and acute care inpatient admissions (OR = 2.4; p < 0.01). Conclusions These results suggest that, among adults living in rural France, those with a lower educational level are at higher risk of ED visits. Policy implications: To reduce health disparities among rural and urban areas, policymakers and primary care professionals should focus on targeted outreach strategies to identify high-needs individuals. Key messages The risk of emergency department visit varies significantly among adult living in rural France. Among adults living in rural France, those with a lower educational level are at higher risk of ED visit.

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What is a primary care advanced practice role in Cornwall?

Practice Nursing ◽

10.12968/pnur.2020.31.1.31 ◽

2020 ◽

Vol 31 (1) ◽

pp. 31-36

Author(s):

Sarah Barea

Keyword(s):

Primary Care ◽

Clinical Practice ◽

Quantitative Study ◽

Broad Spectrum ◽

Educational Level ◽

Current Practice ◽

Scope Of Practice ◽

Advanced Practice ◽

Primary Care Practitioners ◽

Practice Framework

In this quantitative study, Sarah Barea analyses the current advanced practice roles in primary care in Cornwall Aim: To analyse current primary care advanced practice roles in Cornwall, measured against Health Education England's Multi-Professional Framework for Advanced Clinical Practice. Method: A quantitative questionnaire was sent to all primary care practitioners in the county practicing with an advanced title. Findings: In total, 34 respondents (approximately 60% of those invited) took part. Practitioners have a broad spectrum of experience and education and varied scope of clinical practice. The grading of roles does not compare with educational level, experience or scope of practice. This is consistent with current literature which explores the need to regulate the role. Conclusion: If the Advanced Practice Framework is implemented as planned, then there are gaps in current practice that need to be addressed in order to ensure practitioners have the competencies to provide safe, autonomous practice.

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