scholarly journals Assessment Of Treatment For Hypertension In Primary Care

10.3823/2379 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Ana Lívia Araújo Girão ◽  
Glória Yanne Martins Oliveira ◽  
Rodrigo Jacób Moreira De Freitas ◽  
Emiliana Bezerra Gomes ◽  
Rhanna Emanuela Fontenele Lima De Carvalho ◽  
...  

Background: Because hypertension is a multifactorial clinical condition, primary care in this  context consists in strategies for detecting and controlling the disease. Programs emphasizing  this level of care incentive evaluative research as fundamental to generate mechanisms for quality assessment and control, as well as to provide information on the functioning and effectiveness of the health system. The present study aimed to evaluate the quality of health  care provided for hypertensive users in primary health care.  Methods and findings: This is an evaluative research conducted by triangulation of methods  in which the quantitative and qualitative approaches were simultaneously used through  observation, application of questionnaires, interviews and focus group data including  managers, workers and users of a primary health care unit. The study showed that the health  service has fulfilled its role of welcoming users through multidisciplinary teams as a gateway  to the public system. However, the link between the health team and the community has been  gradually undermined by the implementation of spontaneous demand with risk classification,  compromising the continuity of treatment for hypertension.   Conclusions: Multidisciplinary team and empowerment of individuals are fundamental for  the qualification of care. However, the care provided for hypertensive users in primary care  has in most cases been fragmented after the implementation of the system of free access with  risk classification. This fact points to the need to adapt the care needs of hypertensive users to  the new health care model.  

2014 ◽  
Vol 48 (spe) ◽  
pp. 145-151 ◽  
Author(s):  
Luciane Ferreira do Val ◽  
Lucia Yasuko Izumi Nichiata




This study aimed to identify programmatic vulnerability to STDs/HIV/AIDS in primary health centers (PHCs). This is a descrip - tive and quantitative study carried out in the city of São Paulo. An online survey was applied (FormSUS platform), involving administrators from 442 PHCs in the city, with responses received from 328 of them (74.2%), of which 53.6% were nurses. At - tention was raised in relation to program - matic vulnerability in the PHCs regarding certain items of infrastructure, prevention, treatment, prenatal care and integration among services on STDs/HIV/AIDS care. It was concluded that in order to reach comprehensiveness of actions for HIV/ AIDS in primary health care, it is necessary to consider programmatic vulnerability, in addition to more investment and reor - ganization of services in a dialogue with the stakeholders (users, multidisciplinary teams, and managers, among others).





2020 ◽  
Vol 18 (2) ◽  
pp. 1967 ◽  
Author(s):  
Sarah Dineen-Griffin ◽  
Shalom I. Benrimoj ◽  
Victoria Garcia-Cardenas

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles.


2007 ◽  
Vol 13 (2) ◽  
pp. 56 ◽  
Author(s):  
J. Tieman ◽  
G. Mitchell ◽  
T. Shelby-James ◽  
D. Currow ◽  
B. Fazekas ◽  
...  

Australia's population is ageing and the consequential burden of chronic disease increasingly challenges the health system. This has raised interest in, and awareness of, approaches built on multidisciplinary teams and integrated and coordinated care in managing the complex care needs of patient groups such as the chronically ill or frail aged. A systematic investigation of the literature relating to these approaches provided the opportunity to explore the meaning of these terms and their potential application and relevance to the Australian primary health care setting. Five systematic reviews of a sentinel condition and an exemplar approach to coordinated and multidisciplinary care were completed. Common learnings from the individual reviews were identified. The literature suggests that approaches encouraging a coordinated and multidisciplinary plan of care for individual patients and/or particular populations may improve a variety of outcomes. There are many methodological considerations in conducting reviews of complex interventions and in assessing their applicability to the Australian health system.


2020 ◽  
Vol 29 ◽  
Author(s):  
Gisele Cristina Manfrini ◽  
Raiza Santos Treich ◽  
Pamela Camila Fernandes Rumor ◽  
Adriana Bitencourt Magagnin ◽  
María Arcaya Moncada ◽  
...  

ABSTRACT Objective: to identify in the national and international literature Primary Health Care actions in natural disasters. Method: an integrative literature review, which included 24 original surveys between 2006 and 2018 on natural disasters. Results: a qualitative analysis of the studies included primary care actions in the prevention and mitigation, preparation, response, and disaster recovery phases. Conclusion: Primary Health Care actions involve multidisciplinary teams, the community and families in the territory in which the teams operate, articulation in a network of intersectoral services, in managerial and educational dimensions to implement effective plans for disaster situations.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Scepanovic

Abstract Background Primary health care financing reform should be undertaken with aim to support universal health coverage, make the health care accessible and to provide a financial risk sharing in a way that prevents suffering of financial hardship. Objectives To describe challenges, development and introduction of primary health care financing reform in Montenegro. The specific objective was to assess the effectiveness of the implementation of the capitation formula. Methods This retrospective study has been undertaken to describe implementation of a capitation formula in Montenegro. Results Eight years after the implementation (2017 data) indicate that some monitoring indicators reflect output increase in the primary health care, such as number of prevention services provided to the patients (adult population of age 18 years and more). However, other indicators. e.g., number of referrals to other levels of healthcare is rising, indicating that primary care might not be meeting the adequate level of health care needs of the population. Conclusions Montenegrin experience shows that financing reform in short term resulted in establishment of a system based on output models of health care financing and increased capacities for performing main financing functions. Key messages Introduction of a capitation formula represented a fundamental shift in the way primary health care was financed in Montenegro. Further research needs to be done on how primary care responds to the needs of the population.


Author(s):  
Julia Langton ◽  
Sabrina Wong ◽  
Sandra Peterson ◽  
Kim McGrail

ABSTRACTObjectivesPopulation subgroups can be been used organize health services and understand the quality of health care. Most commonly, populations are have been by specific diseases (e.g., health care received by diabetes patients), patient age (e.g., elderly populations), or life-stage (e.g., end-of-life care). However, these subgroups may not adequately capture the complexity and/or health care needs of different patient groups (e.g., multi-morbidity, frail elderly). Our objective is to use health administrative data to develop population segments based on patients’ primary health care needs.  ApproachOur development process occurred in three stages. First, we examined examples of population segmentation in the peer reviewed and grey literature to develop principles for our population segments. Second, we held a workshop with primary care patients, decision-makers, clinicians and researchers to seek their input on important considerations for the population segments. Third, we used health administrative data (physician claims, hospitalisations) to develop population segments for the British Columbia (BC, Canada) population. Segments were based on diagnosis codes over a two year period; for each segment we examined health care use and costs, overall and by service type, in 2014-15. ResultsWe designed our segments to be mutually exclusive, capture the vast majority of people who use primary care services, and range from healthy patients (fewer primary care needs) to more complex patients (more extensive needs). Stakeholders were supportive of population segmentation approach and suggested incorporating patient vulnerability and primary care involvement such that segments would range from patients whose needs could be fully met in primary care to those who require additional services such as specialists/acute care. Our first iteration includes three segments: stable (≤1 chronic condition, needs met by primary care); multi-morbid (≥2 chronic conditions, needs mostly met by primary care); and complex (≤1 chronic condition and presence of a health care event associated with the management of this condition suggesting the patients’ needs not fully met by primary care). ConclusionWe developed population segments designed to account for patient complexity and primary health care needs; as such, segments provide more information than traditional indices of morbidity burden based on counts of chronic conditions. These segments will be used to report information on the quality of primary care. We plan to include conduct validation studies using additional variables (e.g, socio-economic factors, level of vulnerability from patient surveys) so that segments more accurately represent the level of complexity and patients’ primary health care needs.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A P N Fornereto ◽  
M N Ogata ◽  
T A Santos ◽  
A B C Franceschini ◽  
MCRLR Pinto ◽  
...  

Abstract Family Health Support Centres (NASFs, in Portuguese) aim to develop interprofessional practices anchored in the assumptions of Primary Health Care, guided by the criteria of shared care specific professional interventions, management processes, interdisciplinarity, intersectoriality, Continuing Education in Health and health promotion. This health management methodology (Matrix Support) still represents a challenge to workers and managers, as it switches the logic of clinical thought from individual-centred, ambulatory and disciplinary care to collective, territory and interdisciplinary care. This study might illustrate and allow sharing of experiences about a work management format for multidisciplinary teams in Primary Health Care. A partnership between the University and the state health department was established in order to elaborate a collaborative, educational and supportive action. We formed a group of workers in the target area (24 municipalities and 18 teams) who had a focus on Continuing Education in Health using Institutional Analysis as theoretical reference. The main goal of the action was to provide spaces to share experiences and learning in the perspective of Continuing Education in Health. How does Continuing Education in Health support interprofessional practices in the field of Collective Health? Among the main results, we list: reflection about organisation practices of multiprofessional work, reflection about care practices and clinic management in the technical-assistance and pedagogic perspectives of Matrix Support; encouragement to improve the services offered in this level of care and their relationship with other points of the network. This experience showed us the importance of three main aspects: Continuing Education in Health, as a strategy of critical analysis about work and workers; the partnership and integration between teaching and service; and interprofessional formation processes (necessary to NASF and Collective Health). Key messages Continuing Education in Health is a strategy to deal with challenges and possibilities of interprofessional practices in the field of Collective Health. Enabling experiences and providing spaces for health professionals to share experience and learning.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L F Pinto ◽  
D Soranz ◽  
L J Santos ◽  
M S Paranhos ◽  
L S Malta ◽  
...  

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.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Pinto ◽  
J V Santos ◽  
M Lobo ◽  
J Viana ◽  
J Souza ◽  
...  

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.


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