Identification, Prevention and Treatment of Drug Toxicity in the Primary Care Settings

Studies from global countries indicate that poisoning is a common etiology for morbidities and associated mortality. Most of the cases did not require medical intervention as they were treated at home. However, around one-fourth required management at a healthcare facility. In addition to the healthcare burdens, evidence indicates that these events also have significant economic burdens on the affected patients and healthcare facilities. The present literature review provided evidence regarding the proper ways to identify patients presenting with suspected medication poisoning and the recommended management approaches. Obtaining a complete history from the patient should be the first step that can lead to diagnostic clues. Then, a thorough examination should be provided, followed by relevant imaging and laboratory studies to confirm the diagnosis. Management might be supportive in many cases, and an antidote can enhance the treatment process. Approaches should also be conducted to achieve decontamination and enhance the elimination of the affected patients.

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DEEP SCOPE: A Framework for Safe Healthcare Design

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157780 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7780

Author(s):

Ellen Taylor ◽

Sue Hignett

Keyword(s):

Human Factor ◽

Healthcare Facility ◽

Built Environments ◽

Facility Design ◽

Healthcare Facilities ◽

Healthcare Design ◽

Accident Causation ◽

Healthcare Facility Design

Thinking in patient safety has evolved over time from more simplistic accident causation models to more robust frameworks of work system design. Throughout this evolution, less consideration has been given to the role of the built environment in supporting safety. The aim of this paper is to theoretically explore how we think about harm as a systems problem by mitigating the risk of adverse events through proactive healthcare facility design. We review the evolution of thinking in safety as a safety science. Using falls as a case study topic, we use a previously published model (SCOPE: Safety as Complexity of the Organization, People, and Environment) to develop an expanded framework. The resulting theoretical model and matrix, DEEP SCOPE (DEsigning with Ergonomic Principles), provide a way to synthesize design interventions into a systems-based model for healthcare facility design using human factors/ergonomics (HF/E) design principles. The DEEP SCOPE matrix is proposed to highlight the design of safe healthcare facilities as an ergonomic problem of design that fits the environment to the user by understanding built environments that support the “human” factor.

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Efficiency of Health Care Risk Waste Management in Rural Healthcare Facilities of South Africa: An Assessment of Selected Facilities in Vhembe District, Limpopo Province

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16122199 ◽

2019 ◽

Vol 16 (12) ◽

pp. 2199 ◽

Cited By ~ 2

Author(s):

Foluke C. Olaniyi ◽

Jason S. Ogola ◽

Takalani G. Tshitangano

Keyword(s):

South Africa ◽

Healthcare Facility ◽

Study Data ◽

Limpopo Province ◽

Healthcare Facilities ◽

The Public ◽

Efficient Management ◽

The Social ◽

Vhembe District ◽

And Storage

Waste generated form healthcare facilities is a potential source of health risks to the public, if it is not properly handled from the point of generation to disposal. This study was conducted to assess the efficiency of healthcare risk waste (HCRW) management in Vhembe District of Limpopo Province, South Africa. Fifteen healthcare facilities were selected in Vhembe District for this study. Data were obtained through in-depth interviews, semi-structured questionnaires, observation and pictures. Qualitative data were thematically analyzed, while the quantitative data were analyzed using the Statistical Package for the Social Sciences, version 25. In all the healthcare facilities; mismanagement of HCRW was noted at different points along the management chain. Poor segregation, overfilling of waste bins, inappropriate transportation and storage of waste in substandard storage rooms were observed in the facilities. All the waste from the district are transported to a private-owned treatment facility outside the district, where they are mainly incinerated. Enforcement of healthcare risk waste guidelines, provision of standardized equipment for temporary storage, empowerment of each healthcare facility to treat at least some of the waste, and employment of non-burn techniques for treatment of waste are recommended for more efficient management of healthcare risk waste in Vhembe District.

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Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111478 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11478

Author(s):

Andrea Brambilla ◽

Tian-zhi Sun ◽

Waleed Elshazly ◽

Ahmed Ghazy ◽

Paul Barach ◽

...

Keyword(s):

Case Studies ◽

Assessment Tool ◽

Healthcare Facility ◽

Health Impact ◽

Design Guidelines ◽

Assessment Tools ◽

Validity And Reliability ◽

Evaluation Tool ◽

Healthcare Operations ◽

Healthcare Facilities

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

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Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response

10.1101/2020.07.17.20152389 ◽

2020 ◽

Cited By ~ 1

Author(s):

Pascal Geldsetzer ◽

Marcel Reinmuth ◽

Paul O Ouma ◽

Sven Lautenbach ◽

Emelda A Okiro ◽

...

Keyword(s):

Older Adults ◽

Travel Time ◽

Healthcare Facility ◽

Access To Healthcare ◽

Sub Saharan Africa ◽

Travel Times ◽

Healthcare Resources ◽

Healthcare Facilities ◽

Sub Saharan ◽

Physical Access

Background: SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km x 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA. Methods: We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km x 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km x 1km raster using a cost-distance algorithm. Findings: 9.6% (95% CI: 5.2% - 16.9%) of adults aged 60 and older years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged 60 years and older had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged 60 and older years with the longest travel times was 348 minutes (IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (IQR: 1065 - 2440 minutes) in Gabon. Interpretation: Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.

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Latvian Family Physicians’ Experience and Attitude in Diagnosing and Managing Depression

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2019-0026 ◽

2019 ◽

Vol 73 (2) ◽

pp. 164-170

Author(s):

Vineta Viktorija Vinogradova ◽

Jeļena Vrubļevska ◽

Elmārs Rancāns

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Common Mental Disorders ◽

Current Knowledge ◽

Family Physicians ◽

Research Programme ◽

Primary Care Settings ◽

National Research Programme ◽

Management Approaches ◽

Training Programmes

Abstract Depression is among the most common mental disorders in primary care. Despite high prevalence rates it remains to be under-diagnosed in primary care settings over the world. This study was aimed to identify Latvian family physicians’ (FPs) experience and attitude in diagnosing and managing depression. It was carried out within the framework of the National Research Programme BIOMEDICINE 2014–2017. After educational seminars on diagnosing and managing depression, FPs were asked to complete a structured questionnaire. In total 216 respondents were recruited. Most of the doctors, or 72.2% (n = 156), agreed with the statement that patients with depression use primary care facilities more often than other patients. More than a half of physicians, or 66.3% (n = 143) quite often asked their patients about their psycho-emotional status and 65.7% (n = 142) of clinicians thought that they can successfully assess a patient’s psychoemotional status and possible mental disorders. The majority, or 91.6 % (n = 198), supposed that routine screening for depression is necessary in Latvia. Despite the fact that a significant number, or 62.6% (n = 135) of FPs thought that their practice was well suitable for the treatment of depressive patients, half of the respondents, or 50.9% (n = 110), assessed their ability to build a trustful contact and to motivate patients for treatment as moderate. Although FPs acknowledged the importance and necessity to treat depression, current knowledge and management approaches were far from optimal. This justifies the need to provide specific training programmes for FPs.

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Understandings of depression among community members and primary healthcare attendees in rural Ethiopia: A qualitative study

Transcultural Psychiatry ◽

10.1177/13634615211064367 ◽

2021 ◽

pp. 136346152110643

Author(s):

Bethlehem Tekola ◽

Rosie Mayston ◽

Tigist Eshetu ◽

Rahel Birhane ◽

Barkot Milkias ◽

...

Keyword(s):

Primary Care ◽

Depressive Disorders ◽

Medical Intervention ◽

Community Members ◽

Group Discussions ◽

Individual Interviews ◽

Rural Ethiopia ◽

Primary Care Settings ◽

Prevalence Of Depression ◽

Community Data

Available evidence in Africa suggests that the prevalence of depression in primary care settings is high but it often goes unrecognized. In this study, we explored how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection. We conducted individual interviews with purposively selected primary care attendees with depression (n = 28; 16 females and 12 males) and focus group discussions (FGDs) with males, females, and priests (n = 21) selected based on their knowledge of their community. Data were analyzed using thematic analysis. None of the community members identified depression as a mental illness. They considered depressive symptoms presented in a vignette as part of a normal reaction to the stresses of life. They considered medical intervention only when the woman's condition in the vignette deteriorated and “affected her mind.” In contrast, participants with depression talked about their condition as illness. Symptoms spontaneously reported by these participants only partially matched symptoms listed in the current diagnostic criteria for depressive disorders. In all participants’ accounts, spiritual explanations and traditional healing were prominent. The severity of symptoms mediates the decision to seek medical help. Improved detection may require an understanding of local conceptualizations in order to negotiate an intervention that is acceptable to affected people.

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Abstract 15: Public Access Defibrillators: Sex-Based Inequities in Access and Application

Circulation ◽

10.1161/circ.140.suppl_2.15 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Brian E Grunau ◽

Emad Awad ◽

Takahisa Kawano ◽

Frank Scheuermeyer ◽

Robert Stenstrom ◽

...

Keyword(s):

Healthcare Facility ◽

Public Access ◽

Home Healthcare ◽

Healthcare Facilities ◽

Public Property ◽

The North ◽

Private Location ◽

Residential Institutions ◽

Adjusted Logistic Regression ◽

Location Type

Introduction: It is unclear if the benefits of public access defibrillator (PAD) programs are similar between men and women. We investigated the location of out-of-hospital cardiac arrests (OHCA) stratified by sex to determine what proportion was eligible for PAD application. Second, we sought to determine if patient sex was associated with PAD utilization. Methods: We analyzed prospectively collected data from the North American Resuscitation Outcomes Consortium (ROC) Epistry dataset (2011 - 2015), excluding emergency medical services (EMS)-witnessed cases, those not treated by EMS, and children aged less than 10. We compared sex-based differences in public vs private location, and location type (street or highway, public building, place of recreation, industrial place, home residence, farm or ranch, healthcare facility, residential institution, other public property, or other private location). Among public location OHCAs with bystander interventions, we fit an adjusted logistic regression model to estimate the association between sex and PAD application. Results: Among the 61,473 cases, 20,933 (34%) were female, 30,353 had resuscitation attempted by bystander, and 13,597 had initial shockable rhythms. The OHCA incidence in a public location for women and men was 8.8% and 18%, respectively (95% CI for difference 8.7 - 9.7). Women had a significantly lower proportion of OHCAs on the street/highway, in public buildings, places of recreation, and farms, but a significantly higher proportion in the home, healthcare facilities, and residential institutions. Among public location OHCAs with bystander interventions, female sex was associated with a lower odds of bystander PAD application (adjusted OR 0.83, 95% CI 0.70-0.99). Conclusion: Women had fewer OHCAs in public locations eligible for PAD application. Further, among public OHCAs with bystander interventions, women were less likely to have PADs applied.

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60 Opening the Narrative on Deprivation of Liberty for the Older Person in Residential Healthcare Facilities: A Legal and Ethical Dilemma

Age and Ageing ◽

10.1093/ageing/afz103.35 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Florence Hogan ◽

Adrian Ahern

Keyword(s):

Human Rights ◽

Residential Care ◽

Healthcare Providers ◽

Community Support ◽

Healthcare Facility ◽

Moral Dilemmas ◽

Legal Framework ◽

Best Interest ◽

Healthcare Facilities ◽

The Individual

Abstract Background While many people enter residential care of their own free will and because it is their preference, the evidence tells us that there are also many who if they had the choice would remain in their own homes. Lack of appropriate community supports may provide some impetus to enter residential care. According to Care Alliance Ireland, an additional four million hours of homecare needs to be provided to cope with the successful ageing demographics, at a cost of €110 million. There is no statutory or common-law power to detain a patient in a Healthcare Facility outside of the application of the Mental Health Act 2001. This presents legal, ethical and moral dilemmas for Healthcare Providers when caring for a person who lacks capacity wishes to self - discharge. A duty of care obligates healthcare professionals to act in the best interest of the individual. Under the Health Act 2007 the requirement is to provide for a ‘safe discharge’. Pending advancement of the Assisted Decision Making (Capacity) Act 2015 which provides a statutory framework to assist and support individuals to make legally-binding agreements about their welfare, their property and affairs we are currently acting under the Lunacy Regulations (1871). Methods We developed a ‘Deprivation of Liberty’ form which enable comprehensive Interdisciplinary Team discussion and direction of care. Presumption of capacity, respect for the resident’s wishes and consideration of all possible supportive actions up to and including sourcing community support services were considered. Results This format has enabled comprehensive discussion and robust adherence to human rights for three residents thus far Conclusion The situation remains that there is no legal framework to guide healthcare providers currently. Using a Human Rights based approach is imperative to guide us while awaiting advancement of the ADMA (2015) and Deprivation of Liberty legislation to be included in this act.

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How Medical Studies in Poland Prepare Future Healthcare Managers for Crises and Disasters: Results of a Pilot Study

Healthcare ◽

10.3390/healthcare8030202 ◽

2020 ◽

Vol 8 (3) ◽

pp. 202 ◽

Cited By ~ 3

Author(s):

Patrycja Misztal-Okońska ◽

Krzysztof Goniewicz ◽

Attila J. Hertelendy ◽

Amir Khorram-Manesh ◽

Ahmed Al-Wathinani ◽

...

Keyword(s):

Public Health ◽

Pilot Study ◽

Online Survey ◽

Medical Personnel ◽

Healthcare Facility ◽

Healthcare Organizations ◽

Healthcare Facilities ◽

Organization And Management ◽

Proactive Management ◽

Professional Assistance

In the event of a crisis, rapid and effective assistance for victims is essential, and in many cases, medical assistance is required. To manage the situation efficiently, it is necessary to have a proactive management system in place that ensures professional assistance to victims and the safety of medical personnel. We evaluated the perceptions of students and graduates in public health studies at the Medical University of Lublin, Poland, concerning their preparation and management skills for crises such as the COVID-19 pandemic. This pilot study was conducted in March 2020; we employed an online survey with an anonymous questionnaire that was addressed to students and graduates with an educational focus in healthcare organization and management. The study involved 55 people, including 14 men and 41 women. Among the respondents, 41.8% currently worked in a healthcare facility and only 21.7% of them had participated in training related to preparation for emergencies and disasters in their current workplace. The respondents rated their workplaces’ preparedness for the COVID-19 pandemic at four points. A significant number of respondents stated that if they had to manage a public health emergency, they would not be able to manage the situation correctly and not be able to predict its development. Managers of healthcare organizations should have the knowledge and skills to manage crises. It would be advisable for them to have been formally educated in public health or healthcare administration. In every healthcare facility, it is essential that training and practice of performing medical procedures in full personal protective equipment (PPE) be provided. Healthcare facilities must implement regular training combined with practical live scenario exercises to prepare for future crises.

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Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: the first experience from Makassar telemedicine program, Indonesia

BMC Family Practice ◽

10.1186/s12875-020-01325-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Idar Mappangara ◽

Andriany Qanitha ◽

Cuno S. P. M. Uiterwaal ◽

Jose P. S. Henriques ◽

Bastianus A. J. M. de Mol

Keyword(s):

Primary Care ◽

Female Gender ◽

Middle Income ◽

Healthcare Facilities ◽

Primary Care Settings ◽

Lower Blood ◽

History Of ◽

Primary Care Patients ◽

Male Patients

Abstract Background Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations. Methods ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes. Results Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p < 0.01), while older age (> 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation. Conclusions Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients.

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