Primary care system factors and clinical decision-making in patients that could have lung cancer: A vignette study in five balkan region countries

Introduction Lung cancer is the leading cause of cancer death, with wide variations in national survival rates. This study compares primary care system factors and primary care practitioners’ (PCPs’) clinical decision-making for a vignette of a patient that could have lung cancer in five Balkan region countries (Slovenia, Croatia, Bulgaria, Greece, Romania). Methods PCPs participated in an online questionnaire that asked for demographic data, practice characteristics, and information on health system factors. Participants were also asked to make clinical decisions in a vignette of a patient with possible lung cancer. Results The survey was completed by 475 PCPs. There were significant national differences in PCPs’ direct access to investigations, particularly to advanced imaging. PCPs from Bulgaria, Greece, and Romania were more likely to organise relevant investigations. The highest specialist referral rates were in Bulgaria and Romania. PCPs in Bulgaria were less likely to have access to clinical guidelines, and PCPs from Slovenia and Croatia were more likely to have access to a cancer fast-track specialist appointment system. The PCPs’ country had a significant effect on their likelihood of investigating or referring the patient. Conclusions There are large differences between Balkan region countries in PCPs’ levels of direct access to investigations. When faced with a vignette of a patient with the possibility of having lung cancer, their investigation and referral rates vary considerably. To reduce diagnostic delay in lung cancer, direct PCP access to advanced imaging, availability of relevant clinical guidelines, and fast-track referral systems are needed.

Using Test Positivity Rate (TPR) as an Indicator for Strategic Action in COVID-19: A Situational Analysis in Kerala, India

Administrators and policymakers have relied on test positivity rate (TPR) for making policy decisions regarding local, regional, and national lockdowns. It has the advantage of easily available data with an easy technique for calculation on day-to-day basis. However, concerns are being raised regarding its use as a sole indicator for determining movement restrictions and lockdowns. The present review provides a perspective of the alterations in TPR in Kasaragod district of Kerala during the first half of 2021. The variations in the number of antigen and reverse transcription polymerase chain reaction (rt-PCR) tests along with the trend of proportion of rt-PCR test are depicted. In places like Kerala where primary care system and contact tracing is comparatively robust than several other regions, testing the appropriate persons in a timely fashion alone is sufficient to cause an upswing in the TPR. Rather than daily change, the overall change in a larger time frame of 1 to 2 weeks could give early warning regarding the emergence of a new wave. TPR alone may not be able to reflect the transmission patterns of COVID-19. Using 7-day median value of TPR along with weekly tests done per 10,000 population, 7-day rolling average of active cases per 10,000 population, or daily number of new positive cases per 10,000 population could bring out a more composite indicator. Such an indicator reflecting the disease dynamics at regional levels will enable people to improve their livelihood without compromising on COVID-19.

Satisfaction Affecting Factors of Mohalla Clinic Services in the Times of COVID -19 Pandemic: A Cross-Sectional Study

The Delhi government has launched the Mohalla clinic concept in the year 2015 to make health universal and strengthen the primary care system of Delhi. The basic aim was to provide primary care to people located in remote and poor areas of Delhi. This study was conducted from April 2020 to July 2020 to determine the community dwellers' perception and satisfaction level towards Mohalla clinics and their role in the situation of the COVID-19 pandemic. An online survey was conducted with pretested and validated questionnaire. The questionnaire consisted of 28 items, which were identified with the help of a literature review. The responses were collected from 100 respondents selectively from the ones who have availed the Mohalla clinic's service. The analysis of the results revealed that the perception of the community toward the Mohalla clinic is positive. Moreover, out of all the identified factors impacting satisfaction, the availability factor, which includes the availability of doctors and medicines, had the highest influence on the perception of satisfaction from Mohalla Clinics. Additionally, 58 % of the current users have shown willingness to utilize the Mohalla clinic services, even in the times of COVID-19. This is an important finding. It postulates that the Delhi government should focus on the availability of medicines and medical staff to improve satisfaction and render healthcare services in COVID-19.

COVI-Prim survey: Challenges for Austrian and German general practitioners during initial phase of COVID-19

Background Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response. Methods 2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April). Results The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly. Conclusion Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met. Registration Trial registration at the German Clinical Trials Register: DRKS00021231.

Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals

Objective: to understand how the implementation of the e-SUS Primary Care system has been processed and its impact on the daily life of the health teams. Method: a qualitative research study, conducted in a municipality in the inland of the state of São Paulo with professionals who work in Primary Health Care and use the e-SUS Primary Care system as a work tool. Semi-structured interviews and thematic data analysis were used with Kotter’s three-phase approach. Results: a total of 17 professionals, nurses, physicians, dentists and community agents were interviewed. The implementation of e-SUS Primary Care and its impact on the daily life of health teams were understood in terms of mandatory implementation; weaknesses for implementation, such as absence of material resources and implicit imposition for the use of the system; fragile training for deployment and learning from experience. Conclusion: a harmful incentive process was observed, conducted from the perspective of institutional pressure, use of the system to justify the work performed and, on the other hand, there was the creation of collaborative learning mechanisms between the teams.

Patients’ Perceptions Regarding the Availability of Primary Care Services in Romania - A Pilot Survey Among Users of Primary Care Services in Braşov County

In Romania, users’ perceptions about availability of services in primary care have not been explored since 2009, when a national report was produced, and little is therefore known about the subject. The study aims to identify perceptions of primary healthcare service users regarding the availability of services in primary care. This research is a pen-and-paper self-administered survey applied to an opportunity sample of people, addressing family doctor’s practices, from 17 selected settlements of Brasov county. Overall, the analysis of population’s perceptions on the primary care system in Brasov County shows a high degree of satisfaction among the patients despite a narrow spectrum of services offered by family doctors.

Reducing Primary Care Provider Burnout With Pharmacist-Delivered Comprehensive Medication Management

Primary care physicians have among the highest rates of burnout of any medical specialty in the United States. Team-based care is an organizational approach to meet the increasing demands on the primary care system, including the well-being of its providers. Physicians report that pharmacist-delivered comprehensive medication management improves patient care efficiency, decreases workload and provides additional work-based social support, among other benefits. Physician perspectives as well as resources for implementing physician-pharmacist collaborations are discussed.