Primary Healthcare
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Cureus ◽  
2021 ◽  
Abdulrhman Alabdulgader ◽  
Ali O Mobarki ◽  
Ahmed AlDuwayrij ◽  
Abdullah Albadran ◽  
Mohammed I Almulhim ◽  

2021 ◽  
Vol 21 (1) ◽  
Kerensa Govender ◽  
Sarah Girdwood ◽  
Daniel Letswalo ◽  
Lawrence Long ◽  
G. Meyer-Rath ◽  

Abstract Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). Results The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

Shannon Berg

Fisher et al have provided a solid addition to health policy literature in their finding that universal health coverage supports equitable access to Australian primary healthcare (PHC), despite factors such as episodic care and poor distribution of services. Their definition of PHC was comprehensive, extending beyond medical care to include social determinants of health and public policy. However, they limited their operational definition for purposes of the study to general practice, community health and allied health. Applying a narrower definition risks lost opportunities to identify policy implications for equity beyond financial accessibility. The populations most at risk of non-communicable diseases also face significant language, culture, and individual and systemic discrimination barriers to access. Future policy research should consider using a comprehensive PHC definition in determining variables of interest and designing research methodologies, to avoid missing important knowledge that allows existing biases within primary care to continue.

2021 ◽  
Katja Troberg ◽  
Karin Lundqvist ◽  
Helena Hansson ◽  
Anders Håkansson ◽  
Disa Dahlman

Abstract Background: Patients in opioid substitution treatment (OST) have poorer health than the general population. Thus, they do not seek somatic health care to the extent that is medically motivated. Barriers hindering patients from seeking medical help through the conventional healthcare system result in a high degree of unmet healthcare needs. Barriers to and facilitators of OST patients’ healthcare seeking have been sparsely examined.Methods: Mixed methods were employed. The quantitative part consisted of a cross-sectional questionnaire covering questions on physical health, healthcare seeking, and barriers thereof, which was collected from 209 patients in OST. A sub-sample of eleven OST patients participated in semi-structured interviews, for the qualitative part of the study, covering experience of healthcare, lifestyle and self-images, expectations and ideals of Swedish healthcare. Results: Confirmed by qualitative data, quantitative data revealed deprioritization, fear of stigma and of being treated badly, and problems in navigation throughout the healthcare system, leading to unsuccessful establishment of contact, being most common reasons for not seeking somatic healthcare. Thus, interviewees provided a deeper knowledge of the barriers stigma, lack of means to prioritize health and difficulties navigating throughout the healthcare system, leading to resignation and deprioritization. On-site primary healthcare seemed to contribute to increased access and utilization of healthcare.Conclusion: Individual and structural barriers decreasing access to healthcare lead to increased inequalities in healthcare utilization, adding to an already deteriorating health of this ageing population. Integration of on-site primary healthcare and OST could provide acceptable and accessible healthcare. Further investigations into this subject need to be conducted.

2021 ◽  
Vol 79 (1) ◽  
Habtamu Beyene ◽  
Dejene Hailu ◽  
Henok Tadele ◽  
Lars Åke Persson ◽  
Della Berhanu

Abstract Background We have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primary healthcare register reviews and explore health care providers’ and parents’ perceptions regarding factors that hinder or enhance referral. Methods A mixed-methods study was conducted in 11 districts and a town administration of the Hadiya zone in Ethiopia’s Southern region from May to June 2019. Data collection included interviews and focus group discussions with healthcare providers, key informant interviews with parents of sick children who had been referred, and reviewing registers of sick children treated during the last 12 months at health posts and health centres. We analysed the association between healthcare providers’ and sick children’s characteristics and providers’ compliance with referral guidelines for sick children 0–59 months old. Content analysis was undertaken to explore the perceived factors that influenced referral and adherence to referral from providers’ and parents’ perspectives. Results Healthcare providers did not refer nearly half of the severely ill children that should have been referred, according to guidelines. Providers who had received in-service training on child healthcare were more likely to adhere to referral guidelines. The severity of the child’s illness and mobile phone communication and transport availability were perceived to be positively associated with adherence to referral guidelines. Lack of knowledge of treatment guidelines and skills, and high health worker workload, were among the factors perceived to be linked to lower adherence to guidelines. The healthcare providers considered parents of referred sick children as having low compliance with the referral advice. In contrast, parents had the opinion that compliance with a referral for sick children was high. Perceived awareness of severity of the child’s illness, ability to afford referral costs, and availability of transport or ambulance services were perceived to motivate parents to take their children to the referral facility. Traditional illness perceptions, lack of confidence in the referral site’s medical care, and a long distance were perceived to hurdle caregivers’ referral compliance. Conclusions We found that the healthcare providers’ adherence to referral guidelines was not optimal. Care providers and parents had divergent opinions on parents’ compliance with referral advice. Factors related to the health system, family economy, and available ambulance services influence whether care providers and parents pursued severely ill children’s referral. Adequate referral of sick children is an aspect of primary healthcare quality that is essential to avoid unnecessary under-five deaths.

2021 ◽  
Vol 14 (9) ◽  
pp. e244765
Tares Krassanairawiwong ◽  
Chartchay Suvannit ◽  
Krit Pongpirul ◽  
Kriang Tungsanga

In Thailand, 40 000 subdistrict health centre (SDHC) personnel and >1 million village health volunteers (VHVs) are responsible for primary healthcare of 23 million households in 75 032 villages. They were trained, made household visits, gave hygiene advice, participated in the ‘Big Cleaning Day’ campaign, produced cloth face masks, proactively identified high-risk visitors and monitored quarantined cases. 7.4 million Thais received basic education on hygiene, 1.3 million villagers joined the campaign and 3.6 million handmade cloth face masks were produced. In March 2020, 3.9 million households were visited, and 40 000 high-risk cases were detected. The intensity of proactive case findings increased to 12.6 million home visits and 834 000 cases were detected in April 2020. Almost 800 000 cases complied with the 14-day mandatory home quarantine, of which 3.6% developed symptoms suspected of respiratory tract infection. VHVs and SDHC personnel could efficiently contribute to the prevention and control of COVID-19 in Thailand.

2021 ◽  
pp. 097206342110351
Shridhar Kadam ◽  
Bhuputra Panda ◽  
Srinivas Nallala ◽  
Sanghamitra Pati ◽  
Mohammed Akhtar Hussain ◽  

Provision of primary healthcare in India received thrust of National Health Policy 2017. Vacancy, chronic absenteeism and non-availability of allopathic doctors is a chronic problem of the public health system. Engagement of alternative human resources could get the ailing health system rid of this shortage. AYUSH doctors in Odisha are involved in clinical and public health activities since 1970s. This study aims to examine perspectives of key stakeholders on ‘task shifting’ as a possible policy alternative. We reviewed the policies and guidelines of government of Odisha on human resources deployment, recruitment, retention and terms of reference of their engagement in the public health sector. Further, 76 AYUSH doctors and 30 key informants were interviewed. Ethical clearance was obtained beforehand. Most AYUSH doctors were involved in monitoring and supervising community-based public health programmes and village-level health service providers, respectively. Their involvement in the implementation of national health programmes was found to range from 8% to 62%. A sizeable proportion of AYUSH doctors had not been trained on management of national vector borne disease control, Tuberculosis control, immunisation (RI) and disease surveillance. More than 70% of respondents showed interest in implementing and managing public health programmes. Almost all key informants recommended for improved involvement of AYUSH doctors in public health activities. Inadequate logistics support, insufficient training on public health and unequal administrative authorities was perceived to be systemic bottlenecks. Job enrichment, management capacity development, and pre-deployment orientation of AYUSH doctors may precede the opportunity of ‘task-shifting’ of public health functions.

2021 ◽  
Vol 50 (Supplement_1) ◽  
Moleen Dzikiti ◽  
Mark Cotton ◽  
Lawrence Mbuagbaw ◽  
Lehana Thabane

Abstract Focus of Presentation A randomized clinical trial is considered the best experimental study design for comparing the effect of an intervention against a control. Selecting a trial design depends on the trial objective, a better choice would be a design that provides optimal estimation of the intervention effect, i.e. a design that yields smaller variance for the estimated intervention effect and giving stable estimates. The choice of analysis method depends on trial design aspects, reasonable assumption on the underlying probabilistic model generating the data and the credibility of findings depend on the appropriateness of the analysis method used. Here, we describe a planned randomized standard of care-controlled trial on interactive weekly mobile text messaging added to a motivational interviewing intervention aimed at sustaining continued breastfeeding among women living with HIV in South Africa. Under the “findings” heading, we highlight some of the trial design and statistical issues for discussion at the early career workshop, to gain insights on possible approaches to address the methods issues. Methods and trial design: Women from peri-urban informal settlements and a rural setting will be invited to participate within 24 hours of giving birth at selected primary healthcare facilities. Eligible women will be individually randomized to intervention or control arm after providing written informed consent. The intervention will consist of a weekly text message encouraging women to exclusively breastfeed and inquiring if they have any problems breastfeeding their infants. In addition to text messaging, women assigned to the intervention arm must visit the research site where a research nurse or counsellor will conduct an individual motivational interview, at weeks 2, 6, and 10 post-delivery. Women assigned to the control arm will be counselled by the standard of care service, i.e. primary healthcare nurses and trained counsellors will counsel women to exclusively breastfeed for the first six months through group educational infant feeding counselling sessions. Study participation will not change standard of care of participants, so women assigned to the intervention arm will receive the standard of care service, in line with provincial guidelines applicable in the sector during the study period. The primary outcomes are 1) number of women who are exclusively breastfeeding at week 24 post-delivery and 2) number of women reporting any breastfeeding at week 24 post-delivery. Findings or trial design and statistical issues Although women are individually randomly assigned to intervention and control arms, the standard of care at the primary health care facility may induce a dependency between these participants, also called the group therapy effect. For example, promotion of exclusive breastfeeding in HIV-infected women may be enhanced through positive feedback from women who follow this practice or vice versa. The standard of care will be clustered within group infant feeding counselling session, where participants (both assigned to the control and intervention arm) will receive the standard of care in groups. Women assigned to the intervention arm will receive individual motivational interview and the text messages will be send separately, to each woman’s mobile phone. Implications The trial objective will be to determine whether at week 24 following delivery, weekly text message added to motivational interview leads to better adherence to exclusive breastfeeding and leads to extended breastfeeding than standard of care. Trial design and statistical issues to discuss during the workshop will include a discussion around: 1) the appropriateness of invoking the standard experimental design to address the study objectives, and possible alternatives 2) Sample size estimation for a trial comparing group and individual treatments? 3) Reasonable assumption on the underlying probabilistic model generating the outcome data and 4) Candidate statistical models. Key messages Use of sound statistical principles of experimental design established for clinical trials allow objective and unbiased comparisons.

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