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2021 ◽  
Vol 57 ◽  
pp. 41-48
Rachel Cassie ◽  
Christine Griffiths ◽  
George Parker

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 100587
Lucinda B. Leung ◽  
Danielle Rose ◽  
Rong Guo ◽  
Catherine E. Brayton ◽  
Lisa V. Rubenstein ◽  

2021 ◽  
Vol 22 (1) ◽  
Huiling Guo ◽  
Zoe Jane-Lara Hildon ◽  
Victor Weng Keong Loh ◽  
Meena Sundram ◽  
Muhamad Alif Bin Ibrahim ◽  

Abstract Background Singapore’s healthcare system presents an ideal context to learn from diverse public and private operational models and funding systems. Aim To explore processes underpinning decision-making for antibiotic prescribing, by considering doctors’ experiences in different primary care settings. Methods Thirty semi-structured interviews were conducted with 17 doctors working in publicly funded primary care clinics (polyclinics) and 13 general practitioners (GP) working in private practices (solo, small and large). Data were analysed using applied thematic analysis following realist principles, synthesised into a theoretical model, informing solutions to appropriate antibiotic prescribing. Results Given Singapore’s lack of national guidelines for antibiotic prescribing in primary care, practices are currently non-standardised. Themes contributing to optimal prescribing related first and foremost to personal valuing of reduction in antimicrobial resistance (AMR) which was enabled further by organisational culture creating and sustaining such values, and if patients were convinced of these too. Building trusting patient-doctor relationships, supported by reasonable patient loads among other factors were consistently observed to allow shared decision-making enabling optimal prescribing. Transparency and applying data to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery. These themes are synthesised into the VALUE model proposed for guiding interventions to improve antibiotic prescribing practices. These should aim to reinforce intrapersonal Values consistent with prioritising AMR reduction, and Aligning organisational culture to these by leveraging standardised guidelines and interpersonal intervention tools. Such interventions should account for the wider systemic constraints experienced in publicly funded high patient turnover institutions, or private clinics with transactional models of care. Thus, ultimately a focus on Liaison between patient and doctor is crucial. For instance, building in adequate consultation time and props as discussion aids, or quick turnover communication tools in time-constrained settings. Message consistency will ultimately improve trust, helping to enable shared decision-making. Lastly, Use of monitoring data to track and Evaluate antibiotic prescribing using meaningful indicators, that account for the role of shared decision-making can also be leveraged for change. Conclusions These VALUE dimensions are recommended as potentially transferable to diverse contexts, and the model as implementation tool to be tested empirically and updated accordingly.

Ahmed Alhowimel ◽  
Faris Alodibi ◽  
Mazad Alotaibi ◽  
Dalyah Alamam ◽  
Julie Fritz

BACKGROUND: The first-line contact for patients seeking care for low back pain (LBP) can potentially change the disease course. The beliefs and attitudes of healthcare providers (HCPs) can influence LBP management. Although referring patients with LBP to physical therapy is common, the first-line contact for patients with LBP in Saudi Arabia is the primary care physician (PCP). Physical therapy will soon be integrated into primary care; therefore, it is rational to compare physical therapists’ (PTs) beliefs and attitudes regarding LBP with those of PCPs. OBJECTIVE: We compared PCPs’ and PTs’ attitudes and beliefs regarding LBP management. METHODS: We employed a cross-sectional, voluntary response sample research design using the Pain Attitudes and Beliefs Scale (PABS). Participants were PTs and PCPs practicing in Saudi Arabia. RESULTS: In total, 153 participants completed the PABS (111 PTs and 52 PCPs). PCPs demonstrated significantly higher PABS biomedical subscale scores than did the PTs. CONCLUSIONS: HCPs in Saudi Arabia should receive additional training to adopt a biopsychosocial approach to managing LBP. In this study, the HCPs’ treatment recommendations may not correspond with contemporary clinical guidelines. Research to facilitate the implementation of optimal professional education and training to adopt a biopsychosocial approach is an urgent priority.

2021 ◽  
Vol 4 ◽  
pp. 48
Joice Cunningham ◽  
Frank Doyle ◽  
Jennifer M. Ryan ◽  
Barbara Clyne ◽  
Cathal Cadogan ◽  

Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected to increase due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an ‘evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system’. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O’Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines. A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.

2021 ◽  
Vol 21 (1) ◽  
Carlos Alberto dos Santos Treichel ◽  
Ioannis Bakolis ◽  
Rosana Teresa Onocko-Campos

Abstract Background Although matrix support seeks to promote integrating Primary Care with specialized mental health services in Brazil, little is known about the quantitative impact of this strategy on sharing cases between different levels of care. The aim of this study was to investigate the prevalence and factors associated with Primary Care registration of the mental health needs of patients treated at outpatient specialized services in a medium-sized city in Brazil with recent implementation of matrix support. Methods This is a document-based cross-sectional study conducted through an analysis of 1198 patients’ medical records. Crude and adjusted associations with the outcome were explored using logistic regression. Results The prevalence of cases registered in Primary Care was 40% (n = 479). Evidence was found for associations between the outcome and the patients being over 30 years old, and referral by emergency or hospital services. There was conversely an inverse association between the outcome and status as a patient from the Outpatient Clinic or from the Psychosocial Care Center for psychoactive substance misuse. Conclusions Even with the provision of mechanisms for network integration, such as matrix support, our results suggest that more groundwork is necessary to ensure that sharing cases between Primary Care and specialized services is effective.

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5163
Pablo Ignacio Varela-Centelles ◽  
Daniel Pérez López ◽  
José Luis López-Cedrún ◽  
Álvaro García-Rozado ◽  
Pablo Castelo Baz ◽  

This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3–76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61–0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Mulalibieke Heizhati ◽  
Nanfang Li ◽  
Delian Zhang ◽  
Suofeiya Abulikemu ◽  
Guijuan Chang ◽  

Hypertension management is suboptimal in the primary-care setting of developing countries, where the burden of both hypertension and cardiovascular disease is huge. Therefore, we conducted a government-expert joint intervention in a resource-constrained primary setting of Emin, China, between 2014 and 2016, to improve hypertension management and reduce hypertension-related hospitalization and mortality. Primary-care providers were trained on treatment algorithm and physicians for specialized management. Public education was delivered by various ways including door-to-door screening. Program effectiveness was evaluated using screening data by comparing hypertension awareness, treatment, and control rates and by comparing hypertension-related hospitalization and total cardiovascular disease (CVD) and stroke mortality at each phase. As results, 313 primary-health providers were trained to use the algorithm and 3 physicians attended specialist training. 1/3 of locals (49490 of 133376) were screened. Compared to the early phase, hypertension awareness improved by 9.3% (58% vs. 64%), treatment by 11.4% (39% vs. 44%), and control rates by 33% (10% vs. 15%). The proportion of case/all-cause hospitalization was reduced by 35% (4.02% vs. 2.60%) for CVD and by 17% (3.72% vs. 3.10%) for stroke. The proportion of stroke/all-cause death was reduced by 46% (21.9% in 2011–2013 vs. 15.0% in 2014–2016). At the control area, the proportion of case/all-cause mortality showed no reduction. In conclusion, government-expert joint intervention with introducing treatment algorithm may improve hypertension control and decrease related hospitalization and stroke mortality in underresourced settings.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 719
Marija Petrushevska ◽  
Dragica Zendelovska ◽  
Emilija Atanasovska ◽  
Aleksandar Eftimov ◽  
Katerina Spasovska

Introduction: COVID-19 can be worsened by hyper-production of cytokines accompanied by increased level of oxidative stress. The aim of this study was to investigate the correlation between a set of cytokines and the markers of the oxidative stress. Methods: The levels of cytokines IL-2, IL-4, IL-6, IL8, IL-10, VEGF, IFN-γ, TNF-α, IL-1α, MCP-1 and EGF were determined by using High Sensitivity Evidence Investigator™ Biochip Array technology. The oxidative stress parameters (d-ROM, PAT, OS index) were measured in serum on FRAS5 analytical photometric system. Results: IL-6, IL-8, IL-10, VEGF, MCP-1 and EGF were significantly higher (p<0.05) in the patients with severe COVID-19 with increased levels of IL-2, IFN-y, TNF-α and IL-1α. The d-ROM, OS index, and PAT were significantly higher (p<0.05) in severe COVID-19 patients. IL-6 demonstrated the strongest correlation with all of the markers of the oxidative stress, d-ROM (r=0.9725, p=0.0001), PAT (r=0.5000, p=0.0001) and OS index (r=0.9593, p=0.012). Similar behavior was evidenced between IFN-y and d-ROM (r=0.4006, p=0.0001), PAT (r=0.6030, p=0.0001) and OS index (r=0.4298, p=0.012). Conclusion: The oxidative stress markers show good correlation with the tested cytokines which can be measured at the beginning of the disease in a primary care setting to predict the course of COVID-19.

2021 ◽  

Mental Health, Diabetes and Endocrinology examines the main areas of clinical overlap between endocrinology and mental health to address key clinical conundrums. Drawing on the most recent developments from literature and clinical practice, this book gives specific attention to the main areas where clinical conundrums and treatment challenges arise across endocrinology, psychiatry, psychology and primary care. Common challenges in this area include depression which can impact on the person's ability to self-care and to adhere to treatment with consequences for their morbidity and mortality; 'diabulaemia' associated with high mortality rates; obesity and associated mental disorders; cognitive impairment and mental capacity; anti-psychotic medications and their endocrine sequelae; and specific setting-related considerations. Mental Health, Diabetes and Endocrinology is a useful resource for the overlapping conditions across these specialities, and provides clinically-focussed evidence-based resources for all health care professionals who encounter these issues.

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