Entice With Procedures, Inspire With Primary Care: A Preclerkship Pipeline Course

Background and Objectives: The growing demand for primary care clinicians in the United States continues to outstrip their dwindling supply. Many allopathic medical schools, including Stanford University School of Medicine, are not adequately meeting this shortage. We sought to develop a preclerkship elective to increase the visibility and desirability of primary care at our institution. Methods: A novel 9-week preclerkship elective titled “Primary Care Defined: Perspectives and Procedures,” was designed as a series of procedural workshops followed by interactive sessions with local primary care clinicians. A total of 36 medical and physician assistant students were enrolled. We administered a questionnaire pre- and postcourse to evaluate the impact of the elective on learner interest and attitudes toward primary care. Results: Twenty-four enrolled and 10 nonenrolled learners completed the questionnaire both pre- and postcourse. A one-way analysis of covariance controlling for gender, program (medical doctor versus physician assistant), and precourse responses demonstrated that enrollees had a significantly increased interest in primary care compared to nonenrollees after the course (F1,32=9.22, P=.005). Enrollees also more positively rated their attitudes toward compensation, scope of practice, and job fulfillment than nonenrollees. Both groups had high levels of agreement on statements concerning patient-physician interactions and the importance of primary care to the health care system. Conclusion: The design and content of this elective offers a framework for other institutions looking to promote the value of primary care specialties, particularly family medicine. Creating opportunities for experiential learning and early student-faculty engagement may encourage preclerkship learners to consider a career in primary care.

Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

Background: Primary care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim: To understand the experiences of European PCPs working during the first peak of the COVID-19 pandemic. Design and Setting: An exploratory qualitative study, using semi-structured interviews in primary care in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were audio recorded, transcribed and analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance, they often lacked access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and deal with uncertainty. Conclusion: PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions will facilitate easy and coordinated access to practical information on how to adapt services, ongoing training and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

Impact of rurality on melanoma diagnosis in Utah

Aim: To analyze trends in Utah melanoma diagnosis and study the impact of rurality. Patients & methods: State-wide melanoma incidence was calculated using Surveillance, Epidemiology, and End Results data (2005–2013). A subset of 5199 patients treated in an integrated healthcare system was further stratified for urban or rural residence. Results: Early-stage tumors accounted for most of the increase in melanoma incidence over time. Age-adjusted melanoma incidence rate was higher in rural counties (46.7 vs 39.4). Anatomic site and stage did not differ between rural and urban patients. Rural patients were more commonly diagnosed by a local primary care provider. Conclusion: Rurality had an impact on melanoma diagnosis in the specialty and location of the diagnosing provider.

Addressing dementia needs in Australia

Delivering dementia care in rural Australia remains a challenge. Large geographical area, small population, and lack of skilled workforce cause inequity in health outcomes for people living in rural areas. While a third of older people live outside metropolitan areas, the proportion of older people is higher and 40% of people with dementia reside in rural areas. In this chapter, we present government policy to address dementia, the second cause of death in Australia. We showcase latest research and innovative approaches to rural dementia care that aim to build from government policy objectives and here we talk about approaches that include technologies, care pathways, and training volunteers and local primary care workforce in the rural Australian context.

Triage Into the Community for COVID-19 (TICC-19) Patients Pathway – Service evaluation of the virtual monitoring of patients with COVID pneumonia

Introduction: COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand. Methods: We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a ‘Virtual Ward’ for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care ‘Hot Hub’. This allowed the safe and managed readmission of those patients who deteriorated at home. Results: During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month. Conclusion: It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.

The importance of mycorrhiza in agroforestry systems for the stability of ecosystems in semi-arid zones and simple quantification of soil fungi - A study at the Mollesnejta research center for Andean Agroforestry in the valley of Cochabamba, Bolivia

Soil erosion and poor production conditions in developing countries are a major problem for local primary care. It is therefore even more important to ensure a functioning and stable ecosystem from which agricultural plants profit, too. Trees have found a brilliant way to gather enough nutrients for their survival. They enter a symbiosis with special types of fungi, the so-called mycorrhiza. This leads to more resistance of the crops, especially against drought. There is a method that can be used with the simplest means to prove that mycorrhizae are found in tree roots and thus assure improvement of soil fertility.

FAKTOR-FAKTOR YANG MEMPENGARUHI EFEKTIVITAS PENCEGAHAN PENULARAN HIV DARI IBU KE ANAK (PPIA) DI KOTA JAYAPURA

Abstrak Provinsi Papua memiliki prevalensi HIV/AIDS tinggi, dimana terdapat 6957 wanita usia 15-49 tahun menderita HIV/AIDS. Masalah ini dapat menyebabkan penularan HIV/AIDS ke bayi bahkan kematian bayi karena HIV. Penelitian ini bertujuan menganalisa faktor yang mempengaruhi keberlangsungan program PPIA. Penelitian menggunakan metode kualitatif dengan pengumpulan data melalui wawancara mendalam. Penelitian dilakukan di Jayapura, Dinas Kesehatan Kota Jayapura dari Januari 2015 sampai Juni 2015. Populasi penelitian adalah semua tenaga kesehatan di dinas kesehatan kota Jayapura, dan sampel nya adalah 12 orang mencakup kepala UPT AIDS TB, kepala seksi P2PL, kepala puksesmas, kepala KIA, staf KIA dan penanggung jawab HIV puskesmas. Pengambilan sampel adalah purposif sampling dan data dianalisis dengan triangulasi. PPIA tidak berhasil karena rendah nya K1 dan juga K4, dimana ada puskesmas yang memiliki K4 hanya 58%. Di rumah sakit Abepura ditemukan 8 kelahiran bayi dengan HIV, hal ini karena ibu hamil positif yang tidak menkonsumsi ARV secara rutin sampai melahirkan. Rendah nya K1 juga disebabkan oleh beberapa faktor yaitu ibu hamil lebih tertarik ke dokter praktek, suami yang tidak setuju bila istri nya mendapatkan tes VCT, dan rendah nya kesadaran ibu hamil akan pentingnya K1 sampai K4 dan juga VCT. Begitu juga dengan SIHA yang tidak berjalan dengan baik. Kata kunci : Pencegahan HIV, Ibu hamil, bayi, Jayapura Papua province has high prevalence of HIV/AIDS where there was 6957 cases among women age 15-49 years old. Moreover, this increasedthe number of infants with HIV and impact the rise of infant mortality rate.This study aims to analize factors that affected this HIV prevention from mother to child. This study is qualitative using indeep interview, and located in Jayapura City from January 2015 to June 2015. The population is all staffs in Jayapura’s Health Department, and the total sample is 12 including head of this program, staff of local primary care, staf of hospital, and staffs that have responsibily to run this program. This is purposive sampling, and data will analize with triangulation. HIV prevention is not success due to the low rate of pregnant women visit to local primary care. There was a local primary care that only has 58% of pregnant women visit. In Abepura hospital 2015, there was 8 cases of childborn with HIV. This is because many positive mothers did not consum ARV. The low visit in local primary care has several causes such as mother more willing to go to private obsetric, treat from husband where husband didn’t allow VCT to his wive, and the low self efficacy of pregnant mother. The HIV report system is not well implemented. Key words : HIV Prevention, pregnant mother, infant, Jayapura

Middle-Aged and Older Adult Health Care Selection

This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the “outshopping theory,” where respondents select services in larger regional economic centers rather than local “mom and pop” providers, now extends to older adult health care selection.