Pub Date : 2016-11-01Epub Date: 2016-02-09DOI: 10.1017/S1463423616000025
Jonathan Boote, Steven Julious, Michelle Horspool, Heather Elphick, W Henry Smithson, Paul Norman
Aims We describe how patient and public involvement (PPI) was integrated into the design of an intervention for a randomised controlled trial (RCT) based within primary care. The RCT, known as the PLEASANT trial, aimed to reduce unscheduled medical contacts in children with asthma associated with start of the new school year in September with a simple postal intervention, highlighting the importance of maintaining asthma medication for helping to prevent increased asthma exacerbations.
Background: PPI is a key feature of UK health research policy, and is often a requirement of funding from the National Institute for Health Research. There are few detailed accounts of PPI in the design and conduct of clinical trials in the PPI literature for researchers to learn from.
Methods: We held PPI consultation events to determine whether the proposed intervention for the trial was acceptable to children with asthma and their parents, and to ascertain whether enhancements should be made. Two PPI consultation events were held with children with asthma and their parents, prior to the research commencing. Detailed field notes were taken by the research team at each consultation event. Findings At the first consultation event, parents and children endorsed the trial's rationale, made suggestions to the wording of the trial intervention letter, and made recommendations about to whom the letter should be sent out. At the second consultation event, parents discussed the timing of the intervention, commented on the lay summary of the Research Ethics Application, and were invited to join the trial's steering committee, while the children selected a logo for the study. PPI has resulted in enhancements to the PLEASANT study's intervention. A further PPI consultation event is scheduled for the end of the trial, in order for children with asthma and their parents to contribute to the trial's dissemination strategy.
{"title":"PPI in the PLEASANT trial: involving children with asthma and their parents in designing an intervention for a randomised controlled trial based within primary care.","authors":"Jonathan Boote, Steven Julious, Michelle Horspool, Heather Elphick, W Henry Smithson, Paul Norman","doi":"10.1017/S1463423616000025","DOIUrl":"10.1017/S1463423616000025","url":null,"abstract":"<p><p>Aims We describe how patient and public involvement (PPI) was integrated into the design of an intervention for a randomised controlled trial (RCT) based within primary care. The RCT, known as the PLEASANT trial, aimed to reduce unscheduled medical contacts in children with asthma associated with start of the new school year in September with a simple postal intervention, highlighting the importance of maintaining asthma medication for helping to prevent increased asthma exacerbations.</p><p><strong>Background: </strong>PPI is a key feature of UK health research policy, and is often a requirement of funding from the National Institute for Health Research. There are few detailed accounts of PPI in the design and conduct of clinical trials in the PPI literature for researchers to learn from.</p><p><strong>Methods: </strong>We held PPI consultation events to determine whether the proposed intervention for the trial was acceptable to children with asthma and their parents, and to ascertain whether enhancements should be made. Two PPI consultation events were held with children with asthma and their parents, prior to the research commencing. Detailed field notes were taken by the research team at each consultation event. Findings At the first consultation event, parents and children endorsed the trial's rationale, made suggestions to the wording of the trial intervention letter, and made recommendations about to whom the letter should be sent out. At the second consultation event, parents discussed the timing of the intervention, commented on the lay summary of the Research Ethics Application, and were invited to join the trial's steering committee, while the children selected a logo for the study. PPI has resulted in enhancements to the PLEASANT study's intervention. A further PPI consultation event is scheduled for the end of the trial, in order for children with asthma and their parents to contribute to the trial's dissemination strategy.</p>","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"64 1","pages":"536-548"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90345366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-17DOI: 10.1017/S1463423616000359
Adam Balkham, S. Alderson
Background The introduction of the Health and Social Care Bill (2011) changed the role of GPs to include commissioning of health services. Aim This study aimed to identify any differences in the media portrayal of GPs before and after the introduction of the Bill. Methods We retrospectively searched four British newspapers over the period 2009–2013 using the media database Nexis. In order to directly compare the findings of the study with the work of Tanner et al., articles relating to GP pay were analysed using thematic analysis. Themes were identified and each article was scored to determine whether it portrayed GPs positively or negatively. Results GPs were portrayed slightly less negatively after the introduction of the Bill. The theme of ‘high salaries’ persisted despite reference to ‘pay freezes’. References to decreased trust in the patient–doctor relationship appeared after the introduction of the Bill. Conclusion Negative portrayal of GP pay has continued and a lack of trust in GPs has started to be portrayed. This trend may exacerbate the low morale amongst the profession and difficulties in recruiting and retaining GPs.
{"title":"‘The biggest car crash in NHS history’: the media portrayal of GP pay before and after the introduction of the Health and Social Care Bill 2011","authors":"Adam Balkham, S. Alderson","doi":"10.1017/S1463423616000359","DOIUrl":"https://doi.org/10.1017/S1463423616000359","url":null,"abstract":"Background The introduction of the Health and Social Care Bill (2011) changed the role of GPs to include commissioning of health services. Aim This study aimed to identify any differences in the media portrayal of GPs before and after the introduction of the Bill. Methods We retrospectively searched four British newspapers over the period 2009–2013 using the media database Nexis. In order to directly compare the findings of the study with the work of Tanner et al., articles relating to GP pay were analysed using thematic analysis. Themes were identified and each article was scored to determine whether it portrayed GPs positively or negatively. Results GPs were portrayed slightly less negatively after the introduction of the Bill. The theme of ‘high salaries’ persisted despite reference to ‘pay freezes’. References to decreased trust in the patient–doctor relationship appeared after the introduction of the Bill. Conclusion Negative portrayal of GP pay has continued and a lack of trust in GPs has started to be portrayed. This trend may exacerbate the low morale amongst the profession and difficulties in recruiting and retaining GPs.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"64 1","pages":"84 - 91"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75904255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-03DOI: 10.1017/S1463423616000372
P. Brauer, D. Royall, J. Dwyer, A. M. Edwards, T. Hussey, N. Kates, Heidi J. Smith, Ross Kirkconnell
Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. Background It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. Methods The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. Conclusions Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.
{"title":"Obesity services planning framework for interprofessional primary care organizations","authors":"P. Brauer, D. Royall, J. Dwyer, A. M. Edwards, T. Hussey, N. Kates, Heidi J. Smith, Ross Kirkconnell","doi":"10.1017/S1463423616000372","DOIUrl":"https://doi.org/10.1017/S1463423616000372","url":null,"abstract":"Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. Background It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. Methods The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. Conclusions Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"33 8 1","pages":"135 - 147"},"PeriodicalIF":0.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78385470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-03DOI: 10.1017/S1463423616000384
Traci H. Abraham, E. Lewis, K. Drummond, C. Timko, Michael A. Cucciare
Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider–patient communication about harmful drinking. Background Women presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits. Methods Providers (n=14) were recruited from primary care at two veterans Administration Women’s Health Clinics in California, United States. An open-ended interview guide was developed from domains of the consolidated framework for implementation science. Interviews elicited primary care providers’ perspectives on barriers and facilitators to women veterans’ (who may or may not be using alcohol in harmful ways) disclosure of alcohol use during routine clinic visits. Interview data were analyzed deductively using a combination of template analysis and matrix analysis. Findings Participants reported six barriers and five facilitators that they perceived affect women veteran’s decision to accurately disclose alcohol use during screenings and openness to discussing harmful drinking with a primary care provider. The most commonly described barriers to disclosure were stigma, shame, and discomfort, and co-occuring mental health concerns, while building strong therapeutic relationships and using probes to ‘dig deeper’ were most often described as facilitators. Findings from this study may enhance provider–patient discussions about alcohol use and help primary care providers to better identify problematic drinking among women veterans, ultimately improving patient outcomes.
{"title":"Providers’ perceptions of barriers and facilitators to disclosure of alcohol use by women veterans","authors":"Traci H. Abraham, E. Lewis, K. Drummond, C. Timko, Michael A. Cucciare","doi":"10.1017/S1463423616000384","DOIUrl":"https://doi.org/10.1017/S1463423616000384","url":null,"abstract":"Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider–patient communication about harmful drinking. Background Women presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits. Methods Providers (n=14) were recruited from primary care at two veterans Administration Women’s Health Clinics in California, United States. An open-ended interview guide was developed from domains of the consolidated framework for implementation science. Interviews elicited primary care providers’ perspectives on barriers and facilitators to women veterans’ (who may or may not be using alcohol in harmful ways) disclosure of alcohol use during routine clinic visits. Interview data were analyzed deductively using a combination of template analysis and matrix analysis. Findings Participants reported six barriers and five facilitators that they perceived affect women veteran’s decision to accurately disclose alcohol use during screenings and openness to discussing harmful drinking with a primary care provider. The most commonly described barriers to disclosure were stigma, shame, and discomfort, and co-occuring mental health concerns, while building strong therapeutic relationships and using probes to ‘dig deeper’ were most often described as facilitators. Findings from this study may enhance provider–patient discussions about alcohol use and help primary care providers to better identify problematic drinking among women veterans, ultimately improving patient outcomes.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"23 1","pages":"64 - 72"},"PeriodicalIF":0.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86081753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-03DOI: 10.1017/S1463423616000244
D. Ogaji, Sally J. Giles, G. Daker-White, P. Bower
Background Questionnaires developed for patient evaluation of the quality of primary care are often focussed on primary care systems in developed countries. Aim To report the development and validation of the patient evaluation scale (PES) designed for use in the Nigerian primary health care context. Methods An iterative process was used to develop and validate the questionnaire using patients attending 28 primary health centres across eight states in Nigeria. The development involved literature review, patient interviews, expert reviews, cognitive testing with patients and waves of quantitative cross-sectional surveys. The questionnaire’s content validity, internal structures, acceptability, reliability and construct validity are reported. Findings The full and shortened version of PES with 27 and 18 items, respectively, were developed through these process. The low item non-response from the serial cross-sectional surveys depicts questionnaire’s acceptability among the local population. PES-short form (SF) has Cronbach’s α of 0.87 and three domains (codenamed ‘facility’, ‘organisation’ and ‘health care’) with Cronbach’s αs of 0.78, 0.79 and 0.81, respectively. Items in the multi-dimensional questionnaire demonstrated adequate convergent and discriminant properties. PES-SF scores show significant positive correlation with scores of the full PES and also discriminated population groups in support of a priori hypotheses. Conclusion The PES and PES-SF contain items that are relevant to the needs of patients in Nigeria. The good measurement properties of the questionnaire demonstrates its potential usefulness for patient-focussed quality improvement activities in Nigeria. There is still need to translate these questionnaires into major languages in Nigeria and assess their validity against external quality criteria.
为病人评价初级保健质量而编制的调查问卷往往侧重于发达国家的初级保健系统。目的报告设计用于尼日利亚初级卫生保健的患者评估量表(PES)的开发和验证。方法采用迭代过程，对尼日利亚8个州28个初级卫生中心的患者进行问卷编制和验证。这一发展包括文献回顾、患者访谈、专家评论、患者认知测试和一波又一波的定量横断面调查。报告了问卷的内容效度、内部结构、可接受度、信度和结构效度。结果经此流程编制出完整版PES 27项，缩短版PES 18项。从连续横断面调查的低项目无反应描述了问卷在当地人口中的可接受性。PES-short form (SF)的Cronbach ' s α为0.87，三个域(代号为“设施”、“组织”和“卫生保健”)的Cronbach ' s α分别为0.78、0.79和0.81。多维度问卷的项目表现出足够的收敛性和判别性。PES- sf得分与全PES得分和歧视人群得分呈显著正相关，支持先验假设。结论PES和PES- sf包含与尼日利亚患者需求相关的项目。该问卷的良好测量特性表明其对尼日利亚以患者为重点的质量改进活动的潜在有用性。仍然需要将这些问卷翻译成尼日利亚的主要语言，并根据外部质量标准评估其有效性。
{"title":"Development and validation of the patient evaluation scale (PES) for primary health care in Nigeria","authors":"D. Ogaji, Sally J. Giles, G. Daker-White, P. Bower","doi":"10.1017/S1463423616000244","DOIUrl":"https://doi.org/10.1017/S1463423616000244","url":null,"abstract":"Background Questionnaires developed for patient evaluation of the quality of primary care are often focussed on primary care systems in developed countries. Aim To report the development and validation of the patient evaluation scale (PES) designed for use in the Nigerian primary health care context. Methods An iterative process was used to develop and validate the questionnaire using patients attending 28 primary health centres across eight states in Nigeria. The development involved literature review, patient interviews, expert reviews, cognitive testing with patients and waves of quantitative cross-sectional surveys. The questionnaire’s content validity, internal structures, acceptability, reliability and construct validity are reported. Findings The full and shortened version of PES with 27 and 18 items, respectively, were developed through these process. The low item non-response from the serial cross-sectional surveys depicts questionnaire’s acceptability among the local population. PES-short form (SF) has Cronbach’s α of 0.87 and three domains (codenamed ‘facility’, ‘organisation’ and ‘health care’) with Cronbach’s αs of 0.78, 0.79 and 0.81, respectively. Items in the multi-dimensional questionnaire demonstrated adequate convergent and discriminant properties. PES-SF scores show significant positive correlation with scores of the full PES and also discriminated population groups in support of a priori hypotheses. Conclusion The PES and PES-SF contain items that are relevant to the needs of patients in Nigeria. The good measurement properties of the questionnaire demonstrates its potential usefulness for patient-focussed quality improvement activities in Nigeria. There is still need to translate these questionnaires into major languages in Nigeria and assess their validity against external quality criteria.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"20 1","pages":"161 - 182"},"PeriodicalIF":0.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91185033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-19DOI: 10.1017/S1463423616000335
E. Paz-Pacheco, M. Sandoval, G. J. R. Ardena, E. Paterno, N. Juban, F. Lantion-Ang, C. Jimeno, Perpetua C Patal, Joseph Bongon
Introduction The purpose of this study is to assess the effectiveness of diabetes self-management education (DSME) in a rural agricultural town. Methods In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months. Results DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination. Conclusion DSME in this rural agricultural town improved glycemic control and promoted foot examination.
{"title":"Effectiveness of a community-based diabetes self-management education (DSME) program in a rural agricultural setting","authors":"E. Paz-Pacheco, M. Sandoval, G. J. R. Ardena, E. Paterno, N. Juban, F. Lantion-Ang, C. Jimeno, Perpetua C Patal, Joseph Bongon","doi":"10.1017/S1463423616000335","DOIUrl":"https://doi.org/10.1017/S1463423616000335","url":null,"abstract":"Introduction The purpose of this study is to assess the effectiveness of diabetes self-management education (DSME) in a rural agricultural town. Methods In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months. Results DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination. Conclusion DSME in this rural agricultural town improved glycemic control and promoted foot examination.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"11 1","pages":"35 - 49"},"PeriodicalIF":0.0,"publicationDate":"2016-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86641025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-19DOI: 10.1017/S1463423616000347
Annette M. Johansson, I. Lindberg, S. Söderberg
Background Patients living in rural areas often need to travel long distances for access to specialist care. To increase access to specialist care, video consultation between patients in primary healthcare and specialist care has been used. In order for this new method to be developed and used to the fullest, it is important to understand healthcare personnel’s experiences with this intervention. Objective The aim of this study was to describe healthcare personnel’s experiences using video consultation in their work in primary healthcare. Method A mixed methods design was used, and the data were analysed using qualitative and quantitative analysis methods. Interviews were conducted with eight general practitioners and one district nurse, all of whom had conducted a video consultation with a patient and a specialist physician or a cardiac specialist nurse. After each video consultation, the participants completed a consultation report/questionnaire. Results Healthcare personnel considered video consultation to provide quicker access to specialist care for the patient, and greater security when the video consultation encounter was conducted at their own primary healthcare centre. They considered video consultation an opportunity to provide education and for the patients to ask questions. Conclusion Video consultation is a satisfactory tool for healthcare personnel, and the technology is a new, useful method, especially for the district nurses. Further, video consultation is an opportunity for healthcare personnel to learn. However, for it to work as an accepted method, the technology must function well and be user friendly. It must also be clear that it is beneficial for the patients and the healthcare personnel.
{"title":"Healthcare personnel’s experiences using video consultation in primary healthcare in rural areas","authors":"Annette M. Johansson, I. Lindberg, S. Söderberg","doi":"10.1017/S1463423616000347","DOIUrl":"https://doi.org/10.1017/S1463423616000347","url":null,"abstract":"Background Patients living in rural areas often need to travel long distances for access to specialist care. To increase access to specialist care, video consultation between patients in primary healthcare and specialist care has been used. In order for this new method to be developed and used to the fullest, it is important to understand healthcare personnel’s experiences with this intervention. Objective The aim of this study was to describe healthcare personnel’s experiences using video consultation in their work in primary healthcare. Method A mixed methods design was used, and the data were analysed using qualitative and quantitative analysis methods. Interviews were conducted with eight general practitioners and one district nurse, all of whom had conducted a video consultation with a patient and a specialist physician or a cardiac specialist nurse. After each video consultation, the participants completed a consultation report/questionnaire. Results Healthcare personnel considered video consultation to provide quicker access to specialist care for the patient, and greater security when the video consultation encounter was conducted at their own primary healthcare centre. They considered video consultation an opportunity to provide education and for the patients to ask questions. Conclusion Video consultation is a satisfactory tool for healthcare personnel, and the technology is a new, useful method, especially for the district nurses. Further, video consultation is an opportunity for healthcare personnel to learn. However, for it to work as an accepted method, the technology must function well and be user friendly. It must also be clear that it is beneficial for the patients and the healthcare personnel.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"4 1","pages":"73 - 83"},"PeriodicalIF":0.0,"publicationDate":"2016-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86547525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-04DOI: 10.1017/S1463423616000098
Ing-Marie Hallgren Elfgren, E. Grodzinsky, E. Törnvall
Aim The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients. Background According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002–2005. Methods Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis. Findings The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDR’s statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patient’s wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.
{"title":"The Swedish National Diabetes Register in clinical practice and evaluation in primary health care","authors":"Ing-Marie Hallgren Elfgren, E. Grodzinsky, E. Törnvall","doi":"10.1017/S1463423616000098","DOIUrl":"https://doi.org/10.1017/S1463423616000098","url":null,"abstract":"Aim The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients. Background According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002–2005. Methods Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis. Findings The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDR’s statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patient’s wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"19 1","pages":"549 - 558"},"PeriodicalIF":0.0,"publicationDate":"2016-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78951865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-31DOI: 10.1017/S1463423616000104
L. Rawal, Kawkab Mahmud, S. M. S. Islam, R. Mahumud, Md Nuruzaman, S. Ahmed
Introduction In recent years, the government of Bangladesh has encouraged private sector involvement in producing mid-level health cadres including Medical Assistants (MAs). The number of MAs produced has increased significantly. We assessed students’ characteristics, educational services, competencies and perceived attitudes towards health service delivery in rural areas. Methods We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyzed thematically. Findings The majority of the students in both public (66%) and private medical assistant training schools (MATS) (61%) were from rural backgrounds. They spent the majority of their time in classroom learning (public 45% versus private 42%) and the written essay exam was the common form of a students’ performance assessment. Compared with students of public MATS, students of private MATS were more confident in different aspects of educational areas, including managing emerging health needs (P<0.001); evidence-based practice (P=0.002); critical thinking and problem solving (P=0.02), and use of IT/computer skills (P<0.001). Students were aware of not having adequate facilities in rural areas (public 71%, private 65%), but they perceived working in rural areas will offer several benefits, including use of learnt skills; friendly rural people; and opportunities for real-life problem solving, etc. Conclusion This study provides a current picture of MATS students’ characteristics, educational services, competencies and perception towards working in rural areas. The MA students in both private and public sectors showed a greater level of willingness to serve in rural health facilities. The results are promising to improve health service delivery, particularly in rural and hard-to-reach areas of Bangladesh.
{"title":"Training mid-level health cadres to improve health service delivery in rural Bangladesh","authors":"L. Rawal, Kawkab Mahmud, S. M. S. Islam, R. Mahumud, Md Nuruzaman, S. Ahmed","doi":"10.1017/S1463423616000104","DOIUrl":"https://doi.org/10.1017/S1463423616000104","url":null,"abstract":"Introduction In recent years, the government of Bangladesh has encouraged private sector involvement in producing mid-level health cadres including Medical Assistants (MAs). The number of MAs produced has increased significantly. We assessed students’ characteristics, educational services, competencies and perceived attitudes towards health service delivery in rural areas. Methods We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyzed thematically. Findings The majority of the students in both public (66%) and private medical assistant training schools (MATS) (61%) were from rural backgrounds. They spent the majority of their time in classroom learning (public 45% versus private 42%) and the written essay exam was the common form of a students’ performance assessment. Compared with students of public MATS, students of private MATS were more confident in different aspects of educational areas, including managing emerging health needs (P<0.001); evidence-based practice (P=0.002); critical thinking and problem solving (P=0.02), and use of IT/computer skills (P<0.001). Students were aware of not having adequate facilities in rural areas (public 71%, private 65%), but they perceived working in rural areas will offer several benefits, including use of learnt skills; friendly rural people; and opportunities for real-life problem solving, etc. Conclusion This study provides a current picture of MATS students’ characteristics, educational services, competencies and perception towards working in rural areas. The MA students in both private and public sectors showed a greater level of willingness to serve in rural health facilities. The results are promising to improve health service delivery, particularly in rural and hard-to-reach areas of Bangladesh.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"49 1","pages":"503 - 513"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85728798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-31DOI: 10.1017/S1463423616000116
P. Groenewegen, J. De Maeseneer, S. Kendall
Announced in August 2015, Primary Health Care Research & Development (PHCRD) is now the Official Journal of the European Forum for Primary Care (EFPC). Both PHCRD and EFPC are delighted with this connection. The EFPC aims to strengthen the position of primary care in European countries. As the health needs of the population of Europe are changing, strong primary care for all is increasingly important. As a result of an ageing population and an increase in multi-morbidity, health care has to move from an emphasis on (single) diseases to person-centred care (De Maeseneer and Boeckxstaens, 2012). The health problems of people do not follow the narrowly defined classifications of health-care professionals. People need – and increasingly expect – collaboration both within primary care and between the boundaries of primary care, the secondary health-care sector and social care. As such, primary care is in a position to offer more integrated care described as putting the patient’s perspective at the heart of any discussion about health care. Achieving integrated care requires those involved with planning and providing services to ‘impose the patient perspective as the organising principle of service delivery’ (Lloyd and Wait, 2005: 7). This could be seen as a guiding principle of strong primary care. However, strong primary care is not something that comes about by itself (Groenewegen et al., 2002). It is not the ‘natural state’ of health-care systems but requires regulation, for example, in making primary care responsible for a defined population and the first point of contact for people with health problems. Therefore, the EFPC provides advocacy for strong primary care. Advocacy is needed at different levels, ranging from local and regional, where primary care practice is shaped, to national, where governments and civil society organizations (patient organizations, professional groups) work towards optimal regulation, and also at European level. The European level is important, even though the organization of health-care systems is not the remit of the EU. In the end, the EU is built on economic principles and consumer choice. When we realize how important a part of the economy the health sector is (on average 10% of gross national product, paying the salaries of again ~10%of the workforce), it will come as no surprise that EU advice on the member states’ economy (eg through the country-specific recommendations of the European Semester) often relates to the health-care sector. European advocacy is therefore at the same time strongly needed but difficult to achieve – for example, exactly where should such advocacy be directed? However, within the EU there is also a need for information and inputs to gain legitimacy and to test ideas and propositions. As an advocate for strong primary care, the EFPC has a track record in responding to relevant consultations, organized by the EU. It is often difficult to assess the impact of these actions, but they place
《初级卫生保健研究与发展》(PHCRD)于2015年8月宣布，现已成为欧洲初级保健论坛(EFPC)的官方期刊。PHCRD和EFPC都对这次合作感到高兴。EFPC旨在加强初级保健在欧洲国家的地位。随着欧洲人口的卫生需求不断变化，为所有人提供强有力的初级保健变得越来越重要。由于人口老龄化和多种疾病的增加，医疗保健必须从强调(单一)疾病转向以人为本的护理(De Maeseneer和Boeckxstaens, 2012年)。人们的健康问题并不遵循狭义的保健专业人员分类。人们需要——而且越来越期望——初级保健内部以及初级保健、二级保健部门和社会保健之间的协作。因此，初级保健能够提供更多的综合护理，将患者的观点置于任何有关卫生保健的讨论的核心。实现综合护理需要那些参与计划和提供服务的人“将患者的观点作为服务提供的组织原则”(Lloyd and Wait, 2005: 7)。这可以被视为强有力的初级保健的指导原则。然而，强大的初级保健不是自发产生的(Groenewegen et al.， 2002)。它不是卫生保健系统的“自然状态”，而是需要监管，例如，使初级保健对特定人群负责，并成为有健康问题的人的第一接触点。因此，EFPC倡导强有力的初级保健。需要在不同层面进行宣传，从形成初级保健做法的地方和区域，到政府和民间社会组织(患者组织、专业团体)努力实现最佳监管的国家，以及在欧洲层面。欧洲层面是重要的，尽管卫生保健系统的组织不是欧盟的职权范围。归根结底，欧盟是建立在经济原则和消费者选择的基础上的。当我们意识到卫生部门是经济的重要组成部分时(平均占国民生产总值的10%，支付约10%的劳动力的工资)，欧盟对成员国经济的建议(例如通过欧洲学期的国别建议)经常与卫生保健部门有关就不足为奇了。因此，同时迫切需要欧洲的倡导，但很难实现- -例如，这种倡导究竟应该指向哪里?然而，在欧盟内部，也需要信息和输入来获得合法性，并测试想法和主张。作为强有力的初级保健的倡导者，EFPC在回应欧盟组织的相关磋商方面有着良好的记录。通常很难评估这些行动的影响，但它们将想法放在欧盟公务员的脑海中，有时会导致文件和提案的措辞和框架的具体变化。EFPC制定了将其成员与倡导进程联系起来的工作方式。例如，对欧盟磋商的反应是基于成员的投入，通过讨论和辩论以及德尔菲调查来明确优先问题。在更结构性的基础上，EFPC通过制定立场文件与其成员合作。这些活动涉及重要问题，带来基于证据的信息和实践经验，并形成对该问题的立场。最近的立场文件涉及初级保健在罗姆人保健中的作用以及初级保健中的跨专业合作。未来，EFPC的立场文件将在PHCRD上发表。期刊名称中的“研究”和“发展”两个词与EFPC初级卫生保健研究与发展2016;17: 207-208编辑doi:10.1017/S1463423616000116
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