BMC primary care最新文献

Background: Hypertension is one of the most common conditions seen in the Philippine primary care setting. Adequate quality of care provided in accordance with clinical practice guidelines (CPG) for the control and management of hypertension is necessary to improve patient outcomes. This study aimed to determine the quality of care received by Filipino patients with hypertension in selected urban, rural and remote primary care facilities.

Methodology: This is a retrospective cohort study involving electronic medical records (EMR) data in three different study sites of the Philippine Primary Care Studies (PPCS) program. All outpatient visits of adult patients with a diagnosis of hypertension who consulted from the years 2019 to 2022 were included. Strong recommendations from the JNC8 guidelines were utilized to determine quality-of-care indicators, namely self-monitoring of blood pressure, type of pharmacologic management, advice on non-pharmacologic management, and advice to follow-up.

Results: The study included a total of 2,452 patients with 7,277 hypertension-related consults across urban, rural, and remote study sites between the years 2019-2022. Across all patients with follow-up consults, 500 (20.5%) attained BP lowering threshold of < 140/<90 mmHg at their last consult. The proportion of patients who attained the desired threshold was lowest for the remote site (11.6%), compared to 24.9% for the urban site and 21.1% for the rural site. The most frequent pharmacologic management prescribed was angiotensin receptor blockers (49.1%), followed by calcium channel blockers (26.7%), thiazide diuretics (2.8%) and ACE-inhibitors (0.8%) across individual patients. These drugs were all moderately recommended in the JNC8 guidelines as initial antihypertensive treatment in the general population. Majority of patients (77.6%) did not have any recorded nonpharmacologic management.

Conclusion: Health disparities in the quality of care in hypertension was observed, with poorest blood pressure control observed in the remote site. If not sufficiently addressed, the difference in hypertension control and burden of disease leads to inadvertent aggravation of pre-existing economic disadvantages.

Background: Depression remains underdiagnosed in primary care, particularly in low- and middle-income countries (LMICs). Despite advocacy for mental health integration into primary care, evidence on practical implementation strategies in diverse international settings is limited. This study evaluated the feasibility of implementing practice-driven systematic depression screening among adult patients with diabetes mellitus (DM) across primary care practices in four countries.

Methods: The Major Depressive Disorder Management in Primary Care (MDD Minds) initiative implemented a 12-week quality improvement pilot across nine primary care practices in Brazil, Japan, Kenya, and Nigeria. Practices received local coaching, educational resources, and adaptable workflow tools to screen adult patients with DM for depression during routine care visits. Data on screening rates, depression identification, and resource provision were collected using standardized forms.

Results: Among 1,592 adult patients with diabetes seen during the 12-week implementation period, 582 (36.6%) were newly screened for depression. Practices without baseline depression documentation identified depression in 54.9% of screened patients, compared to 12.2% in practices with existing documentation, demonstrating substantial under-detection in settings without systematic screening. Of those screened, 105 (18.0%) had positive screens indicating depressive symptoms. An additional 211 patients (13.3%) had prior documented depression diagnoses. In total, 326 patients (19.6%) were diagnosed with depressive symptoms.

Conclusions: This multi-country implementation study demonstrates that systematic depression screening integrated into routine diabetes care is feasible across diverse primary care settings when supported by adaptable workflows and structured coaching. Findings highlight the importance of local ownership and context-specific implementation strategies for integrating mental health screening into chronic disease management in global primary care.