Primary health care research & development最新文献

Background: The urban First Nations population in Australia is rapidly increasing. The health policy and research focus on urban First Nations Australians, however, is limited. To contribute to addressing this situation, The University of Queensland Poche Centre for Indigenous Health (UQ Poche Centre), a First Nations-led health research centre, is working closely with urban Aboriginal Community-Controlled Health Services (ACCHS) across Australia.

Aim: Our study examined urban ACCHSs stakeholders' perspectives of the health and wellbeing of urban First Nations Australians and identified their priorities for a national Indigenous urban health research agenda.

Methods: Ten stakeholders were recruited for in-depth interviews from ACCHS that were members of the Research Alliance for Urban Community-Controlled Health Services (RAUCCHS), a partnership between the UQ Poche Centre and urban ACCHS focused on achieving equitable health outcomes for urban First Nations Australians. Six stakeholders identified as First Nations Australians. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed using inductive thematic analysis.

Results: Stakeholders highlighted a lack of research focused on the health of urban First Nations Australians. Specific priority areas they identified for an urban First Nations health research agenda were: evaluating the effectiveness and adaptability of Indigenous models of care, strengthening care pathways between ACCHS and specialist services, examining the intersection of cultural identity, racism and determinants of health, and greater investment in Indigenous research governance structures and processes.

Conclusions: There is a clear opportunity for researchers to engage with RAUCCHS members to establish a body of urban First Nations health research in Australia that responds to their research priorities.

Introduction: The increasing diversity of the UK's population, along with significant inequalities in health outcomes among diverse cultural and ethnic groups, highlights the critical need for healthcare providers, including physiotherapists, to deliver culturally competent care. Research demonstrates that cultural competency (CC) in healthcare can enhance patient outcomes, improve treatment adherence, and address health inequalities. This quality improvement project aimed to evaluate the impact of a brief training intervention on perceived CC among physiotherapists engaging in cross-cultural, clinical encounters.

Methods: The design of this project was informed by principles of the Plan-Do-Study-Act (PDSA) cycle. Musculoskeletal physiotherapists voluntarily participated in this educational intervention by completing a CC e-learning course developed by Health Education England. A retrospective evaluation method was used, where participants rated their awareness, knowledge, and skills in providing care to diverse patient groups after completing the training as compared to before.

Results: The pre-and post-training responses assessed three constructs of CC: awareness, knowledge, and skills. Significant increases were observed in the mean scores for each construct, as well as in the overall aggregate CC score, indicating measurable improvements following the training.

Conclusions: Improvement in CC is viable and achievable through targeted training. CC is a lifelong, dynamic process that requires ongoing education. Therefore, further PDSA cycles are recommended with more advanced educational sessions. Additionally, future projects should assess the impact of enhanced CC on patient outcomes and experiences. Cultural competency must encompass cultural issues beyond racial and ethnic differences.

Aim: To investigate the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.

Background: Nurse independent prescribers in UK general practice are facing increasing complex clinical decision-making when assessing patients presenting acutely with undifferentiated and undiagnosed conditions as multimorbidity and polypharmacy becomes increasingly common. This qualitative study investigated the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.

Methods: Fourteen general practice nurse prescribers were recruited through purposive sampling. Think aloud in response to staged vignettes was used followed by semi-structured interviews. Thematic analysis was used to analyse think aloud and interview data.

Findings: Participants were experienced nurses with a range of clinical exposure and training who mostly made appropriate diagnostic and prescribing decisions. Pockets of expertise were revealed which reflected participants' clinical experience, but there was a high rate of referral to the GP for some vignettes. Participants' decision-making was underpinned by both analytical and intuitive processes, the quality of which was dependent on their individual knowledge and experience. A reliance on pattern recognition, aligned to intuitive decision-making, to determine the content of the consultations was identified as an area of risk and showed all participants to be inconsistent in their identification of complex factors. Omission of these factors could have important implications for prescribing decision-making. Organizational issues such as time-limited clinics also shaped the content of participants' consultations, encouraged a limited, problem-focused approach, and reduced the opportunity for mentorship. Comprehensive knowledge, clinical experience, and mentorship are critical to ensure nurse prescribers make optimal decisions in the context of patients with multimorbidity. A team approach to the management of acute presentations in these patients is recommended to improve patient experience and maximize nurse prescribers' contribution to the general practice workforce.

Objectives: Palliative care development in primary care is crucial worldwide. This study reports on the secondary outcomes of a study that evaluated whether a complex intervention in primary care for patients with palliative care needs impacted their healthcare utilization.

Methods: A before-after study was conducted with family physicians and patients with palliative care needs. Physicians received palliative care training and implemented a new primary palliative care consultation model. Healthcare utilization in the 12 weeks before, during, and after the intervention was compared.

Results: We analysed healthcare utilization for 33 patients with advanced disease. Pre-intervention, there were high rates of no medical consultations, emergency visits, hospital admissions, and outpatient referrals (84.8%, 75.8%, 81.8%, and 84.8%, respectively). Despite slight reductions during and after the intervention, the differences were not statistically significant.

Conclusions: The reduction in healthcare utilization was not statistically significant, but the data inform sample size calculations for future economic analyses.

Trial registration: ClinicalTrials.gov ID - NCT05244590. Registration: 14th February 2022.

Objectives: Smartphones have become essential, making our daily lives more manageable; however, excessive use may cause problems. University students are particularly vulnerable to smartphone addiction. This study examines the relationship between smartphone addiction and health-promoting lifestyles among university students.

Methods: A cross-sectional study was conducted with 911 students at Dokuz Eylul University, Izmir, Turkey. Data were collected via Smartphone Addiction Scale-Short Version (SAS-SV) and Health Promotion Lifestyle Profile II (HPLP II). The printed forms were used, and the researcher administered the survey in person and recorded the responses.

Results: Prevalence of smartphone addiction was 34.1%. Several factors were significantly associated, including female gender (p = 0.049), being single (p = 0.042), self-perceived smartphone addiction (p < 0.001), daytime sleepiness (p < 0.001), and poor sleep quality (p < 0.001). Students with smartphone addiction had significantly lower HPLP II scores (p = 0.001).Logistic regression analysis showed that gender was no longer a significant factor. Those without a partner (OR: 1.47, 95% CI: 1.07-2.03), those who considered themselves smartphone addicts (OR: 6.86, 95% CI: 4.99-9.42), and those with daytime sleepiness (OR: 1.52, 95% CI: 1.08-2.14) had higher odds of smartphone addiction. Higher HPLP II scores were protective against smartphone addiction (OR: 0.99, 95% CI: 0.98-0.99).

Conclusions: This study highlights that students with smartphone addiction engage in less health-promoting behaviours and experience poor sleep quality and daytime sleepiness. Self-perceived smartphone addiction was strongly associated with actual addiction, while a healthier lifestyle appeared to have a protective effect. There is a need for strategies to promote healthy habits and reduce smartphone addiction among university students.

Background: This study analyses the relationship between fear of stigma and bypassing primary ART facilities by ART clients in the Upper East Region of Ghana.

Methodology: Methodology: The study employed an exploratory case study design, involving 52 participants of: ART clients (n = 37), nurses (n = 7), a counsellor (n = 1), cadres (n = 2), pharmacists (n = 2) and data managers (n = 3) through convenient and purposive sampling techniques. Data was collected using semi-structured interview guides and analysed using a thematic framework.

Results: The study provides ample evidence of the occurrence of stigma-driven bypassing of primary ART facilities by clients. The analysis shows entrenched cultural norms and values and the population's low awareness of the efficacy of ART fuel the processes of stigma and discrimination towards ART clients.

Strengths and limitations: We acknowledge the following limitations and strengths: convenient and purposive sampling procedures may not represent the views of all ART clients on bypassing primary facilities. Sensitive nature of HIV and the location of ART centres, coupled with time constraints in probing into all ART bypassing issues. Yet, given the depth of the issues presented and the scope of participants and ART facilities, we believe relevant data was generated to address the research question.

Conclusion: An integrated approach could be used to address the drivers of stigma and discrimination focusing on awareness creation to undo the entrenched negative cultural beliefs around HIV transmission, and implement anti-HIV stigma legislation to eliminate prejudice towards PLHIV.

Aim: This exploratory project aimed to develop online learning materials with interactive narratives for supporting persons living with dementia, with particular focus on initial diagnosis and helping children to understand changes which may occur.

Background: Dementia is a range of neurological conditions that cause the ongoing decline in brain function, manifesting as loss of memory, language, and problem-solving abilities. Over 55 million people worldwide are living with dementia, straining health and social care resources in their ability to provide information, care, and support for the family. There is a need for easily accessible, high-quality, and nationally scalable resources for dementia support for this growing population.

Methods: Twine was used to produce online digital storytelling media titled 'Grandad Forgot My Name', following the narrative of dementia care for family members. Design, theming, artwork, and story pathways reflected key aspects of dementia and dementia care to facilitate additional support for readers, and health and social care workers. Usage statistics were monitored and readers answered evaluative surveys with numerical scoring and descriptive free responses. Story pathways and information were continuously updated following survey responses.

Findings: Twine and interactive storytelling had potential to reach a wide audience at minimal cost, bridging the gaps between initial concerns, diagnosis, and appointment. However, there were issues with stakeholder adoptability and uptake when sharing materials which must be resolved in full-scaled outputs. Grandad Forgot My Name successfully demonstrated key design and logistical considerations when creating support resources of national impact, with cross-generational communication and reader-centric design optimising engagement.

The world faces an era of 'permacrisis', marked by overlapping challenges such as climate change, conflicts, economic instability, and recurrent disease outbreaks, which disrupt health systems and deepen inequalities. Primary Health Care (PHC) is vital for addressing immediate health needs and social determinants, fostering resilience, and promoting equity during such crises. This opinion piece highlights PHC's unique role in ensuring essential services, reducing barriers to care, and integrating health with broader social and environmental policies. In conflict-affected and climate-impacted regions, PHC supports community resilience, promotes health equity, and adapts to systemic shocks. Investing in PHC infrastructure, empowering community health workers, early disease detection, promoting climate-adaptive health practices and delivering integrated care can advance health for all. PHC offers a sustainable pathway to resilient health systems capable of navigating the complexities of a rapidly changing world.

Aim: This study aimed at investigating the clinical, individual, and systemic factors influencing paediatricians' and family physicians' clinical decision-making process in the vaccination of children during infection from the physician's perspective.

Methods: A qualitative study through semi-structured in-depth interviews was conducted among 10 paediatricians and 10 family physicians working in Ankara, Türkiye. The audio-recorded interviews were translated into written texts, and the obtained data was analysed using the thematic analysis method proposed by Braun and Clarke.

Results: Four main themes were identified in of thematic analysis: (I) Impact of clinical conditions on vaccination decisions, (II) attitudes of families and their communication processes with physicians, (III) impact of practice settings and institutional factors, and (IV) vaccine postponement and compensation approaches. It was observed that the decision-making processes of the paediatricians were mainly based on the clinical evaluation criteria, while family physicians considered the expectations of the families and institutional conditions. Also, the importance of establishing effective communication with vaccine-hesitant families has been emphasized by both groups of physicians.

Conclusion: In the immunization of infected children, decision-making is shaped in addition to medical facts in relation to the parental attitude, organizational factors within health institutions, and personal experiences of medical staff. Decisions of paediatricians are largely grounded in medical facts, whereas family practitioners assess that social and organizational factors are of higher importance. Improved adherence to medical guidelines and communication competencies of medical professionals can contribute towards medical practice consistency.

Background: Veterans Affairs Medical Centers offer multiple weight-loss treatments, including a comprehensive lifestyle intervention program (i.e., MOVE!), anti-obesity medications (AOMs) and bariatric surgery. Yet, most eligible veterans do not receive these treatments.

Aim: To describe the design, rationale, and planned evaluation of a comprehensive Weight Management and Metabolic Health program (WMMHP), consisting of (1) weight-focused visits with physicians or pharmacists trained in obesity medicine; (2) patient-centered use of available weight-loss treatments; and (3) coordinated, team-based care.

Methods: This is a quality improvement program implemented within the VA Ann Arbor Healthcare System. WMMHP eligibility criteria include body mass index (BMI) ≥ 30 kg/m² or BMI ≥ 27 kg/m² and ≥ 1 weight-related condition and participation in the MOVE! program. We plan to conduct an 18-month retrospective program evaluation using a propensity-matched cohort analysis to estimate the added benefit of WMMHP vs. MOVE! alone. The primary outcome will be mean change in weight at 18 months after baseline. Secondary outcomes will include mean weight loss at 6, 12, and 24 months, percentage of patients achieving thresholds of ≥ 5%, ≥ 10%, and ≥ 15% weight loss, initial prescriptions for and refilled prescriptions as a measure of adherence to AOMs, and referrals to, engagement with, and completion of bariatric surgery. We will also examine between-group differences in health system resource utilization.

Discussion: The WMMHP is an innovative approach to improving treatment and outcomes for veterans with overweight and obesity. If effective, its components may inform obesity care delivery in VA and non-VA settings.