Primary health care research & development最新文献

Aim: This study aimed to identify how frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity affect annual foot examinations in individuals with diabetes.

Background: Diabetes mellitus (DM), particularly type 2, is a growing problem in the United States and causes serious health complications such as cardiovascular disease, end-stage renal disease, peripheral neuropathy, foot ulcers, and amputations. There are guidelines in place for the prevention of foot ulcers in individuals with diabetes that are not often followed. Poor mental health and poor physical health often arise from DM and contribute to the development of other complications.

Methods: We performed a cross-sectional analysis of the 2021 Behavioural Risk Factor Surveillance System dataset to determine the relationship between annual foot examinations and frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity using a bivariate logistic regression model. The regression model was controlled for age, sex, race/ethnicity, health insurance, level of education, current smoking status, and Body Mass Index (BMI) category.

Findings: Our results showed that 72.06% of individuals with frequent poor mental health days received a foot check, compared with 76.38% of those without poor mental health days - a statistically significant association (AOR: 1.25; 95% CI: 1.09-1.43). Of those reporting a sedentary lifestyle, 73.15% received a foot check, compared with 77.07% of those who were physically active, which was also statistically significant (AOR: 1.31; 95% CI: 1.14-1.49). Although individuals reporting depressive disorder diagnoses and frequent poor physical health days had lower rates of foot examinations, these results were not statistically significant. To reduce rates of foot ulcers and possible amputations, we recommend the implementation of counselling or support groups, increased mental health screening, educational materials, or exercise classes.

Aim: This study aims to assess the effect of primary health care (PHC) service provision continuity on inpatient admissions for people with chronic diseases in Estonia.

Background: Non-communicable diseases (NCDs) were collectively responsible for more than 7 out of 10 deaths worldwide in 2019. As the burden of NCDs increases, PHC has an increased role of coordinating care management. High-performing PHC can reduce unnecessary hospitalizations. Estonia has a strong PHC system focusing on multidisciplinary care. Yet it has not been evaluated for its effect on hospitalizations. Therefore, it is imperative to evaluate PHC continuity to improve care for NCD patients.

Methods: This study used routinely collected electronic medical billing data of the Estonian population aged 15 years or older from 2005 to 2020 identifying patients with seven ambulatory care sensitive chronic (ACSC) conditions. We developed an indicator to describe the continuity of PHC. Charlson Comorbidity Index (CCI) was used to assess the impact of comorbidities and we controlled the patient's age, gender, county of residency and socio-economic status. We estimated multilevel logistic regression models with family doctor patient list random effects to assess how the odds of hospitalization depend on continuity of care, allowing for confounders.

Findings: We identified that 45% of the adult Estonian population had at least one of the target diagnoses. Among the target population, 96% had contact with their PHC providers. We found that there is a non-linear relationship between PHC continuity and patient outcomes. Any contact with PHC provider during the past 5 years decreases odds for hospitalization, but hospitalization risk is higher for people who are elderly and have higher CCI score. We found that after accounting for patient characteristics, differences among patient lists minimally impact outcomes. Further research should explore policies to better support family doctors in reducing hospitalizations for chronic patients.

Background: Primary health care (PHC) delivered in Austria's newly established primary health care units (PHCU) is based on interprofessional collaboration (IPC) between health care and social professionals.

Aim: This study aims to explore the requirements and challenges in IPC in Austrian PHCUs from the perspective of health care and social professionals.

Methods: 15 semi-standardized, online, mono-professional focus group interviews were conducted with a total of 58 professionals with the following backgrounds: biomedical sciences, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiography, social work, and speech therapy. The participants were representatives from PHC practice (especially PHCUs), respective educational institutions, and professional organizations. The data were inductively analysed using qualitative content analysis according to Mayring.

Findings: The analysis displayed two main fields discussed by the participants, the setting for IPC and the professional relationships. The content analysis revealed three and four topics, respectively, within the main discussion fields. Within the setting for IPC, these topics were elaborated on (1) the operational area where IPC takes place in PHC, (2) the structural and organizational premises for this cooperation in PHCUs, and (3) the observed benefits of PHCUs for patients. Regarding the professional relationships, these topics were discoursed: (1) successful IPC, (2) challenges in IPC, (3) competencies required for IPC, and (4) previous and present corresponding training content.

Conclusion: Austrian health care and social professionals aim to get more involved in PHC in general and PHCUs specifically. They see opportunities and also challenges for their professional groups. Specific training is desired focusing on the unique requirements of Austrian PHCUs and equipping the workforce for the intensive, necessary, and beneficial collaboration between multiple professional groups in the increasingly important setting.

Aim: To summarize the findings from the PHC Measurement and Improvement (PHCMI) initiative in the World Health Organization WHO Eastern Mediterranean Region (EMR) and highlight key lessons to build PHC-oriented health systems.

Background: To support countries in enhancing their commitment to the primary health care (PHC) approach, the WHO Regional Office for the Eastern Mediterranean (EMRO) established the PHCMI initiative in 2019 to evaluate PHC performance and identify priorities for improvement.

Methods: Building on the experience of the global PHC Performance Initiative (PHCPI), PHCMI updated the master indicator list through iterative processes and reflecting country priorities. Progress in five domains: system/structure, inputs, processes, outcomes, and impact was assessed. Existing policy documents, data sources, and key informant interviews were used in the assessment.

Findings: Of the 21 countries and one territory, 14 participated in the assessment including Afghanistan, Bahrain, Egypt, I.R. of Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Oman, Pakistan, occupied Palestinian territory, Qatar, and Yemen. Despite the observed heterogeneity in PHC implementation, most countries reported that public primary care services were acceptable, accessible, and affordable. Strong leadership, the existence of PHC-related national health policies, and the engagement of stakeholders were key success factors.Areas for additional attention include the need to increase investment in PHC, increase the PHC workforce, enhance equitable distribution of the workforce, expand training of primary care clinicians, improve health information systems, and inform the population on the benefits of preventive care. Health systems should be more tailored to the PHC approach and encouraged towards a more holistic view of the PHC approach.The PHCMI initiative provides a foundation for an open discourse for advancing universal health coverage (UHC) and health security in EMR and re-orienting health systems towards the PHC approach.

Objective: The rural-oriented tuition-waived medical education program in China, started in 2010, provides free medical education to students committed to serving in rural areas to address medical staff shortages. Despite its success in training and deploying graduates, retaining them post-obligation remains challenging. This study explores the mechanisms behind the turnover intentions of rural-oriented medical students in Western China, offering insights for their retention.

Methods: Semi-structured interviews were conducted with 47 rural-oriented medical students and 30 health clinic directors in Nanning City. Interview data were analysed using grounded theory, and open, axial and selective coding was applied.

Results: Through three levels of coding analysis, 34 tree nodes, 13 sub-categories and 3 main categories were identified from the interviews with rural-oriented medical students and health clinic directors. 3 main categories were Subjective Norms, Behavioural Attitudes, and Perceived Behavioural Control.

Conclusion: A model of turnover intention among rural-oriented medical students was developed. This model can serve as a valuable reference for future policy optimization concerning China's rural order-directed medical students.

Aim: To describe the prevalence and characteristics of hearing loss in a self-referred adult cohort in low-income South African communities and to evaluate the effectiveness of a cerumen management protocol within a community-based service setting.

Background: Hearing loss affects 1.5 billion people globally, with a disproportionate impact on individuals in low- and middle-income countries (LMICs) and the elderly, often attributed to age-related factors and cerumen impaction. Despite the high prevalence, access to ear and hearing care remains challenging, particularly in LMICs, such as Africa.

Methods: A total of 227 participants aged 43-102 were recruited from two community centres in low-income South African communities for hearing evaluation and cerumen management for those with cerumen impaction. A cross-sectional, predominantly quantitative approach was used.

Findings: Video otoscopy of 448 ears revealed normal findings in 57.9%, cerumen impaction in 29.1%, and other abnormalities in 1.3%. The prevalence of confirmed hearing loss was 97.8%, primarily mild (45.8%), and sensorineural hearing loss (SNHL) was the most common (55.3%). Cerumen impaction accompanied hearing loss in 28.4% of cases. Post-treatment, 50.9% of participants with cerumen impaction showed normal otoscopy results, with mean hearing improvements of 16.2 dB (±17.9 SD) in the left ears and 15.8 dB (±17.2 SD) in the right ears, though overall significance was limited.

Conclusion: The high prevalence of hearing loss and cerumen impaction in low-income communities emphasizes the importance of ear care in primary healthcare (PHC) settings, especially for the elderly. Effective community-based cerumen management highlights the potential of integrating community resources and task-shifting strategies for cost-effective ear care in resource-limited settings.

Objectives: To analyze the sociodemographic characteristics and trends in clinical and analytical parameters among individuals with chronic kidney disease (CKD) in Aragon (Spain), who remain uninfected with COVID-19 during the first year of pandemic. The secondary objectives were to identify the associated comorbidities and their evolution throughout the pandemic, as well as to determine the cases that got worse and their possible relationship with the control of the main risk factors.

Background: CKD is a major public health problem worldwide. Studies encompassing national, European, and global contexts, show a rise in the prevalence of CKD, with a significant decrease in life quality, high morbidity and mortality, and increased healthcare costs. In this scenario, primary care is a cornerstone for the early detection of CKD and for the management of progression factors. To date, there are few publications regarding the evolution of the CKD population throughout the pandemic that are not related to hospitalizations or complications due to COVID-19.

Methods: We conducted a retrospective longitudinal study with real-world data from the population over 16 years of age registered in Aragon (Spain), collecting data from electronic health records. The variables included were sociodemographic, analytical and clinical (glomerular filtration rate, cholesterol, triglycerides, glycated haemoglobin, and blood pressure) and comorbidities (hypertension, dyslipidemia, obesity, diabetes, and smoking). The data were archived and processed using the SPSS v22.0 software package.

Results: During the first six months of COVID-19 pandemic, the clinical parameters of people with CKD were poorly controlled, although there was a later improvement which could be related to the progressive recovery of health services. The glycated haemoglobin value found was low, which makes us suspect possible overtreatment. There is a high prevalence of high blood pressure, diabetes, dyslipidemia, obesity and smoking. Interventions targeting these factors could help reduce the burden of CKD.

Background: Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored.

Aims: We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants' knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.

Methods: A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).

Discussion: We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.Trial registration: ClinicalTrials.gov (NCT06408493).

Introduction: Changing dynamics are pushing institutions to focus on care delivery innovation. To address the shortage of general practitioners (GPs), an Italian health district recently introduced a new primary care model called Primary Health Point (PHP) to provide primary integrated care to its population.

Aim: To investigate the healthcare professionals' (HCPs) experience regarding the introduction of the PHP and to describe its process of care delivery.

Methods: Qualitative study design with a grounded theory approach and convenience sampling. Interviews were conducted using a semi structured guide to explore the experience of HCPs working at the PHP. The development of open coding was followed by the creation of categories. The analysis was conducted utilizing NVivo software.

Results: Twelve HCPs working at the PHP were interviewed and highlighted the model structure. The themes were the context and the antecedents that identified the most common health complaints and the patients with more needs and reflected on the traditional GP model; the process, which highlighted the complexity of interdisciplinary teamwork and the role of the Family and Community Nurse (FCN) in the new model; the outcome identified the factors mediating satisfaction with the care delivered by the PHP.

Conclusions: The PHP has been considered a possible alternative to the GP model by its end users. It addresses disease pathway coordination, referrals, and medication management, focusing on chronic and older adult populations. It features interdisciplinary workflows with rotating physicians and consistent family nurse support. Proactive monitoring and a focus on disease education benefit fragile patients.