Primary health care research & development最新文献

Background: Primary healthcare units (PHCUs) in Austria play a crucial role in providing regionally tailored, high-quality care through interprofessional teams. Barriers, such as limited training and unclear roles, hinder effective interprofessional collaboration (IPC). Additionally, healthcare and social professionals (HCSPs) in primary healthcare (PHC) face a rise in patients with non-communicable diseases and increasing climate-related challenges, underscoring the need for education addressing IPC and sustainability to build resilient healthcare.

Aim: This paper presents the protocol of the REALISE study, which aims to evaluate the effectiveness of a didactic concept integrating collaborative, digital, and sustainability skills within multimodal training modules (including simulations).

Methods: In this prospective trial, HCSPs working in PHC and students in their final year of education in related professions are recruited to participate in interprofessional training modules, which take place on four days within a month in person and with additional e-learning elements between those days. The modules consist of didactic elements on IPC and sustainability, simulation scenarios with acting patients, and immersive virtual reality scenarios. The primary outcomes assess IPC by utilizing the Teamwork Assessment Scale, the Interprofessional Socialization and Valuing Scale (9a/9b), and the Interprofessional Collaborative Competency Attainment Survey. Secondary outcomes focus on sustainability and environmental awareness, as well as the organization and structure of the training modules.

Discussion: The findings of this study will demonstrate the effect of proprietary training modules on IPC and will inform on the integration of respective modules into standard curricula and continuing educational programmes at the Salzburg University of Applied Sciences.

Aim: The aim of this study is to describe the rollout of nursing activities during the pilot project's first 12 months (2019-2021), especially relating to what was initially planned in the nurses' job description.

Background: To provide more comprehensive services and reinforce primary care, a pilot implementation study assessed the integration of nursing activities into eight general practitioners' (GPs') practices. The study evaluated how new types of activities were integrated and rolled out over the first year.

Methods: A mixed-methods observational study collected quantitative data on nursing activities and duration and qualitative data via five interviews with nurses and patients and one focus group with six GPs. Investigators combined quantitative and qualitative data in discussions about their results.

Results: New nursing activities were rolled out progressively, especially follow-up activities with chronically ill patients, with a median time dedicated/month of 21h58 (range: 9h25 to 64h50) at six months and 48h43 (range: 11h01 to 59h51) at 12 months. One-off clinical activities are more easily integrated: the median time dedicated/month was 40h01 (range: 13h44 to 74h53) at six months and 40h30 (range: 9h38 to 76h51) at 12 months. Three elements were crucial in the implementation of nursing activities. The nurse's previous professional experience influenced the scope of activities developed. GPs' willingness to refer patients to the nurses enabled the latter to carry out follow-up activities with care plan. Lastly, the implementation of nursing activities was also made possible by patients' acceptance of being cared for by nurse instead of a GP.

Conclusion: Implementation of nursing activities increased progressively, although more slowly for activities with chronically ill patients and within care plans, principally due to the overall change faced by GPs and nurses.

Aim: This study aimed to assess the impact of oral Fe⁺² iron preparations on weight, body composition, metabolic, and appetite parameters in adults undergoing treatment for iron deficiency.

Methods: In this observational prospective study, a total of 119 patients, aged 18-45, initiating Fe⁺² iron therapy for iron deficiency within the last month at Family Medicine Outpatient Clinic, were included. Data on sociodemographic variables, health, dietary habits, anthropometric measurements, metabolic parameters, and appetite scores were collected. The Power of Food (PFS), Visual Analogue Scale (VAS), and Three-Factor Eating Questionnaire (TFEQ) were utilized for appetite assessment.

Findings: After three months of iron treatment, a statistically significant increase was found in the mean values of Hb, Hct, MCV, ferritin, iron, and transferrin saturation; anthropometric measurements displayed a significant reduction in body weight, body mass index (BMI), fat percentage, waist circumference, hip circumference, and waist/hip circumference ratios post-treatment. Notably, VAS scores for certain food items decreased, while carbonated drinks VAS score increased. Appetite-related factors, as per PFS, exhibited a significant decrease in PFS factor 1 (food available), PFS factor 2 (food present).

Conclusions: In conclusion, our findings indicate that oral Fe⁺² iron preparations positively influence the treatment of iron deficiency anaemia by improving haematological parameters and concurrently leading to a significant reduction in body weight, BMI, and appetite scores related to specific food items. The study underscores the multifaceted impact of iron supplementation on both physiological and behavioural aspects, providing valuable insights for optimizing iron deficiency anaemia management.

Introduction: Healthcare systems worldwide are under pressure due to increasing demand and rising costs. Simultaneously, there is a shortage of healthcare workers. This is leading to increased pressure on primary care, especially in countries where general practitioners (GPs) perform a gatekeeping function. One way to alleviate this pressure on GPs, and to reduce healthcare costs, is to introduce or expand, direct accessibility to allied health professionals. This study investigated the factors associated with this direct accessibility in the Netherlands.

Method: We used data from electronic health records of physiotherapists, speech therapists, and dietitians, drawn from the 2022 Dutch Nivel Primary Care Database (Nivel's PCD). The data included information ranging from 15,470 to 776,690 patients, and for 62 to 593 practices, depending on the particular paramedic discipline. Multilevel logistic regressions were employed to identify patient and practice characteristics associated with direct access.

Results: Patient characteristics significantly associated with direct access included younger age, higher socioeconomic status, and diagnosis. The patient's sex was also identified as a factor associated with the use of direct access in physiotherapy and dietetics, but not in speech therapy. Moreover, we observed significant variation between practices. We found that the dominant health insurer in an area was sometimes associated with direct access, as well as the number of therapists working in a practice.

Conclusion: We observed significant associations between patient and practice characteristics and the direct access to allied health professionals in primary care. These findings suggest that the use of direct access to allied health professionals could be increased in order to enhance healthcare efficiency and thereby relieve pressure on GP care.

Aim: To tailor an existing Person-Centred Integrated Care (PC-IC) approach to the needs of patients with low socioeconomic status (LSES) and chronic conditions in primary care.

Background: While Disease Management Programs (DMPs) have been introduced to reduce the burden of chronic diseases, their effectiveness for patients with LSES remains uncertain due to insufficient attention to the individual context. A PC-IC approach may enhance patient outcomes by addressing patients' cultural backgrounds, values, and health literacy needs, because these factors are particularly relevant for patients with LSES.

Method: A qualitative study was conducted using three co-creation sessions with patients with LSES and chronic conditions, along with general practitioners and practice nurses, to adapt, develop, and test specific elements of the PC-IC approach. Participatory learning and action (PLA) techniques incorporating visual materials were employed to ensure meaningful engagement and input by all participants, including those with limited reading and language skills. Following these sessions, we conducted a validation check by patients on the draft materials.

Findings: In the co-creation sessions, an existing PC-IC approach was tailored to the needs of LSES patients with chronic conditions in primary care. The adapted PC-IC approach emphasized key elements as trust, being seen as a person in the social context, shared decision-making, and access to clear and easily understandable information. Existing materials needed to be adapted, resulting in a visual conversation tool. This tool covers the physical, social, and mental health domains as well as daily life, each domain with six to eight topics. It helps to get better insight into the patient's daily life, wishes, and possibilities. It maps medical and psychosocial issues and supports the patient in gaining a better understanding. The adapted PC-IC approach with the conversation tool is being presented in a training for primary care professionals.

Led by national policy, standardisation has enhanced hospital discharge communication to primary care over recent decades. However, discharge summary content standards and their corresponding templates can be over-relied on by authors, risking the exclusion of important contextual and explanatory information for patients with more complex care.This information can be critical for GPs to deliver high quality, safe, and efficient post-discharge care, especially for this patient cohort which can be at higher risk of avoidable harm from suboptimal communication. Discharge summary authors can lack sufficient understanding of the recipient primary care perspective to mitigate this issue and communicate effectively through standardised letter templates. Strengthening this interprofessional understanding is an essential next step to improve discharge communication.In response to this challenge, we propose the basis of a new framework of interprofessional discharge communication that accounts for the different paradigms of specialism and generalism and supports summary authors to tailor their content to the patient's post-discharge care.We call for the co-development of this framework through a programme of applied research, alongside the exploration of primary-secondary care interface learning communities as a vehicle for interprofessional education. These initiatives can serve to augment the current strengths of standardised discharge summaries and mitigate their limitations, maximising the quality, safety, and efficiency of post-discharge care. Progress in this field can benefit wider cross-interface communications and practice and assist the NHS integration agenda.

Aim: The Pain Recognition and Evaluation to Validate Effective Neck and back Treatment (PREVENT) study aims to identify cognitive, behavioral, and treatmentrelated predictors of chronic musculoskeletal pain (CMP) development following emergency department (ED) care for acute neck or back pain after trauma.

Background: CMP is a leading cause of global disability, yet early risk factors for its development remain poorly characterized, particularly in ED settings. This prospective observational study will recruit 246 adult patients presenting with acute (≤ 4 weeks) neck or back pain after a recent trauma. Pain beliefs - measured using pain and attitude questionnaires - serve as the primary independent variable. Mediating variables include catastrophic thinking, fear-avoidance behaviors, low physical activity, poor recovery expectations, and low self-efficacy for pain management. Covariates include demographics, social determinants of health, mental health disorders, and high-risk substance use. The primary outcome is the presence of CMP at six months, defined as pain on most or every day for at least three months. Participants will complete follow-ups at 1, 3, and 6 months. Multivariable logistic regression, mediation analyses, and interaction testing will explore effects of pain beliefs on CMP development. As a secondary aim, a subset of participants will complete Think Aloud cognitive interviews to assess response process validity for the Neck Pain Attitudes Questionnaire (Neck-PAQ), a region-specific adaptation of the Back Pain Attitude Questionnaire, analyzed using a deductive content analysis framework.

Discussion: This study is among the first to investigate the cognitive and behavioral predictors of pain chronification in the ED. Ethical approval has been obtained from The George Washington University Institutional Review Board. Findings will inform the design of targeted, ED-based screening and intervention strategies, including adaptation of a pain-specific Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. Results will be disseminated through peer-reviewed publications, conferences, and stakeholder engagement.

Social disadvantage can result in healthcare gaps and primary care may be a suitable healthcare context to identify unmet social needs. A variety of screening tools exists but none of them is consolidated in clinical practice. After reviewing the available instruments, we conducted a rigorous translation and trans-cultural adaptation into Italian language of the EveryONE social need screening tool questionnaire of the American Academy of Family Physicians. The translated questionnaire was piloted among 45 patients consecutively recruited in two general practices in the northern Italian city of Modena in 2023 and obtained excellent scores in comprehension and acceptability. The cross-cultural adaptation presented in this study is a first step towards a complete validation. A full validation study is needed to safely adopt EveryONE in routine general practice and to evaluate its effects on health provision.

Background: Demographic transitions, societal changes, and evolving population health needs are placing increasing pressure on healthcare systems, necessitating ongoing reforms. Primary health care (PHC) is a foundational component of Universal Health Coverage (UHC) and sustainable health systems. Many countries have undertaken PHC reforms aimed at improving population health. This review explores the objectives, implementation mechanisms, challenges, and outcomes of these reforms.

Methods: We conducted a systematic review of studies sourced from five databases (PubMed, Scopus, Proquest, Embase, and Science Direct), applying the World Health Organization's Health Systems Framework for deductive content analysis. The PRISMA guidelines were followed to ensure transparency and rigour in summarizing the published literature.

Results: A total of 147 types of interventions were identified, with most targeting service delivery and financing. Key reform objectives included expanding access to care, improving financing and payment systems, scaling up family physician programmes, increasing government health expenditure, leveraging private sector capacities, and strengthening the PHC workforce. These interventions resulted in expanded public health coverage, enhanced access to PHC, increased utilization of services among low-income populations, broader social insurance coverage, and improved service quality, contributing to better community health outcomes.

Conclusion: The success of PHC reforms depends on their alignment with political, social, and cultural contexts, as well as consideration of the social determinants of health. Strong governmental support, managerial stability, decentralization, and regional capacity building are essential for sustainable implementation. Reforms should be gradual, supported by accurate forecasting, adequate and sustainable resources, and evidence-based strategies, drawing on international experiences.