Primary health care research & development最新文献

Aim: In this systematic review, we identify and critically appraise randomised controlled trials of effectiveness of available educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine.

Background: Non-pharmacological interventions have the potential to help people living with chronic migraine. Little is known about their true effectiveness.

Methods: We searched Cochrane, Embase, Medline, PsychINFO, Scopus, and Web of Science for randomised controlled trials assessing the effectiveness of educational, behavioural, cognitive, and self-management support interventions, compared to usual care, for adults with chronic migraine. Our outcomes of interest were headache frequency, headache-related disability, quality of life, pain intensity, medication consumption, and psychological wellbeing at baseline and follow-up.

Findings: We included six randomised controlled trials (713 participants) whose interventions met our inclusion criteria: two educational, two psycho-educational, and two behavioural interventions. Trial heterogeneity precluded statistical pooling. Several small trials reported some between-group differences. One trial (N = 177) found more people had ≥50 reduction in headache frequency at 12 months following a psychological (mindfulness-based) intervention added to acute medication withdrawal in people with medication overuse headache: 43/89 (48%) control vs. 69/88 (78%) intervention, p < 0.001. However, the largest included study (N = 396) had effectively excluded the possibility that their intervention had a worthwhile effect on headache-related disability at 12 months; mean difference in Headache Impact Test (HIT-6) 0.7 (95% Confidence Interval -0.65 to 1.97). Current evidence does not support the use of educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine to improve headache-related symptoms and quality of life. Very limited evidence suggests they may contribute towards headache frequency reduction.

Background: Rehabilitation with removable complete dentures (RCDs) involves navigating public dental systems that often present barriers like long wait times and limited access. While clinical outcomes are often known, patient experiences with service delivery remain underexplored. Understanding these experiences is key to improving denture care in public settings.

Objectives: This study aimed to explore and gain a comprehensive understanding of the service delivery experiences of patients rehabilitated with RCDs through the public dental health system in the State of Tasmania in Australia with the goal of informing improvements to the patient journey and overall service quality.

Methods: A qualitative study using a Constructivist Grounded Theory (CGT) approach was undertaken. Twenty-five adult participants who received RCDs between 2017 and 2022 were purposively selected from public dental clinics. Data were collected through in-depth, semi-structured, face-to-face interviews. Analysis followed CGT principles, including iterative coding, constant comparison, memo writing, and the co-construction of meaning with participants.

Results: Participants reported emotional distress linked to prolonged waiting times and limited continuity of care. Despite valuing the professionalism and empathy of individual practitioners, many expressed a need for improved communication, more coordinated interdisciplinary care, and greater system responsiveness. Good service was characterised by accessibility, affordability, approachability, friendly staff, and high-quality care. Suggestions for improvement included moving services close to patients, better integration with other health sectors, and the use of visual aids to support understanding and self-management.

Conclusions: Patient narratives reveal a pressing need to address delays, communication gaps, and fragmented care in the public denture service pathway. System-level changes adopting a more holistic approach such as patient-centred approach, improving interprofessional collaboration, decentralising service provision, and enhancing health communication may significantly improve the denture rehabilitation experience and patient outcomes.

Background: The influence of severity of migraine-like symptoms on different levels of executive functions is not well established. In this study, we investigate the impact of severity of migraine-like symptoms on the relationship between core-level executive functions (attention and memory) and fluid intelligence.

Methods: A cross-sectional study was conducted on university students (n = 427, age = 20.7 + 1.8 years). Participants completed self-report measures of Migraine Screen Questionnaire (MS-Q), single-item visual analogue scales (VASs) each for the subjective accounts of problems in core-level executive functions (attention and memory), and a single-item VAS for problems in fluid intelligence (PFI), and sociodemographics tool. The mediation effect model was used to determine the relationship.

Results: The study found a correlation between i) attention problems and severity of migraine-like symptoms (b = 0.109, standard error (SE) = 0.026, p < 0.001), ii) severity of migraine-like symptoms and memory problems (b = 0.318, SE = 0.076, p < 0.001), and iii) severity of migraine-like symptoms - PFI (b = 0.243, SE = 0.083, p < 0.003), with an indirect effect of attention problems on memory problems and PFI and no correlation between severity of migraine-like symptoms and PFI.

Conclusions: Self-reported accounts of problems in core-level executive functions and fluid intelligence are correlated. Severity of migraine-like symptoms may mediate the inter-relationship between some core-level and higher-level executive functions.

Aim: This review explored whether and how prescribers modify their prescribing behaviour for older people (≥65) with hearing, visual or dual impairment (hereafter referred to as sensory impairment) in primary care settings and identified what evidence sources exist to inform prescribing for these specific patient populations.

Background: Older people with sensory impairment may experience substantial challenges with medicines management compared with older people without sensory impairment. The prevalence of sensory impairment and medicine use increases with age, as such, practitioners may need to consider how to modify their prescribing behaviour to improve the safe and effective use of medicines.

Methods: This study was conducted to reflect the Joanna Briggs Institute [JBI] methodology for scoping reviews. Electronic databases were searched: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google, and Google Scholar. Qualitative and quantitative studies were included if published between January 2012 and April 2023. Grey literature sources, including Google and Google Scholar, were also searched. Studies were eligible for inclusion if they focussed on prescribing behaviour for older people with sensory impairment in primary care settings. Independent duplicate data extraction was undertaken of details about the participants, concept, context, study methods, outcomes, and key findings relevant to the review question.

Findings: A total of 3,590 records were identified through database searching and 10 full text articles were retrieved. Grey literature identified a further 61 records. On examination, none of the articles fulfilled the inclusion criteria for this review.

Conclusions: This review has highlighted a gap in the evidence regarding prescribing for these high risk patient populations. There may be a need for the development of resources, such as evidence based guidelines, to support the safe and effective use of medicines for these specific patient populations.

Information on registered primary healthcare diagnoses from the Register of Primary Health Care Visits (RPV) is used to allocate healthcare funding in Finland. Our aim was to analyse the diagnosis rate trajectories in the RPV and, through that, assess the equitable development of funding. We extracted national- and regional-level diagnosis numbers from the RPV. Joinpoint regression analysis with Model 1 (overall trend) and Model 2 (potential changes in trend) was used to assess diagnosis rate trajectories from 2018 to 2024. Model 1 demonstrated that the number of registered primary healthcare diagnoses has increased between 2018 and 2024, but the growth has not been uniform across all trajectories. Model 2 showed significant differences in the diagnosis rate trajectories between regions and diagnostic groups. There were significant discrepancies in the registration of primary care diagnoses. Reducing these discrepancies by standardizing diagnosis registration practices is necessary to ensure equitable healthcare funding.

Functional referral systems are critical to primary health care and universal health coverage. Referral and counter-referral are key relational mechanisms to link communities to the care they need and primary care to secondary and multi-sectoral services. Many referral systems are fragmented, leading to inefficiencies, coverage gaps, and compromised continuity and quality of care. In June 2024, we conducted a scoping review of PubMed, Global Index Medicus and WHO publication databases to identify referral coordination and process initiatives at national, subnational, and local levels.We classified reports from 181 papers into non-exclusive categories based on referral system design, operational elements, service delivery platform, and/or user group. Initiatives targeting referral system design included modelling, organization and assessment methodologies. Initiatives focusing on operational elements included networks and linkages, pathways and algorithms, e-referral systems and platforms, digital processes and tools, and facility-level processes and tools.When classified by service delivery platform, community-level initiatives emphasized improved recognition, screening, diagnosis, and communication by community health workers and use of SMS text messaging or mHealth apps. At initiating facilities, reports focused on standardizing referral criteria and protocols and optimizing communication with referral facilities, including for real-time clinical decision-making to improve timely referral and to reduce under- and over-referral. Structured algorithms and pathways were key to minimize the time between referral, diagnosis, and treatment for time-sensitive conditions. At receiving facilities, actions included supporting initiating facility clinical decision-making prior to referral, prioritizing urgent cases, and consistent counter-referral and/or onward referral.Findings are informing WHO guidance on two-way referral systems.

Background: In South Africa, community health workers (CHWs) provide home-based care and health promotion for patients with chronic conditions like hypertension. However, their views on patients' poor blood pressure control remain unclear. Understanding CHWs' perspectives could inform future community-level strategies for improving blood pressure management.

Objectives: To explore CHWs' experiences about factors contributing to uncontrolled hypertension among adults living in a South African District.

Methods: A qualitative exploratory design, based on 22 face-to-face, semi-structured interviews with CHW. Data was transcribed and analysed manually using thematic analysis.

Findings: Four themes emerged: (1) adequate knowledge about blood pressure and hypertension. However, lack of comprehension about the physiological concept of blood pressure and hypertension, (2) interventions used for hypertension control were contextualized and very simple, (3) contextual barriers to hypertension control included financial, personal, systemic, medication as well as cultural and traditional factors, (4) strategies to improve hypertension control included improved team work, awareness creation, holistic healthcare, improved access to clinic facilities, system-related improvements and patient initiatives.

Conclusion: Community health workers (CHWs) demonstrated sufficient knowledge of hypertension, highlighting the need to strengthen and standardize their training, supervision, and support. Their patient advice was practical and context-specific. To address barriers and stigma around hypertension, CHWs should lead awareness campaigns and engage in community-based exercise and support groups, with help from rehabilitation teams. Collaborating with local police and community leaders to address violence, alcohol, and crime, along with initiatives like community gardens, multidisciplinary teamwork, and more frequent home visits, could further improve hypertension control.

Aim: To explore factors shaping social prescribing (SP) link workers (LWs) experiences of their job, and how they influence decisions about whether or not to leave it.

Background: LWs support healthcare delivery by listening to patients' non-medical concerns and social or relational difficulties, connecting them to 'community assets' (groups, organizations, charities) when relevant to help. LWs try to assist people with often complex emotional and/or social issues. This can affect how they feel in their job.

Methods: As part of a mixed methods project on LW retention, a qualitative study was conducted. It involved 20 LWs, purposively selected from respondents to a questionnaire; variation in the sample was sought in terms of self-efficacy in the role, length of time in it, intention to leave or not, employing organization, where they worked in the UK and gender. Semi-structured interviews, conducted via Microsoft Teams, were audio-recorded and transcribed verbatim. Prior to interviews, we asked participants to take photographs of: a typical part of their working day; something that gave them confidence in their role; an unexpected part of their role. These photographs were discussed at the start of the interview. Thematic analysis was used to interpret data (the computer programme NVIVO supported this); this involved coding and clustering codes to develop analytical themes.

Findings: We produced four themes from the data; 1) Disconnection through place and space: straddling different organizational spheres; 2) Delivery ambiguity: vagueness around the link worker role; 3) Job misalignment and realignment: navigating identity and boundaries; 4) Clouded by instability: uncertainty around career advancement and sustainability. This led to the development of an overarching theme of LWs inhabiting a liminal space as they entered and undertook the role. Findings highlight the importance of training, supervision and other support to ensure LWs do not experience a prolonged liminal state.

Background: Primary care serves as the foundation of a well-functioning healthcare system and is critical for ensuring equitable access, early disease management, and cost-effective service delivery. In China, reforming primary-level healthcare institutions has become a national priority to achieve universal health coverage. Understanding the service users' perspectives is essential to align primary care services with population health needs and improving trust in grassroots healthcare providers.

Aim: To evaluate satisfaction and unmet service needs among primary care users in Jiangsu Province, China.

Methods: A cross-sectional survey using structured questionnaires was given to 424 residents in urban and rural Jiangsu Province to measure satisfaction with primary hospitals, doctors, service preferences, and perceived gaps. Data was analyzed using descriptive statistics and chi-square tests to identify regional differences.

Results: The primary care utilisation rate among respondents was 73.3%. While 75.2% reported satisfaction with medical expenses at primary-level facilities, significant urban-rural and regional differences were observed in service awareness, health policy knowledge, and perceived quality of doctor-patient communication. Primary care doctors received the highest ratings for using "easy-to-understand language"(mean score 4.13 ± 0.821) but lower scores for "professional competence" and "treatment effectiveness" (both 3.91). Rural inhabitants expressed high demand for services like management of common diseases (65.8%) and routine health examinations (52.4%), but highlighted shortages in advanced diagnostic tools (e.g., CT scans, endoscopy). Most inhabitants (67.2%) felt that primary care providers require improvement, particularly in clinical competency and communication.

Conclusion: The findings highlight areas for targeted policy interventions to improve primary care service delivery and capacity-building of primary care doctors in Jiangsu Province.