Primary health care research & development最新文献

Aim: To understand patterns of cannabis use and self-management experiences in patients with chronic disease during the post-legalization period in Thailand and to quantify such experiences and perceptions.

Background: Patients with chronic disease are a population in which disease self-management is potentially involved with the use of complementary and alternative medicines (CAMs). The recent changes in cannabis regulation in Thailand have allowed retail selling and home cultivation. Cannabis is a medicinal herb in many traditional Thai recipes and is often adopted as a CAM in the chronic disease population. The adoption of cannabis products as part of CAM could lead to changes in chronic disease outcomes.

Methods: Exploratory-sequential mixed methods were used in this study. A descriptive qualitative study was conducted to acquire a basic understanding of the patients' experiences. Semi-structured in-depth interviews were conducted, and thematic analysis was applied. Subsequently, a cross-sectional study was conducted to quantify the patterns of cannabis use and self-management experience in patients with diabetes and/or hypertension.

Findings: Eleven patients were interviewed, and 124 patients participated in the cross-sectional study. Most of the participants were male, married, and identified as Buddhist. Many patients believed that cannabis could improve their health, while fewer considered it a threat to their health. In general, the patients viewed cannabis as a way to enhance their quality of life and treat chronic diseases. Some patients embraced the principles of CAM. They primarily used cannabis tea daily to manage diabetes or hypertension, with their approaches being more complementary than alternative. However, only one-third (34.7%) were aware of potential drug interactions with their concurrent medications.

Background: Written referrals and follow-up correspondence between referring general practitioners (GPs) and psychiatrists is a medico-legal responsibility and integral part of caring for patients with mental illness. Objective: To describe expectations and practices that GPs and psychiatrists have when exchanging correspondence concerning patients with mental health problems.

Methods: In this observational, declarative, and cross-sectional study, two surveys were used to evaluate the expectations, frequency, and content of correspondence exchanged between GPs and psychiatrists. The questionnaire was based on the National College for the Quality of Psychiatric Care 2010 recommendations. Conducted in a regional setting in France between 2014 and 2016, the study involved 2754 GPs and 575 psychiatrists.

Results: Overall, we achieved a positive response rate of 33% (189/575) of psychiatrists and 23% (628/2754) of GPs, which was similar in each local region. Regarding the correspondence from GPs to psychiatrists, 478 (75%) GPs declared having written a referral for an initial consultation and 84 (44%) psychiatrists declared having received a referral. Regarding the correspondence from psychiatrists to GPs, 144 (76%) psychiatrists declared having written at least one letter after the initial consultation or during follow-up and 160 (25%) GPs declared having received return correspondence. The GPs would like to be better informed about psychotherapeutic or long-term management, leave of absence from work, surveillance measures, prognosis, and division of specialist roles. The psychiatrists would like to receive more information about previous medication trialed, the level of willingness the patient has to consult a psychiatrist and any allergies or intolerances to medication.

Conclusion: This study highlights the need to improve the disparity between expected and received correspondence from GPs and psychiatrists concerning patients with mental health problems.

Aim: This study aimed to investigate self-management experiences at home among gynaecological cancer patients with lower limb lymphoedema.

Background: Lower limb lymphoedema is a common complication following gynaecological tumour treatment, causing physical and psychological distress and significantly impacting patients' quality of life. Clinical observations reveal that many patients with lower limb lymphoedema following gynaecological tumour treatment exhibit poor compliance with family self-management, leading to complications such as worsening oedema, cellulitis, or erysipelas. This study seeks to gain insight into patients' actual self-management experiences within their families, offering insights for tailored intervention plans and improved patient self-management compliance in clinical practice.

Methods: Employing a phenomenological approach in qualitative research, one-on-one semi-structured interviews were conducted to gather face-to-face data from participants. A total of 16 gynaecological cancer patients with lower extremity lymphoedema were selected via purposive sampling from a tertiary cancer hospital. Semi-structured in-depth interviews took place between February and July 2021, with data analysed via the Colaizzi 7-step analysis method.

Findings: Five key themes emerged: inadequate and uneven availability of medical resources for patients with lymphoedema, limited support for patients, deficient home self-management skills, considerable psychological stress during home management, and variations in self-management behaviours.

Conclusion: Based on the study findings, increased investment in lymphoedema-related medical care is recommended. Additionally, healthcare professionals can consider promoting family and social support, enhancing patient health education, offering remote psychological counselling, encouraging positive coping behaviours among gynaecological cancer patients with lower limb lymphoedema, and ultimately enhancing their self-management at home.

Aim: To investigate factors influencing the recruitment and retention of adult community nurses.

Background: The recruitment and retention of community nurses is a growing global challenge, exacerbated by aging populations and increasing demand for primary and home-based care. Across Europe, nurse shortages threaten healthcare sustainability, with high attrition rates linked to workplace pressures, inadequate staffing, and emotional exhaustion. Despite efforts to strengthen retention, many European countries struggle to maintain adequate staffing levels, particularly in community nursing.

Methods: An exploratory qualitative approach was used with semi-structured interviews. The interview schedule was shaped by the study's aims, a prior integrative literature review, and the 'causal model of turnover for nurses'. Questions explored participants' experiences of recruitment into community nursing and factors influencing retention. The study focused on registered nurses and service managers within adult community nursing organizations across diverse geographical areas.

Findings: The study identified eight main themes influencing recruitment and retention: the perfect job, finding true self and fulfilment, alignment with organizational values, prior development and transitional experience, job dissatisfaction, shift in traditional practices, lack of compassionate leadership, and family commitments. Key factors included workplace flexibility, professional identity, job security, and organizational culture. However, challenges such as staffing shortages, lack of career progression, and increased administrative tasks were significant barriers to retention.

Conclusion: This study highlights the multifaceted challenges surrounding community nurse recruitment and retention, emphasizing the need for targeted strategies that go beyond traditional hospital-focused approaches. While salary improvements remain crucial, broader systemic changes including workplace flexibility, compassionate leadership, and career development opportunities are essential to fostering a sustainable workforce. By addressing these factors through co-designed solutions and evidence-based policy adjustments, healthcare organizations can enhance job satisfaction, reduce attrition, and ultimately strengthen the future of community nursing.

Aim: The aim of this study was to develop an up-to-date system of Structural Indicators for the Strength of Primary Care (SiSPC) to enable comparisons of primary care systems across countries.

Background: Indicators are needed for international research into the development of primary care and to support countries in monitoring improvements in access, responsiveness and efficiency of their primary care services. International comparisons with use of identical indicators for the strength of primary care offer policymakers opportunities to learn lessons from abroad.

Methods: Our point of departure was the Primary Health Care Activity Monitor Europe (PHAMEU), that effectively measured the strength of primary care at the beginning of this century. We went through the following steps: (1) Reduction, refining and tuning of the PHAMEU indicator system (2) comparison with the European Primary Health Care, Impact, Performance and Capacity Tool (PHC-IMPACT) (3) addition of topics from other frameworks (4) identification of topical issues from the literature. The resulting draft indicator system was discussed at meetings and received feedback from experts from 25 countries.

Findings: SiSPC consists of three care-related domains: Structure of Primary Care, Systemic Aspects of Facility Management and Systemic Aspects of Care Delivery. SiSPC also contains a domain on the Context of Primary Care. Care processes that vary between care providers, were not included as a domain at the system level.

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.