Primary health care research & development最新文献

Aims: To evaluate the impact of telemedicine on the workload of primary care physicians (PCPs).

Background: Telemedicine, including video visits, telephone visits, and digital correspondence, is increasingly offered by physicians, particularly since the COVID-19 pandemic. It is still unclear whether increasing the variety of services creates an increase in demand and therefore causes an increase in the workload of PCPs. In this study.

Methods: A population-based descriptive study, conducted during the 2020-2021 period, on a cohort of 464,119 patients, all members of Leumit Health Services and without a diagnosis of COVID-19. The patients were stratified into three distinct groups based on the nature of their healthcare visits: Patients who used only face-to-face (FTF) visits; Patients who used asynchronous visits with or without FTF visits but did not use synchronous telemedicine visit; and patients who used synchronous telemedicine visits with or without other types of visits. We performed a comparative analysis on Accumulated Annual Duration of Time (AADT) as an index for workload, across the different periods, using standard descriptive statistics methods.

Findings: Telemedicine use was higher in older persons, females, those of higher socioeconomic status, and patients with comorbidities. The greater the number of telemedicine visits, the greater the time the PCP spent on visits during the year. The largest increase in AADT (56.1%) was observed in patients who had only FTF meetings in 2020 but in 2021 made all types of visits. Overall, there was an increase of 2.5% in time invested in 2021 and a 5.8% increase in the number of patients making digital visits.

Conclusions: Policymakers encouraging telemedicine should consider the additional load on PCPs associated with telemedicine use and plan resources accordingly.

Background: Physical activity (PA) promotion in primary healthcare is an effective way of addressing population-based physical inactivity. Advancements in technology could help overcome barriers to promoting PA. This scoping review aims to provide an overview of technology (digital health) for PA promotion in primary healthcare, including effectiveness and acceptability, from research published between January 2020 and December 2023.

Methods: A scoping review was conducted across five databases (Cochrane library, Embase, MEDLINE, PubMed and WebofScience). Search terms focused on three components: PA counselling, technology and primary healthcare. Articles from 01/01/2020 to 05/12/2023 were included. Paediatric populations and populations with diseases requiring specialist care were excluded.

Results: Of 2717 studies identified during database searches, twenty-nine were included in the review. Mobile-phone applications were the preferred method of implementation (n = 12, 52%), with most interventions aiding in assessment of PA levels (n = 16, 70%) and/or assisting in addressing it (via education, monitoring or support) (n = 22, 96%). Findings revealed mixed evidence on the effectiveness of digital health interventions in increasing PA but reported widespread acceptability of digital health interventions. Qualitative studies revealed three main themes desired by stakeholders: (1) ease of use, (2) complements pre-existing primary healthcare provision and (3) patient-centred.

Conclusion: Future research should focus on developing standardised approaches for assessing digital health interventions, exploring the impact on prescribing behaviours and addressing the desired features highlighted by stakeholders. Integration of technology in healthcare, including PA promotion, holds promise for enhancing access and facilitating widespread implementation.

Background: Many countries have permitted community pharmacists to administer vaccines to increase the immunization rate. The policy of Thailand has recently expanded and permitted pharmacists to play a role in immunization.

Aim: The objective of this study was to survey the opinion and readiness of community pharmacists as immunizers.

Methods: This study was a prospective, mixed-methods questionnaire and semi-structured interview. The study included community pharmacists in Hatyai, Songkhla, Thailand. A Likert scale questionnaire to evaluate readiness, opinions, and barriers to providing vaccines was distributed online. The volunteer pharmacists were interviewed about their opinions, distress, and benefits of vaccination services.

Findings: An online survey was completed by 146 pharmacists, and 12 community pharmacists agreed to be interviewed. More than 65% of respondents agreed that vaccination services in community pharmacies are easily accessible to patients. Approximately 46% of pharmacist respondents were willing to be immunizers, and 45% of respondents showed readiness with the availability of pharmacy space for handling vaccinations, their storage, and disposing of sharp objects. Almost all of the respondents showed readiness with knowledge of adverse events following immunization (AEFI) and management. However, most of the concerns were vaccine administration skills, the conflict with other professionals, and the cost of setup and management. The pharmacists required training in vaccine administration skills before providing the service.

Conclusions: The community pharmacies were willing and ready to provide vaccination services for the National List of Essential Vaccines. Vaccine administration skills were the main barriers to vaccination. The training should be done in faculty classes or workshops.

Introduction: The benefits of pulmonary rehabilitation (PR) on exercise capacity, health-related quality of life (HRQoL), and prevention of readmission post exacerbation in chronic respiratory diseases (CRD) are well established. However, accessibility to PR programmes is limited by PR programmes mostly being available through hospital clinics only. Utilizing existing workforce and infrastructure in private physiotherapy and exercise physiology practices may be a solution to increase access.

Methods: A mixed-methods assessor-blinded randomized controlled feasibility trial will be conducted in two parts. First, the efficacy of a training programme for private practice (PP) physiotherapists and accredited exercise physiologists who have not previously provided PR will be evaluated. Participant knowledge, skills, and confidence to provide PR will be measured before and after the training and at three months follow-up. Secondly, patient participants with CRD will be randomly allocated to receive twice weekly PP PR for 8 weeks or usual care from their general practitioner (GP). Exercise capacity, HRQoL, and health status will be measured before and after PR. A purposive sample of clinician and patient participants will partake in semi-structured interviews at the study conclusion. Interviews will continue until data saturation is achieved.

Discussion: This study will provide data on the feasibility of providing PR by physiotherapists and exercise physiologists in the PP setting. Provision of PR in the PP setting has the potential to increase access to this highly evidence-based intervention to improve outcomes for people with CRD.

Aim: This study examines the impact of a continuing medical education (CME) intervention on smoking cessation among primary-care professionals (PCPs) and explores the relationship between PCP smoking status and patient tobacco-treatment delivery.

Background: High rates of tobacco use among PCPs have been reported in several European countries. PCPs who smoke are less motivated to provide cessation support to their patients.

Methods: A before-after study was conducted with 228 PCPs from Greece and Cyprus. The intervention included a one-day CME training, a 2.5-hour seminar three months later, and practice tools. Expert faculty provided informal support to smoking PCPs. Changes in PCP smoking status and 5As (ask, advise, assess, assist, and arrange) tobacco treatment delivery were assessed before and six months after training. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to evaluate the association between the training and PCP smoking status and 5As delivery.

Findings: At baseline, 18% (n = 47) of PCPs were current smokers, and 39% (n = 66) were ex-smokers. At follow-up, 31.9% of current smokers reported quitting (n = 15/47; p < 0.001). Smoking cessation was higher among female PCPs (p = 0.02) and those in Cyprus and Thessaloniki (p < 0.01). PCPs reported increased 5As delivery at follow-up, with the highest rates among ex-smokers (>6 months) and never smokers. PCPs reported significant quitting rates following a comprehensive evidence-based training intervention. The findings suggest that addressing PCPs' smoking status can improve both health-care provider and patient smoking outcomes.

Aim: The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. This survey assessed which criteria in the EGPRN concept of multimorbidity could detect decompensating patients in residential care within a primary care cohort at a six-month follow-up.

Method: Family physicians included all multimorbid patients encountered in their residential care homes from July to December 2014. Inclusion criteria were those of the EGPRN definition of multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Decompensation was defined as the occurrence of death or hospitalization for more than seven days. Statistical analysis was undertaken with uni- and multi-variate analysis at a six-month follow-up using a combination of approaches including both automatic classification and expert decision. A multiple correspondence analysis and a hierarchical clustering on principal components confirmed the consistency of the results. Finally, a logistic regression was performed to identify and quantify risk factors for decompensation.Findings: About 12 family physicians participated in the study. In the study, 64 patients were analyzed. On analyzing the characteristics of the participants, two statistically significant variables between the two groups (decompensation and Nothing To Report): pain (p = 0.004) and the use of psychotropic drugs (p = 0.019) were highlighted. The final model of the logistic regression showed pain as the main decompensation risk factor.

Conclusion: Action should be taken by the health teams and their physicians to prevent decompensation in patients in residential care who are experiencing pain.

Aim: This systematic review aimed to analyze studies assessing the extent to which General Practitioners (GPs) engage patients in the decision-making process during consultations.

Background: Shared Decision Making (SDM) stands at the core of patient-centred care, particularly in primary healthcare, where a diverse array of medical decisions transpires. In a 2015 systematic review summarizing studies on the Observing Patient Involvement in Decision Making (OPTION) instrument to assess SDM objectively across healthcare settings, a notable dearth of patient involvement was observed.

Methods: A comprehensive literature search encompassing three digital databases was conducted up to November 2023. Inclusion criteria focused on studies employing a comparative study design, centric to primary healthcare, and utilizing the OPTION-5 or -12 instrument to gauge SDM levels. Two investigators independently performed study selection, risk of bias assessment, and data extraction using a list of predefined variables, with discrepancies resolved by a third reviewer. PROSPERO registration-ID: CRD42023475419.

Findings: Initially, harvesting 447 articles, our review retained 29 studies published between 2003 and 2022. Mean age of GPs was 45.5 (range 33-53) years. Reported baseline OPTION scores varied between 1.5 and 57.2 on a 0-100-point scale, with a median score of 16. Following SDM interventions, OPTION-scores increased significantly to a median of 28.5, range 16-83.

Conclusion: The overall level of SDM among GPs remains relatively low and has shown minimal improvement over the past decade. However, interventions promoting SDM appear to enhance patient involvement levels. This underscores the necessity for increased education and tools, directed at GPs and patients, to foster and elevate the practice of SDM.

Background: Effective mental health primary prevention and early detection strategies targeting perinatal mental healthcare settings are vital. Poor maternal mental health places the developing foetus at risk of lasting cognitive, developmental, behavioural, physical, and mental health problems. Indigenous women endure unacceptably poor mental health compared to all other Australians and disproportionately poorer maternal and infant health outcomes. Mounting evidence demonstrates that screening practices with Indigenous women are neither effective nor acceptable. Improved understanding of their perinatal experiences is necessary for optimizing successful screening and early intervention. Achieving this depends on adopting culturally safe research methodologies.

Methodology: Decolonizing translational research methodologies are described. Perspectives of Australian Indigenous peoples were centred on leadership in decision-making throughout the study. This included designing the research structure, actively participating throughout implementation, and devising solutions. Methods included community participatory action research, codesign, and yarning with data analysis applied through the cultural lenses of Indigenous investigators to inform culturally meaningful outcomes.

Discussion: The Indigenous community leadership and control, maintained throughout this research, have been critical. Allowing time for extensive community collaboration, fostering mutual trust, establishing strong engagement with all stakeholders and genuine power sharing has been integral to successfully translating research outcomes into practice. The codesign process ensured that innovative strengths-based solutions addressed the identified screening barriers. This process resulted in culturally sound web-based perinatal mental health and well-being assessment with embedded potential for widespread cultural adaptability.

Aim: This study explored the enablers and challenges influencing the performance of community health volunteers (CHVs) in Machakos County, Kenya, during the COVID-19 pandemic.

Background: The COVID-19 pandemic disrupted healthcare systems globally, with particularly severe impacts in developing countries. Community health workers (CHWs) played a critical role in crisis communication, community engagement, case detection, referrals, and maintaining care continuity. However, limited evidence exists on the factors enabling and hindering their performance during the pandemic.

Methods: This study employed a convergent mixed-methods design, integrating focus group discussions (FGDs), in-depth interviews (IDIs), and structured data extraction from the Kenya Health Information System (KHIS). Analysis of the data was guided by Agarwal et al.'s conceptual framework for measuring community health workforce performance with the quantitative data being analyzed using descriptive statistics, while qualitative data being analyzed through thematic analysis.

Findings: CHVs effectively disseminated COVID-19 information, addressed vaccine hesitancy, and mobilized communities, supported by training, supervision, and community recognition. Their efforts led to significant improvements in healthcare services, including increased household visits, immunizations, and maternal health referrals. Despite their contributions, CHVs faced challenges such as delayed stipends, limited resources, and occasional community stigma, which hindered performance. Social support networks, community appreciation, and priority healthcare access emerged as key enablers, fostering resilience and motivation. Improved reporting mechanisms also highlighted CHVs' expanded roles during the pandemic.

Conclusion: This study underscores the critical role of CHVs in sustaining healthcare services during the COVID-19 pandemic, despite facing financial, logistical, and social barriers. Their resilience and adaptability led to significant improvements in key health services, supported by effective supervision and training. Strengthening systemic support, integrating CHVs into long-term strategies, and enhancing community recognition are essential to maximize their impact in future health challenges.

Aim: To achieve more efficient and comprehensive maternal and child health (MCH) care services in rural areas through optimizing resource allocation and enhancing service quality.

Background: With the increasing awareness of health among rural residents and the growing demand for MCH care, township health centers, as a crucial component of primary medical services, have emerged as a key factor in ensuring the health of women and children in rural areas.

Methods: Using a multi-stage stratified random sampling method, this study conducted on-site investigations on 49 township health centers across six districts and counties of Guilin, Guangxi. Descriptive statistics, entropy weight coefficient method, Data Envelopment Analysis (DEA) Banker-Charnes-Cooper (BCC) Model and Malmquist index were employed for dynamic analysis.

Findings: The results indicate an upward trend in the incidence rates of birth defects and low birth weight in MCH services. Disparities in efficiency across regions are observed, which are associated with the economic status and capacity of MCH services in each area. Dynamic results from the Malmquist index show that the total factor productivity of MCH services experienced an upward trend from 2016 to 2021, with efficiency primarily influenced by scale efficiency. Updating management concepts is crucial for effectively addressing the relationship between scaling up and quality improvement.