Primary health care research & development最新文献

Aim: This research aimed to explore the perspectives of primary and community care providers on the challenges that hinder the delivery and uptake of personalized type 2 diabetes (T2D) care, with a focus on the integration of mental health support and care.

Background: The day-to-day burden and demand of self-managing T2D can negatively impact quality of life and take a toll on mental health and psychological well-being. As a result, there is a need for personalized T2D self-management education and support that integrates mental health care. Despite the need for this personalized care, existing systems remain siloed, hindering access and uptake. In response, innovative, comprehensive, and collaborative models of care have been developed to address fragmentations in care. As individuals living with T2D often receive their care in primary care settings, linking mental health care to existing teams and networks in primary care settings is required. However, there is a need to understand how best to support access, adoption, and engagement with these models in these unique contexts.

Methods: A cross-sectional survey was distributed to primary and community providers of an Ontario-based smoking cessation network. Survey data were analyzed descriptively with free text responses thematically reported.

Findings: Survey respondents (n = 85) represented a broad mix of health professions across primary and community care settings. Addressing challenges to the delivery and uptake of personalized T2D care requires comprehensive strategies to address patient-, practice-, and system-level challenges. Findings from this survey identify the need to tailor these models of care to individual needs, clearly addressing mental health needs, and building strong partnership as means of enhancing accessibility and sustainability of integrated care delivery in primary care settings.

Aims: To support policymakers in enhancing access to eye care for the population aged 45 years and older in Pakistan, this study aims to identify and quantify the barriers that hinder effective eye care delivery to this group. Additionally, it seeks to explore patients' experiences with the Sehat Sahulat (health insurance) programme in the context of eye care services.

Background: Accessible eye care services can reduce avoidable blindness by delivering timely, high-quality interventions. In Pakistan, the lack of primary eye care burdens overcrowded hospitals and combined with economic challenges, limits access for underprivileged populations. To address this, a nationwide health insurance scheme - the Sehat Sahulat programme (SSP) was introduced to reduce out-of-pocket (OOP) expenses and improve healthcare access for economically disadvantaged groups.

Methods: Using an exploratory sequential mixed methods design, an initial qualitative phase explored participant experiences and identified specific barriers. The qualitative study provided the basis for the development of a customized survey tool. The survey tool was then used in a second phase to obtain quantitative data to capture the magnitude of barriers and costs associated with accessing eye care in Pakistan.

Findings: Numerous considerable barriers were identified including illiteracy, long travel times, female gender, old age, mobility issues, and costs, all of which limited access to eye care in Pakistan. Awareness surrounding use of the SSP was poor, with the programme seldom used towards eye care costs. This study highlights patient experiences with eye care in urban and rural Pakistan, including enablers and barriers to accessing eye care. Improvements should focus on educating the public on eye health, increasing availability of eye care services in rural areas, improving accessibility within eye care facilities, addressing gender disparities, and reducing costs associated with eye care treatments, potentially through advancement of the SSP.

Aim: The objectives of this study were to study the psychometric properties of the Implementation Drivers Scale (IDS), for the mhGAP programme, both clinical and community; to test its structural validity, and to propose an instrument to accompany the implementation of the mhGAP in similar contexts. For this purpose, a cross-sectional quantitative methodology study was conducted.

Background: Mental health programmes proposed in low- and middle-income countries to address gaps in care have implementation problems.

Methods: A cross-sectional quantitative methodology study was conducted. During 2022 and 2023, the instrument was administered to 204 individuals, including primary care professionals (50%), national administrative leaders (19.11%), and community strategy leaders. Three departments of Colombia participated, two with low levels of implementation in mental health programmes and one with high levels of implementation of programmes and services.

Findings: The Kaiser-Meyer-Olkin factor analysis resulted in 0.861, which indicated the suitability of the data for a factor analysis. Bartlett's Test of Sphericity had a value of 2480.907 (153 degrees of freedom, p <.001). The exploratory factor analysis explained variance of 66.781%. The four factors proposed in the AIF model (System enablers for implementation, Accessibility of the strategy, Adaptability and acceptability, and Strategy training and supervision) were confirmed, with all items with loadings greater than 0.4. For the entire instrument, a Cronbach's alpha was 0.907. The IDS could contribute to the monitoring of some components of mhGAP implementation, both clinical and community-based, in low- and middle-income settings through appropriate validation processes.

Aim: This study investigated the factors influencing the mental health of rural doctors in Hebei Province, to provide a basis for improving the mental health of rural doctors and enhancing the level of primary health care.

Background: The aim of this study was to understand the mental health of rural doctors in Hebei Province, identify the factors that influence it, and propose ways to improve their psychological status and the level of medical service of rural doctors.

Methods: Rural doctors from 11 cities in Hebei Province were randomly selected, and their basic characteristics and mental health status were surveyed via a structured questionnaire and the Symptom Checklist-90 (SCL-90). The differences between the SCL-90 scores of rural doctors in Hebei Province and the Chinese population norm, as well as the proportion of doctors with mental health problems, were compared. Logistic regression was used to analyse the factors that affect the mental health of rural doctors.

Results: A total of 2593 valid questionnaires were received. The results of the study revealed several findings: the younger the rural doctors, the greater the incidence of mental health problems (OR = 0.792); female rural doctors were more likely to experience mental health issues than their male counterparts (OR = 0.789); rural doctors with disabilities and chronic diseases faced a significantly greater risk of mental health problems compared to healthy rural doctors (OR = 2.268); rural doctors with longer working hours have a greater incidence of mental health problems; and rural doctors with higher education backgrounds have a higher prevalence of somatization (OR = 1.203).

Conclusion: Rural doctors who are younger, male, have been in medical service longer, have a chronic illness or disability, and have a high degree of education are at greater risk of developing mental health problems. Attention should be given to the mental health of the rural doctor population to improve primary health care services.

Aim: We assessed patient experience of care, comparing current and past smokers, and whether frequency of advice to quit smoking impacts patient rating of care.

Background: Experience of care may be a concern for people who smoke and affect their partnership with healthcare providers.

Methods: We surveyed adults aged over 35 years who had visited a general practitioner (GP) for health care in the past year (n = 611 current and n = 275 ex-smokers). Questions assessed smoking history, experience of care, anticipation of stigma, and perceptions of smoking cessation advice received in general practice.

Findings: Fewer than half (48.8%) of current smokers reported 'always' or 'usually' being advised to quit smoking, or being advised in a way that motivated them to quit by a GP or other care provider at their GP practice. Current smokers tended to delay or avoid help seeking when needed and experienced more anticipation of stigma in healthcare settings. Conversely, respondents who reported being advised to quit more frequently rated overall quality of care more highly. These data show that asking about smoking and providing advice to quit smoking was acceptable to most respondents and associated with higher ratings of quality of care. However, advice should be provided in a way that motivates patients, without exacerbating the stigma associated with smoking, which may impact help seeking.

Background: Interventions based on testing and communication training have been developed to reduce antibiotic prescribing in primary healthcare (PHC) for the treatment of acute lower respiratory infections (ALRTIs). However, research based on the experiences of PHC clinicians participating in ALTRIs interventions to reduce antibiotic prescribing in Barcelona is scanty.

Aim: This study aimed to explore the perceptions and experiences of clinicians (physicians and nurses) on an intervention to reduce antibiotic prescription in PHC in Barcelona (Spain). This intervention was a randomised controlled study (cRCT) based on three arms: 1) use of a C-reactive protein (CRP) rapid test; 2) enhanced communication skills; and 3) combination of CRP rapid test and enhanced communication skills. In addition, the study aimed to explore the impact of COVID-19 on the detection of ALRTIs.

Methods: This qualitative study used a socio-constructivist perspective. Sampling was purposive. Participants were selected based on age, sex, profession, intervention trial arm in which they participated, and the socioeconomic area of the PHC where they worked. They were recruited through the healthcare centres participating in the study. Nine participants (7 women and 2 men) participated in two focus groups, lasting 65-66 min, in September-October 2022. Framework analysis was used to analyse the data.

Findings: Three themes were identified: '(The intervention) gave us reassurance': intervention experiences among health professionals. This theme includes accounts of clinicians' satisfaction with the intervention, particularly with CRP testing to support clinical diagnoses; 'We don't have time in primary healthcare': structural and community resources in healthcare services. This theme encompasses clinicians' experiences on healthcare pressures and PHC organisational structures barriers to PHC interventions; and 'I only did three CRP': impact of COVID-19 pandemic on the intervention. The last theme focuses on the impact of the COVID-19 pandemic on the intervention's implementation.

Conclusions: CPR testing and promoting communication skills can be useful tools to support clinical decisions for ALRTIs. Structural barriers (e.g., healthcare pressures) and social inequities amongst service users were acknowledged as the main barriers for the implementation of ALRTIs interventions.

Aim: To evaluate sex differences in the triage and assessment of chest pain in Dutch out-of-hours primary care (OOH-PC).

Background: Prior research illustrated differences between women and men with confirmed cardiac ischemia. However, information on sex differences among patients with undifferentiated chest pain is limited and current protocols used to assess chest pain in urgent primary care in the Netherlands do not account for potential sex differences.

Methods: A retrospective cohort study of consecutive patients who contacted a large OOH-PC facility in the Netherlands in 2017 regarding chest pain. We performed descriptive analyses on sex differences in patient and symptom characteristics, triage assessment, and subsequent clinical outcomes, including acute coronary syndrome (ACS).

Findings: A total of 1,802 patients were included, the median age was 54 years, and 57.6% were female. Compared to men, women less often had a history of cardiovascular disease (CVD) (16.0% vs 25.8%, p < 0.001) or cardiovascular risk factors (49.3% vs 56.0%, p = 0.005). Symptom characteristics were comparable between sexes. While triage urgencies were more frequently altered in women, the resulting triage urgencies were comparable, including ambulance activation rates (31.1% and 33.5%, respectively, p = 0.33). Musculoskeletal causes were the most common in both sexes; but women were less likely to have an underlying cardiovascular condition (21.1% vs 29.6%, p < 0.001), including ACS (5.4% vs 8.5%, p = 0.019).

Conclusion: Women more frequently sought urgent primary care for chest pain than men. Despite a lower overall risk for cardiovascular events in women, triage assessment and ambulance activation rates were similar to those in men, indicating a potentially less efficient and overly conservative triage approach for women.

Variation between general practices in the rate of consultations for musculoskeletal pain conditions may signal important differences in access to primary care, perceived usefulness, or available alternative sources of care; however, it might also just reflect differences in underlying 'need' between practices' registered populations. In a study of 30 general practices in Staffordshire, we calculated the proportion of adults consulting for a musculoskeletal pain condition, then examined this in relation to selected practice and population characteristics, including the estimated prevalence of self-reported musculoskeletal problems and chronic pain in each practices' registered population. Between September 2021 and July 2022, 18,388 adults were consulted for a musculoskeletal pain condition. After controlling for length of recruitment, time of year, and age-sex structure, the proportion consulting varied up to two-fold between practices but was not strongly associated with the prevalence of self-reported long-term musculoskeletal problems, chronic pain, and high-impact chronic pain.

Objective: To understand mental suffering from the point of view of the people affected.

Method: A qualitative study was carried out with 22 users of Primary Health Care units in Ribeirão Preto, São Paulo, Brazil. The data were collected through individual interviews using the Oral Life History technique and analysed using Thematic Analysis.

Results: Two categories emerged: 'Vulnerabilities in the life history of people with mental suffering' and 'Perceiving and living with suffering and/or mental disorder'. The experience was permeated by situations of violence, poverty and abandonment, from childhood to adulthood. The recognition of mental suffering and its consequences was based on behavioural changes and work difficulties, which did not lead them to seek immediate treatment. The difficulty of living with suffering and/or mental disorder is directly related to adherence to treatment.

Final considerations: Subjective aspects present in human life are still disregarded and the late search for professional help seems to result in the stigma and self-stigma of people with mental suffering and/or disorders.

Background: Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned.

Approach and development: This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme.

Conclusion: Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.