Primary health care research & development最新文献

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.

This paper is a short report considering the role of occupational therapy in providing mental health services in primary care. Primary care is the first point of contact most people have with the healthcare system. Occupational therapists have a role working with people with mental illness but the role of an occupational therapist working in mental health in a primary care setting is not well understood. Common interventions discussed in the literature included lifestyle approaches, assessment and information gathering, and the teaching of skills for daily living. There was a clear divide in the literature regarding the use of generic or specialist (occupation-focused) roles. Physical health was often prioritized over mental health concerns. Limited research examined both the population group of people with mental health concerns and the practice setting of primary care, identifying the need for further research to articulate the role of occupational therapy in working with mental health in primary care settings.

Aim: To synthesize evidence on approaches used in the co-design of maternal and early childhood primary care interventions with structurally marginalized populations.

Background: Involving end-users when developing health interventions can enhance outcomes. There is limited knowledge on how to effectively engage structurally marginalized populations (i.e., groups that are affected by structural inequities resulting in a disproportionate burden of social exclusion and poor health) when co-designing maternal child primary care interventions.

Methods: A rapid scoping review was conducted by searching EMBASE and CINAHL for studies indexed between January 2010 and December 2024. Peer-reviewed studies describing co-designed health interventions or services tailored to structurally marginalized populations during prenatal, postpartum, or early childhood periods were included if they reported on one or multiple steps of a co-design process in community-based primary care practices in high-income countries.

Findings: Of the 5970 records that were screened, nine studies met the inclusion criteria. The co-designed interventions included three eHealth tools, a health- and social-care hub, a mental health service, a health literacy program, an antenatal care uptake intervention, an inventory of parenting support strategies, and a fetal alcohol spectrum disorder prevention campaign. Women, mothers, fathers, and health- and social-service providers contributed to the co-design process by participating in workshops, focus groups, individual interviews, or surveys. They provided feedback on intervention prototypes, existing resources, and new intervention designs or practice models. Ethical and practical considerations related to the population and context (e.g., marginalization) were not consistently addressed.

Conclusion: This synthesis on intervention co-design approaches with structurally marginalized populations can provide guidance for primary care organizations that are considering maternal child health intervention co-design with this clientele. Future work should include a critical reflection on the ethical and practical considerations for co-design with structurally marginalized populations in the context of maternal and early child care.

Aim: This study explores the perspectives of cancer lay health providers and civil society on the barriers and facilitators to cancer detection and treatment among women.

Background: In 2010, the Moroccan Ministry of Health implemented a national plan for cancer care and control. Activities focused on strengthening multisectoral collaboration in cancer care and control, including promoting early detection in primary care. Despite progress in reducing women's cancer mortality, socio-cultural challenges impede further gains. Elucidating the perspectives of the community-based and civil society allied in cancer control is critical to addressing cancer disparities.

Methods: Data were collected through in-depth interviews with cancer lay health advisors (n = 10) and civil society members (n = 10) on topics of challenges and opportunities to improve care-seeking and treatment. Data were analysed using thematic analysis and guided by the socio-ecological model.

Findings: Barriers and facilitators to early diagnosis and treatment were identified at levels of the individual, family, community/societal, and the health system. Barriers to early detection include taboo and stigma, fear of death, and gender norms and roles. Financial and geographic barriers, lack of psychosocial support, and poor health system/provider communication were major deterrents related to treatment. Results suggest intervention targets to reduce late-stage presentation for women, including enhancing educational efforts and augmenting community outreach linkages to primary care.

Aim: This study aims to evaluate the effect of smokers' nicotine addiction levels and physical activity capacities (aerobic capacities) on exhaled carbon monoxide (CO) measurement values in respiratory air.

Methods: This study is a cross-sectional epidemiological descriptive type study. About 146 smokers, aged 18 and above, who applied to Hacettepe University Family Medicine outpatient clinics between March and May 2023 were included in the study. The Fagerström Test for Nicotine Dependence (FTND) and 6-minute walk test (6-MWT) were performed to the participants, and the relationship of the data with exhaled CO level was examined.

Results: In the data we obtained, it was observed that the addiction score evaluated by the FTND had a positive, moderately statistically significant effect on the CO level (r = 0.483 p < 0.001). Although the percentage of aerobic capacity (physical activity capacities) assessed by the 6-MWT appeared to have a very weak negative relationship with the exhaled CO level, it was found to be not statistically significant (r = -0.112 p = 0.177).

Conclusion: The data we obtained showed that smoking addiction has harmful effects such as increasing CO in the body, but there is no relationship between physical activity and the amount of exhaled CO. It has been observed that quitting smoking and complying with lifestyle change recommendations are an important necessity for a healthier life. To improve patients' overall health outcomes, family physicians are crucial in helping patients quit smoking and encouraging lifestyle modifications. This study might have encouraged the reflection of smoking habits and thus motivated quitting.

Aim: In the United States, roughly one million pregnancies occur every year from the misuse and discontinuation of oral contraceptives - which may be affected by an individual's exposure to social determinants of health (SDOH). For those experiencing poorer SDOH, significant barriers may exist when family planning. Thus, our primary objective is to examine associations between domains of SDOH and contraceptive use as well as pregnancy intention using the Behavior Risk Factor Surveillance System (BRFSS).

Methods: A cross-sectional analysis of 2017 BRFSS was conducted using the SDOH module to examine differences in family planning. We used bivariate and multivariable logistic regression models to measure associations, via odd ratios, between SDOHs and contraceptive use and pregnancy intention controlling for other sociodemographic variables.

Results: We found that individuals experiencing negative SDOH who reported running out of food (AOR: 0.65; CI: 0.50-0.86), were unable to afford balanced meals (AOR: 0.64; CI:0.49-0.84), or had no money left at the end of the month (AOR: 0.45; CI: 0.32-0.64) were less likely to have used contraceptive methods compared to those not experiencing challenges within these SDOH domains. Among women not utilizing contraceptive methods, individuals not intending to get pregnant were more likely to report difficulty affording balanced meals or having financial stability compared to women attempting to become pregnant.

Conclusions: Our study found that the SDOH domains of monthly financial instability and food insecurity are significantly associated with women not using contraceptive measures but not wanting to become pregnant. Addressing barriers to contraceptive access and FP is becoming more important with shifting policies regarding women's reproductive healthcare. For women seeking contraceptive and FP advice, increased funding may help provide a solution.

Aim: The purpose of this study was to report on the prevalence of hypertension and anaemia, and types of medications prescribed to expectant mothers attending antenatal clinics at Intermediate Hospital Katutura in Windhoek, Namibia.

Background: Millennium Development Goals 4 and 5 speak to reduction of child mortality and improvement of maternal health by 2015, respectively. Gestational hypertension is a major contributor to maternal and perinatal mortality and is reported to affect up to 10% of women world-wide. Prevalence of anaemia among pregnant women is reported higher in low- and middle-income countries than in developed countries.

Methods: This was a cross-sectional study involving the review of outpatient and clinic health records for patients attending antenatal clinics at Intermediate Hospital Katutura, Windhoek during October to November 2022. Data for patients on first antenatal clinic visit were obtained from facility antenatal clinic patient registers while that of follow-up patients were from patient health passports. All expectant mothers over 18 years of age who had provided written consent to participate, were included. Data collected were: age, body weight, haemoglobin concentration, blood pressure, gravida, number of babies delivered, pregnancy stage, comorbidities, and prescribed medications. The results were summarised using descriptive statistics. A p-value <0.05 is considered to be statistically significant.

Findings: 354 records were included: 303 (85.6%) first visit, and 51 follow-up (14.4%). There was a significant correlation between systolic blood pressure (BP) and body weight (r = 0.31, p < 0.001). 13.5% of first-time visitors had haemoglobin levels lower than the normal range (11 g/dL). Difference in haemoglobin levels between trimesters 1 and 3 were significant (p < 0.001). Methyldopa was prescribed for all hypertensive expectant mothers. To reduce the incidences of anaemia and hypertension during pregnancy, women of childbearing age should be encouraged to attend antenatal visits earlier in pregnancy and to take measures for body weight reduction, respectively.

Background: Electronic medical record (EMR) systems in primary care present an opportunity to address frailty, a significant health concern for older adults. Researchers in the UK used Read codes to develop a 36-factor electronic frailty index (eFI), which produces frailty scores for patients in primary care settings.

Aim: We aimed to translate the 36-factor eFI to a Canadian context.

Methods: We used manual and automatic mapping to develop a coding set based on standardized terminologies used in Canada to reflect the 36 factors of the eFI. Manual mapping was completed independently by two coders, followed by group consensus among the research team. Automatic mapping was completed using Apelon TermWorks. We then used EMR data from the British Columbia Canadian Primary Care Sentinel Surveillance Network. We searched structured data fields related to diagnoses and reasons for patient visits to develop a list of free text terms associated with any of the 36 factors.

Results and conclusions: A total of 3768 terms were identified; 3021 were codes. A total of 747 free text terms were identified from 527,521 reviewed data entries. Of the 36 frailty factors, 24 were captured mostly by codes; 7 mostly by free text; and 4 approximately equally by codes and free text. Three key findings emerged from this study: (1) It is difficult to capture frailty using only standardized terminologies currently used in Canada and a combination of standardized codes and free text terms better captures the complexity of frailty; (2) EMRs in primary care can be better optimized; (3) Output from this study allows for the development of a frailty screening algorithm that could be implemented in primary care settings to improve individual and system level outcomes related to frailty.