Relevant bibliographies by topics / Medical clinic –primary healthcare

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Medical clinic –primary healthcare'

Author: Grafiati
Published: 24 April 2022

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Journal articles on the topic "Medical clinic –primary healthcare"

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Awang, Siti Salmiah, Shaza Eva Mohamad, and S. Maria Awaluddin. "Humanitarian disaster: mental health disorders at primary healthcare clinic." Disaster and Emergency Medicine Journal 7, no. 1 (March 31, 2022): 1–10. http://dx.doi.org/10.5603/demj.a2022.0001.

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Nuako, Akua, Jingxia Liu, Giang Pham, Nina Smock, Aimee James, Timothy Baker, Laura Bierut, Graham Colditz, and Li-Shiun Chen. "Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system." PLOS ONE 17, no. 2 (February 10, 2022): e0263718. http://dx.doi.org/10.1371/journal.pone.0263718.

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Purpose The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. Methods We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. Findings Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. Conclusions Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.
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Jordan, Jacob N., Thomas G. Wadsworth, Renee Robinson, Hayli Hruza, Amy Paul, and Shanna K. O’Connor. "Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic." Pharmacy 9, no. 4 (November 21, 2021): 187. http://dx.doi.org/10.3390/pharmacy9040187.

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(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.
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Shabbir, Syed H., and Maria Teresa M. Santos. "The role of prehealth student volunteers at a student-run free clinic in New York, United States." Journal of Educational Evaluation for Health Professions 12 (October 30, 2015): 49. http://dx.doi.org/10.3352/jeehp.2015.12.49.

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Purpose: The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations. Methods: We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals. Results: A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service. Conclusion: After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care.
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Kovaleva, Mariya A., Melinda Higgins, Bonnie Mowinski Jennings, Mi-Kyung Song, Carolyn K. Clevenger, Patricia C. Griffiths, and Kenneth W. Hepburn. "THE INTEGRATED MEMORY CARE CLINIC AS A HEALTHCARE NETWORK." Innovation in Aging 3, Supplement_1 (November 2019): S559. http://dx.doi.org/10.1093/geroni/igz038.2067.

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Abstract The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.
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Joughin, Andrea, Sarah Ibitoye, Amy Crees, David Shipway, and Philip Braude. "Developing a virtual geriatric perioperative medicine clinic: a mixed methods healthcare improvement study." Age and Ageing 50, no. 4 (May 15, 2021): 1391–96. http://dx.doi.org/10.1093/ageing/afab066.

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Abstract Background the Geriatric Perioperative Care clinic at North Bristol NHS Trust was suspended in March 2020 during the COVID-19 pandemic. A virtual clinic was piloted to deliver preoperative health optimisation and shared decision-making for patients undergoing critical elective surgery. No literature existed on virtual preoperative clinics for older people to support the development. Objective this healthcare improvement study describes the setup and delivery of the virtual clinic as its primary aim. Secondary aims included: assessing older people’s access to technology and their digital literacy for virtual consultation; to describe barriers and facilitators for consultations, as well as evaluation of patient and clinician satisfaction with the consultations' mode of delivery and outcomes. Methods a mixed methods healthcare improvement study was undertaken through plan-do-study-act cycles, semi-structure interviews, and quantitative service benchmarking. Results the pilot evaluated 67 preoperative consultations (43.3% video, 56.7% telephone, mean age 75) with a mix of surgical pathology (vascular 88.1%, colorectal 10.4%, urological 1.5%). Patient feedback demonstrated improved understanding of conditions (90.6%), and adequate opportunity to express opinions and questions (96.2%). Clinicians preferred video consultations (adequate to deliver services: 89.7% video; 68.4% telephone). The greatest barriers to engagement, none of which were exclusions to participation, included cognitive impairment, sensory impairment, or needing technical assistance setting up video consultations (52.2%). Conclusions delivering a virtual preoperative medical optimisation and shared decision clinic for older people is feasible. This study will aid other units in developing their own virtual preoperative clinics. Future work should evaluate perioperative outcomes of delivering a face-to-face versus virtual clinic.
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Waters, Nicole P., Trenton Schmale, Allison Goetz, Jason T. Eberl, and Jessica H. Wells. "A Call to Promote Healthcare Justice: A Summary of Integrated Outpatient Clinics Exemplifying Principles of Catholic Social Teaching." Linacre Quarterly 84, no. 1 (February 2017): 57–73. http://dx.doi.org/10.1080/00243639.2016.1272330.

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There is an urgent need to promote healthcare justice for patients as well as members of the healthcare team including physicians. In this article, we explain how principles of Catholic social teaching (i.e., dignity of the individual, common good, destination of goods, solidarity, and subsidiarity) are applied to health care, by featuring various types of outpatient clinics including free, charitable–direct primary care, hybrid, federally qualified health center, and rural health clinic. We describe how attempts have been made to improve the quality and access of health care by creating new medical schools (i.e., Marian University College of Osteopathic Medicine) and training programs as well as allocating government funding to alleviate the cost of training new healthcare providers through the National Health Service Corps. Finally, we suggest a few approaches (i.e., adopting new clinic models to include volunteer healthcare professionals and cross-training members of the healthcare team) to fill in current gaps in health care. Summary There is a need to promote justice in healthcare. In this article, we explain how principles of Catholic social teaching are applied to health care. To illustrate this, we feature various types of outpatient clinics. We also describe how attempts have been made to improve the quality and access of health care. Finally, we suggest further ways to improve healthcare reform based upon Catholic social teaching.
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Adily, Armita, Seham Girgis, Catherine D'Este, Veronica Matthews, and Jeanette E. Ward. "Syphilis testing performance in Aboriginal primary health care: exploring impact of continuous quality improvement over time." Australian Journal of Primary Health 26, no. 2 (2020): 178. http://dx.doi.org/10.1071/py19070.

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Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic’s STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.
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Fathima Begum Syed Mohideen1, Mohd Radzniwan A Rashid, Sharifah Najwa Syed Mohamad, Zuhairiah Mohamad, Muhammad Shamsir Bin Mohd Aris, and Azlan Jaafar. "Waqf concept health clinic – “Uniqueness in disguise” USIM experience." Malaysian Journal of Science Health & Technology 7, no. 2 (October 1, 2021): 54–57. http://dx.doi.org/10.33102/mjosht.v7i2.211.

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Waqf or religious endowment is of a benevolence instrument emerged to help reduce the burden of the disadvantaged people. As the cost for medical expenses are exorbitant, the availability of waqf should contribute to the improvement of the community health. The establishment of Universiti Sains Islam Malaysia (USIM) Specialist healthcare clinic was founded by the idea of waqf through healthcare for the less fortunate. With collaboration from many agencies the establishment of the clinic has served community in need to access better health care. The primary aim of waqf clinic establishment is to continually uphold the Islamic aspects in its establishment and management for betterment of health among disadvantaged people.
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Wang, Roy, Amanda Guth, Alyssa Tate, Michele Ly, and James Plumb. "Filling Gaps and Setting Boundaries: Examining Utilization of Health and Social services at JeffHOPE Student Run Clinics." Journal of Primary Care & Community Health 12 (January 2021): 215013272110375. http://dx.doi.org/10.1177/21501327211037532.

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The objective of this study was to describe the frequency that healthcare and social support services offered by JeffHOPE, a student run clinic for people experiencing homelessness in Philadelphia, PA, were utilized by patients. This study also aimed to investigate where patients would seek medical care on a given day had they not been able to access JeffHOPE. This study was conducted via mixed methods consisting of retrospective chart review of patient encounter records and a patient survey conducted weekly throughout 2019, both at a single clinic site, and retrospective chart review of January through March 2020 records at 5 clinic sites. This study found that the frequency of services utilized varied between clinic sites, and that Pharmacy and Procedure committees were the most utilized when examining the combined clinic data. Additionally, the survey found that JeffHOPE provided medical care to those that otherwise would not have sought it. Clinics also served as an alternative to accessing care for non-emergent issues in an Emergency Department (ED) for some patients, but for others it replaced seeing their primary care provider (PCP). This study confirmed that the services offered by JeffHOPE are well-utilized by patients experiencing homelessness in Philadelphia. It also revealed that while the organization’s medical services filled care gaps and potentially decreased unnecessary ED visits, they were also sometimes accessed in lieu of a PCP visit. A focused effort on linkage to formal primary care services for all JeffHOPE patients and expanding collection of more granular data to all clinics represent important future endeavors for this student run organization.
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Dissertations / Theses on the topic "Medical clinic –primary healthcare"

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Deedat, Raees. "Lessons learnt from a private sector business pilot targeting the primary healthcare needs of poor South Africans : the case of RTT Unjani Clinics." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/95693.

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Thesis (MBA)--Stellenbosch University, 2012.
Railit Total Transportation (RTT) is a multinational corporation whose core business is to be a logistics and distribution partner to other multinational corporations. Many of RTT’s key clientele are in the healthcare and pharmaceutical industry, with various key relationships and networks being developed over many years of operation. RTT set the trend by becoming one of the first large South African companies to participate in and profit from the rest of the African continent at a time when it was not popular to do so. On a similar motivation, the current CEO of the RTT Group, Dr Iain Barton, believes that it is a strategic imperative to participate in the Base of the economic Pyramid (BoP), both for economic and developmental reasons. The BoP is not a new market, but recent interest in its potential profitability has being sparked in the business community by the works of management gurus such as the late C.K. Prahalad and the current sustainability champion Stuart Hart. This dissertation presents a case study that will analyse the phenomenon of developing a business model that targets the primary healthcare (PHC) needs of poor South Africans. This study will also extract lessons learnt from the case study in the context of existing BoP theory, primary healthcare in South Africa, and a similar initiative implemented in Kenya in the form of the Child and Family Wellness Clinics (CFW). The case study presents the reader with the pilot phase of RTT’s Unjani Clinic project, and contrasts the findings and lessons learnt from the two main pilot sites in Johannesburg’s Etwatwa and Wattville peri-urban BoP communities. This study also explores a smaller business model concept among Cape Town’s informal traders, also known as spaza shops. The data collection for the case study was undertaken in the qualitative research methodological format with a comprehensive set of interviews that aimed to triangulate the views of management, operational staff, community participants and patient participants. The strength of the case study findings is enhanced by the inclusion of comprehensive case study data, which includes verbatim transcripts of all interview participants and focus group participants. The database can be found at the end of this research report. Many lessons emerged that were both expected and unexpected, with three major themes coming to the fore: • The strategic funding of Unjani, within the dichotomy of profit and non-profit hybrid models • Challenges in achieving operational scale and efficiencies within the BoP • Marketing the value proposition to the BoP. RTT’s management has already begun to implement many of the lessons that have emerged. This includes the marketing mix that requires greater appreciation at a detailed ethnographic level of the dynamics of non-traditional BoP markets. The research report also provides other recommendations to stimulate demand in BoP markets as well as suggestions for the ideal funding and business partners to move this project forward. This research is unique in exploring the challenges of business model development specifically to service the healthcare needs of poor South Africans, and to contribute a small but significant part in the broader understanding of doing business in the South African BoP.
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Luttig, Jana. "Evaluation and management of diabetic patients in a primary healthcare clinic / Jana Luttig." Thesis, North-West University, 2007. http://hdl.handle.net/10394/1834.

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In many African countries, including South Africa, much attention has been centred on the management of HIV/AIDS and tuberculosis epidemics. However, there is growing awareness in South Africa that life-style related non-communicable conditions, such as diabetes and obesity, represent an important health priority (Pirie, 2005:42). The general objective of this study was to evaluate the treatment of diabetic patients in clinics on primary healthcare level and to determine what contributions can be made in the prevention of diabetic complications. The research method consisted out of the selection of the study population, data collection (questionnaire) and the data analysis. There was no structural way of deciding which patients would be selected to be interviewed. As the patients arrived for their appointments the interviewer was informed. No patient was forced to participate in this study and after they agreed to the interview, they signed a consent form that releases the University of any liability that may occur and to give their permission for the interview. The questionnaire was compiled which covered all the aspects of diabetes. This included diagnostic data, life-style, well-being, compliance and monitoring. The researcher completed the questionnaires whilst interviewing the patients. The data obtained from the questionnaires were statistically analysed by using the Statistical Analysis System, SAS 9.1. Effect size, which was given by the Phi coefficient, was used as a descriptive statistic. In this particular study population, the majority of patients were classified as type 2 diabetics. This can be viewed in table 4.8 where 62.14% of the total study population was classified as group B, which means that these patients use oral glucose lowering drugs to control their disease. A further 33.98% of the population was classified as group C diabetics, which means that these patients need oral glucose lowering drugs as well as exogenous insulin to maintain a healthy life. The latter group obviously consists of patients whose diabetic status was not under control in the past, thus the need for the insulin. This clearly shows that these patients have not been informed about how they can manage the disease by dietary modification and lifestyle interventions. Lifestyle, socio-economic and education played a major role in the development of this disease in these patients. The weight status of the study population was determined and can be viewed in table 4.15. Only 20.39% of them were of normal weight with a body mass index (BMI) ranging between 18.5 - 24.9 kg/m2. 39.81% of them were overweight with their BMI ranging between 25 - 29.9 kg/m2 and the remaining 39.81% of the study population were classified as obese with their BMI's above 30 kg/m2. The majority (an estimated 80%) of the study population were above optimal weight. This may cause the development of chronic complications, such as retinopathy, neuropathy and nephropathy. The socio-economic status of the study population was relatively poor because of unemployment. Although 90.07% of them said they had no difficulty to follow their diet (table 4.56) almost half of the patients said they had some difficulty to get the correct food for their specific needs (table 4.53). The first may be because they are still eating they way they used to with no modifications and the latter may be because of their financial status. Not being able to find work has a major effect on their lives. They cannot afford to buy foods suitable for their needs. As previously stated, patient education is fundamental in the managing and controlling diabetes. When these patients were asked whether they know what diabetes is, and what the complications of the disease might hold, most of them answered that it means they have 'sugar', and cannot eat sugary foods any more. This clearly indicates that they did not have a complete knowledge of their disease. After having explained to them in uncomplicated terms what the disease implicates, many of them said it had not been not explained to them previously and that they now understood it better. It was concluded that the majority of the studied population were under a false impression of what diabetes implied. This is partly due to the lack of time the clinic staffs have to spend with each patient, educating them about the disease. One aspect that was most obvious during this study was the fact that an estimated 20% of all patients studied had their own blood glucose monitor (table 4.80). This is somewhat concerning because to have optimal control over one's blood glucose levels, one needs to has a blood glucose monitor for regular monitoring. An estimated 70% of the studied population measures their blood glucose only once a month when they attend the clinic for their monthly visit (table 4.81). This is not nearly enough to ensure optimal control. The average blood glucose levels were calculated and described in section 4.7. Even with the minimal measurement, about 50% of these patients' blood glucose levels were fairly under control with an average of 6-9mmol/L (table 4.88). But the other estimated 50% of the population were not controlled with averages of either below 5mmol/L or above 9mmol/L. This is concerning because the possibility that these uncontrolled cases may develop chronic complications, might be unavoidable unless they start taking control of their lives. And for this to happen, these patients need all the possible education from qualified health care providers and the support of their families. Certain recommendations and restrictions were formulated and discussed.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.
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Bender, Kelly L. "Choosing a healthcare facility a survey of women's views in a local healthcare setting /." Online version, 2008. http://www.uwstout.edu/lib/thesis/2008/2008benderk.pdf.

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Wilsey, Katherine Lambos. "Why Patients Miss Appointments at an Integrated Primary Care Clinic." Antioch University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1595879483897791.

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Barker, McKayla, Angela Chrisman, Mason Johnson, Matthew Gouge, and Emily K. Flores. "I.M.P.A.C.T. of Interprofessional Student Teams at a Remote Area Medical Clinic in Rural Appalachia." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/26.

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Introduction: Remote Area Medical (RAM), a non-profit organization serving underserved populations, partnered with East Tennessee State University to provide a unique learning opportunity for student volunteers at a clinic in rural Appalachia. Interprofessional student teams were established with undergraduate and graduate students in multiple professions. This study examined the impact on attitudes of students who participated and the impact of student teams on the event, hypothesizing that a positive impact would be seen on both. COVID-19 adjustments made were also evaluated. Methods: Surveys of student participants were conducted electronically utilizing REDCap before and after participation in the event. Surveys included demographic questions, validated surveys, and open-ended questions. Demographic questions gauged personal background, level of education, and history of interprofessional education or events. The previously validated surveys utilized were the Interprofessional Collaborative Competency Attainment Scale-Revised (ICAAS-R) and the Student Perceptions of Interprofessional Clinical Education-Revised Instrument Version 2 (SPICE-R2). Quantitative data was analyzed with SPSS version 25. Qualitative data was analyzed with deductive coding. Interventions were tallied by student teams during the event. Results: Eighty-nine students participated logging 1,213 interventions and 84 completed portions of the survey (94% response rate). ICAAS-R (n=79) displayed mean increases from 4.19 out of 5 in the pre-survey to 4.58 in the post-survey (p Conclusion: Statistically significant quantitative findings and qualitative themes supported the hypothesis that working in interprofessional teams at a RAM event would positively impact student attitudes towards interprofessional practice, and that student teams would have a positive impact on the event. COVID-19 adjustments made were well perceived. Findings can be summarized with the I.M.P.A.C.T. neumonic.
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Stephenson, Melanie K. "Safety-Net Medical Clinic Behavioral Health Integration." Wright State University Professional Psychology Program / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wsupsych152767560332411.

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Chimezie, Raymond Ogu. "A Case Study of Primary Healthcare Services in Isu, Nigeria." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1057.

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Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included that (a) healthcare is focused on children and pregnant women; (b) healthcare is largely ineffective because of insufficient funding, misguided leadership, poor system infrastructure, and facility neglect; (c) residents lack knowledge of and confidence in available primary healthcare services; (d) residents regularly use traditional healers even though these healers are not recognized by local government administrators; and (e) residents can be valuable participants in community-based research. The potential for positive social change includes improved communication between local government, residents, and traditional healers, and improved access to healthcare for residents.
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Campbell, Kami S. "Enhancing Interest and Knowledge of How to Start a Nurse Practitioner-Led Clinic." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1461151661.

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Allen, Susan. "Creating an integrated nursing team within primary healthcare : an action enquiry approach." Thesis, University of Leicester, 2005. http://hdl.handle.net/2381/27841.

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This thesis is based on a journey towards developing team working within a primary healthcare setting which enabled the NHS agenda for primary care service delivery to keep pace with the government modernisation agenda. (Department of Health, 1997). Initially the focus was on the development of an integrated nursing team which enabled all disciplines of nurses to work towards a patient focussed healthcare service, but it soon became evident that all staff involved in delivering the primary healthcare service were essential to the process and developments of the enquiry if the objective was to be achieved. An action enquiry approach based on collaborative and participative action research (Carr and Kemmis, 1986; Lincoln and Guba, 1989; Cayer, 1997) was discussed and was the prime method of enabling changes to occur in the healthcare practice. This is represented by the interrelated four main cycles of enquiry that have emerged from the data, and discussed in this thesis. Key to the success of the developments was an understanding of team working and leadership as it applied within a healthcare setting and also the underlying dynamics, which are evident when different professional groups from different traditions and knowledge base work together. (Schon, 1983) This was explored within the context of a systems approach to organisational development and through reflective dialogue along the principles advocated for creating a learning organisation. (Senge, 1990) This thesis will demonstrate how confidence developed in myself and the practitioners, especially those from marginalised groups, and how the wider healthcare system made an impact on the developments within the practice. The area of leadership will be discussed from multiple perspectives and recognition that as a concept all stakeholders had a poor understanding of leadership. The key finding from this study identifies the need for a holistic approach to manage and sustain change, and indeed everyday productive working relationships. This especially identifies the importance of giving attention to the preparation of future healthcare workers, the appropriateness of organisational structures in which services are delivered and support structures available to those in team leadership positions.
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Nwachuku, Ada Nwachuku. "Type 2 Diabetes Prevention and Management in a Primary Care Clinic Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3314.

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Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.
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Books on the topic "Medical clinic –primary healthcare"

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Hossain, Shahed. Operations research on ESP delivery: Addressing missed opportunities for service provisions in Primary Healthcare clinics. Dhaka: ICDDR,B, Centre for Health and Population Research, 2003.

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Merrick, Joav, Bell Erica, and G. P. Westert. Translational research for primary healthcare. Hauppauge, N.Y: Nova Science Publisher's, 2011.

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World Health Organization (WHO). Gender, women and primary health care renewal: A discussion paper. Geneva: World Health Organisation, 2010.

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Chambers, Ruth. Mental healthcare matters in primary care. Abingdon: Radcliffe Medical, 2001.

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Iyengar, Shreekant. Access of the rural poor to primary healthcare in India. Ahmedabad: Indian Institute of Management, 2011.

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Rona, Dougall, ed. Community nursing and primary healthcare in twentieth-century Britain. New York: Routledge, 2007.

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Pietroni, Roger. The toolbox for portfolio development: A practical guide for the primary healthcare team. Abingdon: Radcliffe Medical Press, 2001.

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Linden, Robert A. The rise and fall of the American medical empire: A trench doctor's view of the past, present, and future of the U.S. healthcare system. North Branch, MN: Sunrise River Press, 2010.

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Lindsey, Mary P. Once a day: One or more people with learning disabilities are likely to be in contact with your primary healthcare team : how can we help? London: NHS Executive, 1999.

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United States. Advisory Committee on Training in Primary Care Medicine and Dentistry. Training culturally competent primary care professionals to provide high quality healthcare for all Americans: The essential role of Title VII, Section 747, in the elimination of healthcare disparities : third annual report to the Secretary of the U.S. Department of Health and Human Services and to Congress. Washington, D.C.]: U.S. Dept. of Health and Human Services, Health Resources and Services Administration, 2003.

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Book chapters on the topic "Medical clinic –primary healthcare"

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Rosa, F. S., and R. Garcia. "Health Technology Management for Digital Medical Scales in Primary Healthcare." In VII Latin American Congress on Biomedical Engineering CLAIB 2016, Bucaramanga, Santander, Colombia, October 26th -28th, 2016, 289–92. Singapore: Springer Singapore, 2017. http://dx.doi.org/10.1007/978-981-10-4086-3_73.

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Ding, Wei, Yang Liu, and Ying Jiang. "Improving Design of Intelligent Clinic Product Service System: A Case Study." In Advances in Human Factors and Ergonomics in Healthcare and Medical Devices, 211–18. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-80744-3_27.

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Choi, Kup-Sze, Rebecca K. P. Wai, and Esther Y. T. Kwok. "Healthcare Information System: A Facilitator of Primary Care for Underprivileged Elderly via Mobile Clinic." In Smart Health, 107–12. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-39844-5_13.

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Rhodes, Penny, Ruth McDonald, Stephen Campbell, Gavin Daker-White, and Caroline Sanders. "Sensemaking and the co-production of safety: a qualitative study of primary medical care patients." In The Sociology of Healthcare Safety and Quality, 87–101. Chichester, UK: John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119276371.ch6.

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Drei, Samuel Martins, Paulo Sérgio de Arruda Ignácio, Antônio Carlos Pacagnella Júnior, Li Li Min, and Thiago Augusto de Oliveira Silva. "Lean Healthcare Applied Systematically in the Basic Image Examination Process in a Medium-Sized Medical Clinic." In Advances in Production Management Systems. Artificial Intelligence for Sustainable and Resilient Production Systems, 403–12. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-85902-2_43.

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Assis-Hassid, Shiri, Tsipi Heart, Iris Reychav, and Joseph S. Pliskin. "Modelling Factors Affecting Patient-Doctor-Computer Communication in Primary Care." In Consumer-Driven Technologies in Healthcare, 161–80. IGI Global, 2019. http://dx.doi.org/10.4018/978-1-5225-6198-9.ch010.

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This work presents a conceptual model aimed at explaining factors affecting the formation of effective patient-doctor-computer communication at the primary care clinic. The authors define a new construct – patient-doctor-computer communication (PDCC), aimed to replace the traditional concept of dyad patient-doctor communication (PDC). PDC has been characterized as one of the most significant factors affecting healthcare outcomes. To better understand PDCC and its antecedents, the authors integrate theories from the patient-centered care and the Information Systems domains and suggest that the characteristics of the EMR, the user (doctor) and the task determine the doctor's perception of fit between the EMR and the medical task, which in turn positively affects PDCC. The suggested conceptual model contributes to both theory and practice. On the theoretical side, it opens several new research trajectories. For practice, the model implies that there is a need for a tighter collaboration between experts from both the information systems and medicine domains in designing EMR systems that are aligned with and support the medical task at hand.
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Noteboom, Cherie. "Physician Interaction with EHR." In Healthcare Administration, 1088–100. IGI Global, 2015. http://dx.doi.org/10.4018/978-1-4666-6339-8.ch058.

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Research Medical Center is a regional medical center that meets the needs of residents of a rural area in the Midwest. It is part of a large healthcare system. The primary care hospital implemented the Electronic Health Record (EHR). The endeavor to implement Health IT applications including Computerized Physician Order Entry (CPOE), EHRs, nursing documentation, and paperless charts, adverse drug reaction alerts, and more were introduced with the corporate initiative. The core applications were clinical and revenue cycle systems, including CPOE. The planning, implementation, and training was developed by the parent operating company and efforts to engage the local physicians were minimal. There were over 300 physicians involved. The physicians were primarily not hospital employees. They had the ability to choose to adopt the EHR and adapt their social, work, and technology practices, or to avoid usage. Follow up research indicated the change management and support efforts were not successful for the physician stakeholder.
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Vincent, Ben. "Views of the clinic: non-binary perceptions and experiences of general healthcare services." In Non-Binary Genders, 133–68. Policy Press, 2020. http://dx.doi.org/10.1332/policypress/9781447351917.003.0006.

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Chapter five scrutinises accounts of primary care services for the most part (with some mention of secondary care), focusing on the experiences and views participants reported of interactions with doctors and other staff. Experiences are subdivided into ‘gendered medicine’ – healthcare which is differentiated in gendered terms, such as smear tests – and generalizable healthcare experiences, such as arm pain. The chapter also addresses how clerical administration in medical institutions may affect non-binary patients. This includes discussion of how names and pronouns are used and recorded, and medical forms specifically discussed by participants – including feedback forms and documentation related to tertiary care. Whilst this chapter is structured around primary care, the cross-practice nature of administration renders a general discussion that cuts across all forms of care appropriate. Discussion of the key administrative process of referral brings this chapter to a close.
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Christensen, Bryan E., and Ryan P. Fagan. "Healthcare Settings." In The CDC Field Epidemiology Manual, 341–62. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190933692.003.0018.

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Healthcare-associated infections (e.g., bloodstream, respiratory tract, urinary tract, or surgical site) can be common in patients. Patients receiving acute and chronic healthcare across various settings, such as hospitals, dialysis clinics, and nursing homes, tend to have comorbidities that make them more susceptible to infection than their counterparts in the general community. Also, some pathogens may be more likely to cause infection in healthcare settings because of the unique exposures that patients can experience, such as invasive procedures or indwelling medical devices. Similar to community outbreak investigations, the primary purpose of an investigation in a healthcare setting is to determine the source of the outbreak, define mode of transmission, disrupt disease transmission, and prevent further transmission.
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Bergkvist, Sofi, and Hanna Pernefeldt. "Primary Care through a Public-Private Partnership." In Advances in Healthcare Information Systems and Administration, 127–53. IGI Global, 2011. http://dx.doi.org/10.4018/978-1-61520-885-2.ch008.

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The primary care delivery model developed by the Health Management and Research Institute (HMRI) in India, integrates innovative technical solutions and process-oriented operations for the provision of healthcare services, while supporting the public health system. Through a public-private partnership with the state government of Andhra Pradesh, HMRI has a unique base to pilot large scale health interventions. The HMRI Model includes components such as a medical helpline, rural outreach health services, a disease surveillance program, a blood bank application, and telemedicine projects. Both clinical and non-clinical procedures are strengthened by technology that enables research, tailored and evidence-based interventions, as well as improves efficiency and quality of healthcare delivery. Health management and decision-making is assisted by the organization’s large database of electronic medical records. Challenges to implementation include implications of large government contracts, funding issues, as well as technical constraints and human resources issues. This chapter describes the Model’s various components and its contextual framework with enabling and constraining factors. HMRI has developed a unique system for preventive and primary care that can serve as a model for low, middle, and high income countries, though external evaluations are critically needed for further assessment of best practices.
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Conference papers on the topic "Medical clinic –primary healthcare"

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Cadwalladera, Jason, Steve Mellemab, and Nancy J. Lightnera. "Using Simulation to Provide Insights into the Concept Development of Patient-Centered Care Services." In Applied Human Factors and Ergonomics Conference. AHFE International, 2021. http://dx.doi.org/10.54941/ahfe100495.

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The United States’ Institute of Medicine established patient-centered care as an aim for the 21st-century health care system. Patient-centered care focuses on the patient, their family members and staff experience, while ensuring patient safety and high clinical quality. A medical center in the Veterans Affairs healthcare system approached the Veterans Affairs Center for Applied Systems Engineering to assist in the redesign of the facility that provides medical cancer care. Their goals were to design a patient-centered, state-of-the-art center. Discrete event simulation provided rough order of magnitude estimates for facility and resource planning. Primary metrics of concern were patient length of stay, patient wait time, and room and staff utilization. The simulation included an animated visualization of ‘a day in the life’ of a patient. It also collected metrics on patient experience and center efficiency. Watching the patient flow animation provided two primary insights to the stakeholders. First, it was evident that the patient care process was patient-centered in that it limited patient movement. Second, observations of traffic flow indicated that the design can accommodate the desired patient demand. The visualization showed that increasing the number of providers resulted in reductions in patient wait times and that reducing the number of exam rooms did not significantly affect patient wait time. This exercise demonstrated the value of simulation in the planning and analysis of facility configurations when considering patient-centered design.
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Weaver, Kyle, Dylan Shumway, Tae-Heon Yang, Young-Min Kim, and Jeong-Hoi Koo. "Investigation of Variable Stiffness Effects on Radial Pulse Measurements Using Magneto-Rheological Elastomers." In ASME 2019 Conference on Smart Materials, Adaptive Structures and Intelligent Systems. American Society of Mechanical Engineers, 2019. http://dx.doi.org/10.1115/smasis2019-5708.

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Abstract Current wearable technologies strive to incorporate more medical functionalities in wearable devices for tracking health conditions and providing information for timely medical treatments. Beyond tracking of a wearer’s physical activities and basic vital signs, the advancement of wearable healthcare devices aspires to continuously monitor health parameters, such as cardiovascular indicators. To properly monitor cardiovascular health, the wearables should accurately measure blood pressure in real-time. However, current devices on the market are not validated for continuous monitoring of blood pressure at a clinical level. To develop wearable healthcare devices such applications, they must be validated by considering various parameters, such as the effects of varying skin properties. Being located between the blood vessel and the wearable device, the skin can affect the sensor readings of the device. The primary goal of this study is to investigate the effect of skin property on the radial pulse measurements. To this end, a range of artificial vein-inserted skin samples with varying properties is fabricated using Magneto-Rheological Elastomers (MRE), materials whose mechanical properties can be altered by external magnetic fields. The samples include layers to simulate the structure of skin and a silicone vein for the pulse to pass through. Note that they are not intended to represent real human skin-vein properties but created to vary a range of stiffness properties to carry out the study. Experiments are performed using a cam system capable of generating realistic human pulse waveforms to pass through the samples. During the indentation testing, the sample is compressed using a dynamic mechanical analyzer (DMA) to record experienced surface pressure, allowing the pulse patterns to be studied. Various samples are used to probe the effects of base resin hardness, iron content, and magnetic field. A pressure sensor incorporated in the cam simulator is used to benchmark the internal pulse pressure of the vein while the DMA indents the sample in order to note the pulse pressures being passed through the sample. Test results show that the properties of the skin influence the resulting pulse behaviors, particularly the ratio of the recorded pulse pressures from the sensor and the DMA.
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Popham, Susan L. "Competing and Disruptive Objectives: Inefficient Communication Design in Medical Clinic and Healthcare Systems." In 2018 IEEE International Professional Communication Conference (ProComm). IEEE, 2018. http://dx.doi.org/10.1109/procomm.2018.00041.

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Liang, Shao-Fen, Xiaohui Sun, Martin Gulliford, and Vasa Curcin. "Inclusion and Exclusion of Medical Codes for Primary Care Data Extraction." In 2018 IEEE International Conference on Healthcare Informatics (ICHI). IEEE, 2018. http://dx.doi.org/10.1109/ichi.2018.00070.

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DREI, SAMUEL MARTINS, and PAULO SÉRGIO DE ARRUDA IGNÁCIO. "Lean Healthcare applied in medicines? preparation in medical clinic at a medium-sized hospital." In IJCIEOM 2020 - International Joint Conference on Industrial Engineering and Operations Management. IJCIEOM 2020 - International Joint Conference on Industrial Engineering and Operations Management, 2020. http://dx.doi.org/10.14488/ijcieom2020_full_0001_37384.

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Nuryati, Dian Budi Santoso, and Nur Rokhman. "Integration of ICPC in an Electronic Medical Records Prototype for Family Physician Clinic." In The 2nd International Conference on Technology for Sustainable Development. Switzerland: Trans Tech Publications Ltd, 2022. http://dx.doi.org/10.4028/p-vx078k.

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Recorded morbidity data in primary health care is different from data found in other health services. Therefore, in managing this data, ideally, a specific classification standard for primary health care services should be used, namely the International Classification for Primary Care (ICPC), where so far primary health care services in Indonesia are still using International Statistical Classification of Disease and Related Health Problems Tenth Revision (ICD-10) as a classification standard. This paper aims to integrate ICPC into an electronic medical record prototype in a family physician clinic. Focus group discussions, interviews, documentation studies, and observations were carried out with family physician clinic stakeholders regarding the need for ICPC implementation. The initial stage of implementation was carried out by data mapping between ICD-10 and ICPC. Furthermore, the data is displayed in a web-based electronic medical record where the officer only needs to do a codification with one of the classification standards and it will automatically display both the ICD-10 code and the corresponding ICPC code. Family physician clinic stakeholders welcomed the integration of ICPC in an electronic medical record prototype that made it easier for them to make disease index. Keywords: electronic medical record, ICPC, primary health care
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Gregorio, Joao, Tiago Lopes Ferreira, Afonso Cavaco, Miguel Mira da Silva, Christian Lovis, and Luis Velez Lapao. "Community pharmacies and eHealth services: Barriers and opportunities for real Primary Healthcare integration." In 2013 IEEE 26th International Symposium on Computer-Based Medical Systems (CBMS). IEEE, 2013. http://dx.doi.org/10.1109/cbms.2013.6627824.

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De Gloria, Alessandro, Marco Chirico, Claudio Launo, Riccardo Berta, Francesco Bellotti, Giuseppe Gioco, and Ivan Carmosino. "3D software simulator for primary care training." In the 8th International Workshop on Innovative Simulation for Healthcare. CAL-TEK srl, 2019. http://dx.doi.org/10.46354/i3m.2019.iwish.019.

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"Medical software simulators are used to teach specific procedures that allow the user to follow only a strict sequence of steps without the possibility of alternative, avoiding considering the consequence of an error and then potentially admitting its tolerance. Usually these applications are a state machine implementation where learners must make a specific action to obtain a specific result. In our work we propose a brand-new approach with a “open world” serious game medical simulator, based on Agent Based Model Paradigm. Starting by these concepts, a user can learn and test his skills in a dynamic environment that changes in real time based on his actions. We provide a configurable starting set of conditions (patient heath state, available medical instruments and drugs) to create, potentially, infinite scenarios; alongside these boundary values the game permits to configure real time events that influence patient in an unpredictable way by the user side."
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Kotzé, Paula, and Rosemary Foster. "A Conceptual Data Model for a Primary Healthcare Patient-Centric Electronic Medical Record System." In Environment and Water Resource Management. Calgary,AB,Canada: ACTAPRESS, 2014. http://dx.doi.org/10.2316/p.2014.815-010.

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Levin, Rebecca, Kira Mascho, Michael Stratton, Jack Maypole, and Jodi Wenger. "Optimizing Emr Usage to Improve Outcomes in a Pediatric Primary Care Clinic for Children with Complex Medical Needs." In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.152.

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Reports on the topic "Medical clinic –primary healthcare"

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Carney, Nancy, Tamara Cheney, Annette M. Totten, Rebecca Jungbauer, Matthew R. Neth, Chandler Weeks, Cynthia Davis-O'Reilly, et al. Prehospital Airway Management: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), June 2021. http://dx.doi.org/10.23970/ahrqepccer243.

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Objective. To assess the comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) by emergency medical services in the prehospital setting, and how the benefits and harms differ based on patient characteristics, techniques, and devices. Data sources. We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020 and reference lists, and posted a Federal Register notice request for data. Review methods. Review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center Program methods guidance. Using pre-established criteria, studies were selected and dual reviewed, data were abstracted, and studies were evaluated for risk of bias. Meta-analyses using profile-likelihood random effects models were conducted when data were available from studies reporting on similar outcomes, with analyses stratified by study design, emergency type, and age. We qualitatively synthesized results when meta-analysis was not indicated. Strength of evidence (SOE) was assessed for primary outcomes (survival, neurological function, return of spontaneous circulation [ROSC], and successful advanced airway insertion [for SGA and ETI only]). Results. We included 99 studies (22 randomized controlled trials and 77 observational studies) involving 630,397 patients. Overall, we found few differences in primary outcomes when airway management approaches were compared. • For survival, there was moderate SOE for findings of no difference for BVM versus ETI in adult and mixed-age cardiac arrest patients. There was low SOE for no difference in these patients for BVM versus SGA and SGA versus ETI. There was low SOE for all three comparisons in pediatric cardiac arrest patients, and low SOE in adult trauma patients when BVM was compared with ETI. • For neurological function, there was moderate SOE for no difference for BVM compared with ETI in adults with cardiac arrest. There was low SOE for no difference in pediatric cardiac arrest for BVM versus ETI and SGA versus ETI. In adults with cardiac arrest, neurological function was better for BVM and ETI compared with SGA (both low SOE). • ROSC was applicable only in cardiac arrest. For adults, there was low SOE that ROSC was more frequent with SGA compared with ETI, and no difference for BVM versus SGA or BVM versus ETI. In pediatric patients there was low SOE of no difference for BVM versus ETI and SGA versus ETI. • For successful advanced airway insertion, low SOE supported better first-pass success with SGA in adult and pediatric cardiac arrest patients and adult patients in studies that mixed emergency types. Low SOE also supported no difference for first-pass success in adult medical patients. For overall success, there was moderate SOE of no difference for adults with cardiac arrest, medical, and mixed emergency types. • While harms were not always measured or reported, moderate SOE supported all available findings. There were no differences in harms for BVM versus SGA or ETI. When SGA was compared with ETI, there were no differences for aspiration, oral/airway trauma, and regurgitation; SGA was better for multiple insertion attempts; and ETI was better for inadequate ventilation. Conclusions. The most common findings, across emergency types and age groups, were of no differences in primary outcomes when prehospital airway management approaches were compared. As most of the included studies were observational, these findings may reflect study design and methodological limitations. Due to the dynamic nature of the prehospital environment, the results are susceptible to indication and survival biases as well as confounding; however, the current evidence does not favor more invasive airway approaches. No conclusion was supported by high SOE for any comparison and patient group. This supports the need for high-quality randomized controlled trials designed to account for the variability and dynamic nature of prehospital airway management to advance and inform clinical practice as well as emergency medical services education and policy, and to improve patient-centered outcomes.
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McDermott, Joseph T., Jr Haigler, Rembold Wilson D., Shimp Ronald L., Slayton William E., Sprull Frank W., Van Meter Clifton E., and Jack A. Review of the Medical Equipment Purchased for the Primary Healthcare Centers Associated with Parsons Global Services, Inc., Contract Number W914NS-04-D-0006. Fort Belvoir, VA: Defense Technical Information Center, July 2006. http://dx.doi.org/10.21236/ada517207.

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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Apiyo, Eric, Zita Ekeocha, Stephen Robert Byrn, and Kari L. Clase. Improving Pharmacovigilliance Quality Management System in the Pharmacy and Poisions Board of Kenya. Purdue University, December 2021. http://dx.doi.org/10.5703/1288284317444.

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The purpose of this study was to explore ways of improving the pharmacovigilance quality system employed by the Pharmacy and Poisons Board of Kenya. The Pharmacy and Poisons Board of Kenya employs a hybrid system of pharmacovigilance that utilizes an online system of reporting pharmacovigilance incidences and a physical system, where a yellow book is physically filled by the healthcare worker and sent to the Pharmacy and Poisons Board for onward processing. This system, even though it has been relatively effective compared to other systems employed in Africa, has one major flaw. It is a slow and delayed system that captures the data much later after the fact and the agency will always be behind the curve in controlling the adverse incidents and events. This means that the incidences might continue to arise or go out of control. This project attempts to develop a system that would be more proactive in the collection of pharmacovigilance data and more predictive of pharmacovigilance incidences. The pharmacovigilance system should have the capacity to detect and analyze subtle changes in reporting frequencies and in patterns of clinical symptoms and signs that are reported as suspected adverse drug reactions. The method involved carrying out a thorough literature review of the latest trends in pharmacovigilance employed by different regulatory agencies across the world, especially the more stringent regulatory authorities. A review of the system employed by the Pharmacy and Poisons Board of Kenya was also done. Pharmacovigilance data, both primary and secondary, were collected and reviewed. Media reports on adverse drug reactions and poor-quality medicines over the period were also collected and reviewed. An appropriate predictive pharmacovigilance tool was also researched and identified. It was found that the Pharmacy and Poisons Board had a robust system of collecting historical pharmacovigilance data both from the healthcare workers and the general public. However, a more responsive data collection and evaluation system is proposed that will help the agency achieve its pharmacovigilance objectives. On analysis of the data it was found that just above half of all the product complaints, about 55%, involved poor quality medicines; 15% poor performance, 13% presentation, 8% adverse drug reactions, 7% market authorization, 2% expired drugs and 1% adulteration complaints. A regulatory pharmacovigilance prioritization tool was identified, employing a risk impact analysis was proposed for regulatory action.
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