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Journal articles on the topic 'Primary health care post'
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Coetzee, R. H., R. Simpson, and N. Greenberg. "Detecting Post-Deployment Mental Health Problems in Primary Care." Journal of the Royal Army Medical Corps 156, no. 3 (September 1, 2010): 196–99. http://dx.doi.org/10.1136/jramc-156-03-16.
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Brimkulov, Nurlan N., and Damilya S. Nugmanova. "The role of Astana primary health care declaration for development of primary health care at postsoviet countryes." Russian Family Doctor 23, no. 3 (November 19, 2019): 13–18. http://dx.doi.org/10.17816/rfd2019313-18.
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The article presents the goals, principles and results of the implementation of the Almaty Declaration of the World Health Organization (WHO) on primary health care (PHC) of 1978; the background and main provisions of the Astana Declaration of WHO on PHC 2018. The article presents the stages of PHC development in the USSR, which was characterized by the widespread introduction of narrow specialists at the primary level of health care, which subsequently had certain negative consequences. In a number of post-Soviet countries, the principles of General medical practice (family medicine) were implemented in health care reform, but some provisions of the Alma-Ata Declaration were introduced with distortions. This has led to a lack of effective functioning of the PHC system, a shortage of General practitioners, especially in rural areas. The implementation of the main principles of the new Astana Declaration will be important for the effective implementation of health care reforms in all post-Soviet countries.
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Wright, C., MK Nepal, and WDA Bruce-Jones. "Mental Health Patients in Primary Health Care Services in Nepal." Asia Pacific Journal of Public Health 3, no. 3 (July 1989): 224–30. http://dx.doi.org/10.1177/101053958900300309.
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Patients attending two primary care settings in Nepal (a village health post and a district hospital outpatient department) were screened for psychiatric morbidity using the Self Reporting Questionnaire. Approximately one-quarter of all patients screened were found to have psychiatric morbidity. Women presenting were found to have higher frequency of “psychiatric caseness” than men. All these psychiatric patients presented with physical complaints, none with psychological, and the most common physical symptoms presented were abdominal pain, headache and cough. Health worker recognition of these cases was 29% in the health post and 0% in the hospital. Conclusions are drawn regarding the need for sufficient and relevant psychiatric teaching in health worker curriculae
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Morikawa, M. J., S. Schneider, S. Becker, and S. Lipovac. "Primary care in post-conflict rural northern Afghanistan." Public Health 125, no. 1 (January 2011): 55–59. http://dx.doi.org/10.1016/j.puhe.2010.08.021.
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Rayan-Gharra, Nosaiba, Efrat Shadmi, Boaz Tadmor, Natalie Flaks-Manov, and Ran Balicer. "Meaningful post-discharge primary care visits and readmissions: Are primary care post discharge explanations associated with reduced risk for readmission?" International Journal of Integrated Care 18, s2 (October 23, 2018): 223. http://dx.doi.org/10.5334/ijic.s2223.
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Kirby, Magnus, Sue Anderson, Paul Bidwell, Ann Clarke, Hilary Cool, Mike Cressey, Alex Croom, et al. "Excavations at Musselburgh Primary Health Care Centre." Scottish Archaeological Internet Reports 89 (March 10, 2020): 1–153. http://dx.doi.org/10.9750/issn.2056-7421.2020.89.
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An excavation was undertaken by CFA Archaeology Ltd (CFA) between August and November 2010 on the site of the new Musselburgh Primary Health Care Centre. The site, which lies to the south of Inveresk Road, is centred on NGR 33430 67224. Until its demolition, the area had been occupied by Brunton Wireworks. The Scheduled Monument of Inveresk Roman Fort lies at the top of the steep slope c 50m to the south of the excavation site. The excavation identified six phases of activity on the site, the earliest being a Mesolithic flint scatter (Clarke & Kirby forthcoming). The area was used as a burial ground in the Iron Age and a ring ditch may also be of prehistoric date. Later, six Roman inhumation burials (four of which had been decapitated) and a horse burial were interred, and a possible Roman fortlet was constructed. Across the site, a network of interconnected ditches formed part of a Roman-period field system, which cut through the rampart of the possible fortlet, and through a number of the graves. Along the southern boundary of the site a large accumulation of Roman midden deposits overlay features associated with the field system, although it may have started to build up while the latter was still in use. A post-built structure was also found, one post of which cut a ditch of the field system. The midden deposits extended along the full length of the southern boundary of the site, measuring 110m long by up to 20m wide. Numerous artefacts were recovered, representing the rubbish and discarded personal belongings of the fort occupants. The pottery included samian bowls with personal names scratched on the bases. Evidence from these, together with isotopic analysis of the human skeletons, shows that the ethnic origin of those living in the fort was diverse, as would be expected for the Roman army.
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Soedirham, Oedojo. "Integrated Services Post (Posyandu) as Sociocultural Approach for Primary Health Care Issue." Kesmas: National Public Health Journal 7, no. 5 (December 1, 2012): 195. http://dx.doi.org/10.21109/kesmas.v7i5.40.
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The birth of Integrated services post (Posyandu) in 1980s is no doubt based on the effort of the Goverment of Indonesia to improve the health status of the population following the International call the Declaration of Alma-Ata (Kazakhstan) about Primary Health Care in 1978. The key concept of thedeclaration is community participation. In Indonesia specifically the community participation is called “gotong royong”. Community plays an important role in the improvement of their own health. To involve community in the health care, the volunteer has to be recruited and trained to recognize basic health care issues. The idea is that the volunteers that called village health worker (kader) as part of the community would be much easier to deliver health programs because they are closer to them compare to the public health officials.This paper is intended to discuss Posyandu which is basically a sociocultural approach for primary health care as a strategy to improve the health status of Indonesian people.Keywords: Posyandu, primary health care, sociocultural approachAbstrakKelahiran posyandu pada tahun 1980-an merupakan usaha pemerintah Indonesia untuk meningkatkan status kesehatan masyarakat, mengikuti panggilan internasional, Deklarasi Alma Ata (Kazakhstan) tentang kesehatan masyarakat tahun 1978. Konsep kunci deklarasi tersebut adalah partisipasi masyarakat. Di Indonesia, partisipasi masyarakat disebut “gotong royong”. Masyarakat memainkan peran penting dalam meningkatkankesehatan masing-masing. Untuk melibatkan masyarakat dalam kesehatan masyarakat, relawan harus direkrut dan dilatih untuk mengenal isu-isu kesehatan masyarakat dasar. Gagasan mengenai relawan yang disebut kader (village health worker) tersebut diajukan agar relawan sebagai bagian darimasyarakat dapat lebih mudah menyampaikan program-program kesehatan karena lebih dekat dibandingkan pejabat kesehatan masyarakat. Di dalam artikel ini dibahas tentang Posyandu yang pada dasarnya merupakan pendekatan sosiokultural dalam pelayanan kesehatan masyarakat sebagai strategi untuk meningkatkan status kesehatan masyarakat Indonesia.Kata kunci: Posyandu, pelayanan kesehatan dasar, pendekatan sosiokultural
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Kordsmeier, Julia A., Christopher Ty Williams, and Angelina Anthamatten. "Teamwork and Oral Health in Diabetes Care." Journal of Doctoral Nursing Practice 13, no. 1 (February 26, 2020): 17–24. http://dx.doi.org/10.1891/2380-9418.13.1.17.
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BackgroundThe integration of oral health into primary care is often limited, despite its significant connection with many diseases, including diabetes mellitus (DM).ObjectiveThis project aimed to develop, implement, and evaluate an oral health education program for medical assistants (MAs) to increase oral health knowledge and enhance practice using standardized oral health screening questions for patients with DM.MethodsA nurse practitioner-led oral health program was implemented. Medical assistants completed a pre-test and post-test to assess oral health knowledge, a pre-survey and post-survey to assess likelihood of performing screening questions, and a post-implementation survey to assess barriers.ResultsAnalyses of pre-test and post-test results using the Wilcoxon matched pairs signed rank test (two-tailed) showed a significant increase in correct answers on the post-test (W = 0, N = 8, p ≤ 0.05), with the mean score increasing from 81% to 95%. In addition, the MAs' likelihood of asking screening questions increased and 62.5% reported no barriers to implementation after 1 week.ConclusionsAll participants demonstrated an increase in knowledge and likelihood of using screening questions.Implications for NursingAn oral health program using a team approach to equip MAs with training offers a practical method to incorporate evidence-based recommendations into primary care.
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Liseckiene, Ida, Wienke G. W. Boerma, Zemyna Milasauskiene, Leonas Valius, Irena Miseviciene, and Peter P. Groenewegen. "Primary care in a post-communist country 10 years later." Health Policy 83, no. 1 (September 2007): 105–13. http://dx.doi.org/10.1016/j.healthpol.2006.11.011.
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McHugh, Patrick, Michael Gordon, and Michael Byrne. "Evaluating brief cognitive behavioural therapy within primary care." Mental Health Review Journal 19, no. 3 (September 2, 2014): 196–206. http://dx.doi.org/10.1108/mhrj-02-2014-0004.
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Purpose – The purpose of this paper is to evaluate the clinical effectiveness of a brief CBT intervention within a primary care adult mental health service. Design/methodology/approach – In total, 92 participants with mild to moderate mental health difficulties were provided with five sessions of brief CBT. Clinical improvement was measured using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, mid-treatment and post-treatment, and on the Beck Depression Inventory-II (BDI-II) at pre-treatment and post-treatment. Findings – The planned five sessions of CBT were completed by 48.9 percent (n=45) of participants. Treatment completers with full clinical data (n=31) showed large statistically significant improvements on the CORE-OM and BDI-II from pre-therapy to post-therapy. Of treatment completers and non-completers with post-therapy and mid-therapy CORE-OM data, respectively (n=34), 61.8 percent showed reliable and clinically significant change. No statistically significant differences were found between treatment completers (n=45) and non-completers (n=47) in their pre-therapy clinical scores or socio-demographic characteristics. Practical implications – Brief CBT can be a clinically effective primary care intervention but needs to be implemented in a way that ensures high treatment engagement across a range of service users. Originality/value – This paper contributes to the evidence base of a primary care psychological intervention and demonstrates the importance of assessing treatment completion when evaluating clinical effectiveness.
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Siniscalchi, Kimberly A., Marion E. Broome, Jason Fish, Joseph Ventimiglia, Julie Thompson, Pratibha Roy, Ronny Pipes, and Madhukar Trivedi. "Depression Screening and Measurement-Based Care in Primary Care." Journal of Primary Care & Community Health 11 (January 2020): 215013272093126. http://dx.doi.org/10.1177/2150132720931261.
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The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.
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Howard, Susan J., Rebecca Elvey, Julius Ohrnberger, Alex J. Turner, Laura Anselmi, Anne-Marie Martindale, and Tom Blakeman. "Post-discharge care following acute kidney injury: quality improvement in primary care." BMJ Open Quality 9, no. 4 (December 2020): e000891. http://dx.doi.org/10.1136/bmjoq-2019-000891.
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BackgroundOver the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI.DesignWe conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI.ResultsAKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality.ConclusionThe findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.
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Bolaños-Carmona, Victoria, Ricardo Ocaña-Riola, Alexandra Prados-Torres, and Pilar Gutiérrez-Cuadra. "Variations in health services utilization by primary care patients." Health Services Management Research 15, no. 2 (May 1, 2002): 116–25. http://dx.doi.org/10.1258/0951484021912888.
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This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.
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Bhanu, Cini, Mary Elizabeth Jones, Kate Walters, Irene Petersen, and Claudia Cooper. "Routine health monitoring and preventative care for people with dementia in UK primary care." British Journal of General Practice 69, suppl 1 (June 2019): bjgp19X703097. http://dx.doi.org/10.3399/bjgp19x703097.
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BackgroundUK National Dementia Strategies prioritise fair access to dementia treatment for all. It has been shown that people from black and minority ethnic (BME) groups are diagnosed later and those are less likely to receive anti-dementia medication.AimIt is hypothesised that access to primary care services post diagnosis is also reduced in ethnic minority groups.MethodThe Health Improvement Network (THIN) database of UK primary care records was analysed between 2015 and 2016, all patients with dementia were identified, and health service use was compared. Annual GP consultations, blood pressure (BP), weight/body mass index (BMI), Quality and Outcomes Framework (QOF) dementia review, and flu vaccination recordings were compared between ethnic groups.ResultsOver 20 000 individuals with a dementia diagnosis aged 50–105 years were included. There was no significant difference between white, black, and Asian groups across all outcomes. Overall 80% received an annual BP check, 86% received at least one annual GP consultation, 68% received an annual dementia review, and 48% had a weight/BMI recorded. People with dementia who did not have cardiovascular risk factors were less likely to have their BP checked (59%) and be seen by a GP.ConclusionThere do not appear to be ethnic inequalities in primary care service use post-dementia diagnosis. The overall proportion receiving an annual dementia review and weight check was low, despite recommendations that a care plan should be reviewed annually (including nutrition as a key priority). Post-diagnosis support and preventative care should be prioritised in general practice for all people living with dementia.
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Arroll, Bruce, GM Allan, C. Raina Elley, Tim Kenealy, James McCormack, Ben Hudson, and Karen Hoare. "Viewpoint: Diagnosis in primary care: probabilistic reasoning." Journal of Primary Health Care 4, no. 2 (2012): 166. http://dx.doi.org/10.1071/hc12166.
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This article develops the concept of probabilistic reasoning as one of the techniques clinicians use in making a diagnosis. We develop the concept that every question and every examination is a diagnostic test ultimately leading to a rule in or rule out of a diagnosis. We also develop the concept of pre-test probability pointing out that false positive tests are an issue in low-prevalence settings and false negative tests are a problem. Investigative tests work best in medium-prevalence settings. The purpose of taking a history and conducting an examination is to increase the pre-test probability to a point where either treatment is commenced or more expensive/time-consuming/dangerous tests are indicated. Pre-test probabilities on their own can be used to rule out conditions. We also show how pre-test probabilities relate to the Fagan nomogram which enables visualisation of large changes in post-test probabilities which can lead to treatment/further investigation. KEYWORDS: Likelihood ratio; pre-test and post-test probability; diagnostic accuracy; probabilistic reasoning
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Sorocco, Kristen, Joseph Mignogna, Michael R. Kauth, Natalie Hundt, Melinda A. Stanley, Elyse Thakur, Chelsea G. Ratcliff, and Jeffrey A. Cully. "Online CBT training for mental health providers in primary care." Journal of Mental Health Training, Education and Practice 13, no. 4 (July 9, 2018): 228–37. http://dx.doi.org/10.1108/jmhtep-08-2017-0049.
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Purpose The purpose of study was to assess the impact of an online training program for a brief cognitive-behavioral therapy (CBT) that integrated physical health management designed for use by mental health providers in the primary care setting. Design/methodology/approach In total, 19 providers from two Veterans Health Administration (VHA) medical centers completed online training as part of a larger trial. Statistical analyses compared provider self-reported CBT knowledge and abilities at pretraining, posttraining, and long-term follow-up. Additionally, data were collected on providers’ experiences of the training. Findings Providers’ baseline to post-training scores improved on general CBT knowledge and ability, as well as across 11 CBT principles and techniques. Post-training scores were maintained over time. Research limitations/implications A small sample size, sole focus on VHA data, and reliance on self-report measures are limitations of the study. Practical implications Qualitative data suggested training was feasible, acceptable, and potentially scalable; however, a one-size-fits-all approach may not be ideal. Originality/value Online training has potential for providing wider access to providers with limited access to traditional face-to-face training.
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Moon, J. Robin, and Amanda Falick Ascher. "Post–COVID-19 Health Care System: A Call for Community-Based, Person-Centered, and Primary Care–Driven Care." American Journal of Public Health 111, no. 8 (August 2021): 1451–55. http://dx.doi.org/10.2105/ajph.2021.306160.
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Royce, Trevor J., Gavin P. Jones, Vinayak Muralidhar, Mudit Chowdhary, and George M. Holmes. "US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019." Journal of Graduate Medical Education 13, no. 3 (June 1, 2021): 385–89. http://dx.doi.org/10.4300/jgme-d-20-00941.1.
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ABSTRACT Background Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. Objective We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. Methods Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001–2010, vs post-ACA, 2011–2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. Results Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). Conclusions We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.
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Arbogast, Kristy B., Allison E. Curry, Kristina B. Metzger, Ronni S. Kessler, Jeneita M. Bell, Juliet Haarbauer-Krupa, Mark R. Zonfrillo, Matthew J. Breiding, and Christina L. Master. "Improving Primary Care Provider Practices in Youth Concussion Management." Clinical Pediatrics 56, no. 9 (May 19, 2017): 854–65. http://dx.doi.org/10.1177/0009922817709555.
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Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care–based intervention including an electronic health record–based clinical decision support tool (“SmartSet”) and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.
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Homan, Fay F., Cristina S. Hammond, Ellen F. Thompson, Donald O. Kollisch, and James C. Strickler. "Post-Conflict Transition and Sustainability in Kosovo: Establishing Primary Healthcare-Based Antenatal Care." Prehospital and Disaster Medicine 25, no. 1 (February 2010): 28–33. http://dx.doi.org/10.1017/s1049023x00007627.
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AbstractIntroduction:Kosovo is a post-conflict nation with an extensively damaged infrastructure, a weak primary care base, and poor maternal-child health outcomes. The Kosovo-Dartmouth Alliance for Healthy Newborns (the Alliance) sought to improve maternal and neonatal health in Kosovo by providing family medicine-based antenatal care (ANC).Methods:The ANC Program used a modification of the World Health Organization's four-visit, prenatal care model. The program is based in family medicine and requires minimal medical equipment, such as a blood pressure cuff, fetal doppler, measuring tape, urine dipstick, and charting materials. Patient education and counseling are stressed. Women are taught about danger signs in pregnancy and establishing an emergency plan, so that they can respond promptly if complications occur. Antenatal care doctors and nurses are trained to refer women to obstetricians for deviations from normal pregnancy. The providers are taught using a “Training of Trainers” approach, building on an existing system of family medicine trainers. In order to address challenges in implementation and sustainability, microsystems methodology is used to focus on implementing change and assuring quality improvement through shared decision-making and the study of outcomes.Results:Based on chart reviews and direct observation, ANC providers showed mastery of the components of ANC, including physical examination, recognition and referral of high-risk pregnancies, and patient education. After an initial pilot project, Kosovo's Ministry of Health recommended this program for dissemination throughout the country. During the next year, ANC was implemented at 27 Family Medicine Centers in nine municipalities; 1,671 women were seen for a total of 3,399 visits. Currently, the Alliance's model of ANC is offered in 30% of Kosovo's municipalities.Discussion:International aid projects often lack attention to long-term sustainability. Microsystems training gives participants the tools and framework to implement and sustain change, even after international support is withdrawn.Conclusions:The Alliance's model of family medicine-based ANC is simple to teach and emphasizes sustainability. It may be modified for use in different cultures and healthcare systems and offers the opportunity to improve maternal and infant health by providing low cost antenatal care, available in a woman's own community.
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Andersen, N. A. "Primary Care in Australia." International Journal of Health Services 16, no. 2 (April 1986): 199–212. http://dx.doi.org/10.2190/3l1k-c30d-j5af-2ajn.
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The Australian health care delivery system is reviewed in this article, with special comment on the implications of the financial components of the system and government concerns regarding costs and over-servicing. General practitioners' perception of their role is not significantly different from the expectation of patients, yet the reality may not match the idealized view. There are problems related to availability and there are developments which seem to pose some threat to the continuing care of patients. New developments have occurred in the way in which practice is organized which give an emphasis to continual availability over 24 hour periods, and these developments pose a challenge to the way in which doctors have organized their practices. Population features-Aborigines, migrants, and the elderly-present significant problems that are not always well met, and the concept of total patient care thereby suffers. The general practitioner's apparent failure to fill the expected role in co-ordination of services is discussed, as is the need for general practitioners to become more actively involved in health education and promotion. The hope for the future lies in the Family Medicine Programme of The Royal Australian College of General Practitioners, which represents a major attempt to provide appropriate vocational training for general practice.
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Richardson, Anna, and Jeffrey Gage. "What influences practice nurses to participate in post-registration education?" Journal of Primary Health Care 2, no. 2 (2010): 142. http://dx.doi.org/10.1071/hc10142.
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INTRODUCTION: There is a need for educated primary health nurses to develop their practice, educational and career pathways in response to opportunities emerging from the Primary Health Care Strategy (PHCS). This study aimed to explore the opportunities and constraints encountered by practice nurses when participating in post-registration education. METHODS: This study used exploratory qualitative design, incorporating focus group interviews with 16 practice nurses employed by Pegasus Health, Christchurch. Qualitative thematic analysis used a general inductive approach. FINDINGS: Seven key themes emerged, including motivation to learn, enablers for learning and challenges to accessing education. Practice nurses also described their changing roles with clients and their vision for practice nursing in the future. CONCLUSION: This study considered accessibility of post-registration education for practice nurses and the extent to which they are embracing these opportunities in order to meet their practice needs. The PHCS states that primary health care nursing is crucial to its implementation. Successful expansion of primary health care nursing roles rests on the development of educational qualifications and skills, as well as career frameworks. It is envisaged that, with strong leadership and research skills resulting from professional development, practice nurses will be more able to reduce health inequalities. Study findings indicate that practice nurses are rising to the challenge of expanding their roles and engaging in post-registration education. They are more likely to pursue this if constraints are minimised and support increased. Currently practice nurses make significant contributions to primary health care and have the potential for an even greater contribution in the future. KEYWORDS: Nurses; practice nursing; nursing education, post-registration; New Zealand
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Bista, Bihungam, D. Rai, RA Sagtani, and SS Budhathoki. "Utilization pattern of health care services at a peripheral health care facility of Nepal." Health Renaissance 13, no. 2 (June 20, 2017): 160–63. http://dx.doi.org/10.3126/hren.v13i2.17566.
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Background: In Nepal, basic health care services at the grass root level are delivered by Subhealth Posts (SHPs) and Health Posts (HPs). The basic aim of these institutions is to deliver essential health care services. In accordance of the Alma Ata declaration on primary health care (PHC) Government of Nepal (GoN) adopted free health care policy on 2006 A.D. to make basic health care services accessible, affordable and available. Thus, SHPs and HPs offer free of cost services to every Nepali citizen. The current study was conducted with the aim of finding utilization pattern of health care services in a peripheral level institution of Sunsari District.Methods: A descriptive study was carried out in Panchkanaya, a sub- health post of Sunsari district utilizing both qualitative and quantitative methods. Data was collected through face to face structured interviews with fifty patients and an in depth interview with in charge of the sub health post. Furthermore, secondary data from records of Health Management Information System (HMIS) of Nepal were also utilized.Results: Out of total patients, most of them were female (67.4%) and majority of patients were from higher age group (>50years).Most of the patients were involved with agriculture as their occupation. Regarding accessibility of health services, most of the respondents could reach sub- health post via walking within 15 minutes. Fifty percent of the patients were satisfied with services provided by the sub-health post. From qualitative aspect, health careservices were under utilized by the people from the northern side of VDC due to inappropriate location of the health post.Conclusion: Health care services were easily accessible although only fifty percent of patients were satisfied by the services.Health Renaissance 2015;13(2): 160-163
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Li, Hua, Angela Bowen, Michael Szafron, John Moraros, and Nazeem Muhajarine. "Maternal mental health: a shared care approach." Primary Health Care Research & Development 17, no. 02 (June 17, 2015): 175–83. http://dx.doi.org/10.1017/s146342361500033x.
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BackgroundMaternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems.AimThe purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians).MethodsWe used a pre and post cross-sectional study design to evaluate women’s depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program.FindingsDepression and anxiety symptoms significantly improved with involvement with the program. Women and physicians reported high levels of satisfaction with the program. Physician knowledge and confidence treating maternal mental health problems improved.ConclusionsShared care can be an effective and efficient way to provide maternal mental health care in primary health care settings where resources are limited.
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O'Hanlon, Katherine P., and Boris Budosan. "Post-Disaster Recovery: A Case Study of Human Resource Deployment in the Health Sector in Post-Conflict Kosovo." Prehospital and Disaster Medicine 26, no. 1 (February 2011): 7–14. http://dx.doi.org/10.1017/s1049023x10000051.
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AbstractIntroduction: A professional understanding of disasters, paired with the need for health service development, can provide opportunities for the recovery and improvement of the health sector. Investment in training capacity ranks among the top priorities of a recovering health sector. The recovery and development of primary healthcare delivery systems has been implemented by various international and local health players in the aftermath of conflicts around the world. However, human resource development in the post-conflict environment has not been evaluated and/or published appropriately in the medical literature.Objective: In this retrospective, descriptive study, the authors describe the strategy and evaluate the effectiveness of a field-based training program for primary healthcare doctors implemented by the US-based international non-governmental organization, the International Medical Corps, after the conflict in Kosovo in 1999.Methods: A six-month, comprehensive education and training program on primary healthcare issues was delivered to 134 Kosovar primary healthcare physicians in 10 Kosovo municipalities in 1999 and 2000. Qualitative and quantitative data were collected. The qualitative methods included open-ended, semi-structured, key informant interviews, structured focus groups, and unstructured participant observations. The quantitative method was multiple-choice knowledge tests.Results: The education and training program proved to be culturally appropriate and well-accepted by local communities. The program met its overall objective to refresh the knowledge of primary care doctors on various primary healthcare issues and set the stage for further strengthening and development of primary health services and their required human resources in Kosovo.Conclusions: The comprehensive education and training of primary healthcare doctors in Kosovo was a feasible, much appreciated, and effective intervention implemented in a difficult post-conflict environment. This training was one of the early steps in the modernization of primary healthcare services in Kosovo. Later, primary health care was strengthened by the introduction of a Department of Family Medicine at the university, which includes a residency program. The intervention described in this study has the potential to be reproduced in other post-disaster environments, especially in resource-poor settings with long-time troubled health sectors in developing countries.
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Savageau, Judith A., Linda Cragin, Warren J. Ferguson, Laura Sefton, and Joan Pernice. "Recruitment and Retention of Community Health Center Primary Care Physicians post MA Health Care Reform: 2008 vs. 2013 Physician Surveys." Journal of Health Care for the Poor and Underserved 27, no. 3 (2016): 1011–32. http://dx.doi.org/10.1353/hpu.2016.0106.
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Shrestha, Shumneva, Randhir Sagar Yadav, and Satish Kumar Deo. "Burgeoning Irrational Antibiotics use in Primary Health Care in Nepal." Journal of Nepal Health Research Council 16, no. 41 (January 28, 2019): 473–75. http://dx.doi.org/10.33314/jnhrc.v16i41.1273.
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Rational use of drugs has immense impact on quality health care. Developing nations have 80% essential drug list prescription. Even though WHO estimates 15-25% antibiotics prescription in these regions, majority of Nepalese patients are prescribed more than one antibiotic in addition to inappropriate prescription in 10%-42% patients.Moreover, Nepal stands as a leading antibiotics prescribing Asian nation. Escalating irrational prescription and excessive over the counter use of antibiotics at peripheral regions of Nepal is possibly leading the emergence of multidrug resistant bacteria.Organisms like S. pneumoniae, K. pneumoniae, Salmonella spp., E. coli, N. gonorrhea, MRSA are rapidly developing first-line, second-line and multi-drug resistance in Nepal. Antimicrobial resistance is the biggest global health concern of the present day threatening the emergence of post antibiotic era. Timely intervention is must to safeguard future generation.Keywords: Antimicrobial resistance; irrational prescription; primary health care.
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Agil, Hilda Meriyandah, Rina Veronica, and Tjipto Rini. "Correlation of Laboratory Experts’ Performances in Primary Health Care (Puskesmas) and Patience Perception." Journal of Public Health Research and Community Health Development 2, no. 2 (April 1, 2019): 135. http://dx.doi.org/10.20473/jphrecode.v2i2.12041.
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Background: Health laboratory services are an integral part of health services to the community and expected to provide accurate information in each stage: pre-analytic, analytic and post-analytic.Aims: This study aimed to determine the relationship between laboratory experts’ performances in Puskesmas against community perceptions conducted in 24 Puskesmas in Surabaya with a sample of 30 laboratory experts and 30 communities.Methods: This is a multivariate analysis research and data was obtained from the questionnaires given to the respondents and then performed data analysis using Pearson correlation.Results: The results indicated there was a significant relationship between the performance of laboratory experts with the perception of the community (ρ = 0.001). There is a relationship between the pre-analytic stage performance (ρ = 0.002), the analytic stage (ρ = 0.004) and post-analytic (ρ = 0.007).Conclusion: Based on the performance appraisal of laboratory personnel in the Puskesmas including significant pre-analytic, analytic and post-analytic activities on public perceptions there was a significant relationship, and the most significant relationship was found at the pre-analytic stage.
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Cheung, Kung, Swati Mehta, Amanda McIntyre, Dalton Wolfe, and Robert Teasell. "Poster 97 Patterns of Health Care Utilization in Primary Care Settings and Rehospitalization Post-Spinal Cord Injury." Archives of Physical Medicine and Rehabilitation 93, no. 10 (October 2012): e42. http://dx.doi.org/10.1016/j.apmr.2012.08.133.
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Chaudhary, Ramanand, and BK Karn. "Maternal and neonatal health skills of nurses working in primary health care centre of Eastern Nepal." Health Renaissance 13, no. 1 (August 6, 2017): 30–39. http://dx.doi.org/10.3126/hren.v13i1.17945.
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Background: Nepal has one of the world’s highest maternal and neonatal mortality. In Nepal, 73% of delivery is take place at home without trained attendant. Delivery by trained persons is 27% which reflects the need for attention of women's health in particular reproductive health.Objective: To assess knowledge and performance skills of nurses regarding maternal and neonatal health.Methods: Descriptive analytical study was carried out on nurses working in selected primary health care center of eastern region of Nepal. Random sampling technique was used to select 10 PHC and purposive sampling technique was used to select nurses in different primary health care center. Nurses were interviewed using pre-designed questionnaire and performance skill check list. Collected data were entered in SPSS 10.5 software package and analyzed.Results: The study showed that knowledge of auxillary nurse midwife/staff nurse was satisfactory in antenatal, intra-natal and post natal care of mother while they were relatively poor in newborn resuscitation. ANM/staff nurses showed very poor skills i.e. only 16.7%, 36.7% and 7% were competent in providing antenatal, intra-natal and post natal care respectively. Unfortunately none were found to be competent in newborn resuscitation.Conclusion: Birth handling competence levels are generally low in ANM/Staff nurses working in PHCCs Health Renaissance 2015;13 (1): 30-39
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Wang, Xin, Kuimeng Song, Lijin Chen, Yixiang Huang, and Stephen Birch. "Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up." International Journal of Environmental Research and Public Health 18, no. 16 (August 5, 2021): 8317. http://dx.doi.org/10.3390/ijerph18168317.
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Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.
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Wong, Edwin S., Matthew L. Maciejewski, Paul L. Hebert, Adam Batten, Karin M. Nelson, Stephan D. Fihn, and Chuan-Fen Liu. "Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use?" Medical Care Research and Review 75, no. 1 (September 20, 2016): 33–45. http://dx.doi.org/10.1177/1077558716669432.
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Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre–post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA–Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.
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Swavely, Deborah, David T. O’Gurek, Veronica Whyte, Alexandra Schieber, Daohai Yu, Allen Y. Tien, and Susan L. Freeman. "Primary Care Practice Redesign: Challenges in Improving Behavioral Health Care for a Vulnerable Patient Population." American Journal of Medical Quality 35, no. 2 (June 21, 2019): 101–9. http://dx.doi.org/10.1177/1062860619855136.
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This study examined a program focused on integrating mental health in a family medicine practice in an economically challenged urban setting. The program included using a behavioral health technology platform, a behavioral health collaborative composed of community mental health agencies, and a community health worker (CHW). Of the 202 patients screened, 196 were used for analysis; 56% were positive for anxiety, 38% had scores consistent with moderate to severe depression, and 34% were positive for post-traumatic stress disorder. There was a statistically significant difference in the diagnosis of depression when comparing the screened group to a control group. Only 27% of patients followed through with behavioral health referrals despite navigational assistance provided by a CHW and assured access to care through a community agency engaged with the Behavioral Health Alliance. Further qualitative analysis revealed that there were complex patient factors that affected patient decision making regarding follow-up with behavioral health care.
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Chaput, Genevieve, Kristin Hendricks, Vinita D'Souza, Sarah Khan, and Laura Naismith. "Survivorship workshop delivery to primary care providers." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 2. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.2.
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2 Background: There are approximately 15 million cancer survivors (CS) in North America. In addition to higher risk of recurrence, over 50% of CS are afflicted with late effects. CS are burdened with more medical conditions than the general population. CS visit specialists during treatment, and 75% of them also see their primary care provider (PCP) during and after treatments. Despite their integral role in survivorship care, PCP lack survivorship knowledge and have low confidence regarding CS care, supporting the urgent need to educate them about CS issues and surveillance needs. This study aimed to assess the educational benefit of a survivorship workshop targeting PCP in Montreal, Canada. Methods: An accredited workshop based on NCCN’s 8 common survivor issues was developed and delivered to 155 PCP at 5 sites. Matched pre and post surveys were designed using Likert scale and short-answer questions, and were completed on a voluntary basis by PCP. Specific outcome measures were based on the first 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behaviour. Data analysis included an open-coding approach to identify major themes of qualitative data. Ethics approval was granted. Results: Response rate was 64%. 95% indicated high satisfaction and relevancy of content for primary care. Using t-tests to compare pre and post responses, results were statistically significant for both “list 2 standards of survivorship” and “name 2 late-effects of cancer treatment” survey items, indicating an increase in both standards and late effects identified post workshop. 99% expressed behavioural intent to incorporate survivorship information into practice. Conclusions: Much research has focused on identifying PCP barriers to optimal survivorship care delivery such as limited topic proficiency, yet further efforts are warranted to close that knowledge gap. Our findings revealed increased knowledge of CS issues and surveillance needs post workshop. 3 months survey data is being collected to evaluate for actual practice changes and willingness to manage specific CS issues (i.e. treating depression). A second workshop targeting cardiovascular health promotion interventions has been created: delivery is anticipated early 2016.
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Bajracharya, Sumana, Ashis Shrestha, and Rose House. "Newborn and Child Health Care in Humanitarian Crisis Settings: Piloting of Training Package for Primary Health Care Workers in Rural Nepal." Prehospital and Disaster Medicine 34, s1 (May 2019): s32—s33. http://dx.doi.org/10.1017/s1049023x19000839.
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Introduction:The community-based integrated management of newborn and childhood illness (CBIMNCI) training package has been widely used throughout Nepal. Adding a component of disaster response and management to this program would greatly impact the community, and could improve the knowledge and skills of community workers for the management of children during a disaster.Aim:Describe the development and implementation of a community-based training for children in disasters.Methods:Using expertise from emergency and pediatric emergency physicians, pediatricians, and psychiatrists, we developed a two-day training and facilitator manual covering topics such as trauma, resuscitation, burn, drowning, disaster, nutrition, and care of the newborn. The information and manuals were presented to the Nepal Division of Child Health for approval. Four pilot trainings were conducted in Bardia and Bardibas in Nepal in September 2017, including knowledge and skill-based sessions. Knowledge was tested pre- and post-training using multiple choice questions (MCQ) and self-reflections. Skills were evaluated by direct observation and marked using a Likert scale. Confidence was assessed using a confidence matrix before and after the course. Overall feedback was taken at the end of the session.Results:Of 82 participants, 74 participants from four trainings were included for analysis. Post-test Cronbach’s alpha for MCQ was 0.82 and the confidence matrix was 0.86. Mean score for the pre-test MCQ was 6.12 (SD 2.22) compared to the post-test mean of 10.97 (SD 2.97), which was a statistically significant improvement (p<0.05). Trainees reported that the trauma teaching was helpful. They felt that it improved confidence regarding trauma and disasters.Discussion:Adding this training to current CBIMNCI can be an effective tool to reach out to primary health care workers, and provide further knowledge and skills on care of children during a disaster or humanitarian crisis.
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TAUBMAN-BEN-ARI, O., J. RABINOWITZ, D. FELDMAN, and R. VATURI. "Post-traumatic stress disorder in primary-care settings: prevalence and physicians' detection." Psychological Medicine 31, no. 3 (April 2001): 555–60. http://dx.doi.org/10.1017/s0033291701003658.
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Background. Little is known about the prevalence of PTSD in primary-care settings and regarding the ability of primary-care physicians to detect PTSD. The current study examines prevalence of PTSD in a national sample of primary-care attenders and primary-care physicians' detection of PTSD and general psychological distress in PTSD patients.Methods. Data are from a national study of 2975 primary-care attenders in Israel. Demographic data, responses to the GHQ-28, PTSD Inventory and physicians' diagnoses were examined.Results. Twenty-three per cent of all patients who attended clinics (N=684) reported traumatic events, 39% of whom (males 37%, females 40%) met criteria for PTSD on the PTSD Inventory. Eighty per cent of the males and 92% of the females with PTSD were distressed according to the GHQ. According to physicians, 37% of persons who reported trauma (40% of the women, 32% of the men) suffered from psychological distress. Only 2% of patients meeting PTSD criteria on the self-report measure were given a diagnoses of PTSD by physicians.Conclusions. Many primary-care patients suffer from PTSD, which is usually accompanied by major psychological distress. Attention by primary-care physicians to a history of trauma could improve physicians' detection of this disabling disorder.
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Connolly, Anne. "Post-coital bleeding." InnovAiT: Education and inspiration for general practice 11, no. 2 (January 24, 2018): 90–95. http://dx.doi.org/10.1177/1755738017742173.
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Post-coital bleeding is a frequent presentation in primary care, and one that causes concern to women, their sexual partners and health care professionals. Causes include trauma to a cervical ectropion, or cervicitis secondary to chlamydial infection, however, cervical cancer can present with post-coital bleeding. There are no national guidelines for the management of post-coital bleeding, however, cervical examination is essential to exclude serious cervical pathology and may require fast track colposcopy referral before considering other investigations and treatment. This article provides a framework for history taking, examination, initial investigations and recommendations for colposcopy referral.
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Kennedy, Jonathan Donald, Serena Moran, Sue Garrett, James Stanley, Jenny Visser, and Eileen McKinlay. "Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study." BJGP Open 4, no. 1 (February 18, 2020): bjgpopen20X101013. http://dx.doi.org/10.3399/bjgpopen20x101013.
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BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.
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Oliphant, Nicholas Paul, Nicolas Ray, Khaled Bensaid, Adama Ouedraogo, Asma Yaroh Gali, Oumarou Habi, Ibrahim Maazou, et al. "Optimising geographical accessibility to primary health care: a geospatial analysis of community health posts and community health workers in Niger." BMJ Global Health 6, no. 6 (June 2021): e005238. http://dx.doi.org/10.1136/bmjgh-2021-005238.
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BackgroundLittle is known about the contribution of community health posts and community health workers (CHWs) to geographical accessibility of primary healthcare (PHC) services at community level and strategies for optimising geographical accessibility to these services.MethodsUsing a complete georeferenced census of community health posts and CHWs in Niger and other high-resolution spatial datasets, we modelled travel times to community health posts and CHWs between 2000 and 2013, accounting for training, commodities and maximum population capacity. We estimated additional CHWs needed to optimise geographical accessibility of the population beyond the reach of the existing community health post network. We assessed the efficiency of geographical targeting of the existing community health post network compared with networks designed to optimise geographical targeting of the estimated population, under-5 deaths and Plasmodium falciparum malaria cases.ResultsThe per cent of the population within 60-minute walking to the nearest community health post with a CHW increased from 0.0% to 17.5% between 2000 and 2013. An estimated 10.4 million people (58.5%) remained beyond a 60-minute catchment of community health posts. Optimal deployment of 7741 additional CHWs could increase geographical coverage from 41.5% to 82.9%. Geographical targeting of the existing community health post network was inefficient but optimised networks could improve efficiency by 32.3%–47.1%, depending on targeting metric.InterpretationsWe provide the first estimates of geographical accessibility to community health posts and CHWs at national scale in Niger, highlighting improvements between 2000 and 2013, geographies where gaps remained and approaches for optimising geographical accessibility to PHC services at community level.
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Irani, Ninin. "Analysis Relationship Family Support and Health Cadre with Elderly Hypertension Practice in Controlling Health at Primary Health Care Mranggen Demak." South East Asia Nursing Research 1, no. 1 (June 23, 2019): 7. http://dx.doi.org/10.26714/seanr.1.1.2019.7-13.
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Hypertension is a major risk factor for cardiovascular disease which is the leading cause of death in Indonesia. Data Research Department of Health in 2005, showed hypertension and cardiovascular disease is still quite high and even tends to increase with the lifestyle that much of the behavior of healthy and clean life, high cost of treatment of hypertension, erroneous perception of the public accompanied by a lack of safety facilities hypertension , Hypertension is actually a disease that can be prevented if the risk factors can be controlled and healthy behaviors (healthy behavior) which practices or activities related to efforts to maintain, control and improve health. Data from Demak district health department, the incidence of hypertension has increased within the last three years. The aim of this study was to determine the relationship of family support and cadres with elderly Hypertension practices in controlling health in Puskesmas Mranggen, Demak by using a cross-sectional study with a quantitative approach. The sample size for a quantitative approach is 285 respondents (total sampling). The data were analyzed using univariate, bivariate with chi-square. The results showed an association between family support for elderly people who suffer from hypertension with the practice of elderly hypertension in controlling health (p = 0.048), there is a relationship between support for health workers to the elderly who suffer from hypertension with Practice elderly hypertension in controlling health (p = 0.049). Advice to the puskesmas officers in order to improve the quality of health care, home visits, provide health education particularly on controlling health benefits for elderly hypertension and cross-sectoral cooperation in the implementation of an integrated program of coaching post (posbindu) elderly.
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Paulsen, T. E., T. C. M. Lee, S. M. Tollman, and A. McKenzie. "Evaluating a post-graduate diploma in primary health care education (DPHCE): Issues and interpretations." Evaluation and Program Planning 18, no. 4 (October 1995): 385–89. http://dx.doi.org/10.1016/0149-7189(95)00028-3.
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Duckett, Stephen. "What should primary care look like after the COVID-19 pandemic?" Australian Journal of Primary Health 26, no. 3 (2020): 207. http://dx.doi.org/10.1071/py20095.
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The response to COVID-19 transformed primary care: new telehealth items were added to the Medicare Benefits Schedule, and their use quickly escalated, general practices and community health centres developed new ways of working and patients embraced the changes. As new coronavirus infections plummet and governments contemplate lifting spatial distancing restrictions, attention should turn to the transition out of pandemic mode. Some good things happened during the pandemic, including the rapid introduction of the new telehealth items. The post-pandemic health system should learn from the COVID-19 changes and create a new normal.
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Owen, Randall, Caitlin Crabb, Kaitlin Stober, Dale Mitchell, Kiyoshi Yamaki, and Tamar Heller. "Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care." Journal of Disability Policy Studies 31, no. 2 (October 5, 2019): 67–76. http://dx.doi.org/10.1177/1044207319880278.
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The objective of this study was to determine whether seniors and disabled adults in Illinois’s Medicaid managed care (MMC) were more likely to see, maintain longitudinal relationships with, and have continuity of care with a primary care provider (PCP) compared with fee-for-service (FFS) Medicaid enrollees. Medicaid PCP service claims for 13,221 MMC and 54,625 FFS enrollees were analyzed using an inverse propensity score weighted difference-in-differences design to match the groups by demographic characteristics and historical Medicaid utilization. All data came from Medicaid claims data and corresponding administrative records. Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP. However, FFS enrollees were more likely to maintain a relationship with their PCP providers from the pre-period through the post-period. Therefore, while more people in MMC than FFS visit a PCP each year, for people in MMC, it is often a new provider relationship, which can be problematic for people with disabilities. Additional training for PCPs, to prepare them for working with people with disabilities, and additional efforts to expand the MMC network of providers are needed.
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Wahyuningtyas, Sheilla Mufidha, Endang Sri Lestari, Jojok Mukono, and Endro Sukmono. "The Impact of Environmental Health Services in Primary Health Care on Improving the Behavior of Pulmonary Tuberculosis Patients in Banyuwangi Regency." JURNAL KESEHATAN LINGKUNGAN 12, no. 3 (July 29, 2020): 181. http://dx.doi.org/10.20473/jkl.v12i3.2020.181-188.
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Introduction: Tuberculosis (TB) is a global health crisis. Environmental health services in Primary health care provide counseling services, inspections and environmental health interventions. Research aims to determine the impact of environmental health services in Primary health care on the behavior of TB patients that includes the knowledge, attitudes and actions of pulmonary tuberculosis patients in the prevention of the transmission of pulmonary tuberculosis disease. Method: The method in this study was experimental quasi. Respondents were a new case of pulmonary TB at 6 Primary health care in Banyuwangi Regency April S/d June 2019. Pre test before obtaining environmental health services. Post test was given after counseling, inspection and environmental health intervention. Result and Discussion: The results showed a total of 24 respondents to the majority pulmonary tuberculosis patient was male (54.17%). Pre test knowledge of pulmonary TB patient is good (4.16%), enough (8.33%) and less (87.50%). Category Post test knowledge of TB patients acquired good (20.83%), sufficient category (75.00%) and less (4.20%). The average Pre test knowledge score is 37.70 and the Post test is 67.20. Category Prettest Action patients TB is good (4.16%) and less (95.83%). Category Post Test action patients pulmonary TB is good (54.17%), enough (41.67%) and less (4.16%) Which is an improvement in the form of masks, hand washing soap, the habit of spitting, the use of individual cutlery and drinking equipment, washing dinnerware and drinking with hot water/drying, drying the sleeping tools, opening a window every day, separate sleeping habits. Conclusion: The conclusion of this research is environmental health services in Primary health care in patients with pulmonary tuberculosis improves the behavior of TB patients in the form of increased knowledge, attitudes and actions of the patient in the prevention of disease transmission of TB.
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Frost, Rachael, Kate Walters, Su Aw, Greta Brunskill, Jane Wilcock, Louise Robinson, Martin Knapp, et al. "Effectiveness of different post-diagnostic dementia care models delivered by primary care: a systematic review." British Journal of General Practice 70, no. 695 (May 18, 2020): e434-e441. http://dx.doi.org/10.3399/bjgp20x710165.
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BackgroundGlobal policy recommendations suggest a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered.AimTo assess the effectiveness and cost-effectiveness of primary care-based models of post-diagnostic dementia care.Design and settingA systematic review of trials and economic evaluations of post-diagnostic dementia care interventions where primary care was substantially involved in care plan decision making.MethodSearches were undertaken of MEDLINE, PsychINFO, EMBASE, Web of Science, and CINAHL (from inception to March 2019). Two authors independently critically appraised studies and inductively classified interventions into types of care models. Random effects meta-analysis or narrative synthesis was conducted for each model where appropriate.ResultsFrom 4506 unique references and 357 full texts, 23 papers were included from 10 trials of nine interventions, delivered in four countries. Four types of care models were identified. Primary care provider (PCP)-led care (n = 1) led to better caregiver mental health and reduced hospital and memory clinic costs compared with memory clinics. PCP-led care with specialist consulting support (n = 2) did not have additional effects on clinical outcomes or costs over usual primary care. PCP–case management partnership models (n = 6) offered the most promise, with impact on neuropsychiatric symptoms, caregiver burden, distress and mastery, and healthcare costs. Integrated primary care memory clinics (n = 1) had limited evidence for improved quality of life and cost-effectiveness compared with memory clinics.ConclusionPartnership models may impact on some clinical outcomes and healthcare costs. More rigorous evaluation of promising primary care-led care models is needed.
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Levin, W., D. R. Campbell, K. B. McGovern, J. M. Gau, D. B. Kosty, J. R. Seeley, and P. M. Lewinsohn. "A computer-assisted depression intervention in primary care." Psychological Medicine 41, no. 7 (October 20, 2010): 1373–83. http://dx.doi.org/10.1017/s0033291710001935.
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BackgroundThe clinical benefit for depression of an interactive computer-assisted cognitive-behavioral program on CD-ROM, the Wellness Workshop (WW), was evaluated in a randomized controlled trial.MethodA total of 191 individuals referred by primary-care physicians were randomly assigned to a control group, where physician-directed treatment as usual (TAU) was provided, or to a treatment group, where TAU was supplemented with the WW CD-ROM, delivered by mail (WW+TAU). Data were collected at baseline, at 6 weeks' post-intervention, and at a 6-month follow-up assessment. Participants were given a strong incentive by a reimbursement of $75 for completion of each assessment. Measures included symptom ratings obtained via structured clinical diagnostic interviews, as well as a battery of self-report questionnaires on symptoms specifically targeted by the intervention.ResultsAnalysis of results demonstrated evidence for skill acquisition for improving dysfunctional thinking and reducing anxiety. Among those who met diagnostic criteria for depression, WW+TAU participants were three times more likely to remit at 6 weeks' post-test than TAU participants.ConclusionsThe evidence supports the conclusion that the WW intervention added benefit to traditional care for depression. No placebo comparison group was included and the WW+TAU participants received slightly more attention (a supportive telephone contact, ⩽5 min from a psychologist 2 weeks after receiving the program). Overall, the findings add support to the accumulating evidence for the potential clinical benefit of computer-assisted behavioral health interventions.
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Cape, J., J. Leibowitz, C. Whittington, C. A. Espie, and S. Pilling. "Group cognitive behavioural treatment for insomnia in primary care: a randomized controlled trial." Psychological Medicine 46, no. 5 (December 16, 2015): 1015–25. http://dx.doi.org/10.1017/s0033291715002561.
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BackgroundInsomnia disorder is common and often co-morbid with mental health conditions. Cognitive behavioural therapy (CBT) for insomnia is effective, but is rarely implemented as a discrete treatment. The aim of this study was to evaluate the effectiveness of brief CBT groups for insomnia compared to treatment as usual (TAU) for insomnia delivered by mental health practitioners in a primary-care mental health service.MethodA total of 239 participants were randomized to either a five-session CBT group or to TAU. Assessments of sleep and of symptoms of depression and anxiety were carried out at baseline, post-treatment and at 20 weeks. Primary outcome was sleep efficiency post-treatment.ResultsGroup CBT participants had better sleep outcomes post-treatment than those receiving TAU [sleep efficiency standardized mean difference 0.63, 95% confidence interval (CI) 0.34–0.92]. The effect at 20 weeks was smaller with a wide confidence interval (0.27, 95% CI −0.03 to 0.56). There were no important differences between groups at either follow-up period in symptoms of anxiety or depression.ConclusionsDedicated CBT group treatment for insomnia improves sleep more than treating sleep as an adjunct to other mental health treatment.
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Sun, Virginia, Anne Reb, Marc Debay, Marwan Fakih, and Betty Ferrell. "Rationale and Design of a Telehealth Self-Management, Shared Care Intervention for Post-treatment Survivors of Lung and Colorectal Cancer." Journal of Cancer Education 36, no. 2 (January 8, 2021): 414–20. http://dx.doi.org/10.1007/s13187-021-01958-8.
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AbstractSurvivors of lung and colorectal cancer have high post-treatment needs; the majority are older and suffer from greater comorbidities and poor quality of life (QOL). They remain underrepresented in research, leading to significant disparities in post-treatment outcomes. Personalized post-treatment follow-up care and care coordination among healthcare teams is a priority for survivors of lung and colorectal cancer. However, there are few evidence-based interventions that address survivors’ post-treatment needs beyond the use of a follow-up care plan. This paper describes the rationale and design of an evidence-informed telehealth intervention that integrates shared care coordination between oncology/primary care and self-management skills building to empower post-treatment survivors of lung and colorectal cancer. The intervention design was informed by (1) contemporary published evidence on cancer survivorship, (2) our previous research in lung and colorectal cancer survivorship, (3) the chronic care self-management model (CCM), and (4) shared post-treatment follow-up care between oncology and primary care. A two-arm, parallel randomized controlled trial will determine the efficacy of the telehealth intervention to improve cancer care delivery and survivor-specific outcomes. ClinicalTrials.govIdentifier: NCT04428905
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Desta, Seare Hadush, and Shaik Yousuf Basha. "The Role of Health Extension Workers in Primary Health Care in AsgedeTsi'mbla District: A Case of Lim'at T'abya Health Post." International Journal of Social Sciences and Management 4, no. 4 (October 30, 2017): 248–66. http://dx.doi.org/10.3126/ijssm.v4i4.18504.
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Health Extension Workers are the health service providers to the community in delivering integrated preventive, promotive and basic curative health services. Hitherto no studies have been carried out in Lim ‘at T’abya health post focusing on the role of health extension workers. Thus the researcher has randomly selected 263 participants in order to achieve the intended objectives of the study. The researcher used both quantitative and qualitative approaches. The result of the study identified the major Health Extension Program services which are delivered by Health Extension Workers in the health post to seek malaria treatment, child immunization and Antenatal Care followed by Postnatal Care, family planning, referral for delivery, diarrhea treatment and health education. The challenges of Health Extension Workers hindering their performance for the unsuccessful health service provision identified as strong societal cultural beliefs, remoteness, poor relation with supervisors, communication system and road construction, low remuneration, lack of refresher courses and improper attention by Qebelle administrators to health agendas. Attitude of community towards Health Extension Workers communication skill, quality of service provision and social behaviors is over all positive but the following up of referred patients and the skill to diagnosing community health problems that Health Extension Workers need to work sensitively which are answered negatively by the respondents. To increase community’s health post utilization, health posts should be equipped with minimum essential medical equipment with particular focus on malaria treatments, family planning, deliver, treatment of common illnesses and immunization services in the study area.Int. J. Soc. Sc. Manage. Vol. 4, Issue-4: 248-266
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Daly, Barbara, Bruce Arroll, Nicolette Sheridan, Timothy Kenealy, and Robert Scragg. "Characteristics of nurses providing diabetes community and outpatient care in Auckland." Journal of Primary Health Care 5, no. 1 (2013): 19. http://dx.doi.org/10.1071/hc13019.
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INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 20062008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. KEYWORDS: Community health nursing; diabetes mellitus; internet; nurses; primary health care