Integrating a whānau-ora approach in primary care to mitigate the impact of syndemics: whānau and key informant views.

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

Handbook of Cognitive-Behavioural Approaches in Primary Care, by Robert A. DiTomasso, Barbara A. Golden, & Harry J. Morris (Eds.). New York, NY: Springer Publishing Company, 2011, 753 pages (ISBN 978-082610383-3, US $95.00 Hardcover) Reviewed by JEAN GRENIER DOI: 10.1037/O.0027784 Primary health care reform has been a major point of interest from various perspectives (clinical, healtii care, health policies, etc.) in many countries over the past 12 years. One of the premises of primary health care reforms across the world is the recognition that physical and mental healtii problems are more often than not intertwined and interact in complex and sometimes unknown ways. Left ignored, or addressed in silos, this complex mind- body connection or interaction often leads to physical and mental health problems that increasingly need to be addressed bodi from a physical as well as a mental health perspective. For this reason, there has been rising awareness that primary care physicians can benefit from collaborating with other health professionals such as psychologists, psychotherapists, mental health counsellors, and behavioural educators, and share the burden of healtii problems seen in primary care. Interprofessional collaboration and clinical best practices are two other major points of interest in primary care reforms. Interprofessional collaboration has been generally shown to improve some clinical outcomes and increase satisfaction with care for both patients and providers. It is hoped that the longer term impact of such collaboration amongst various health professionals with different expertise and scopes of practice will include not only better healtii outcomes for patients but also reduce costs to the healdi care system and society as a whole. As for best practices, one aim of reform is to increase population access to empirically supported treatments in primary care. This being said, early career as well as seasoned clinicians and scholars are not always sure as to how all of these knowledge bases get transferred and articulated efficiently in day-to-day practice. The Handbook of Cognitive-Behavioural Approaches in Primary Care takes these theoretical concepts, empirically supported knowledge bases, experiences in clinical healdi psychology and behavioural medicine, and the realities of primary care medical settings, and uses the solid judgment and accumulated wisdom of various author-contributors to help readers understand just how all of those elements can be efficiently integrated and articulated not only in day-to-day practice, but as part of a healdi practitioner's practice philosophy and professional identity. This volume is impressively comprehensive and covers a broad spectrum of theory, research, and practice issues related to the growing awareness of the mind-body connection in primary care. Its broad micro-to-macro spectrum spans from the individual patient level all the way up to professional and health care systems level, and up again to the level of societal access to empirically supported interventions in primary care and primary mental health care. As a psychologist and clinician-investigator, I teach and conduct research in a university-affiliated hospital and also provide psychological services in a Family Health Team in primary care. I wish to underline to potential readers that this book is very well written and comprehensive enough to stand on its own as an invaluable volume to health care practitioners who wish to develop a combination of broad as well as in-depth understanding of all of the pertinent issues related to the integration of medical and mental healdi care services and, more specifically, how empirically supported cognitive-behavioural approaches can be applied and tailored to a variety of presenting problems in the primary care setting. …

Research in primary care is not customary [1] although in the Nordic countries there have been efforts to enhance primary care research [2]. Special challenges are associated with research within general practice and primary care. Research has traditionally not promoted the general practitioner's (GP) or other professionals’ careers in primary care, thus demotivating research [3]. Further, primary care is usually not well connected to universities or other research units. Therefore, research training, support, and supervision may not be easily available. Although developmental projects are often appreciated in primary care, rigorous research projects are not commonly accepted in the busy working culture. However, there are several potentialities in primary care that could make research highly attractive [4]. Primary care has a wide range of unselected patients – from those with mild symptoms and early stages of diseases to those with chronic illnesses and multimorbidities. We have those “normal” patients on whom the common care guidelines should be implemented [5]. The working approach in primary care is comprehensive, coordinated, promoting continuity and it is simultaneously patient-centred and population-oriented. These approaches are markedly different from specialized care and should be highlighted. Consequently, there are multitudes of original research topics and representative materials available. Fortunately, the internet has brought researchers and supervisors closer to each other making networking easier. However, we do need a research culture, funding, and good networks of senior researchers in primary care to make it academic and more valued. At the University of Helsinki we have worked for several years with a multilevel strategy to promote primary care research. In 2002 the University of Helsinki entered into contracts with several communities to build a network, the Academic Health Center. The idea is to support and enable multidisciplinary research within primary health, combined with support from the university. The researchers identify research projects within their own area in primary care. A 12-module research course for professionals working in primary care was initiated in 2007, the aims being to prepare researchers to understand the methodology of clinical epidemiology and scientific thinking, to develop their own research plans, and to provide them with peer support. The courses are multidisciplinary including nurses, nutritionists, physiotherapists, and dentists in addition to primary care physicians. This has enriched the discussions and interactions. We also aim at identifying suitable supervisors for the participants. The ongoing course is our seventh and over 60 people have completed the course and developed their own research plans. We have also been able to help participants to get funding and grants for doing research. Researchers in the post-doctoral phase also need support. For this group we have arranged courses supporting their continued research including topics on how to supervise PhD students, how to make a good research plan, and how to apply for funding; the courses also offer support on their road towards docentships. This network has provided us with a network of senior researchers working in primary care who are capable of supervising PhD students and having an impact on research in primary care. At the moment our primary health care department is able to give support and supervise about 40 PhD students. Simultaneously, we have cooperated with primary health care and used it as a platform to perform randomized controlled trials. Our senior researchers have developed and tested care models that are especially suitable for primary health care including prevention of metabolic syndrome and gestational diabetes, the enhancement of self-management and self-efficacy in dementia families, exercise as rehabilitation in dementia, and psychosocial intervention for loneliness among older people. These care models, their implementation, and our network of researchers have provided visibility and recognition to research among health authorities. Further, networking with researchers in specialized care has provided academic recognition. In Finland, the updated Healthcare Act in 2011 stated that multidisciplinary research should be a task for health centres. This, along with a higher number of researchers and good research plans within primary health care, has resulted in more funding for primary care research. At the moment we are establishing a research network in the primary care sector of the metropolitan area of Finland. A research network has been emphasized to be a key factor to promote primary care research [5,6].

As governments attempt to focus more intently on how to deal with alarming measures of health disadvantage and inequities, a reformist gaze seems to have settled on the primary care sector. Simultaneously, in literature about this area, whether intended or not, primary health care and primary care are terms that are increasingly interchanged. This article argues that the slippage in language is counter-productive, first because it disguises the transformative potential of strategies and approaches that can make the fundamental changes necessary to improve health status, and second because the structures and practices of the primary care sector are not necessarily compatible with notions of comprehensive primary health care. There is much to be lost if primary health care and health promotion are disguised as primary care, and not understood for their capacity to make a difference to health inequities although of course in some circumstances, comprehensive primary health care is interdependent with services provided by primary care. In this article, characteristics of primary care and primary health care are juxtaposed to show that if the strengths and limitations of each model are understood, they can be mobilised in collaborative partnerships to deal more effectively with health inequities, than our system has so far been able to do.

In three primary health care clinics run by Médecins Sans Frontières in the informal settlement of Kibera, Nairobi, Kenya, we describe the caseload, management and treatment outcomes of patients with hypertension (HT) and/or diabetes mellitus (DM) receiving care from January 2010 to June 2012. Descriptive study using prospectively collected routine programme data. Overall, 1465 patients were registered in three clinics during the study period, of whom 87% were hypertensive only and 13% had DM with or without HT. Patients were predominantly female (71%) and the median age was 48 years. On admission, 24% of the patients were obese, with a body mass index (BMI) > 30 kg/m2. Overall, 55% of non-diabetic hypertensive patients reached their blood pressure (BP) target at 24 months. Only 28% of diabetic patients reached their BP target at 24 months. For non-diabetic patients, there was a significant decrease in BP between first consultation and 3 months of treatment, maintained over the 18-month period. Only 20% of diabetic patients with or without hypertension achieved glycaemic control. By the end of the study period,1003 (68%) patients were alive and in care, one (<1%) had died, eight (0.5%) had transferred out and 453 (31%) were lost to follow-up. Good management of HT and DM can be achieved in a primary care setting within an informal settlement. This model of intervention appears feasible to address the growing burden of non-communicable diseases in developing countries.

Introdução: O zumbido teve um aumento significativo de sua prevalência na última década e, conhecidamente, pode ter impacto negativo na qualidade de vida de seu portador. No entanto, ainda é pouco explorado no contexto da atenção básica. Objetivo: Evidenciar a escassez de literatura que aborde o zumbido no âmbito da atenção básica. Método: Foi realizada uma revisão de literatura, utilizando as bases de dado PubMed, Bireme, SciELO, Web of Science, Medline e Cochrane Library. Foram considerados os artigos publicados em inglês, português e espanhol e que abordassem o zumbido no contexto específico da atenção básica. Resultados: Foram encontrados 33 artigos, sendo que 10 cumpriram os critérios de inclusão. Os trabalhos selecionados evidenciam o impacto do zumbido na vida do indivíduo, a importância de sua abordagem na atenção básica, a necessidade da capacitação dos profissionais envolvidos na linha de cuidado e a relevância de se ter uma equipe multiprofissional. Conclusão: O zumbido é fator relevante no cuidado, sendo necessário fortalecer ações relacionadas na atenção básica e ampliar os estudos nesta área específica.

2005 APA Gold Award: Improving Treatment Engagement and Integrated Care of Veterans

This paper deals with the some of the important variable factors relating to health care in Saudi Arabia, with special emphasis on primary health. Other aspects considered are the financial influen...

Primary health care is not just a service delivery platform

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

BackgroundA team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania by exploring the experiences of teamwork by general practitioners (GPs) and community nurses (CNs) involved in PHC.MethodsSix focus groups were formed with 29 GPs and 27 CNs from the Kaunas Region of Lithuania. Discussions were recorded and transcribed verbatim. A thematic analysis of these data was then performed.ResultsThe analysis of focus group data identified six thematic categories related to teamwork in PHC: the structure of a PHC team, synergy among PHC team members, descriptions of roles and responsibilities of team members, competencies of PHC team members, communications between PHC team members and the organisational background for teamwork. These findings provide the basis for a discussion of a thematic model of teamwork that embraces formal, individual and organisational factors.ConclusionsThe need for effective teamwork in PHC is an issue receiving broad consensus; however, the process of teambuilding is often taken for granted in the PHC sector in Lithuania. This study suggests that both formal and individual behavioural factors should be targeted when aiming to strengthen PHC teams. Furthermore, this study underscores the need to provide explicit formal descriptions of the roles and responsibilities of PHC team members in Lithuania, which would include establishing clear professional boundaries. The training of team members is an essential component of the teambuilding process, but not sufficient by itself.

Editorial

Shoulder patients in primary and specialist health care. A cross-sectional study

Has traditional medicine had its day? The need to redefine academic medicine

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Pietrzykowska M, Nowicka-Sauer K, Siebert J. Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review. 2021;23(2):203-208. doi:10.5114/fmpcr.2021.105924. APA Pietrzykowska, M., Nowicka-Sauer, K., & Siebert, J. (2021). Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review, 23(2), 203-208. https://doi.org/10.5114/fmpcr.2021.105924 Chicago Pietrzykowska, Małgorzata, Katarzyna Nowicka-Sauer, and Janusz Siebert. 2021. "Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year". Family Medicine & Primary Care Review 23 (2): 203-208. doi:10.5114/fmpcr.2021.105924. Harvard Pietrzykowska, M., Nowicka-Sauer, K., and Siebert, J. (2021). Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review, 23(2), pp.203-208. https://doi.org/10.5114/fmpcr.2021.105924 MLA Pietrzykowska, Małgorzata et al. "Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year." Family Medicine & Primary Care Review, vol. 23, no. 2, 2021, pp. 203-208. doi:10.5114/fmpcr.2021.105924. Vancouver Pietrzykowska M, Nowicka-Sauer K, Siebert J. Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review. 2021;23(2):203-208. doi:10.5114/fmpcr.2021.105924.