Access To Primary Care Research Articles

Global primary care research challenges

Healthcare needs are changing globally as people live longer, but not necessarily in better health. Increased population migration is leading to culturally diverse patient populations with more diverse health needs and expectations. The provision of accessible and equitable primary care poses workforce, infrastructure and management challenges for high- and lower-middle income countries that transcend national borders. In this special issue, we describe ‘global primary care’ as primary care training, research and service delivery that places a priority on the needs and overall health of individuals and their communities, to advance health equity worldwide. Given this nascent definition, what should ‘global primary care research’ look like? The following case demonstrates the breadth of physical, mental, and social issues a primary care practitioner must consider when faced with a patient from a marginalised group in an inner-city practice and why training and research must have a focus on equity.

(082) Integrated Urology and Primary Care Model Improves Outcomes for Men with Testosterone Deficiency

Abstract Introduction Testosterone deficiency affects approximately 4-5 million men in the United States. The bidirectional association between testosterone deficiency and metabolic syndrome has been well-established. The diagnosis of testosterone deficiency should serve as a trigger for medical evaluation of other comorbidities. Furthermore, male sex is an independent predictor of decreased routine health maintenance; men are 40% less likely to have a primary care provider (PCP) compared to women in the United States. Thus, many patients who present to the urologist for symptomatic testosterone deficiency might have undiagnosed or poorly managed comorbidities coupled with a lack of a PCP. Objective We sought to investigate the impact of offering primary care access within an integrated Men’s Health Center to men presenting for initial evaluation of symptomatic testosterone deficiency. Methods This is a retrospective single institution study. All new patients presenting with testosterone deficiency between October 2019 and October 2022 were offered evaluation by a PCP within a university-based Men’s Health Center. Patients who were seen by the PCP underwent standard health screening and blood work including a lipid profile, liver function testing, and diabetes screening with hemoglobin (Hgb) A1c. All data were collected from the electronic medical record and deidentified. Institutional review board (IRB) exemption was obtained. Variables collected for analysis included age, race, body mass index (BMI), testosterone level on presentation, prior access to a pre-existing PCP, and number of visits attended with our PCP. Outcomes measured include new diagnoses made by the PCP and referral patterns to other specialties. All statistical analysis was conducted utilizing SPSS version 28. Results 81 men were evaluated over the 3-year study period. Median age was 49.0 (range: 21.2-93.7 years). 48 men (59%) established continuity of care and were seen by our PCP for more than 1 visit. 33 men (41%) did not have a pre-existing PCP. Older men were significantly more likely to have a pre-existing PCP (OR 1.06 [95% CI: 1.02-1.10], p<0.001). Hispanic men were significantly less likely to have an existing PCP (OR 0.16 [95% CI: 0.03-0.84], p=0.01). Newly diagnosed comorbidities included hypertension (41%), obesity (37%), hyperlipidemia (27%), obstructive sleep apnea (OSA; 25%), depression (23%), and diabetes (14%). 41 patients (51%) were prescribed a new medication. 21 patients (26%) were referred to nutrition, with mean BMI decrease of 1.75. 26 patients (32%) underwent sleep medicine evaluation for OSA. 27 (33%) and 37 patients (46%) received a flu vaccination and immunization updates. 11 patients (14%) were referred for screening colonoscopy. Patients who established continuity of care were significantly more likely to be treated for a new diagnosis (p<0.001) and receive a flu vaccination (p=0.007; Table 1). Conclusions This is the first report of integrated primary care and urology evaluation for testosterone deficiency. This comprehensive model results in improved outcomes including increased access to subspecialty referrals, objective weight loss, treatment of new diagnoses, updated immunizations, and cancer screening. Further studies are needed to assess reproducibility across other institutions, cost-effectiveness of this model, and patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals.

Barriers and facilitators to digital primary health care access in immigrant and refugee populations: a scoping review

Barriers and facilitators to digital primary health care access in immigrant and refugee populations: a scoping review

Exploring the experiences and preferences of South Asian patients' of primary care in England since COVID-19.

Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operateon a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care. Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data. Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choiceand (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and 'hands-on' care leading to perceptions of reduced psycho-social safety. SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future. Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.

Evaluating the cost of NP-led vs. GP-led primary care in British Columbia.

In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC's NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC's new Longitudinal Family Physician (LFP) model. The analyses relied on administrative data, mostly from the Medical Services Plan (MSP) and Chronic Disease Registry (CDR) via BC's Health Data Platform. Results show the cost of NPs providing care in the NP-PCCs is slightly lower than what it would cost to provide similar care in medical clinics staffed by physicians paid through the LFP model. This suggests that the NP-PCC model is an efficient approach to increase accessibility to primary care services in BC and should be considered for expansion across the province.

Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research

BackgroundInterprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care.MethodsA narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation.ResultsData were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed.ConclusionsBarriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.

Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19

Primary care (PC) receipt is associated with better health outcomes. How telehealth expansion and internet speed are associated with PC use is unclear. To examine the association of telehealth and internet speed with PC use across sociodemographic determinants of health. This cohort study performed difference-in-differences regression of the change in in-person and telehealth PC visits between pre-COVID-19 public health emergency (PHE) (June 1, 2019, to February 29, 2020) and an initial (March 1, 2020, to May 31, 2020) and prolonged (March 1, 2020, to December 31, 2021) PHE period among continuously enrolled nonpregnant, nondisabled Wisconsin Medicaid beneficiaries aged 18 to 64 years. Data were analyzed from March 2022 to March 2023. PHE-induced telehealth expansion. Change in PC telehealth (using Current Procedural Terminology codes) visits: (1) count; (2) visit share completed by telehealth; (3) percentage of PHE-induced visit decline offset by telehealth. High-speed internet (HSI) defined as living in a census block group with a median block maximum download speed of 940 megabits per second or greater (June 2020 Federal Communications Commission broadband data); other census block groups classified as low-speed internet (LSI). In the total cohort of 172 387 participants, 102 989 (59.7%) were female, 103 848 (60.2%) were non-Hispanic White, 34 258 (19.9%) were non-Hispanic Black, 15 020 (8.7%) were Hispanic, 104 239 (60.5%) were aged 26 to 45 years, and 112 355 (66.0%) lived in urban counties. A total of 142 433 (82.6%) had access to HSI; 72 524 (42.1%) had a chronic condition. There was a mean (SD) of 0.138 (0.261) pre-PHE PC visits per month. In the pre-PHE period, visit rates were significantly higher for female than male participants, non-Hispanic White than non-Hispanic Black individuals, urban than rural residents, those with HSI than LSI, and patients with chronic disease than patients without. In the initial PHE period, female participants had a greater increase in telehealth visits than male participants (43.1%; 95% CI, 37.02%-49.18%; P < .001), share (2.20 percentage point difference [PPD]; 95% CI, 1.06-3.33 PPD; P < .001) and offset (6.81 PPD; 95% CI, 3.74-9.87 PPD; P < .001). Non-Hispanic Black participants had a greater increase in share than non-Hispanic White participants (5.44 PPD; 95% CI, 4.07-6.81 PPD; P < .001) and offset (15.22 PPD; 95% CI, 10.69-19.75 PPD; P < .001). Hispanic participants had a greater increase in telehealth visits than Non-Hispanic White participants (35.60%; 95% CI, 25.55%-45.64%; P < .001), share (8.50 PPD; 95% CI, 6.75-10.26 PPD; P < .001) and offset (12.93 PPD; 95% CI, 6.25-19.60 PPD; P < .001). Urban participants had a greater increase in telehealth visits than rural participants (63.87%; 95% CI, 52.62%-75.11%; P < .001), share (9.13 PPD; 95% CI, 7.84-10.42 PPD; P < .001), and offset (13.31 PPD; 95% CI; 9.62-16.99 PPD; P < .001). Participants with HSI had a greater increase in telehealth visits than those with LSI (55.23%; 95% CI, 42.26%-68.20%; P < .001), share (6.61 PPD; 95% CI, 5.00-8.23 PPD; P < .001), and offset (6.82 PPD; 95% CI, 2.15-11.49 PPD; P = .004). Participants with chronic disease had a greater increase in telehealth visits than those with none (188.07%; 95% CI, 175.27%-200.86%; P < .001), share (4.50 PPD; 95% CI, 3.58-5.42 PPD; P < .001), and offset (9.03 PPD; 95% CI, 6.01-12.04 PPD; P < .001). Prolonged PHE differences were similar. Differences persisted among those with HSI. In this cohort study of Wisconsin Medicaid beneficiaries, greater telehealth uptake occurred in groups with higher pre-PHE utilization, except for high uptake among Hispanic and non-Hispanic Black individuals despite low pre-PHE utilization. HSI did not moderate disparities. These findings suggest telehealth and HSI may boost PC receipt, but will generally not close utilization gaps.

Evolution of the availability of Information and Communication Technologies in primary health care in Brazil, 2012 to 2018.

To verify the evolution of the availability of information and communication technology equipment and inputs in primary health care services that participated in the external evaluation of the Access and Quality Improvement Program in Primary Care and its distribution according to context characteristics social and geographic. Cross-sectional study, analyzed the distribution of information and communication technology equipment in basic health units in Brazil, during the three cycles (2012 to 2018) of the Program for Improving Access and Quality in Primary Care. The variables were examined at the municipal level and stratified by geopolitical region. Univariate analysis was performed, using the chi-square test and testing the distributions of exposures among themselves and between the outcome and exposures. The availability of information and communication technology equipment increased from 9.4% (2012) to 17.5% (2018), with emphasis on the Southeast and South regions, in municipalities with a population size of up to 10,000 inhabitants², with greater family health coverage and high/very high HDI-M. Over the period from 2012 to 2018, basic units joined the program and increased availability of information and communication technologies, such as Internet access, which ranged from 45.2% (n=6,249) to 74.0% (n=21,423), with emphasis on the Northeast region, which increased from 19.1% (n=970) to 58.8% (n=7,087). Investment in technologies and constant evaluation of primary care in the country is necessary, contributing to its strengthening.

Acessibilidade aos serviços de Atenção Primária à Saúde em municípios rurais do Brasil

ABSTRACT This study aimed to analyze aspects of the structure of primary healthcare units and the organization of work processes within health teams, focusing on socio-organizational accessibility to Primary Health Care (PHC) services in rural municipalities in Brazil. This descriptive, cross-sectional study used data from the external evaluation instrument of the 3rd cycle of the National Program for Access and Quality Improving Access in Primary Care (PMAQ-AB), conducted in 2017. This instrument was, applied to 8,711 Family Health teams from 2,940 rural municipalities. The modules comprising this instrument were used as the basis for constructing the Logical Model and defining variables validated through consensus by researchers in the field. The data is presented in absolute frequencies and percentages. The results disclose aspects that interfere with the accessibility of individuals to the services, such as deficiencies in the physical structure of healthcare units; limited access to information technologies by professionals; scarce availability of immunobiologicals and diagnostic tests; and indications of issues in the teams’ work processes. Most small-sized Brazilian municipalities suffer a shortage of other levels of healthcare, including those located in remote and hard-to-reach areas find it difficult to retain professionals and suffer from other infrastructure deficiencies.

Qualidade da visita domiciliar do agente comunitário de saúde na atenção básica e fatores associados

Objective: to evaluate community health workers’ and quality of home visits associated factors. Method: a cross-sectional study of 38,865 teams and 140,444 Primary Care Access and Quality Improvement Program users. We established the “quality of home visits” and its association with the characteristics of the municipalities, teams and individuals, estimated by the prevalence ratio and 95% confidence intervals. Results: 139,362 (99.2%) users said the health team had community workers. The prevalence of quality was 51.9%. After adjustments, the prevalence was higher in the Northeast (Prevalence Ratio: 1.19 [1.18-1.21]), smaller municipalities (PR: 1.06 [1.03-1.09]), among teams with area definition (PR: 1.15 [1.06-1.25]), evaluation of indicators (PR: 1.14 [1.12-1.17]) and user satisfaction (PR: 1.11 [1.08-1.13]), that considered risk and vulnerability criteria for defining the number of people under responsibility (PR: 1.05 [1.04-1.07]) and without an uncovered population of workers (PR: 1.03 [1.01-1.04]); among users with chronic diseases (PR: 1.02 [1.01-1.05]) and with someone at home with walking difficulties (PR: 1.05 [1.02-1.07]). Conclusion: the importance of organizing the teams’ work process for the quality of the worker’s home visits and their role in health equity is highlighted.

Uneven geography of health opportunities among subsidized households: Illustrating healthcare accessibility and walkability for public rental housing in Seoul, Korea.

Planners and policymakers significantly consider providing suitable living environments for marginalized households, beyond creating affordable homes. Previous studies have explored various socioeconomic attributes of neighborhoods with public rental housing (PRH), particularly regarding education, job, and transportation opportunities; however, we have a limited understanding of health opportunities among such subsidized households. This study, therefore, explores the accessibility and spatial equity of emergency medical services (EMS) and primary health care (PHC) for PRH residents in Seoul, Korea. The findings show that neighborhoods with PRHs are associated with lower odds ratios for EMS and PHC accessibility. In particular, the relationships between the locations of PRHs and medical services accessibility in neighborhoods varied across the types of PRHs. While neighborhoods with large-scale PRHs are associated with lower PHC access, those with small-scale PRHs are associated with lower EMS access. In addition, our findings show that PRHs tend to be located in neighborhoods with lower walkability. These results may help in empirically determining the spatial accessibility of PHC and EMS, as well as neighborhood walkability, which may affect the health status of individuals in subsidized households.

Uso de prontuário eletrônico e parâmetros de acesso e acolhimento segundo dados do terceiro ciclo do PMAQ-AB

Abstract The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.

Use of electronic health records and primary health care accessibility according to data from the third cycle of the PMAQ-AB.

The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.

Actual questions of ensuring accessibility of primary health care for the adult population (review)

Actual questions of ensuring accessibility of primary health care for the adult population (review)

Experiences of access and use of primary health care by users with systemic arterial hypertension.

To identify and analyze users' perceptions of access and use of health services and actions to monitor Systemic Arterial Hypertension (SAH) in Primary Health Care (PHC). This is a qualitative, descriptive and exploratory study based on 38 semi-structured interviews conducted with users selected from Basic Health Units (BHUs) in a large municipality in the state of Rio de Janeiro. Thematic content analysis was used to identify the empirical categories. Users faced difficulties in scheduling appointments, accessing laboratory test results and medicines at the BHU. Home visits by Community Health Workers (CHWs) intermediated demands for appointments and tests. There were no health education activities and follow-up by the nursing team was residual. The doctor was the main reference, although links were weakened by turnover. The study identified the need to expand access to basic medicines and test results at the BHU, the role of nurses in promotional, preventive and clinical actions, the scope of CHWs' work in health education and interprofessional work.

Avaliação de estrutura da atenção primária à saúde materno-infantil. Roraima, região Norte e Brasil, 2012-2017

Abstract Primary healthcare is the main gateway and priority for healthcare management in Brazil. However, there are significant challenges in the quality of care, particularly for those most vulnerable, especially maternal and infant healthcare. This fact is exacerbated by regional inequalities, which have historically left the North and Northeast regions at a relative disadvantage. The study involves an analysis of the resources available for maternal and infant healthcare in the state of Roraima, the North region, and Brazil as a whole in 2012, 2014, and 2017, using data from Module I of the National Program for the Improvement of Access and Quality of Primary Care (PMAQ-AB). There was a significant improvement in physical infrastructure indicators (e.g., ventilation and air conditioning) as well as improvement in the distribution of supplies and equipment needed for maternal and infant care between 2014 and 2017. However, the availability of medicines and the number of human resources and hours worked diminished. The study offers a crucial longitudinal analysis, comparing the situation in Roraima and Brazil, whose findings could contribute to the development of programs and public policymaking for reproductive rights and maternal and infant health.

Characteristics of house calls in Brazil: analysis of PMAQ-AB external evaluation cycles.

To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.

Experiences of access and use of primary health care by users with systemic arterial hypertension

RESUMO Objetivo: Identificar e analisar a percepção dos usuários quanto ao acesso e uso dos serviços e ações de saúde para acompanhamento da Hipertensão Arterial Sistêmica (HAS) na Atenção Primária à Saúde (APS). Métodos: Estudo qualitativo, descritivo e exploratório, a partir de 38 entrevistas semiestruturadas realizadas com usuários selecionados em Unidades Básicas de Saúde (UBS) em município de grande porte, no estado do Rio de Janeiro. Foi utilizada a análise temática de conteúdo para identificação das categorias empíricas. Resultados: Os usuários enfrentavam dificuldades para marcação de consultas, acesso aos resultados dos exames laboratoriais e aos medicamentos nas UBS. As visitas domiciliares dos Agentes Comunitários de Saúde (ACS) intermediavam demandas de marcação de consultas e exames. Não ocorriam ações de educação em saúde e o acompanhamento pela equipe de enfermagem era residual. O médico era a principal referência, embora os vínculos estivessem fragilizados pela rotatividade. Conclusão: O estudo identificou necessidade de ampliar o acesso aos medicamentos básicos e resultados dos exames nas UBS, o papel dos enfermeiros nas ações promocionais, preventivas e clínicas, o escopo de atuação dos ACS na educação em saúde e o trabalho interprofissional.

Assessment of Awareness and Knowledge of Oral Potentially Malignant Disorders and Oral Cancer among Accredited Social Health Activist Workers from Randomly Selected Blocks of Thrissur District, Kerala, India: A Cross Sectional Study

Introduction: Oral and oropharyngeal cancers are prevalent in the head-and-neck region, with global rates decreasing. However, in India, they are rising due to a lack of knowledge about risk factors and symptoms. The Indian government launched the National Health Mission to provide accessible, affordable, and reliable primary health care. Accredited social health activist (ASHA) workers can link health services to rural people. This study aimed to evaluate the awareness level among these workers about potentially malignant oral disorders and oral cancer (OC). Materials and Methods: A predesigned semi-structured questionnaire-based descriptive cross-sectional study was conducted among 150 voluntary ASHA workers from randomly selected blocks of Thrissur district, Kerala, to collect the data. Results: Our study showed that the majority of ASHA workers (82.3%) were aware of the role of tobacco in OC. A substantial portion of workers (88.4%) expressed that early detection of OC is possible at its initial stage. Less than 10% (7.5%) of all the ASHA workers were educated by dentists, whereas almost three-quarters (75.5%) of ASHAs preferred primary health center health practitioners as primary representatives for early OC detection, despite their being poorly trained in the early diagnosis and detection of OC. Conclusion: India has made progress in controlling malignancies but still lags in reducing OC mortality rates. Spreading knowledge of contributory agents and early detection methods through ASHA workers could reduce the incidence and mortality of OC. Including more dentists in the public health system and training ASHA workers on early OC detection can play a major role in reducing its incidence.

The Doctor Dilemma: Improving Primary Care Access in Canada

The Doctor Dilemma: Improving Primary Care Access in Canada