Adults In Primary Health Care Research Articles

Caregivers' Experience of Decision-Making regarding Diagnostic Assessment following Cognitive Screening of Older Adults.

Targeted screening for dementia among older adults in primary healthcare has potential benefits such as better clinical outcomes and the opportunity to access services. Cognitive screening can be followed up by further diagnostic assessment to determine a diagnosis of dementia. Unfortunately, the rates of accepting further diagnostic assessment following cognitive screening are low. The objective of this study was to explore the caregivers' decision-making process regarding uptake of diagnostic assessment following positive screening results. A qualitative design was employed, and interpretative phenomenological analysis was used to analyze the data. Three major themes in caregiver decision-making were identified: gathering information, protecting the patient, and balancing obligation and convenience in caregiving. These findings suggest that the decision-making process involved effort to process information through observations of the patient and that caregivers emphasized quality of life.

Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria.

Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem. To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications - EU (7)-PIM List. This is a cross-sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)-PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohen's kappa coefficient. A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)-PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)-PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)-PIM List. Logistic regression showed association of PIM use with polypharmacy, self-reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self-perception of health. The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.

Wellbeing and older adults in primary health care in Poland.

The Polish health service is in need of improvement because of the increasing number of geriatric patients. Identifying the resources available to patients is important for ameliorating deficits. The goal of this research was to measure the health and wellbeing of seniors and to investigate to what extent health services meet their needs. Differences in access and scope of received services between patients from different localities (i.e villages, small towns and big cities) were analysed. Questionnaires (Satisfaction with Life Scale; VAS Numeric Pain Distress Scale) and a structured interview assessing the quality of healthcare were carried out in 2015 on a sample of 459 seniors. Each candidate gave consent for participation in the study. Statistica 12.5 software was used for analyses. The overall measure of satisfaction with life of the respondents (M=22.34 SD=5.78) was good. Inhabitants of small towns had a significantly lower sense of quality of life than seniors from big cities (Tukey HSD = 0.047, p<.05). Multimorbidity and polypharmacy were present to a limited extent. The issue of discrimination of older individuals by medical personnel affected a fifth of seniors living in villages, and one- third of those living in big cities. Geriatric patients did not have equal opportunities for access to medical services. State-provided geriatric care is insufficient and does not meet the real needs of patients. A holistic care approach and/or individualized care for older adults are often indicated but are only theoretical constructs in Poland. This inefficient system places the burden of caregiving on the family of the ageing patient. Anxiety among geriatric patients is growing regarding exclusion and lack of care.

Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care.

To validate and standardize the Brazilian version of the Medication Regimen Complexity Index (MRCI) for older adults in primary healthcare. A cross-sectional methodological study was carried out with elderly patients attending primary healthcare centers in southeastern Brazil. Convergent validity was tested by correlating MRCI scores with medication number. Divergent validity was tested by correlating MRCI scores with age, sex, cognition, and basic and instrumental activities of daily living. Reliability was assessed by interrater and test-retest reliability. Regarding standardization, percentiles were calculated for the total MRCI scores. A total of 227 older adults were included, with a mean age of 71.4 years (standard deviation 7.5 years) and mostly women (70.9%). There was a correlation between MRCI scores and medication number (rho = 0.890; P = 0.000). There was no correlation between MRCI scores and age (P = 0.192), sex (P = 0.052), cognition (P = 0.369), and basic (P = 0.682) and instrumental (P = 0.582) activities of daily living. High interrater (intraclass correlation coefficient = 0.98; rho = 0.991) and test-retest (intraclass correlation coefficient = 0.996; rho = 0.985) reliability was obtained. The following complexity was considered: low, MRCI ≤ 9.0 points; average 0.9 < MRCI ≤ 16.5 points; and high, MRCI > 16.5 points. MRCI showed satisfactory psychometric qualities for measuring regimen complexity of older adults attending the primary healthcare centers evaluated. Standardization might increase the applicability of MRCI to the health research context. Geriatr Gerontol Int 2018; 18: 853-859.

Nursing Minimum Data Sets for documenting nutritional care for adults in primary healthcare: a scoping review.

To identify all published nutritional screening instruments that have been validated in the adult population in primary healthcare settings and to report on their psychometric validity. Within health care, there is an urgent need for the systematic collection of nursing care data in order to make visible what nurses do and to facilitate comparison, quality assurance, management, research and funding of nursing care. To be effective, nursing records should accurately and comprehensively document all required information to support safe and high quality care of patients. However, this process of documentation has been criticized from many perspectives as being highly inadequate. A Nursing Minimum Data Set within the nutritional area in primary health care could therefore be beneficial in order to support nurses in their daily documentation and observation of patients. The review considered studies that included adults aged over 18 years of any gender, culture, diagnosis and ethnicity, as well as nutritional experts, patients and their relatives. The concepts of interest were: the nature and content of any nutritional screening tools validated (regardless of the type of validation) in the adult population in primary healthcare; and the views and opinions of eligible participants regarding the appropriateness of nutritional assessment were the concept of interest. Studies included must have been conducted in primary healthcare settings, both within home care and nursing home facilities. This scoping review used a two-step approach as a preliminary step to the subsequent development of a Nursing Minimum Data Set within the nutritional area in primary healthcare: i) a systematic literature search of existing nutritional screening tools validated in primary health care; and ii) a systematic literature search on nutritional experts opinions on the assessment of nutritional nursing care of adults in primary healthcare as well as the views of patients and their relatives. Multiple databases (PubMed, CINAHL, Embase, Scopus, Swemed+, MedNar, CDC, MEDION, Health Technology Assessment Database, TRIP database, NTIS, ProQuest Dissertations and Theses, Google Scholar, Current Contents) were searched from their inception to September 2016. The results from the studies were extracted using pre-developed extraction tools to all three questions, and have been presented narratively and by using figures to support the text. Twenty-nine nutritional screening tools that were validated within a primary care setting, and two documents on consensus statements regarding expert opinion were identified. No studies on the patients or relatives views were identified. The nutritional screening instruments have solely been validated in an over-55 population. Construct validity was the type of validation most frequently used in the validation process covering a total of 25 of the 29 tools. Two studies were identified in relation to the third review question. These two documents are both consensus statement documents developed by experts within the geriatric and nutritional care field. Overall, experts find it appropriate to: i) conduct a comprehensive geriatric assessment, ii) use a validated nutritional screening instrument, and iii) conduct a history and clinical diagnosis, physical examination and dietary assessment when assessing primarily the elderly's nutritional status in primary health care.

Salbutamol Prescribing in Primary Care May Represent Undiagnosed Heart Failure

Aim: Salbutamol, a beta-2 agonist inhaler, is commonly prescribed in primary health care for adults with dyspnoea, wheeze and cough thought to be due to respiratory causes, but the diagnosis may be uncertain. Salbutamol prescription may indicate an increased risk of hospital admission for new heart failure (HF) Method: From a cohort of ∼5 million primary care patients, HF cases were defined as any patient with a first hospital admission for HF between 2008 and 2014. Control patients with no diagnosis of HF were matched 1: 4-5 based on age, gender and timing of the primary care encounter. The index date was the date of hospital admission for HF cases and their matched controls. The National Pharmaceutical Collection identified all medications prescribed ≤90 days, and new medications prescribed ≤30 days prior to the index date. Odds Ratios (OR) for risk of HF were calculated for salbutamol prescription for all HF cases compared to controls, and stratified by comorbidities. Logistic regression was used to calculate ORs adjusted for comorbidities. Results:Tabled 1HF CasesControlsORAdjusted ORn = 62,164n = 276,223(95% CI)*P<0.001 for all.(95% CI)*P<0.001 for all.Salbutamol dispensed ≤90 days9,538(15.3%)13,160(4.8%)3.6(3.5-3.7)2.5(2.4-2.6)Risk-associated with salbutamol use over prior 90 days and comorbidityAtrial fibrillation1,079(1.7%)461(0.2%)10.6(9.5-11.8)4.0(3.5-4.5)Coronary artery disease915(1.5%)460(0.2%)9.0(8.0-10.0)2.9(2.6-3.3)Chronic kidney disease970(1.6%)499(0.2%)8.8(7.9-9.8)2.8(2.5-3.2)New prescription for salbutamol ≤30 days1,393(2.2%)931(0.3%)6.8(6.2-7.4)6.0(5.5-6.6)* P < 0.001 for all. Open table in a new tab Conclusion: Salbutamol prescription in primary care was associated with an increased risk of hospital admission for HF, particularly following a new prescription.

The Relationship between Perceived Social Support and Quality of Life of Older Adults with Hypertension in Tangerang

The aging population is a common situation in developing countries caused by the successful health care outcome. However, the increasing prevalence of chronic diseases, such as hypertension is the impact of physical deterioration caused by the aging process. Older adults with hypertension require social support as a source of external support to help maintain health, which could affect the quality of life. A cross-sectional study was used by recruiting 71 older adults in primary health care in Tangerang. The standardized questionnaires, including the Multidimensional Scale of Perceived Social Support (MSPSS) and World Health Organization Quality of Life (WHOQOL) -BREF were provided based upon validity and reliability. Statistical analysis was conducted by employing the Pearson Product-Moment coefficient correlation. The result showed that perceived social support was significantly positively correlated with the quality of life of older adults with hypertension. In conclusion, this study suggests that maintaining social support from family, friends, and significant other needs to be considered in achieving a better quality of life for older adults with hypertension. Keywords: Older Adult, Hypertension, Social Support, Quality of Life.

Management and prevalence of long‐term conditions in primary health care for adults with intellectual disabilities compared with the general population: A population‐based cohort study

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n=764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses. Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%-100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation. Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.

Pilot Evaluation of a Dementia Case Finding Clinical Service Using the Informant AD8 for At-Risk Older Adults in Primary Health Care: A Brief Report

BackgroundAn AD8 cut-off score of ≥4 has been reported to successfully detect 90% of dementia cases in elderly patients aged 75 years and above. ObjectiveWe investigated the benefits of a pilot clinical service conducted in primary care that used the AD8 to identify patients with dementia in an at-risk population. MethodPatients ≥75 years of age were recruited from a primary health care center in Singapore. Trained nurses administered the AD8 to informants of eligible patients. Patients screened positive (AD8 score ≥4) were referred to specialist memory clinics by primary health care physicians for further evaluation. ResultsOf the 551 eligible patients in the primary health care center, 168 (30.5%) consented and the AD8 was administered to their informants. Among the recruited patients, 23 (13.7%) were screened positive and 7 (30.4%) of them accepted referrals to specialist memory clinics. The clinical diagnoses for these patients were as follows: no cognitive impairment (NCI) (n = 1), cognitive impairment no dementia (CIND) (n = 5), and dementia (n = 1). Most of the (98.8%) nurses found AD8 user-friendly and could track functional decline. Eighteen of the 23 (78.3%) primary health care physicians who referred patients to specialist memory clinics considered the AD8 useful for facilitating referrals. The remaining physicians (21.7%) preferred performance-based tests. ConclusionThe AD8 is easily administered by nurses and useful to a majority of primary health care physicians to generate referrals. However, physician preference for performance-based tests and a lower prevalence of dementia in the at-risk population may indicate the need to consider a “2-pronged assessment approach” that combines both performance-based and informant-based brief tests to reduce false positive rates and better detect dementia.

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol.

REVIEW QUESTION / OBJECTIVE The primary objective of the scoping review is to identify all published nutritional screening instruments that have been validated in the adult population in primary healthcare settings and to report on their psychometric validity. The scoping review will also seek to include published evidence from the perspective of relevant experts in the field as to what is viewed as appropriate to assess in relation to nutritional care for adults in primary healthcare. Furthermore, published evidence of adult patients’ and their relatives’ views of nutritional assessment and documentation will also be sought for inclusion. Review question 1: What nutritional screening instruments have been validated for use for the adult population in primary healthcare settings? Review question 2: What is the psychometric validity of these nutritional screenings tools? Review question 3: What do nutritional experts, patients and their relatives find appropriate to assess in relation to the nutritional status of adults in primary healthcare? In this scoping review, the term “appropriate” refers to what patients, their relatives and experts consider as “suitable” or “meaningful” to assess in relation to the nutritional status of adults. INCLUSION CRITERIA Types of participants For Question 1 and 2, this scoping review will seek to include studies with participants who are adults (aged 18 years and over) of any sex, culture, diagnoses and ethnicity. For Question 3, studies will be sought that report on the views and opinions of nutritional experts as well as the views of patients (defined above) and their relatives.TRUNCATED AT 250 WORD

Examining the prevalence and patterns of multimorbidity in Canadian primary healthcare: a methodologic protocol using a national electronic medical record database.

In many developed countries, the burden of disease has shifted from acute to long-term or chronic diseases – producing new and broader challenges for patients, healthcare providers, and healthcare systems. Multimorbidity, the coexistence of two or more chronic diseases within an individual, is recognized as a significant public health and research priority. This protocol aims to examine the prevalence, characteristics, and changing burden of multimorbidity among adult primary healthcare (PHC) patients using electronic medical record (EMR) data. The objectives are two-fold: (1) to measure the point prevalence and clusters of multimorbidity among adult PHC patients; and (2) to examine the natural history and changing burden of multimorbidity over time among adult PHC patients. Data will be derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The CPCSSN database contains longitudinal, point-of-care data from EMRs across Canada. To identify adult patients with multimorbidity, a list of 20 chronic disease categories (and corresponding ICD-9 codes) will be used. A computational cluster analysis will be conducted using a customized computer program written in JAVA. A Cox proportional hazards analysis will be used to model time-to-event data, while simultaneously adjusting for provider- and patient-level predictors. All analyses will be conducted using STATA SE 13.1. This research is the first of its kind using a pan-Canadian EMR database, which will provide an opportunity to contribute to the international evidence base. Future work should systematically compare international research using similar robust methodologies to determine international and geographical variations in the epidemiology of multimorbidity.

Magnitude of depression problem among primary care consumers in Saudi Arabia

Background: Depression is one of the leading causes of disability worldwide. It is estimated that 5–10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. Objective: To determine the prevalence of depression and associated risk factors among adult primary care consumers in Saudi Arabia Materials and Methods: A cross-sectional study was conducted in four primary healthcare (PHC) centers in Al Khobar for screening of adult consumers for depression. The data were collected by interviewing a sample of 850 male and female visitors by using the Arabic version of Patient Health Questionnaire 9. Results: The prevalence of moderate to severe depression among adult PHC consumers was about 16%. Its occurrence was more than double among women than men. The most common manifestations of depression were sleeping and eating problems, while suicidal thoughts were reported by 3.8% of depressed people. The main predictors of depression were female gender, family history of depression or psychiatric diseases, personal history of chronic diseases, especially cardiovascular and skin diseases, and being unemployed or unmarried; the predictors of suicidal ideation were severe depression, female gender, and low level of education. Conclusion: We conclude from this study that about one-sixth of PHC consumers in Saudi Arabia are suffering from moderate to severe depression and its occurrence was more in women than men, illiterate, and unemployed.

Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics.

Malawi has chronic shortages of health workers, high burdens of human immunodeficiency virus (HIV) infection and malaria and a predominately rural population. Mobile health clinics (MHCs) could provide primary health care for adults and children in hard-to-reach areas. To determine the feasibility, volume, and types of services provided by three MHCs from 2011 to 2013 in Mulanje District, Malawi. Cross-sectional retrospective study. The MHCs conducted 309 492 visits for primary health care, and in 2013 services operated on 99% of planned days. Despite an improvement in service provision, overall patient visits declined over the study period. Malaria and respiratory and gastro-intestinal conditions constituted 60% of visits. Females (n = 11 543) significantly outnumbered males (n = 2481) tested for HIV, yet males tested HIV-positive (27%) more often than females (14%). Malaria accounted for 26 421 (35%) visits for children aged <5 years, with a significant increase in the rainy season. Implementation of rapid diagnostic testing was associated with a decline in numbers treated for malaria. Antibiotic stockouts at government clinics were associated with increased MHC visits. MHCs can routinely provide primary health care for adults and children living in rural Malawi and complement fixed clinics. Moving from a complementary role to integration within the government health system remains a challenge.

Professional competencies in primary health care for attending to older adults

To identify and analyze the necessary competencies in primary health care for attending to older adults. An exploratory, descriptive, and quali-quantitative study was developed. Three rounds of the Delphi Technique were conducted with participants from primary health care services and a multidisciplinary committee. The first questionnaire asked participants to indicate the competencies needed for attending to older adults in primary health care. They were compiled into a list and added to a Likert Scale (from 1 to 5) for the second and third questionnaires. A consensus criterion of 70% was adopted. Twenty eight competencies were reached by consensus and were classified into twelve domains. The competencies reflect Brazilian health care policy and constitute a reference for professional health practice and education when caring for the older adult in primary health care.

Prevalence of pre-diabetes in young Mexican adults in primary health care

Pre-diabetes in young people is frequently unrecognized or not treated on time, with the consequent loss of opportunity for diabetes prevention. In Mexico, there is scarce information about the prevalence of pre-diabetes in young adults. To determine the prevalence and risk factors for pre-diabetes in young Mexican adults in primary health care. In a cross-sectional study, 288 subjects, aged 18-30 years, from a primary care unit were included. Pre-diabetes was diagnosed (according to the criteria of the American Diabetes Association) as impaired fasting glucose (8-12 hours fasting plasma glucose level: 100-125 mg/dl) or impaired glucose tolerance (140-199 mg/dl after a 2-hour oral glucose tolerance test). Prevalence of pre-diabetes was 14.6% [95% confidence interval (CI): 10.7-19.2], whereas that of diabetes was 2.4% (95% CI: 1.0-4.9). A high proportion of patients had history of obesity, diabetes, hypertension and consumption of tobacco and alcohol. Pre-diabetic patients were older than normoglycaemics (pre-diabetic patients: 26±4 years versus normoglycaemic subjects: 24±3 years, P = 0.003) and had higher body mass index (BMI; pre-diabetic patients: 29.4±6.8 kg/m(2) versus normoglycaemic subjects: 26.8±5.8 kg/m(2); P = 0.009), particularly in the case of men (pre-diabetic men: 29.3±7.0 kg/m(2) versus normoglycaemic men: 26.4±5.1 kg/m(2); P = 0.03). Although waist circumference showed a trend to be higher among pre-diabetics, no significant differences were found according to gender (among males: pre-diabetics: 99.5±18.8 cm versus normoglycaemics: 93.3±14.4 cm, P = 0.09; among females: pre-diabetics: 91.5±13.8 cm versus normoglycaemics: 85.8±15.9 cm, P = 0.16). Only age and BMI were significantly associated with the presence of pre-diabetes. Almost 15% of these young adults had pre-diabetes. Many modifiable and non-modifiable risk factors were present in these patients, but only age and a higher BMI were independent variables significantly associated with pre-diabetes. Timely interventions in primary health care are needed to prevent or delay the progression to diabetes.

Chronic pain and depression: A descriptive survey among adult primary health care centre patients

Knowledge of chronic pain and its relationship to depression among primary health care patients in Turkey is inadequate. The aim of this study was to evaluate the frequency of chronic pain and its relationship to depression. Materials and methods: In this descriptive study, data was collected with a questionnaire based on sociodemographic and pain-related characteristics, which was administered to a study population (n = 259) of primary care patients, 18-64 years old. The Visual Analogue Scale (VAS) (min-max = 0-10) and Beck Depression Inventory (BDI) (min-max = 0-63) were used for the assessment of pain severity and depression. Results: Of the participants, 50.6% complained of chronic pain and 48.8% had only one type of chronic pain. According to the VAS, 64.9% of patients’ chronic pain severity scores were between 4 and 8. Among those without chronic pain, 24.2% got a score equal to 17 or higher on the BDI (increased risk for depression), as compared with 38.3% of the patients who had chronic pain complaints (P = 0.015). Conclusion: This study is one of the few that have investigated chronic pain and considered it as a serious health problem among primary health care patients in Turkey. Physicians’ attention should be drawn to the effects of chronic pain, causing mental health disability, within the health system of Turkey.

A Model Intervention to Improve Primary Health Care for Adults With Developmental Disabilities

A Model Intervention to Improve Primary Health Care for Adults With Developmental Disabilities

Mental unhealth among young adults in primary health care

Mental unhealth among young adults in primary health care

Why target sedentary adults in primary health care? Baseline results from the Waikato Heart, Health, and Activity Study

Background The question of whether the public health issue of physical inactivity should be addressed in primary health care is a controversial matter. Methods Baseline cross-sectional analysis of a physician-based physical activity intervention trial involving sedentary adults was undertaken within 42 rural and urban family practices in New Zealand to examine self-reported levels of physical activity and cardiovascular risk factors. A self-administered single question about physical activity was used to screen 40- to 79-year-old patients from waiting rooms for physical inactivity. Results The positive predictive value of the screening question was 81%. Participation rates for the study were high, including 74% of family physicians ( n = 117) in the region. Eighty-eight percent of consecutive patients in the age group agreed to be screened and 46% were identified as sedentary. Of those eligible, 66% ( n = 878) agreed to participate in a study involving a lifestyle intervention from their family physician. Blood pressure and BMI were significantly greater than that in the general population. There were high rates of hypertension (52%), diabetes (10.5%), obesity (43%), previous cardiovascular disease (19%), and risk factors for cardiovascular disease (93%). Decreasing total energy expenditure was associated with increasing cardiovascular risk ( P = 0.001). Conclusion Sedentary adults in primary care represent a high cardiovascular risk population. Screening for inactivity in primary care is effective and efficient. Two-thirds of sedentary adults agreed to receive a lifestyle intervention from their family physician.