Attributes Of Primary Care Research Articles

The Case for the Role of Primary Care in Patient Blood Management.

Patient blood management (PBM) is a patient-centered evidence-based strategy designed to preserve a patient's own blood and improve health outcomes. The effectiveness of PBM programs is now well-established globally within tertiary and secondary sectors, with demonstrable outcome benefits and cost savings. However, the role of primary care and the general practitioner in PBM is poorly understood. Yet the essential attributes of primary care, including access, continuity, coordination, and comprehensiveness, align well with PBM principles, enabling general practitioners to provide personalized holistic management of anemia for the community. The skill set of general practitioners in integrating and continuing care through the transition period after hospitalization is especially important. General practitioners are well-suited to the roles of health promotion and prevention, and have the potential to deliver substantial population health benefits. Given the public health imperative of this condition, it is vital that policy-makers appropriately support the role of general practitioners with financing, education, and resources for PBM in primary care.

Physician-Led Synchronous Telemedicine Compared to Face-To-Face Care in Primary Care: A Systematic Review.

The COVID-19 crisis rapidly introduced telemedicine as the predominate modality to deliver healthcare however this change has not received attention in primary care settings and the health-related impacts are unknown. The study's objective was to explore the effects of physician-led synchronous telemedicine compared to face-to-face care delivered in the primary care setting on healthcare system use and attributes of primary care as reported in recent studies. We performed a comprehensive literature search in five databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycInfo) and critical appraisal using the Joanna Briggs Institute tools. Of 6,247 studies identified, 157 studies underwent full text review, and 19 studies were included. Most studies were conducted in the U.S. (78.9%) and used video and telephone telemedicine (57.9%). An outcome-based qualitative description and narrative synthesis showed similar or fewer emergency department visits, hospital visits, and prescribing, and fewer diagnostic tests and imaging for telemedicine visits compared to face-to-face care. Our systematic review fills a gap in the literature on telemedicine in primary care settings however our results need to be interpreted cautiously given studies' susceptibility to selection bias, confounding, and limited applicability to other health systems and time periods.

The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study.

The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC. This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.

Association of physical performance and sarcopenia with use of health services in elderly people living in rural riverside areas in the Amazon: a cross-sectional study.

Access is considered one of the necessary conditions for achieving effectiveness and quality in health services. However, it represents a complex construct, with several interpretations, and can be understood as the ease or degree of difficulty with which people obtain effective and timely care. Barriers to access can be related to individual characteristics and those of health systems and services. Regarding elderly people living in rural riverine localities, these limitations are exacerbated due to the territorial dispersion of households and the difficulty of obtaining the necessary care near their homes. The aim of this study was to describe and test the association of sarcopenia and physical performance with primary healthcare attributes and the use of health services by elderly people living in rural riverside areas in the Amazon, Brazil. This cross-sectional observational study was carried out in households with individuals aged 60 years or older living in nine communities located on the left bank of the Negro River, in the rural riverside area of the municipality of Manaus, Amazonas, Brazil. The study evaluated socioeconomic and demographic conditions, health services utilization and the primary care attributes related to the use of and access to services, assessed by components of the Primary Care Assessment Tool instrument (PCATool-Brazil), a reduced version validated for Brazilian adult users. Physical performance was assessed using the Short Physical Performance Battery scale, and handgrip strength was also assessed, according to a dynamometer. The Sarcopenia Formulary (SARC-F) and calf circumference (CC) were used to assess sarcopenia (SARC-CalF). The association of sarcopenia and physical performance with the study outcomes was evaluated using hierarchical logistic regression for health services utilization (having had a medical consultation in the last year), and hierarchical linear regression for the continuous outcomes of the PCATool-Brazil (total score and each of the domains). The sociodemographic variables were inserted in model 1 and the clinical variables in model 2. Variables with p<0.20 were kept in the models. A total of 98 elderly people (55.1% men; mean age 70&plusmn;7.4 years) were included in the study. Low physical performance and suggestive signs of sarcopenia were observed in 52.5% and 28.9% of the study participants, respectively. Elderly with better physical performance reported more health services utilization (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.03-1.81) and higher scores in the affiliation (&beta;=1.67; 95%CI=0.37-2.98), utilization (&beta;=1.19; 95%CI=0.06-2.33) and longitudinality (&beta;=0.99; 95%CI=0.09-1.90) domains of the PCATool-Brazil. The study findings showed high prevalence of impairment in physical performance and suggestive signs of sarcopenia in elderly people living in the studied rural riverside localities. Better physical performance was associated with use of health services in the previous year and with better evaluation of some primary care attributes.

Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review

IntroductionInterprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the...

Patient perception of attributes of primary care: a study of Aam Aadmi Mohalla Clinics in Delhi, India.

Aam Aadmi Mohalla Clinics (AAMC) are the community level public primary care facilities recently introduced to strengthen primary care in Delhi, India by bringing affordable healthcare close to home. This study looks at the primary care attributes of AAMC from a patient perspective, to assess their features, strengths and weaknesses. Using a primary care survey tool, a cross-sectional survey of 360 users was conducted at 18 facilities across 9 districts of Delhi to gather information on six dimensions of primary care delivery. Thematic analysis of responses to quantitative, multiple-choice and Likert scale questions using percentage of respondents in each category; and a strengths, weaknesses, opportunities and suggestions (SWOS) framework, was used to examine the primary care attributes. AAMCs have done well in improving proximity, availability, physical and financial access to primary care with respondents reporting their residence within 1 kilometre of AAMCs (95%), physician being available (100%), free drugs in stock (99%). Service delivery is however not comprehensive with missing preventive care. Respondents reported missing gatekeeping, weak referral mechanism (6-19%), and low physician's familiarity with their overall health (2%). AAMCs have brought affordable healthcare with free medicines and diagnostics to neighbourhood. There is an opportunity for attaining universal healthcare that is responsive to user needs through provision of comprehensive care. Compulsory enrolment of neighbourhood population with an electronic database of patients has an immense potential to improve longitudinality and coordination of care.

Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan.

During a pandemic, when there are many barriers to providing preventive care, chronic disease management, and early response to acute common diseases for primary care providers, it is unclear whether primary care attributes contribute to reducing hospitalization. We aimed to examine the association between core primary care attributes and total hospitalizations during the COVID-19 pandemic. We conducted a nationwide prospective cohort study during the pandemic using a representative sample of the Japanese adult population aged 40 to 75 years. Primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) were assessed using the Japanese version of Primary Care Assessment Tool (JPCAT). The primary outcome measure was any incidence of hospitalization during a 12-month period from May 2021 through April 2022. Data from 1,161 participants were analyzed (92% follow-up rate). After adjustment for possible confounders, overall primary care attributes (assessed by the JPCAT total score) were associated in a dose-dependent manner with a decrease in hospitalizations (odds ratio [OR] = 0.37, 95% CI, 0.16-0.83 for the highest score quartile, compared with no usual source of care). All associations between each domain score of the JPCAT and hospitalization were statistically significant when comparing the highest quartile with no usual source of care. Our study revealed that the provision of primary care, particularly high-quality primary care, was associated with decreased total hospitalization, even during a pandemic when there are many barriers to providing usual medical care. These findings support policies that seek to strengthen primary care systems during and after the COVID-19 pandemic.

OLDER ADULT’S PERCEPTION OF PRIMARY HEALTH CARE REFORM IN A LOW-MIDDLE-INCOME COUNTRY (LMIC): IMPACT ON GERIATRIC CARE

Abstract Health reforms are intended to provide equitable and beneficial care across population groups, it also transforms service delivery. We sought to identify current or potential implementation gaps that divert improvement efforts in service delivery, and practices that prevent holistic approaches in caring for older adults, especially in developing nations. This study examined a major health reform initiative in a LMIC aimed at integrating defragmented health organizations under one management, it also looked at extent to which reform agendas align with primary health care (PHC) principles. Using purposeful random sampling design, this quantitative study obtained participants’ views of care received in 12 sites and 2 states in Nigeria. A total of 218 participants aged 50 years and older in both rural and urban areas. Partial correlations were carried out after accounting for other variables of interest. Findings show there was no significant differences in attributes of primary care received by geography, gender or by state. Although Ondo state scored higher than Federal Capital Territory in previous performance evaluations (66% and 43% in 2015), respondents from both states received only two out of the seven primary care attributes recommended by the World Health Organization. First contact (access to care) and Care continuity, p &amp;lt;.01 and p, 0.5, (d = 0.202 and 0.179) were significant. Overall, our findings suggest that performance improvement at management level dominated reform efforts over service delivery. It is unclear how this aligns with providing older adults with the health care that they need.

Types of Usual Source of Care and Patient-Centered Communications.

A usual source of care (USC) is related to longitudinal and personalized services, which are attributes of primary care. Patient-centered communication, an important element of patient-centered care, helps physicians understand health problems from a patient's point of view. We analyzed the association between USC and patient-centered communication. Data from the Korea Health Panel 2018 were used in the analysis. Patient-centered communication scores were obtained by combining the four communication-related questionnaire items. Usual source of care types were categorized based on responses to two questionnaire items: no USC, a place without a regular doctor and with a regular doctor. Multiple logistic regression analysis was used to adjust for confounders. Good communication rate was higher for those with a regular doctor (71.8%) than for those with no USC (61.8%) or a place only (61.5%). Those with a regular doctor had better communication (odds ratio, 1.49 for individuals with poor/moderate health, and 2.08 for those with good health) than those without a USC after adjusting for confounders. In terms of communication, no difference was observed between individuals with no USC and those with a place only. Having a regular doctor promotes communication between patients and doctors. Good communication may be a mediator between having a regular doctor and related beneficial outcomes. Better communication by having a regular doctor, along with several other benefits identified in previous studies suggests the need for a health policy that encourages individuals to have regular doctors.

Conjoint analyses of patients’ preferences for primary care: a systematic review

BackgroundWhile patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.MethodsWe searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.ResultsOf 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).ConclusionsWe found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.Word Count: 346/350 words.Trial registrationOn Open Science Framework: https://osf.io/m7ts9

Attributes of primary health care in Mato Grosso do Sul state: PCAT-Brazil paired for users and health professionals, 2018

ObjectiveThe objective of the present study was to analyse the quality of adults and older adults health care in Primary Health Care (PHC) services in the State of Mato Grosso do Sul, 2018.MethodsA quantitative survey was carried out in which the municipalities participating in the study included the four macro-regions following the Director Regional Plan (DRP). In this study, the quality of care was verified using the validated version of the PCAT-Br for adult and older adults users over 18 years of age and professionals. The professional’s and users’ views were compared between PHC attributes in the State of Mato Grosso do Sul. We performed the paired student t-test. STATA v.14.2 software (College Station, TX, USA) was used for the analyses. Sensitivity analysis was done to compare socio-demographic characteristics.ResultsEight hundred twenty-five users and 424 professionals participated in the study. According to users, the Accessibility attribute had the worst performance in all macro-regions (mean score PCAT = 3.58). There were significant differences between the perception of users and professionals (PCAT = 5.32 for users and PCAT = 7.11 for professionals) in all attributes evaluated.ConclusionsThere was a difference in users’ and professionals’ perceptions between PHC attributes. Therefore, it is necessary to strengthen PHC care networks in the State, mainly considering the users’ perspectives.

Minding the Gap: Adolescent and Parent/Caregiver Reporter Discrepancies on Symptom Presence, Impact of Covariates, and Clinical Implications.

Primary care practitioners (PCPs) provide care to adolescents in the context of their families. Supporting parent/caregiver knowledge of symptoms can create opportunities for better recognition of symptoms that can then lead to early identification, intervention, and prevention of poor outcomes. Cross-sectional comparative study of parent/caregiver reported versus adolescent reported symptom presence of anhedonia and depressed mood in the participants of ABCD Study. Large discrepancies exist between adolescent and parent-reported presence of symptoms. Improving understanding of the etiology, covariates, and patterns of discrepancies may improve primary care assessment, adolescent access to care, and intervention for adolescents and their families. Furthermore, providing education to families about symptom features, working to improve adolescent-caregiver communication, promoting adolescent advocacy, and connecting families to community resources are important attributes of primary care and areas of adolescent and family functioning that primary care providers can strengthen.

Atenção primária no contexto da epidemia zika e da síndrome congênita da zika em Pernambuco, Brasil: contexto, vínculo e cuidado

The Zika epidemic brought to the fore the birth of children with unknown and unexpected needs that demand longitudinal follow-up, strengthening the bond, comprehensiveness and coordination of care in health, which are essential attributes of primary health care (PHC). This article aims to evaluate the orientation of PHC care, using the PCATool-Brasil. The data were collected between 2016 and 2019, by means of interviews with parents of children who were born in a public maternity hospital in Recife (state of Pernambuco) between October 2015 and February 2016, a critical period of the microcephaly outbreak, especially in the Northeast of Brazil. The parents of 109 children participated in the survey, 15.6% of which had a confirmed microcephaly diagnosis. The degree of affiliation and access was sufficient, but the aspects of coordination of care, longitudinality, comprehensiveness, family and community orientation were insufficient. In the context of congenital Zika syndrome, these attributes are essential for the care of children and families. The fostering of health from these domains depends on the orientation of the models of care and their management with state and federal investments. The defense of life depends on the ability to place life above all other rationalities.

Primary Health Care Quality

This study aims to analyze the dimensions of the Service Quality Scale (SERVQUAL) and its relationship with the essential attributes of Primary Care. This is a qualitative research with elderly people living in eight cities in ‘Serra Gaúcha’ region, in Southern Brazil, with Family Health Teams and Primary Care Teams. Semi-structured interviews were conducted and the responses of each dimension were analyzed, relating them to the essential attributes of Primary Health Care. First contact accessible evidenced in the dimensions reliability, responsiveness, assurance, empathy and tangible. Continuity emerged in reliability, responsiveness, assurance and empathy. Comprehensiveness appeared in the dimensions reliability, responsiveness, assurance and empathy. Finally, coordination was reflected in reliability, responsiveness, assurance and empathy. The SERVQUAL scale proved to be a useful instrument for the evaluation of Primary Care.

Minors using Ritalin: obstacles in Primary Health Care surveillance

Objective: to understand how nursing workers from Family Health Strategy teams track children and adolescents using Ritalin. Methods: qualitative study, based on the theoretical references of the essential primary health care attributes. The participants were 27 nurses from the Family Health Strategy. Data collection took place through interviews later submitted to content analysis in the NVivo software. Results: three categories emerged: (Lack of) knowledge about the population who uses Ritalin: co-responsibilities in the process of assistance and difficulties to follow up on the use of Ritalin; Primary care knowledge and know-how in the setting of Ritalin use; The prescription of Ritalin as a demand from schools. Conclusion: the monitoring of children and adolescents who use Ritalin has shortcomings, and primary health care must organize itself to increase and strengthen the care to this population.

Assessment of the attributes of Primary Health Care with women of reproductive age.

to evaluate the quality of Primary Health Care attributes according to the characterization and perspective of women of reproductive age. descriptive, quantitative, cross-sectional study, with 397 women of reproductive age from six municipalities in the 16th Health Region of the state of Paraná, with variables for sociodemographic characterization and the Primary Care Assessment Tool (PCATool). mean age, 30.43 years old, most were married, 70.2% worked outside the home and 55.5% had completed high school. The highest average score of the eight domains evaluated was "Family Guidance" and "Coordination - Integration of Care", with averages of 5.86 and 4.89. Domains "Integrality - Services Provided" and "Community Orientation" had lower averages (3.32 and 3.76). the study allowed tracing the characterization of the participants and identifying that the attributes of Primary Care are unsatisfactory, making it necessary to expand access to the services offered and to qualify the comprehensive care for women's health.

On challenges to respect for autonomous decision making in primary care

Primary health care is characterised by timely and appropriate health care access, delivered continuously over time to a specific population, providing a comprehensive service, with coordination of care for those that need it. Practitioners deal with a multiplicity of clinical issues within longitudinal relationships, embedded in the context of families and communities. We propose that these aspects of primary care have a bearing on how matters of decision making are considered and implemented. Further, the standard account of autonomous decision making is not wholly adequate when applied to clinician–patient encounters in primary care. We add considerations of the impact of illness (however defined) and self-identity as also relevant to a more measured and full account. The context of primary care is quite different from that of secondary care. Although there are generalists who work in hospitals, we argue that this aspect and the other attributes of primary care generate special ethical considerations. One of these is how autonomy, or more fully, how respect for the principle of autonomy is considered and operationalised in community practice. In this study, we describe some theoretical aspects of autonomy and seek to apply, and challenge, these aspects in the context of clinical work in primary care. In doing so we will review the descriptors of primary care: why in essence it is different from other contexts of clinical work.

Why does mental health care not follow the structuring of primary care?

ABSTRACTOBJECTIVE:To verify if primary care teams with better structured primary health care (PHC) attributes could offer better mental health (MH) care.METHODS:Cross-sectional study based on data from the external evaluation of the second cycle of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB - Access and Quality Improvement of Primary Care Program), involving 31,587 primary care teams, between 2013 and 2014. Two typologies were built: quality of mental health care (dependent variable) and PHC structuring according to essential attributes (independent variable). We identified some contents for the construction of the mental health typology (module II of the PMAQ) and performed sums of questions for the categorization of indices. The Delphi technique rendered consensus in four rounds endorsed by experts, following the attributes of PHC structure. Multinomial logistic regression analyses verified the association between the typologies and identified which attribute most contributed to the quality of mental health care.RESULTS:We found out that 29.2% of the teams are at low levels of quality in assistance to MH, while 7.5% of the teams have a low level of structuring the PHC according to essential attributes. Regional differences are maintained, both for the structuring of the PHC and for the quality of mental health care. There was a greater chance of providing care in MH with better quality when the PHC is better structured at a high level (OR = 14.74) and at a medium level (OR = 2.193). A high level of completeness is associated with a high level of Quality of Care in MH (OR = 3.21).CONCLUSION:results indicate a predominance of low levels of quality in mental health care, out of step with the process of PHC structuring and its essential attributes.

Attributes in primary care practices that promote high value care for patients with high need

Previous research has identified attributes of healthcare delivery that are likely to improve the value of care. Yet, despite policy reforms introducing alternative payment contracts which seek to promote value, no rigorous analysis has associated attributes of primary care with value. This study examines how value-oriented care attributes of primary care practices relate to practices’ cost and quality performance of health care in three types of patients with high need, including patients with major complex chronic conditions, older adults with frailty, and adults under 65 with disability. Our results show that the way care is organized does not differ significantly across patients with different types of need. The observed variation in cost and quality across these groups is likely a result of different patient characteristics. However, when holding patient characteristics constant, our results show that care management, screening for risk factors, and screening for mental health needs result in significant reduction of cost and improvement in quality. For primary care practices, our results suggest ways of organizing, managing and providing care for patients with high need that will likely result in reduced costs and improved quality. Keywords: High need, high costs, care attributes, primary care, vulnerable patients

Organizational attributes of interprofessional primary care for adults with intellectual and developmental disabilities in ontario, Canada: a multiple case study

BackgroundAccess to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context.MethodsA multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis.ResultsAdults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population.ConclusionsThis study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population.