Availability Of Primary Health Care Research Articles

Менеджмент доступности первичного звена здравоохранения в субъектах России с высокой долей сельского населения (Primary Health Care Accessibility Management in Russian Regions With a High Share of the Rural Population)

Russian Abstract: Проблема доступности медицинской помощи на селе является одним из фокусных направлений национальных целей и стратегических задач развития здравоохранения, определенных Указом Президента РФ от 7 мая 2018 года No204 и основными направлениями Паспортов развития здравоохранения субъектов РФ на период 2018-2024 гг. Вопросы охраны здоровья населения, проживающего в сельской местности, находятся в компетенции субъектов РФ, а качество и доступность ПМСП напрямую связаны с районированием сети районных больниц (РБ), фельдшерско-акушерских пунктов (ФАП), сельских амбулаторий. English Abstract: The problem of access to medical care in the countryside is one of the focal areas of national goals and strategic objectives of healthcare development, defined by Decree of the President of the Russian Federation No. 204 of May 7, 2018 and the main directions of Health Development Passports of the constituent entities of the Russian Federation for the period 2018-2024. The health of the population living in rural areas is within the competence of the constituent entities of the Russian Federation, and the quality and availability of primary health care are directly related to the regionalization of the network of district hospitals (RB), feldsher-obstetric centers (FAP), and rural outpatient clinics.

Интегральная оценка социальных детерминант общественного здоровья населения Калининградской области (муниципальный уровень)

Health equality and public health promotion have been and remain relevant throughout the world. The social environment plays a leading role in addressing this issue, along with the geographical one. The complexity and multifactorial social environment lead to the use of integral assessment methods taking into account individual criteria. This article presents the results of an integral assessment of the social determinants of public health at the municipal level. As an individual evaluation criteria were used by 8 indicators that characterize the state of employment, conditions of development and education at an early age, the state of food security, living conditions, the state of crime and the availability of primary health care. ASPID method of randomized composite indicator was used to integrated assessment for social determinants of health. As an example, the article cites the results of two scenarios of calculation and evaluation, social determinants, determining the degree of social benefits in relation to the public health of the population of municipal urban districts Kaliningrad Region. Map models reflecting the spatial variability of integrated assessments are presented. Analysis of the results in the first scenario showed that when there is no preference for any of the indicators, social conditions regarding public health in most municipalities are characterized as “relatively favorable — favorable”. In the second scenario, where primary care accessibility rates are a priority, in most counties social conditions can be described as “favorable — most favorable”. The results of an integrated assessment of social determinants can be useful for decision-makers on public health issues.

Community social deprivation and availability of substance use treatment and mutual aid recovery groups

BackgroundThe spatial distribution of substance use services impacts their use, with greater access to services associated with more positive outcomes. Findings from availability of primary healthcare indicate service shortages exist in areas characterized by social deprivation. This study investigated whether community social deprivation was associated with a lack of availability of substance use treatment or mutual aid recovery support services.MethodsThis is an ecological analysis investigating the availability of substance use services at a community level in the state of New Hampshire. Several public data sources were combined to represent community social deprivation and availability of substance treatment of mutual aid recovery support groups. Principal components analysis and negative binomial regression were used to test the relationship between community structure and the availability of substance use services.ResultsCommunity social deprivation was characterized by high rates of poverty, no access to motor vehicles, renter-occupied housing, less than a high school degree, and nonemployment. Communities high in measures of social deprivation were associated with increased availability of both substance use treatment and recovery support services.ConclusionsContrary to findings in access to primary healthcare services, social disadvantage was positively related to availability for both types of substance use services. This relationship may reflect the stigma associated with substance use where services associated with stigmatized conditions locate in areas with the least resistance to their presence or be a function of affordability of space. Future research could investigate the relationship between access to services and individual client outcomes.

Holistic Nursing Values in Nurse Practitioner Education

Much has been written about the inclusion of holistic nursing values and practices in undergraduate nursing education, but their inclusion and influence in advanced practice nursing education has not been fully explored. Nurse practitioners (NPs) are nurses, so it is assumed that the nursing perspective provides a framework for NP education and practice, and that NP education represents the blending of a holistic nursing approach with medical diagnosis and treatment. Nurse practitioners are taking increasing responsibility for filling the gap in primary healthcare availability in the U.S., and in the current political and economic healthcare climate, NPs are in a position to promote primary care models that honor comprehensive, patient-centered, and relationship-based care. As a result, it becomes essential to quantify the inclusion of these values in NP educational programs and coursework, as instilling core values for practice begins in educational environments. This quantitative, descriptive study explored the inclusion of holistic nursing values by NP faculty, using the Nurse Practitioner Holistic Caring Instrument (NPHCI). The NPHCI exhibited quite high reliability and validity in the sample, including confirmation of its three subscales. Survey results suggest that NP faculty actively incorporate holistic nursing values in educational coursework, and that age, length of time teaching in NP programs, highest educational degree, and academics as the primary area of practice were important indicators of the inclusion of holistic nursing values in NP program curricula. Findings add to knowledge of NP education, but further study is warranted.

Situation of seven-day service among family medicine clinics in Taiwan: A nationwide survey

BackgroundGeneral medicine practices in England are required to provide services from 8am to 8pm on weekdays and to also open on Saturdays and Sundays. Internationally, however, the literature regarding the temporal availability of primary health care on national levels is scarce. MethodsTo provide such information regarding Taiwan, in this study, all family medicine clinics within Taiwan's National Health Insurance system were stratified by urbanization level, and the opening hours of the clinics were then analyzed. The opening hours of the clinics were downloaded and the data were extracted cross-sectionally in July 2015. For each clinic, the number of open sessions (in terms of morning, afternoon, and evening sessions) per week was calculated. For each urbanization level, the opening ratios for out-of-hours services and for seven-day services were also analyzed. ResultsAmong 1621 family medicine clinics, 835 were located in urban areas, 563 were suburban, and 223 were rural. The average numbers of open sessions per week among urban and suburban clinics were higher than among rural clinic (15.7 ± 3.7 and 15.8 ± 3.7 vs. 14.4 ± 4.0). Urban and suburban clinics also had higher opening ratios on weekday evenings and on weekends than rural clinics. Only 53 (3.3%) of all the clinics (29 urban clinics, 18 suburban clinics, and 7 rural clinics) remained open for all 21 sessions of a week. ConclusionThe great majority of family medicine clinics in Taiwan voluntarily offered out-of-hours services, but only a small minority remained open in all 21 sessions of a week.

ACCESS TO HEALTH CARE IN THE OUTPATIENT CLINICS OF ST. PETERSBURG AT THE PRESENT STAGE

The brief analysis of the organization of primary health care on an outpatient basis in the case ofSt. Petersburgis reflected. The structure of primary health care is described, namely healthcare organizations that provide outpatient care; the standards and the level of availability of primary health care, as well as the capacity of outpatient clinics are defined. An important criterion for the quality of care is its accessibility, taking into account the number of attached population. Reforming the ambulatory network in a large city is one of the most difficult health management problems, due to many factors, first of all determined by the needs of the population in primary health care, a variety of organizational forms of outpatient care, intensive changing residential area of the city, the need to ensure effective interactions with other social institutions.

Spatial access disparities to primary health care in rural and remote Australia.

Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS) have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC) access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner) services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

A review of maternal mortality in Malaysia

There has been a significant decline in maternal mortality from 540 per 100,000 live births in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from 6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths. IeJSME 2012: 6 (Suppl 1): S142-S151

The impact of social factors on attendance at antenatal care services and the subsequent effect on mothers’ health, measured during the years of economic transition in Latvia

The goal of the study is to evaluate the risk factors having an impact on attendance at antenatal care services in Latvia during the years of economic transition as well as the impact of those factors on mothers and newborns’ health. Based on Latvian statistical data and published surveys, we analysed the possible impact of social and economic factors on attendance at antenatal care services. To illustrate the posed problems, we carried out a small pilot follow-up study, comparing social profiles, incidences of reproductive tract infections and HIV infection and pregnancy outcome on 200 consecutive unselected pregnant women who received antenatal care and 25 pregnant women who did not. Despite the fact that antenatal care is free of charge and the social security system facilitates the attendance of antenatal care visits, 4.6% of pregnant women in 1997 and 3.3% of pregnant women in 2002 did not attend antenatal care. Their perinatal outcome is significantly worse, as they are more likely to deliver preterm and growth-retarded babies and have a greater risk of perinatal mortality. Women delivering without previous antenatal care were characterised by poor socio-economic status and have limited access to health care and family planning services due to their low educational level, low income and high incidence of different addictions. More frequently, they were in the risk group having sexually transmitted and HIV infections. As a result, newborns had lower birth weight, were more likely to have intrauterine infection and intrauterine growth retardation. Low social class, high substance abuse, and a high rate of genital infections are associated with lack of antenatal care and compromised neonatal outcome. Improving the availability of primary health care and easy access to social and family planning services are priorities for the socially depressed during the reform period of the health care system in Latvia. Standard protocols for the management of women without previous antenatal care have to be developed.

Childhood blindness in the context of VISION 2020--the right to sight.

The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic development, and the availability of primary health care and eye care services. In high-income countries, lesions of the optic nerve and higher visual pathways predominate as the cause of blindness, while corneal scarring from measles, vitamin A deficiency, the use of harmful traditional eye remedies, and ophthalmia neonatorum are the major causes in low-income countries. Retinopathy of prematurity is an important cause in middle-income countries. Other significant causes in all countries are cataract, congenital abnormalities, and hereditary retinal dystrophies. It is estimated that, in almost half of the children who are blind today, the underlying cause could have been prevented, or the eye condition treated to preserve vision or restore sight. The control of blindness in children is a priority within the World Health Organization's VISION 2020 programme. Strategies need to be region specific, based on activities to prevent blindness in the community--through measles immunization, health education, and control of vitamin A deficiency--and the provision of tertiary-level eye care facilities for conditions that require specialist management.

Evaluation of changes in primary health care availability and provision from the patient perspective.

This study was designed to investigate changes in primary care following recent NHS reforms. The study was carried out by home interview of random samples of people aged 65 years and over in three district health authorities; 1500 in 1990 and 1500 in 1992, before and after the introduction of the reforms. The response rate was 94% (1413 in 1990 and 1405 in 1992). Few patients (6%) changed their general practitioner (GP) in 1990 or 1992. There was an increase in the provision of written practice information in 1992, but more than 60% of patients could not recall receiving leaflets. More practices included practice nurses and appointments systems and fewer used rotas of local practices or deputizing services for 'out of hours' calls. In 1992 more patients aged 75 years and over saw their GP within the previous year and significantly more were assessed for vision, hearing, continence, foot problems and blood pressure and had their urine tested, but most of these health assessments, except blood pressure (64%), were recalled by few patients. There have been small changes in the provision and use of primary health care by older people since the introduction of the new GP contract.

Immunization coverage and infant mortality rate in developing countries.

We examined whether immunization coverage (IMC) is one of the predictors of infant mortality rate (IMR), as a single indicator representing the availability of primary health care (PHC) services in developing countries. Multiple regression analysis showed that partial correlation coefficients for IMR with immunization coverage (-0.224), logarithm of per capita GNP (-0.294), total fertility rate (0.269), and adult literacy rate (-0.325) were all statistically significant (p < 0.001) in 97 developing countries which make up more than 97% of the population in all the developing countries of the world. Multiple correlation coefficients of IMR with these four variables in 97 countries was 0.921. Thus, more than 80% of variation of IMR in developing countries were explained by the variation of the four variables. The study also showed that IMC was well correlated (simple correlation) with the four indicators of the availability of primary health care services; access to local care (0.730), care of pregnant women (0.603), delivery care (0.666), and infant care (0.553), all of which were statistically significant (p < 0.001) in the 48 developing countries which make up 42% of the population of all developing countries. Multiple correlation coefficients of these four variables was 0.787. About 60% of the variation of IMC will be explained by the variation of the four variables. Thus we conclude that immunization coverage is one of the main predictors of the infant mortality rate. It represents one of the health intervention components which can be used as a proxy indicator of the availability of PHC service in developing countries.