Conditions In Primary Health Care Research Articles

Safety and upscaling of remote consulting for long-term conditions in primary health care in Nigeria and Tanzania (REaCH trials): stepped-wedge trials of training, mobile data allowance, and implementation

In-person health care poses risks to health workers and patients during pandemics. Remote consultations can mitigate these risks. The REaCH intervention comprised training and mobile data allowance provision for mobile phones to support remotely delivered primary care in Africa compared with no training and mobile data allowance. The aim of this study was to estimate the effects of REaCH among adults with non-communicable diseases on remote and face-to-face consultation rates, patient safety, and trustworthiness of consultations. In these two independent stepped-wedge cluster randomised controlled trials, we enrolled 20 primary care clusters in each of two settings (Oyo State, Nigeria, and Morogoro Region, Tanzania). Eligible clusters had 100 or more patients with diabetes, hypertension, and cardiovascular or pulmonary disease employing five health workers. Clusters were computer-randomised to one of ten (Nigeria) or one of seven (Tanzania) sequences to receive the REaCH intervention. Only outcome assessors were masked. Primary outcomes were consultation, prescription, and investigation rates, and trustworthiness collected monthly for 12 months (Nigeria) and 9 months (Tanzania) from open cohorts. Ten randomly sampled consulting patients per cluster-month completed patient reported outcome measures. This trial was registered with ISRCTN, ISRCTN17941313. Overall, 40 clusters comprising 8776 (Nigeria) and 3246 (Tanzania) patients' open cohort data were analysed (6377 [72·7%] of 8776 females in Nigeria, and 2235 [68·9%] of 3246 females in Tanzania). The mean age of the participants was 55·3 years (SD 13·9) in Nigeria and 59·2 years (14·2) in Tanzania. In Nigeria, no evidence of change in face-to-face consulting rate was observed (rate ratio [RR] 1·06, 95% CI 0·98 to 1·09; p=0·16); however, remote consultations increased four-fold (4·44, 1·34 to >10; p=0·01). In Tanzania, face-to-face (0·94, 0·61 to 1·67; p=0·99) and remote consulting rates (1·17, 0·56 to 5·57; p=0·39) were unchanged. There was no evidence of difference in prescribing rates (Nigeria: 1·05, 0·60 to 1·14; p=0·23; Tanzania: 0·92, 0·60 to 1·67; p=0·97), investigation rates (Nigeria: 1·06, 0·23 to 2·12; p=0·49; Tanzania: 1·15, 0·35 to 1·64; 0·58) or trustworthiness scores (Nigeria: mean difference 0·05, 95% CI -0·45 to 0·42; p=0·89; Tanzania: 0·07, -0·15 to 0·76; p=0·70). REaCH can be implemented and could improve intervention versus control health-care access. Remote consultations appear safe and trustworthy, supporting universal health coverage. The UK Research and Innovation Collective Fund. For the Swahili and Yoruba translations of the abstract see Supplementary Materials section.

Designing an innovative primary health care model for the Iranian health system: A mixed methods study protocol

IntroductionToday, the main strategy of countries to improve the health status of people is primary health care (PHC). The present study has two main objectives: 1) scoping review and mapping of the characteristics of innovative PHC models in different countries, 2) developing and validating a model for innovative PHC considering the PHC conditions and challenges of the Islamic Republic of Iran. MethodsThe study will be performed in five phases. In this regard, first, a scoping review will be conducted to investigate the characteristics of innovative PHC. Second, a qualitative study will be performed on the PHC challenges in Iran. Third, another qualitative study will be conducted to identify the appropriate components for Iran's innovative PHC system, using the opinions of experts in this field. In the fourth phase, using the panel of experts, a suitable model will be designed for the Iranian PHC system. Eventually, in the fifth phase, the goals and components of the model developed by experts will be evaluated through a Delphi study, and the validity of the model will be measured using appropriate criteria. ResultsThe findings of this research provide considerable insight into how Iran's PHC system will be able to consider innovative models and changes in response to a new context and newly emerged problems. ConclusionGiven the importance of PHC in the present era and the need to pay more attention to and strengthen it for all communities, it seems necessary to conduct studies and provide appropriate conditions for the development of PHC.

Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal.

The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study "Working conditions of health professionals in the context of COVID-19 in Brazil" are presented, for further discussion with the report produced by "Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)" on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers' mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

Condições de trabalho na atenção primária à saúde na pandemia de COVID-19: um panorama sobre Brasil e Portugal

Abstract The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study “Working conditions of health professionals in the context of COVID-19 in Brazil” are presented, for further discussion with the report produced by “Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)” on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers’ mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

Mental Health program integration into Primary Health Care: Results of a Project Implemented at Yarmouk Health Care Center & Capital Health Primary Care Center, Kuwait

Objective: World Health Organization (WHO) identified a gap in meeting mental health care needs in the health services. To bridge this gap, at Yarmouk Primary Health Care Center and Capital Health District area in Kuwait, it was decided to implement a best practice model, for integrating mental health services into primary health care services in Kuwait. Methodology: Implementation of the best practice model, for integrating mental health services into primary care services in Kuwait’s health system was initiated in 2008. It involved the integration of cost–effective, feasible evidence-based interventions for mental health conditions in Primary Health Care (PHC) and other priority health programs. It envisioned a mental health component in PHC, to enhance access to mental health care and improve identification and treatment rates for priority mental disorders, to provide holistic care for particularly disabling comorbid physical and mental health problems, and to engage in mental health promotion. Results: The program was initiated in 12 primary mental health care clinics in the Capital Health District area in Kuwait. Two hundred (200) Family Physicians and General Practitioners, were trained in psychiatric integration within the primary health care system. Regular evaluation of the performance of physicians working in primary mental health clinics in the program was ensured. Periodic evaluation of psychiatric patient visits in the Primary mental health clinics was conducted for quality improvement. Mental health awareness days and educational sessions were organized. Discussion: A practice model for integrating mental health services into primary care was developed in Kuwait, involving stakeholders. Its favorable impact on mental health in the community is undergoing scrutiny. Limitations such as human resource shortage and, movement of trained physicians from primary care to other administrative departments in the Ministry of Health (MOH), coupled with a lack of relevant data and the need for better coordination between stakeholders, were identified. Issues regarding electronic health records, patient confidentiality, and quality of services were identified. Stigma related to mental health issues resulted in a delay in implementing the integration. Conclusion: With increasing psychiatric illnesses and a lack of adequate specialized mental health services, addressing this issue at the primary care level offers an attractive cost-effective option to deal with the crisis. Keywords: Mental Health, Primary Health Care, Integration, Health system, Family Physician

Hospitalizations of adolescents due to sensitive conditions in primary health care in the perspective of integrality

Resumo Objetivo analisar, na perspectiva da Integralidade, as internações de adolescentes por condições sensíveis à Atenção Primária em uma Regional de Saúde do Paraná. Método estudo de abordagem quantitativa, retrospectivo, realizado no período de janeiro a julho de 2018. Foram coletados dados públicos de internações de adolescentes de 10 a 19 anos disponíveis na base de dados do sistema de informações hospitalares do Ministério da Saúde, com Tabulador Oficial versão Tabwin 3.2. A análise dos dados ocorreu por estatística descritiva segundo número absoluto e frequência por ano investigado. Resultados das 82.016 internações, 9.029 (11,00%) foram por condições sensíveis à atenção primária. Entre as principais causas, destacam-se a infecção do rim e trato urinário (24,96%); epilepsias (19,27%); gastroenterites infecciosas e complicações (11,91%); doenças relacionadas ao pré-natal e parto (8,88%) e asma (7,39%). As internações do sexo feminino representaram 57,52%, prevalentes no subgrupo da faixa etária de 15 a 19 anos (66,64%). Conclusão e implicações para a prática é necessário avançar na perspectiva da construção da integralidade na atenção à saúde do adolescente, para responder às necessidades em saúde deste segmento populacional e reduzir hospitalizações por causas sensíveis à atenção primária.

Behind open doors: Patient privacy and the impact of design in primary health care, a qualitative study in Indonesia.

The importance and attention to patient privacy in recent decades have been directed mostly toward medical data protection in electronic means. Hence, other aspects of patients' privacy were overlooked, particularly in the primary health care (PHC) level. In the attempt of many countries, including Indonesia, to strive toward universal healthcare provision, a strong and accessible PHC is essential. This situation may create a tension in privacy provision where patients who need to disclose secrets may opt for other facilities, such as hospitals. This study aimed to describe and discuss patients' and doctors' perspectives and experiences about privacy in PHC in Indonesia, particularly since the universal coverage started. We used in-depth interviews and observations to gather information. Inductive and thematic data analyses were conducted. We interviewed PHC users (n = 17), doctors (n = 16), other PHC staff (n = 7), and non-PHC users (n = 5) and observed the PHC activities. We found that privacy is imperative for both patients and doctors. Design and conditions in PHC, including consultation room doors open, separate rooms for treatment, and patients' symptoms asked by other staff were aspects that undermine privacy in PHC. Inadequate physical and informational privacy protection during a patient's visit has affected the quality of care negatively in ways that impede proper anamneses and physical examination. Ensuring patients' and doctors' physical and informational privacy is essential to creating PHC as the primary source of care that responds to the privacy values of its users, but it has been overlooked. The PHC building designs and care provision guidelines should incorporate the privacy needs of patients and doctors.

Domains of Physical and Mental Workload in Health Work and Unpaid Domestic Work by Gender Division: A Study with Primary Health Care Workers in Brazil.

Various studies indicate that workload metrics can be used to assess inequities in the division of labor according to gender and in the mental health of health care professionals. In most studies, the workload is portrayed in a way that does not integrate the different fields of work, that is, work in health services and unpaid domestic work. The objective was to determine the effects of the workload domains of health work and unpaid domestic work according to the gender division of health professionals working in primary health care (PHC), and to analyze the workload as an inducer of anxiety disorders and episodes of depression. This cross-sectional study consisted of 342 health care professionals recruited for interview at primary health care units in the extreme south of Rio Grande do Sul, Brazil. Sociodemographic and occupational variables, workload in PHC and unpaid domestic work, and dichotomies of anxiety disorders and episodes of depression were considered. Poisson and multivariate linear regression models were used for data analysis. Cohen’s standardized effect size was used to assess the magnitude of the difference between women and men in terms of workload. The female professionals presented higher scores in terms of PHC work and unpaid domestic work and higher proportions of episodes of depression and anxiety disorders compared to males. The male professionals showed that anxiety disorders presented a medium standardized effect size on domestic workload and the level of frustration with family involvement was higher in those with episodes of depression. The results illustrate that the workload metric is an important indicator of female vulnerability to working conditions in PHC and in the family environment.

Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden

ObjectiveThe aim of this study was to explore how the COVID-19 pandemic changed the working conditions of physicians in Swedish primary healthcare.DesignThis is a descriptive, qualitative study with individual semistructured...

Organisational models in primary health care to manage chronic conditions: A scoping review.

Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.

Developing evidenced-based quality assessment checklist for real practice in primary health care using standardized patients: a systematic review.

The aim of this review was to explore the quality assessment checklists development methods in previous researches using standardized patients (SPs), as well as to propose an evidence-based checklist development procedure for quality assessment of common conditions in primary health care (PHC) settings. We conducted a systematic review of studies that described checklist development method and extracted the methodology in terms of the developer, the basis and processes. Based on that, we formulated the development procedure according to the recommendations of the WHO Handbook for Guideline Development. We identified a total of 13 articles, and proposed the following five key steps: (I) forming a multidisciplinary team; (II) selecting and evaluating relevant references; (III) extracting medical information and forming the basic items; (IV) clinical expert consensus on the items; and (V) pre-testing the item pool and determining final items. SP has been proven to be an effective method to assess performance in practice. There are still some deficiencies in the developing of case-specific checklists using SPs. To ensure the validity and reliability of checklists, the development processes need to be more standardized and procedural.

Motivational Interviewing in the Management of Type 2 Diabetes Mellitus and Arterial Hypertension in Primary Health Care: An RCT

Motivational interviewing is an effective style of collaborative communication for the promotion of lifestyle changes in the management of Type 2 diabetes and arterial hypertension. This study evaluates the effectiveness of motivational interviewing in the management of these conditions in primary health care. This study is a double-blind parallel-group RCT performed between June 2018 and July 2019. The RCT was conducted in Porto Alegre, Rio Grande do Sul, Brazil, and included individuals with Type 2 diabetes and arterial hypertension. The participants were randomized to the test/motivational interviewing and usual care groups. The test/motivational interviewing group received the nursing consultation intervention on the basis of motivational interviewing conducted by professionals with 20 hours of training, and the usual-care group received conventional nursing consultation. The main outcome measure was the mean difference in HbA1c. The secondary outcome measures were the mean differences in blood pressure and adherence levels. After a mean follow-up of 6 months, 174 participants completed the study (usual-care group=80; test/motivational interviewing group=94). There were statistically significant differences between the groups, with improvement in the test/motivational interviewing group for systolic blood pressure (p<0.01), diastolic blood pressure (p<0.01), and total adherence score as measured by the Martín-Bayarre-Grade questionnaire (p=0.01) and its operational dimensions of treatment adherence and personal involvement (p=0.03, p=0.03). The test/motivational interviewing group showed significantly reduced HbA1c levels (0.4%) at the end of the study (p<0.01). In the context of primary health care, the nursing consultation based on motivational interviewing was shown to be a more effective care strategy than usual care for improving blood pressure levels and adherence levels in individuals with Type 2 diabetes and arterial hypertension. Moreover, motivational interviewing was demonstrated to be useful in reducing HbA1c levels in diabetes management. This study is registered at www.clinicaltrials.gov NCT03729323.

Changes over time in the management of long-term conditions in primary health care for adults with intellectual disabilities, and the healthcare inequality gap.

Quality of primary healthcare impacts on health outcomes. This study aimed to quantify trends in good practice and the healthcare inequalities gap. Indicators of best-practice management of long-term conditions and health promotion were extracted from primary healthcare records on 721 adults with intellectual disabilities in 2007-2010, and 3638 in 2014. They were compared over time, and with the general population in 2014, using Fisher's Exact test and ordinal regression. Management improved for adults with intellectual disabilities over time (OR=5.32; CI=2.69-10.55), but not for the general population (OR=0.74; CI=0.34-1.64). However, it remained poorer, but to a lesser extent, compared with the general population (OR=0.38; CI=0.20-0.73 in 2014, and OR=0.05; CI=0.02-0.12 in 2007-2010). In 2014, health care was comparable to the general population on 49/78 (62.8%) indicators. The extent of the healthcare inequality gap reduced over this period, but remaining inequalities highlight that further action is still necessary.

Performance and user-friendliness of the rapid antigen detection tests QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick for pharyngotonsillitis caused by Streptococcus pyogenes in primary health care

Sensitivity and specificity of rapid antigen detection tests (RADTs) for detection of group A hemolytic streptococcus (GAS) vary. The purpose is to present the first SKUP (Scandinavian evaluation of laboratory equipment for point of care testing) evaluations concerning the assessment of the diagnostic performance and user-friendliness of two RADTs for detection of GAS when used under real-life conditions in primary health care. Throat samples were collected in duplicates at primary health care centers (PHCCs) from patients with symptoms of pharyngitis. The performance of QuickVue Dipstick Strep A test (307 samples) and DIAQUICK Strep A Blue Dipstick (348 samples) was evaluated using culture results at a clinical microbiology laboratory as comparison. The user-friendliness was evaluated using a questionnaire. The diagnostic sensitivity was 92% (90% confidence interval (CI) 87–96%) and 72% (90% CI 65–79%), while the diagnostic specificity was 86% (90% CI 81–90%) and 98% (90% CI 96–99%) for QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick, respectively. Both RADTs obtained acceptable assessments for user-friendliness and fulfilled SKUP’s quality goal for user-friendliness. The diagnostic sensitivity for QuickVue Dipstick Strep A test and the diagnostic specificity for DIAQUICK Strep A Blue Dipstick in this objective and supplier-independent evaluation were higher compared with previous meta-analyses of RADTs. However, the diagnostic specificity for QuickVue Dipstick Strep A test and the diagnostic sensitivity for DIAQUICK Strep A Blue Dipstick were lower compared with previous meta-analyses of RADTs.

Relación entre la inteligencia emocional y el burnout en los médicos de Atención Primaria

AimThe purpose of this study is to analyse the relationship between emotional intelligence (EI) and burnout syndrome (BOS) in doctors in Primary Health Care. Material and methodsCross-sectional descriptive study. SettingAll healthcare centres and clinics in Asturias. ParticipantsDoctors of Primary Health Care who are active. InterventionIn April 2018, an anonymous self-administered questionnaire was sent to all concerned. It included sociodemographic data, employment data, and TMMS-24 (EI) and MBI (BOS) validated scales. VariablesBOS as a dependent variable. Three dimensions of EI, age, sex, marital status, number of children, form of training, contract type, time worked, on-call hours, number of patients per day, quota, rural or urban setting, healthcare area, relationship with nursing/hospital, and teaching as independent variables. Statistical analysis: Bayesian inference. ResultsA total of 647 questionnaires were sent, and 374 subjects took part in the study (response rate: 57.8%). The subsequent distribution of BOS prevalence was 64.5% [95% credibility index: 59.7-69.2]. BOS was associated with 3 dimensions of the EI, and to have higher social skills decreased the risk of presenting with BOS. Age, contract type, urban setting, and number of patients per day tended to increase the odds of prevalence of BOS. Having children or being a guardian tended to decrease the odds of prevalence. ConclusionsThe high level of BOS in Primary Health Care doctors should be pointed out, with more than one out of 2 doctors having burnout. Therefore, we suggest looking into how emotional skills are achieved, and also how to improve working conditions in Primary Health Care.

Assessment of health literacy in the adult population registered to family medicine physicians in the Republic of Srpska, Bosnia and Herzegovina

Background: Health literacy is an important determinant of health. This concept is under-researched in the Republic of Srpska, Bosnia and Herzegovina.Objectives: To assess health literacy and its association with sociodemographic variables, self-perception of health and the presence of chronic conditions in primary healthcare setting.Methods: In May 2016, a cross-sectional study was executed in two primary healthcare centres. Out of approximately 1500 patients who visited both health centres during four consecutive days, about 800 were eligible. Of these, 110 patients agreed to complete the translated Short Test of Functional Health Literacy in Adults (S-TOFHLA). The influence of demographic, social, economic, and health characteristics (independent variables) on the S-TOFHLA score (dependent variable) was assessed by multiple logistic regression analysis.Results: One questionnaire was incomplete and therefore 109 questionnaires were analysed. Inadequate, marginal, and adequate health literacy were present in 19 (17.4%), 16 (14.7%) and 74 (67.9%) respondents. Adequate health literacy was found predominantly among respondents younger than 55 years and those with a high level of education. Regression analyses showed that low level of education (OR: 5.3), age 55 years and over (OR: 3.9), living in a rural area (OR: 3.7) and having three or more chronic diseases (OR: 2) were independently associated with inadequate or marginal health literacy.Conclusion: In this study performed in two primary healthcare centres in the Republic of Srpska, Bosnia and Herzegovina, low health literacy was associated with low level of education, older age, living in a rural area, and having more chronic diseases.

Effect of interprofessional education on teamwork and on knowledge of chronic conditions management

Objective:Evaluate the effect of interprofessional education on the climate of Primary Health Care teams and on the acquisition of knowledge about management of chronic non-communicable diseases.Method:Quasi-experimental study of interprofessional education intervention. Seventeen Primary Health Care teams (95 professionals) participated in the study, of which nine teams (50 professionals) composed the intervention group and eight teams (45 participants) composed the control group. The team climate inventory scale and a questionnaire on knowledge about management of chronic conditions in Primary Health Care were applied before and after intervention. Type I error was fixed as statistically significant (p<0.05).Results:In the analysis of knowledge about management of chronic conditions, the teams that participated in the interprofessional education intervention presented higher mean post-intervention increase than the teams of the control group (p < 0.001). However, in the analysis of both groups, there was no significant variation in the teamwork climate scores (0.061).Conclusion:The short interprofessional education intervention carried out during team meetings resulted in improved apprehension of specific knowledge on chronic conditions. However, the short intervention presented no significant impacts on teamwork climate.

Comparison of Performance of Digital Hemoglobinometer over Automated Hematology Analyzer for Hemoglobin Estimation and Its user-friendliness among the Pregnant Women in Selected District Hospitals of Madhya Pradesh.

Context:There is a need for a simple screening method for the detection of anemia that can be used by public health workers in the field.Aims:The aim of this study was to compare two methods for hemoglobin estimation, i.e., automated hematology analyzer and Digital Hemoglobinometer, and to find out the sensitivity and specificity of Digital Hemoglobinometer for the estimation of hemoglobin.Subjects and Methods:A hospital-based cross-sectional study was carried out for 6 months from April to September 2017 in a District Hospital of five High Priority Districts of Madhya Pradesh. Two hundred and sixty antenatal females per district were selected for the study.Results:The mean hemoglobin by autoanalyzer is 10.19, and that by Digital Hemoglobinometer device is 9.89. Overall, sensitivity of Digital Hemoglobinometer for hemoglobin estimation was calculated to be 89.4% and specificity was calculated to be 63.6%. Positive predictive value was found to be 82.6% and negative predictive value was 75.8% compared against AutoAnalyser (gold standard).Conclusions:As the Digital Hemoglobinometer device has high sensitivity and specificity and good diagnostic accuracy, it must be used at the community level in resource-poor setting for hemoglobin estimation. In primary health-care conditions, Digital Hemoglobinometer can significantly reduce misdiagnosis of anemia compared with clinical assessment alone.

Capacidade funcional de pacientes com indicação de cuidados paliativos na atenção primária

INTRODUCTION: Patients indicated for palliative care may have losses in functional capacity and quality of life, but there is little information about these conditions in primary health care. OBJECTIVE: To characterize the functional and symptomatic aspects of individuals indicated for palliative care in primary care. METHODS: This cross-sectional descriptive study involved six family health teams from three basic health units in Londrina, Paraná, Brazil that indicated patients with palliative care needs. The patients were assessed with the Karnofsky Performance Scale (KPS), the Edmonton Symptom Assessment Scale (ESAS) and a sociodemographic and clinical questionnaire. RESULTS: 73 patients (30 men and 43 women) whose mean age was 77.2 ± 12.1 years were included. Dementia and cerebrovascular diseases were the most frequent conditions, with 20 (27%) and 19 (26%) patients, respectively. The mean KPS score was 47.9 ± 13.9 points (44 ± 11.3 points for men and 51 ± 11.3 for women), with a significant difference between the sexes (p = 0.023). Cancer patients had better functionality than those with neurological diseases. The ESAS, whose mean score was below 3 points (mild intensity), indicated that the most frequent symptoms were impaired well-being, pain, fatigue and drowsiness. Patients without caregivers had better functional status, but greater pain and fatigue intensity. CONCLUSION: All patients had some functional limitations, and those with neurological diseases were the most affected. The symptoms were generally mild. The presence of caregivers may positively influence symptom control.

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.