Primary Health Care Consultations Research Articles

Uncontrolled chronic pain: can a pain consultation in primary care be a solution?

Chronic pain is one of the most frequent medical problems in Portuguese primary health care. These patients significantly show poorer functioning capabilities and quality of life than the general population. The importance of improving the quality of life in patients suffering from chronic pain is paramount, and a holistic approach must be implemented. However, proper pain evaluation and management may be time-consuming in a routine primary health care consultation. Given the significant impact of this disease, we initiated a dedicated consultation for patients with chronic pain in our primary health care unit. A complete evaluation is performed, and, among other questionaries, the Brief Pain Inventory is applied to evaluate pain impact on functioning at the first appointment and re-evaluated after six months of follow-up. In the first six months, 31 patients with uncontrolled pain were referred by their family physicians to this consultation. Non-pharmacological strategies were strongly recommended alongside pharmacological therapies. Although this consultation is relatively recent, our patients with longer follow-ups showed improvement in both maximum and minimum pain levels and substantial improvement in all the measured interferences in the Brief Pain Inventory. Even though there is literature that thoroughly describes the impact of pain on patients’ quality of life, there is much to be done to change this problem. Since family physicians know their patients and their contexts well, they are in a privileged position to manage this problem, and a specific pain consultation in primary health care can be one of the best services for managing pain.

Aberrations in medically certified sick leave and primary healthcare consultations in Norway in 2023 compared to pre-COVID-19-pandemic trends

BackgroundSince 2022, Norway has employed a vaccine-only COVID-19 strategy. Primary healthcare in Norway uses International Classification of Primary Care version 2 (ICPC-2) codes. This study aims to systematically compare medically certified sick leave and primary healthcare consultations in 2023 with the pre-pandemic 2010–2019 trends, and subsequently estimate the magnitude of these changes.MethodsFor the respective outcomes of (A) working person-years lost to medically certified sick leave (WYLSL) and (B) number of primary healthcare consultations, 556 and 85 ICPC-2 code combinations were extracted from the Norwegian Labour and Welfare Administration’s sick leave registry and the Norwegian Syndromic Surveillance System. For each ICPC-2 code combination, a Bayesian linear regression was performed using data between 2010 and 2019 to estimate an expected baseline for 2023, which was then used to calculate the deviation from the pre-pandemic trend. A false discovery rate of 5% was used to account for multiple testing.ResultsAll years from 2020 to 2023 had excess WYLSL, corresponding to 14,491 (90% PI: 8,935 to 20,016) in 2020, 12,911 (90% PI: 5,916 to 19,996) in 2021, 21,263 (90% PI: 12,627 to 29,864) in 2022, and 24,466 (90% PI: 14,023 to 34,705) in 2023. This corresponded to an economic loss of approximately 1.5 billion USD in 2023. Excess WYLSL due to A* (General and unspecified) increased from 2020 to 2023, with an estimated excess of 4,136 WYLSL in 2023 (69% higher than expected). More than half of this increase was explained by A04 (Weakness/tiredness general), whose excess WYLSL in 2023 were estimated at 2,640 (80% higher than expected). The excess in A04 (Weakness/tiredness general) corresponded to an economic loss of 161 million USD and accounted for 11% of the total excess WYLSL in 2023. The excess WYLSL in R* (Respiratory) in 2023 was 3,408, which correspond to an economic loss of 207 million USD and accounted for 14% of the total excess in 2023.ConclusionsSignificant excesses in working person-years lost to medically certified sick leave and primary healthcare consultations in 2023. A sizable proportion of the excesses were due to diseases/symptoms associated with acute and post-acute sequelae of COVID-19.

A qualitative exploration of Gestalt therapy and systemic pedagogy paediatric primary healthcare consultations in Agramunt (Spain).

Gestalt therapy (GT) and systemic pedagogy (SP) are useful tools to approach emotional difficulties and mental health problems among children and adolescents. The main objective of this study was to explore the perceptions on GT and SP techniques in paediatric mental health-related consultations in a primary healthcare (PHC) centre in Catalonia in 2018-2019, among families, healthcare, and education professionals. Qualitative study, combining semi-structured interviews with families (N = 42) and professionals (N = 15), conducted after a series paediatric PHC consultations including GT and SP techniques. Interviews lasted between 15 and 90min and were conducted at the PHC centre where GT/SP consultations took place, and at professionals' workplaces. Socio-demographics, reasons for consultation, and quantitative ratings on the perceived effectiveness of GT/SP consultations were also collected to combine these data with the qualitative interviews. Qualitative data were analyzed descriptively using thematic analysis. Quantitative data were analyzed by calculating frequencies (percentages) for categorical variables, and means, medians, and ranges for continuous variables. Narratives from families and healthcare professionals indicate that GT/SP consultations might have been effective in improving children and adolescents' symptomatology and emotional health. Improved well-being within the family context was another main finding, based on families' perceptions and experiences. Besides, GT/SP were considered acceptable for approaching emotional and mental health in PHC services, although barriers for implementation were identified. This study presents data on the potential usefulness of GT/SP to design and implement services that promote emotional and mental health among children and adolescents in PHC. Also, for the development of health policies and future research in this area.

Perception and Experience of Independent Consultations in Primary Healthcare among Registered Nurses in Kazakhstan: A Qualitative Study.

(1) Background: The nursing profession has undergone a significant transformation not only in a formal context but also in terms of the increased educational competencies required of nurses and their preparedness to adapt to evolving roles and statuses. The aim of our study was to examine the experience of advanced practice nurses who conduct independent consultations on patients and to identify the main challenges they face in their practice. (2) Methods: We carried out 22 semi-structured interviews with nurses responsible for conducting independent consultations across three urban polyclinics located in Aktobe, Almaty, and Astana. All interviews were audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. (3) Results: The content analysis revealed three main themes: "People awareness of the role of an independent nursing appointment", "Adaptation of the work environment", and "Confidence of nurses to provide independent services". (4) Conclusions: Limited competency among nurses and the absence of quality metrics for autonomous nursing consultations present substantial obstacles to assessing and enhancing the quality of care delivered by nurses in their independent roles. Developing and implementing quality indicators for independent nursing appointment, as well as additional training within the framework of interprofessional continuous education for nurses, are important steps toward enhancing the effectiveness, safety, and accessibility of nursing care.

Prevalence of chronic diseases and obstetric complications of pregnant women assisted in primary health care

Objective: to verify the prevalence of chronic diseases and associate them with obstetric complications in pregnant women assisted in Primary Health Care. Method: Analytical cross-sectional study, conducted by searching electronic medical records of pregnant women treated in a Family Health Strategy in a city in the state of Rio Grande do Sul. Results: There was no association between systemic arterial hypertension, diabetes mellitus and obesity with hemorrhage, premature birth and late birth. In the case of premature birth, pregnant women with SAH had an approximately 1.9 times higher risk compared to those who did not have this comorbidity. With regard to pregnant women who are obese, the risk of premature birth was approximately 2.5 times higher compared to women who are not obese. Conclusion: The findings highlight the need to monitor pregnant women in prenatal consultations in Primary Health Care and serve as important guidelines for the planning and implementation of health interventions aimed at chronic diseases and obstetric complications in pregnant women.

A machine learning tool for identifying patients with newly diagnosed diabetes in primary care

Background and aimIt is crucial to identify a diabetes diagnosis early. Create a predictive model utilizing machine learning (ML) to identify new cases of diabetes in primary health care (PHC). MethodsA case-control study utilizing data on PHC visits for sex-, age, and PHC-matched controls. Stochastic gradient boosting was used to construct a model for predicting cases of diabetes based on diagnostic codes from PHC consultations during the year before index (diagnosis) date and number of consultations. Variable importance was estimated using the normalized relative influence (NRI) score. Risks of having diabetes were calculated using odds ratios of marginal effects (ORME). Four groups by age and sex were studied, age-groups 35–64 years and ≥ 65 years in men and women, respectively. ResultsThe most important predictive factors were hypertension with NRI 21.4–29.7 %, and obesity 4.8–15.2 %. The NRI for other top ten diagnoses and administrative codes generally ranged 1.0–4.2 %. ConclusionsOur data confirm the known risk patterns for predicting a new diagnosis of diabetes, and the need to test blood glucose frequently. To assess the full potential of ML for risk prediction purposes in clinical practice, future studies could include clinical data on life-style patterns, laboratory tests and prescribed medication.

Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

Slow-resolving pneumonia, case report

Respiratory infections are one of the main causes of consultation and hospitalization in primary health care, including pneumonia. We present the case of a 3-year-old preschooler who came to the health services for presenting frequent wet cough and fever of up to 39 degrees Celsius of 8 days of evolution, who was previously treated with oral Amoxacillin in his health area without resolution of the symptoms. On physical examination, the patient was found to be in good general condition, where only the presence of crackling rales in the right lung base was positive; antimicrobial therapy was started, showing clinical improvement and cessation of the febrile symptoms. On the fifth day of evolution the febrile symptoms reappeared with peaks of up to 39 degrees Celsius. Physical and radiological examination showed worsening of the symptoms. Results of nasopharyngeal exudate were received, which showed Klebsiella pneumophila. An evolutionary chest X-ray was indicated, resulting in a denser and more homogeneous opacity with radiolucent areolar images towards its upper contour that kept occupied upper and middle segments of the right lung field, showing a phase of hepatization of the process with images suggestive of pneumatoceles. Antimicrobial spectrum was extended with Meropenen associated to Vancomycin according to antibiogram and possible sensitivity according to the most frequent etiology according to age, with satisfactory resolution of the picture. Atypical etiologies, including Klebsiella pneumophila, should be suspected in the case of slowly resolving pneumonia

Determinants of pregnant women’s satisfaction with interactions with health providers at antenatal consultation in primary health care in Southern Mozambique in 2021: a cross-sectional study

SummaryBackgroundThe Ministry of Health of Mozambique (MISAU) and the World Health Organization (WHO) recommend enhancing pregnant women’s satisfaction with health care services in order to advance maternal and child health. This study aims to assess the levels and determinants of pregnant women’s satisfaction regarding their interactions with antenatal care (ANC) providers, the services of which were provided at the primary health care level in southern Mozambique.MethodologyWe conducted an observational, quantitative, and cross-sectional study from November 4 to December 10, 2021. A structured questionnaire was administered to pregnant women who attended ANC during that period. The characteristics of the participants were illustrated using descriptive statistics; to analyse pregnant women’s satisfaction determinants, we estimated crude and adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) using logistic regression models. All analyses were performed in SPSS version 24 using a 5% significance level.ResultsWe selected 951 pregnant women with a mean age of 25 years old; 14% attained a secondary educational level, 36% were married or living in a marital relationship, and 85.9% reported being satisfied with their current ANC. Factors that reduced the odds of being satisfied were the following: an “insufficient” ANC duration (AOR = 0.173; 95% CI: 0.079, 0.381); inadequate ANC waiting area (AOR = 0.479; 95% CI: 0.265, 0.863); women’s perception about the existing norm of nonattendance in case of late arrival to the ANC (AOR = 0.528; 95% CI 0.292, 0.954); the perception of the existing norm that women are obliged to give birth in same health facility where ANC occurred (AOR = 0.481; 95% CI: 0.273, 0.846); and the perception that delivered ANC is not important for foetal health (AOR = 0.030; 95% CI:0.014, 0.066).ConclusionsMost of the pregnant women mentioned being satisfied with the ANC they received. The perception of short consultation duration, inadequate waiting spaces, strict linkage rules to specific health facilities and ANC norms, the perception that the received ANC is not relevant for foetal well-being are determinants of not being satisfied with ANC, and these determinants can be addressed by reorganizing ANC and, indeed, are modifiable by the improved paced implementation of the MISAU strategies for quality maternal and child health care.

Change management on the meso-level: Primary mental health care in Pallieterland, supported by Emergo/PANGG 0-18 (Flanders, Belgium)

Introduction: One of the main current challenges for the Belgian primary health care system is the integration of primary mental health care.
 Belgium is known to have a shortage of mental health professionals. Public mental health services are understaffed, resulting in long waiting lists. Private mental health professionals are too expensive for many people in psychological distress.
 Since 2019, a limited number of primary mental health consultations is reimbursed, to lower the financial threshold to access the private mental health sector. Since 2021, the primary mental health convention changed, towards higher renumeration for psychologists working in the convention, and starting more from a public mental health vision.
 This is a Belgian federal action. In Pallieterland and four other primary care zones, this action is coordinated by two mental health networks: Emergo (for adults) and PANNG 0-18 (for minors).
 In this article the focus is on the change management on the meso-level: how did and still does primary care zone Pallieterland help to implement this policy change?
 What we did: The first step was to have a representative of the mental health sector in the board of the primary care zone, a necessary navigator and go-between, facilitating communication efforts of the primary care zone towards the mental health sector.
 The second step was to help founding a local psychologists’ association. After some previous attempts, the start of the new convention showed to be a good momentum for the start of the local psychologists’ association. Their founders are good communicators, representing the local primary mental health professionals in the boards of both the primary care zone, and of the local implementation group of the new primary mental health care convention.
 The third step is to keep monitoring the implementation progress, making sure that all localities in the primary care zone are well served with reimbursed primary health care consultations.
 
 The primary care zone facilitated and still facilitates these processes, by using a diversity of communication platforms:
 - A monthly electronic newsletter, reaching local healthcare and social care professionals;
 - Siilo Connect, a “medical Whatsapp” respecting GDPR legislation and able to send messages both to the whole contact list and to specific professional groups. Sometimes we sent a targeted request to fill a survey related to this topic, whenever we needed input for local policy decisions;
 - Six-monthly platform meetings on relevant interdisciplinary topics, reaching local healthcare and social care professionals: we both gave dedicated time for this project on one platform meeting and gave short follow-up notices on other platform meetings;
 - Six-weekly board meetings and annual general meeting: short notices on the progress of implementation, allowing questions from diverse stakeholders.
 Conclusion: Summarizing the efforts of primary care zone Pallieterland towards the implementation of the new primary mental health convention through the lens of Donabedian’s theory (Structure – Process – Outcome), we found that we spent most energy and time in modelling the structures, and monitoring processes of communication/collaboration. At the moment, primary care zones don’t have access to any outcome indicator.
 

Patterns of healthcare use among children with immigrant and non-immigrant backgrounds in 2019 and 2020: evidence from the CRIAS cohort study in the metropolitan area of Lisbon, Portugal

BackgroundInternational migrant families may face various barriers in the access and use of health services. Evidence on immigrant children’s health care or prevention facilities’ utilisation patterns is scarce in Portugal. Therefore, the objectives of this study were to compare health services use between immigrant and non-immigrant children in the Metropolitan Area of Lisbon in 2019–2020 with the aim of informing public policies towards equitable access to, and use of health services.MethodsThe CRIAS (Health Trajectories of Immigrant Children) prospective cohort study enrolled 420 children (51.6% immigrant) born in 2015 and attending primary health care (PHC) services in 2019. We compared primary health care facilities and hospital paediatric emergency department (ED) utilisation patterns in the public National Health Service, together with reported private practitioners use, between immigrant and non-immigrant children in 2019 and 2020. The Pearson chi-squared test, Fisher-Freeman-Halton Exact test, two-proportion z-test and Mann‒Whitney U test were used to examine the differences between the two groups.ResultsIn 2019, no significant differences in PHC consultations attendance between the two groups were observed. However, first-generation immigrant children (children residing in Portugal born in a non-European Union country) accessed fewer routine health assessments compared to non-immigrant children (63.4% vs. 79.2%). When children were acutely ill, 136 parents, of whom 55.9% were parents of non-immigrant children, reported not attending PHC as the first point of contact. Among those, nearly four times more non-immigrant children sought healthcare in the private sector than immigrant children (p < 0.001). Throughout 2019, immigrant children used ED more often than non-immigrant children (53.5% vs. 40.4%, p = 0.010), as their parents reported difficulties in accessing PHC. In 2020, during the COVID-19 pandemic, fewer immigrant children accessed PHC compared to non-immigrant children (70% vs. 80%, p = 0.018). Both non-immigrant and immigrant children reduced ED use by 2.5 times, with a higher decrease among immigrant children (46% vs. 34%). In both 2019 and 2020, over 80% of immigrant and non-immigrant children used ED for conditions classified as having low clinical priority.ConclusionBeyond identifying health care use inequalities between immigrant and non-immigrant children, the study points to urgent needs for public policy and economic investments to strengthen PHC for all children rather than for some.

Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010–2016

IntroductionMental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This...

Evaluation of family physicians’ attitude towards primary healthcare consultations

Abstract Background The quality of services in the health care system is very important for both patients’ health and health care providers. In the past decade, good service ratings from the patient's perspective have become crucial in evaluating the work of medical professionals and health care institutions. However, it is also important to consider the opinions of health care specialists, especially when it comes to medical consultation, which is one of the most important components of primary health care (PHC) chain. Aim To evaluate the attitude of family physicians (FP) towards consultations provided in PHC. Methods The study was conducted in 2022. December - 2023 in February. The research contingent is FP of Lithuania. Research method - quantitative momentary research, anonymous questionnaire survey, 206 subjects were interviewed. Calculated chi-square (χ2) and z-criterion. Results The majority of FP indicated that they involve the patient in the decision-making process (68.0%), those working in private institutions said so more often than those working in public institutions (p &amp;lt; 0.05). 89.3% of the subjects stated that the consultation time with the patient is not enough, and 70.4% respondents receive many unregistered patient visits per day. E-health makes it difficult for 81.1%, 86.4% of the respondents indicated that there is too much of a workload and this was mostly said by respondents working in public institutions (p &amp;lt; 0.05). Remote consultations facilitate the workflow (76.2%). The older age of the respondents and greater work experience lead to lower self-confidence during remote consultation, longer consultation time and less belief in the benefits of remote consultation (p &amp;lt; 0.05). Conclusions Most FP positively evaluate the consultation they provide, but they also said that the consultation time is insufficient, they must consult a number of unregistered patients, e-health complicates the work. Remote consultations facilitate the workflow. Key messages • The consultation time is insufficient. • Remote consultations facilitate the workflow.

Implementation of telehealth primary health care services in a rural Aboriginal Community-Controlled Health Organisation during the COVID-19 pandemic: a mixed-methods study.

Globally, primary care organisations responded rapidly to COVID-19 physical distancing requirements through the adoption of telehealth to maintain the delivery of health care to communities. In Australia, temporary Medicare Benefits Schedule (MBS) telehealth items were introduced in March 2020 to enable the provision of telehealth services in the primary care setting. These changes included funding for two modes of telehealth delivery: videoconferencing and telephone consultations. As primary care organisations, Aboriginal Community Controlled Health Organisations (ACCHOs) rapidly adopted telehealth consultations to maintain the delivery of primary care services to Aboriginal and Torres Strait Islander clients. The aim of the present study was to evaluate the implementation (specifically the uptake, acceptability and requirements for delivery) of telehealth primary healthcare services for Aboriginal and/or Torres Strait Islander peoples by a rural ACCHO during COVID-19. A single-site convergent-parallel mixed-methods study was undertaken in the context of an ongoing research partnership established between a rural ACCHO and a university department of rural health. De-identified health service data from March 2020 to March 2021 was extracted, including MBS telehealth consultations and client demographics (eg age, gender and postcode). Variables were analysed using descriptive statistics to examine the uptake of telehealth by Aboriginal and Torres Strait Islander clients. A geographical analysis of postcode data was also undertaken. Semi-structured interviews were undertaken concurrently with a purposive sample of health service personnel (including health professionals) involved in the implementation or delivery of telehealth, and Aboriginal and/or Torres Strait Islander clients who had accessed telehealth, to explore the acceptability of telehealth and requirements for delivery. Thematic analysis using an inductive approach was undertaken. The analyses of quantitative and qualitative findings were merged to identify key concepts pertaining to the uptake, acceptability and requirements for telehealth delivery. During the first year of implementation, 435 telehealth primary healthcare consultations were delivered to Aboriginal and/or Torres Strait Islander clients. Seven health personnel and six Aboriginal and/or Torres Strait Islander clients participated in interviews. Merged findings from an analysis of quantitative and qualitative data were grouped under three concepts: uptake of telehealth consultations by Aboriginal and Torres Strait Islander clients, maintaining the delivery of ACCHO services during COVID-19, and implications for sustaining telehealth in an ACCHO. Findings identified that telehealth maintained the delivery of ACCHO services to Aboriginal and/or Torres Strait Islander clients across the lifespan during COVID-19, despite a preference for face-to-face consultations. A greater uptake of telephone consultations compared to videoconferencing was identified. Barriers to the utilisation of videoconferencing were largely technology related, highlighting the need for additional support for clients. Telehealth was a useful addition to face-to-face consultations when used in the appropriate context such as the administration of long-term medication prescriptions by a GP. Engaging the ACCHO sector in the policy discourse around telehealth is imperative for identifying requirements for ongoing implementation.

Migrant background and the impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study

BackgroundDespite concern about migrant children’s mental health and their access to mental healthcare services during the COVID-19 pandemic, this topic has attracted little research attention. This study aimed to examine the impact of the COVID-19 pandemic on the use primary and specialist healthcare services for mental health problems among children and adolescents with migrant background.MethodsUsing event study models, we investigated the impact of lockdown and subsequent COVID-19 infection control measures on children’s health service use for mental health problems according to migrant background. Drawing on reimbursement data from Norwegian public healthcare providers we observe consultations in a pre-pandemic (2017–2019) and pandemic cohort (2019–2021) in primary and specialised care.ResultsThe pre-pandemic cohort included 77 324 migrants, 78 406 descendants of migrants and 746 917 non-migrants and the pandemic cohort included 76 830 migrants, 88 331 descendants and 732 609 non-migrants (age 6–19). The full cohorts were observed for mental healthcare use in primary care while a subsample (age 6–16) was observed for health care use in specialist care. Lockdown resulted in a dip in consultation volumes for mental disorders for all children, but this dip was relatively larger and more persistent for children with migrant background. After lockdown, consultation volumes rose more for non-migrant children than for children with migrant background. Consultations in primary healthcare peaked during January to April 2021 for non-migrants and descendants of migrants, but not for migrants (4%, 95% CI -4 to 11). In specialist care during the same period, consultations dropped by 11% for migrants (95% CI -21 to -1).By October 2021, all mental health consultations in specialist care were up with 8% for non-migrants (95% CI 0 to 15), and down with -18% for migrants and -2% for descendants (95% CIs -31 to -5 and -14 to 10).Migrant males experienced the largest reduction in consultations.ConclusionsChanges in consultation volumes among children with migrant background after lockdown were not as pronounced as for non-migrants, and at times actually decreased. This suggests that an increase in barriers to care emerged during the pandemic for children with a migrant background.

Regulation of dental consultations in primary health care and performance of services in dental speciality centers

ObjectiveThis study analyzed the regulation of dental specialty centers (CEOs) coordinated exclusively by Primary Health Care (PHC) in four primary outcomes: access and dental consultation, reception services, bonding and responsibility, and social participation.MethodsA cross-sectional study was carried out using secondary data from the National Program for the Improvement of Access and Quality of Dental Specialty Centers (PMAQ-CEO): second cycle, using multilevel logistic regression to calculate the odds ratio (OR) and individual covariates.ResultsThe analytical sample consisted of 9,599 CEO users who had completed all the variables analyzed. Of these, 63.5% were referred to the CEO by PHC. Dental care regulated by PHC was related to better access (OR 1.36, CI 95% 1.10–1.68), better reception (OR 1.33, CI 95% 1.03–1.71), better bonding and responsibility (OR 1.36, CI 95% 0.91–2.04), and social participation (OR 1.13, CI 95% 0.93–1.35) compared to those not regulated by primary health care as the exclusive pathway.ConclusionThe regulation of access to the CEO coordinated by PHC presented the best performance. It is suggested that this form of PHC regulation, as a route for dental specialty centers, can be established in the national oral health care policy for better service performance.

AUDIO SUMMARIZATION IN REAL TIME FOR PODCAST, SPEECHES AND AUDIOBOOKS

The majority of public works are carried out online as a result of the coronavirus disease (COVID19) pandemic. Many job interviews, primary health care consultations, and company meetings are conducted entirely online, and universities all over the world have switched to online teaching. Applications for online meetings like Microsoft Team and Google Meet are widely available on the market. We approach a topic with numerous practical applications in this work. A method that takes recorded video as input and produces identical written or audio summaries as output is the subject of this paper. Additionally, the proposed method can be used to create meeting minutes, subtitle or scribe entertainment videos, and create lecture notes from lecture videos. The audio track of a video is converted into text by the proposed system. We also used a text summarization algorithm to create text summaries. Users of the system have the option of using a text summary or making an audio output that matches the text summary. The proposed strategy is carried out in Python and the proposed conspire is assessed utilizing brief recordings got from YouTube. The proposed method is manually validated on a set of uploaded videos because there are neither specific datasets or benchmarks available to evaluate efficacy nor any benchmarks to use in related studies.

Sharp increase in self-poisonings among adolescent girls during the Covid-19 pandemic: Findings from Norwegian registry data.

Sharp increase in self-poisonings among adolescent girls during the Covid-19 pandemic: Findings from Norwegian registry data.

Short- and intermediate-term impact of DTC telemedicine consultations on subsequent healthcare consumption

AimThe use of direct-to-consumer (DTC) telemedicine consultations in primary healthcare has increased rapidly, in Sweden and internationally. Such consultations may be a low-cost alternative to face-to-face visits, but there is limited evidence on their effects on overall healthcare consumption. The aim of this study was to assess the short- and intermediate-term impact of DTC telemedicine consultations on subsequent primary healthcare consumption, by comparing DTC telemedicine users to matched controls in a Swedish setting.MethodsWe constructed a database with individual-level data on healthcare consumption, for all residents of Region Stockholm in 2018, by linking national and regional registries. The study population included all individuals who had ≥ 1 physician consultation (telemedicine or face-to-face) during the first half of 2018. DTC telemedicine users were matched 1:2 to controls who were non-users of DTC telemedicine but who had a traditional face-to-face consultation during the study period. The matching criteria were diagnosis and demographic and socioeconomic variables. An interrupted time series analysis was performed to compare the healthcare consumption of DTC telemedicine users to that of the control group.ResultsDTC telemedicine users increased their healthcare consumption more than controls. The effect seemed to be mostly short term (within a month), but was also present at the intermediate term (2–6 months after the initial consultation). The results were robust across age and disease groups.ConclusionThe results indicate that DTC telemedicine consultations increase the total number of physician consultations in primary healthcare. From a policy perspective, it is therefore important to further investigate for which diagnoses and treatments DTC telemedicine is suitable so that its use can be encouraged when it is most cost-efficient and limited when it is not. Given the fundamentally different models for reimbursement, there are reasons to review and possibly harmonise the incentive structures for DTC telemedicine and traditional primary healthcare.

Pacientes em uso de análogos de insulina via ação judicial: eles utilizam o Sistema Único de Saúde (SUS)?

Abstract Background Studies show that among the drugs most commonly used in judicial litigation in Brazil, are those used to treat diabetes mellitus, especially insulin analogues. Objective Evaluate the use of the Unified Health System (SUS) by patients with type 1 diabetes mellitus (T1DM), who receive insulin analogues through judicial action, before and after this process. Method In a retrospective longitudinal observational study, secondary data was used from these patients in Minas Gerais, Brazil, in 2018. Socio-demographic information was collected and related to the follow-up of these patients in the SUS. The McNemar χ2 test was used to compare the proportions of the variables. Results Of the 89 patients analyzed, women (53.9%) were predominant. Most patients were aged between 20 and 39 years (52.8%), and more than half, 55.1%, use only a private health system. After the judicial action, there was a significant increase (p &lt;0.05) in the number of patients who had consultations in primary health care (from 19.1% to 30.3%) and emergency medical appointments (from 1.1% to 9.0%). Conclusion It is observed that the majority of patients with T1DM via judicial action in the SUS are not monitored by this health system through examinations, consultations, and hospitalizations.