Demand For Primary Health Care Research Articles

Ready to act? Factors associated with nurses’ desire to work in Primary Health Care in Italy

Abstract Background The rapid increase in demand for primary healthcare (PHC) services after the pandemic requires reconsidering nursing staff planning and availability. The objectives of the study were to i) identify knowledge, attitudes, practices and work expectations of future nurses in primary care; ii) estimate the prevalence of nursing students who desire to be employed in PHC and Family and Community Health Nursing (FCHN) services after graduation. Methods A cross-sectional study is being conducted on a sample of nursing students enrolled in universities in the Lazio Region. A structured instrument was built based on the literature and national regulations and validated (Cronbach’s alpha=0.81). Results In this first phase, 163 nursing students were enrolled. The majority of the sample was female (N = 125, 76.7%), with a mean age of 22 (SD ± 5) years and were enrolled in the last year of degree program (N = 85, 52.1%). A total of 49 students (30%) reported adequate knowledge of PHC service reorganization policies and nursing practice in this setting. While 74% (N = 122) of the sample intended to undertake a PHC curricular internship during their degree program, only seven students (4%) participated in one. 52 individuals (30%) expressed their intention to be employed in PHCs after graduation, and 29 (17.8%) indicated their desire to work as FCHN practitioners. The main factors contributing to the undesirability of employment in PHC reported by students were: i) preferring the hospital settings (N = 53, 48%); ii) not having adequate skills to be employed in the PHC (N = 21, 19%); and iii) believing that the PHC does not offer attractive services for nursing practice (N = 14, 13%). Conclusions A multivariable analysis will be conducted to identify predictors of nursing students’ desire to work in PHCs after graduation. Preliminary results of the study showed that only one-third of nursing students indicated a desire to work in PHCs. Key messages • Only one-third of nursing students express a desire to work in PHC and in Family and Community Health Nursing (FCHN) services post-graduation. • Collaboration between the PHC workforce, academics, stakeholders, and policymakers is needed to create tailored initiatives that increase the attractiveness of PHC.

Integrating Syrian refugees into Lebanon’s healthcare system 2011–2022: a mixed-method study

IntroductionThe Lebanese government estimates the number of Syrian refugees to be 1.5 million, representing 25% of the population. Refugee healthcare services have been integrated into the existing Lebanese health system. This study aims to describe the integration of Syrian refugee health services into the Lebanese national health system from 2011 to 2022, amid an ongoing economic crisis since 2019 and the COVID-19 pandemic.MethodsThis paper employs a mixed-methods approach drawing upon different data sources including: 1- document review (policies, legislation, laws, etc.); 2- semi-structured interviews with policymakers, stakeholders, and health workers; 3- focus group discussions with patients from both host and refugee populations; and 4- health systems and care seeking indicators.ResultsAlthough the demand for primary health care increased due to the Syrian refugee crisis, the provision of primary health care services was maintained. The infusion of international funding over time allowed primary health care centers to expand their resources to accommodate increased demand. The oversupply of physicians in Lebanon allowed the system to maintain a relatively high density of physicians even after the massive influx of refugees. The highly privatized, fragmented and expensive healthcare system has impeded Syrian refugees’ access to secondary and tertiary healthcare services. The economic crisis further exacerbated limits on access for both the host and refugee populations and caused tension between the two populations. Our findings showed that the funds are not channeled through the government, fragmentation across multiple financing sources and reliance on international funding. Common medications and vaccines were available in the public system for both refugee and host communities and were reported to be affordable. The economic crisis hindered both communities’ access to medications due to shortages and dramatic price increases.ConclusionIntegrating refugees in national health systems is essential to achieve sustainable development goals, in particular universal health coverage. Although it can strengthen the capacity of national health systems, the integration of refugees in low-resource settings can be challenging due to existing health system arrangements (e.g., heavily privatized care, curative-oriented, high out-of-pocket, fragmentation across multiple financing sources, and system vulnerability to economic shocks).

Trends in clinical workload in UK primary care 2005-2019: a retrospective cohort study.

Substantial increases in UK consulting rates, mean consultation duration, and clinical workload were observed between 2007 and 2014. To the authors' knowledge, no analysis of more recent trends in clinical workload has been published to date. This study updates and builds on previous research, identifying underlying changes in population morbidity levels affecting demand for primary health care. To describe the changes in clinical workload in UK primary care since 2005. Retrospective cohort study using GP primary care electronic health records data from 824 UK general practices. Over 500 million anonymised electronic health records were obtained from IQVIA Medical Research Data to examine consulting rates with GPs and practice nurses together with the duration of these consultations to determine total patient-level workload per person-year. Age-standardised mean GP direct (face-to-face and telephone) consulting rates fell steadily by 2.0% a year from 2014 to 2019. Between 2005 and 2019 mean GP direct consulting rates fell by 5.8% overall whereas mean workload per person-year increased by 25.8%, owing in part to a 36.9% increase in mean consultation duration. Indirect GP workload almost tripled over the 15 years, contributing to a 48.3% increase in overall clinical workload per person-year. The proportion of the study population with ≥3 serious chronic conditions increased from 9.7% to 16.1%, accounting for over a third of total clinical workload in 2019. Findings show sustained increases in consulting rates, consultation duration, and clinical workload until 2014. From 2015, however, rising demand for health care and a larger administrative workload have led to capacity constraints as the system nears saturation.

Role of herbal medicines in the treatment of infectious diseases.

Herbal medicines have helped to cure illness because the practice has continued for generations. Multiple alkaloids/compounds that occur naturally (as against single extracts) exhibit synergistic actions such as antiviral, antibacterial, anti-protozoal, and antioxidant. The cases related to viral, protozoal, and bacterial infections were selected. Patients with amoebiasis, E-coli, gastrointestinal infection, skin and urinary tract infections were treated using herbal drugs. Diagnoses were confirmed with investigations. Due to their cost effectiveness, these medicines are in great demand for primary health care with cultural acceptability and minimal side effects. The aim of the reported study is to show the actual use of Indian medicinal plants used for the treatment of various types of infectious diseases. Cases varying from COVID 19 to gastrointestinal infection, viral diseases, skin and wound infections are being treated effectively with herbal drugs.

Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study

Background General practices have had difficulty recruiting and retaining enough general practitioners to keep up with increasing demand for primary health care in recent years. Proposals to increase workforce capacity include a policy-driven strategy to employ additional numbers and a wider range of health professionals. Objectives Our objective was to conduct a comprehensive study of the scale, scope and impact of changing patterns of practitioner employment in general practice in England. This included an analysis of employment trends, motivations behind employment decisions, staff and patient experiences, and how skill mix changes are associated with outcome measures and costs. Design NHS Digital workforce data (2015–19) were used to analyse employment changes and to look at their association with outcomes data, such as the General Practitioner Patient Survey, General Practitioner Worklife Survey, prescribing data, Hospital Episode Statistics, Quality and Outcomes Framework and NHS payments to practices. A practice manager survey (August–December 2019) explored factors motivating general practices’ employment decisions. An in-depth case study of five general practices in England (August–December 2019) examined how a broader range of practitioners is experienced by practice staff and patients. Results We found a 2.84% increase in reported full-time equivalent per 1000 patients across all practitioners during the study period. The full-time equivalent of general practitioner partners decreased, while the full-time equivalent of salaried general practitioners, advanced nurse practitioners, clinical pharmacists, physiotherapists, physician associates and paramedics increased. General practitioners and practice managers reported different motivating factors regarding skill mix employment. General practitioners saw skill mix employment as a strategy to cope with a general practitioner shortage, whereas managers prioritised potential cost-efficiencies. Case studies demonstrated the importance of matching patients’ problems with practitioners’ competencies and ensuring flexibility for practitioners to obtain advice when perfect matching was not achieved. Senior clinicians provided additional support and had supervisory and other responsibilities, and analysis of the General Practitioner Worklife Survey data suggested that general practitioners’ job satisfaction may not increase with skill mix changes. Patients lacked information about newer practitioners, but felt reassured by the accessibility of expert advice. However, General Practitioner Patient Survey data indicated that higher patient satisfaction was associated with a higher general practitioner full-time equivalent. Quality and Outcomes Framework achievement was higher when more practitioners were employed (i.e. full-time equivalent per 1000 patients). Higher clinical pharmacist full-time equivalents per 1000 patients were associated with higher quality and lower cost prescribing. Associations between skill mix and hospital activity were mixed. Our analysis of payments to practices and prescribing costs suggested that NHS expenditure may not decrease with increasing skill mix employment. Limitations These findings may reflect turbulence during a period of rapid skill mix change in general practice. The current policy of employing staff through primary care networks is likely to accelerate workforce change and generate additional challenges. Conclusions Skill mix implementation is challenging because of the inherent complexity of general practice caseloads; it is associated with a mix of positive and negative outcome measures. Future work Findings from this study will inform future funding applications for projects that seek to examine the nature and impact of evolving multiprofessional teams in primary care. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

Assessment of staffing needs for registered nurses and licensed practical nurses at primary care units in Brazil using Workload Indicators of Staffing Need (WISN) method

BackgroundThe balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method.MethodsThe Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019.ResultsThe WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019.ConclusionThe assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Time Prices and the Demand for Primary Health Care in Chile

In this paper we study the demand for primary health care in Chile. Particularly, we examine the demand for preventive care using a sample of urban children residents in the Metropolitan Region. Following Acton (1975), we assess the influence of time prices and several other socioeconomic and demographic factors on demand. Although not significant at conventional levels, the negative coefficient of travel time price would indicate that this non-monetary factor (and potentially other sources of time not controlled for in this study) could act, under certain circumstances, as a money price in discouraging demand. The magnitude of the travel time price elasticity is consistent with the range of time price elasticities found in high-income countries. The greatest impact on the probability of demand is found to be associated to food collection, nutritional status of the child and prescription of medicines. Among the nutritional conditions, undernourishment is the most important. The working status of the mother a d economic variables such as earned and non-earned income do not have a relevant impact on demand.

Research and Policy Synergism for Advancing People-centered Care in Thailand

Thailand’s health system, dating back to the 1880s, was traditionally anchored in hospital medicine. Thus, when the family medicine concept was introduced in the 1980s, it was immediately perceived as relating to a hospital-based doctor without a specific specialization. Workforce is a crucial issue for the reform. Overall shortage of human resources is not the only issue. In each facility there should be staff fit to function. The question of human resources can indeed be tackled only when there is an agreement on what is expected from first line services that are close to the population.When the push for universal health coverage gained political momentum starting in Ayutthaya province, in the 1990s, primary care reform became necessary and urgent. It was within this context that person-centered care, family medicine, and community-based care finally made headway in Thailand’s hospital-centered medical culture. A strategy which proved instrumental in facilitating the reforms was that of ‘demonstration’ and ‘diffusion’. The idea behind the ‘demonstration health centers’ was to develop and display the family practice concept in a few selected areas in order to stimulate interest and demand for primary health care towards person- and people-centered care [1,2]. When the universal coverage policy was adopted some years later, family practice as a cornerstone for health sector development had already proven its worth and was therefore taken up as a tested model of care.

Health Care Accessibility Modeling: Effects of Change in Spatial Representation of Demand for Primary Health Care Services

Abstract Health care accessibility can be measured by the number of prospective patients who could reach a medical facility within a prescribed time limit. The representation of health care demand in estimating accessibility is an important consideration since different spatial aggregations of demand have different consequences with regard to accessibility estimates. This article examines the effects of aggregating population demand for primary health care, ranging from census tract to aggregated census block, on estimates of primary health care accessibility. Spatial representations of aggregated demand were incorporated into a location-allocation model in order to determine a measure of accessibility represented by the unmet demand for primary health care services. The model was implemented for the U.S. State of Idaho, based on the allocation of Idaho residents’ demand for primary health care to the state’s existing primary health care facilities. The results confirm a relationship between the level of demand aggregation and the level of potential accessibility. In case of a rural state such as Idaho the relationship is positive; higher levels of aggregation result in higher measures of accessibility.

Impact of a quality improvement intervention on nurses' management of same-day primary care flow.

To evaluate the impact of an interdisciplinary intervention designed to improve the capacity of nurses to manage walk-in patient demand for primary health care. Implementation of a programme to expand nursing practice is a complex process that requires the application of context-appropriate measures and adaptation when results do not meet expectations. A longitudinal, uncontrolled intervention study with a 3-year follow-up, from 2009 to 2012, was carried out in Catalonia (northeast Spain). The intervention included three training periods focused on clinical and instrumentation topics. The capacity of nurses to manage walk-in patient demand was assessed by determining the number of cases resolved and of return visits for the same complaint within 72hours. In total, 2751 patient care demands were evaluated. Resolved cases increased (χ(2) =54.624, df=1, P<0.001) and the number of return visits decreased (χ(2) =54.585, df=1, P<0.001) significantly from baseline to the end of the study period. Nurses' capacity to manage walk-in patient demand improved after an interdisciplinary intervention using a mutually agreed upon, locally adapted approach. To improve outcomes, nurses in management positions should systematically consider the need for skills training, specific academic courses, leadership development and, as appropriate, legislative initiatives.

Family Medicine and Community Orientation as a New Approach to Quality Primary and Person-centered Care in Thailand

Thailand’s health system, dating back to the 1880s, was traditionally anchored in hospital medicine. Thus, when the family medicine concept was introduced in the 1980s, it was immediately perceived as relating to a hospital-based doctor without a specific specialization. Workforce is a crucial issue for the reform. Overall shortage of human resources is not the only issue. In each facility there should be staff fit to function. The question of human resources can indeed be tackled only when there is an agreement on what is expected from first line services that are close to the population.When the push for universal health coverage gained political momentum starting in Ayutthaya province, in the 1990s, primary care reform became necessary and urgent . It was within this context that person-centered care, family medicine, and community-based care finally made headway in Thailand’s hospital-centred medical culture. A strategy which proved instrumental in facilitating the reforms was that of ‘demonstration’ and ‘diffusion’. The idea behind the ‘demonstration health centers’ was to develop and demonstrate the family practice concept in a few selected areas in order to stimulate interest and demand for primary health care towards person- and people-centered care [1,2]. When the universal coverage policy was adopted some years later, family practice as a cornerstone for health sector development had already proven its worth and was therefore taken up as a tested model of care.

Demand for Primary Health Care in Rural North India: Jointly Modelling Revealed Preference and Qualitative Choice Intentions

The combined analysis of revealed preference and qualitative choice data offer complementary features in addressing data shortages and reliability constraints faced in many low-middle income countries. The lack of data for rural north India’s primary health care market provides a context in which this joint modelling is advantageous. This paper specifically highlights the benefits of jointly modelling data to help overcome a lack of price data for non-utilised health care providers. The flexibility of the Mixed Multinomial Logit error component model to apply random draws from non-normal distributions and account for data set specific scaling is compelling.

Impacte do aumento das taxas moderadoras na procura dos cuidados de saúde primários na USF do Parque

Objectives: To assess the impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit, to compare consultation rates in the Parque FHU between January 1and May 31, 2011, and the same period in 2012, and to identify factors associated with patient demand for care in this unit. Design: Retrospective longitudinal, observational and analytical. Setting: Parque Family Health Unit, North Lisbon Health Centres Group (ACES Lisboa Norte) Population: Patients of the Parque Family Health Unit. Methods: A convenience sample of patients was selected from the health records of the Family Health Unit. The Student's t-test, Anova, Pearson correlation and Spearman correlation were used with statistical significance set at the 5% level. Results: We analyzed the records of 338 patients. The majority were female (n = 241; 71,3%), with a mean age of 57 years (standard deviation = 18,92). There was an increase in the consultation rate from 2011 to 2012. The mean number of visits was 0.87 (IC95% 0.623-1.129, p >= 0.01). Older patients, patients with more illnesses, and those taking daily medication had higher visiting rates (p >= 0.05). There were fewer visits made by patients with a higher monthly income (p >= 0.05). A positive correlation between the number of illnesses and the number of medical visits was observed in patients exempt from user fees. Conclusions: In 2012 the number of visits to the Health Unit increased. Advanced age, a larger number of illnesses and daily medication use were associated with a greater number of visits. Higher economic status was associated with lower visiting rates in both study periods. The increase in user fees did not have a negative impact on patient demand for primary health care in the Parque Family Health Unit.

High and variable use of primary care in prison. A qualitative study to understand help‐seeking behaviour

High and variable rates of attendance at GP consultations in prisons are observed. The aim of the study is to have a clearer understanding of social factors influencing inmates' help-seeking behaviour and demand for primary health care. A qualitative study was carried out in five Belgian prisons (three Dutch-speaking and two French-speaking). Twenty-five male inmates were interviewed face-to-face and 18 caregivers (7 nurses and 11 GPs) in focus groups. Five main social factors explain inmates' help-seeking behaviour and demand for primary health care: (1) inmates' negative perception of imprisonment increases help-seeking behaviour; (2) inmates use their rights to health care as strategies to maintain some form of control over their lives; (3) the doctor's role distorts expression of need and demand; (4) health professionals' control over inmates' lives creates mistrust and a controlling therapeutic relationship; and (5) lack of alternatives to health care. These factors are mutually dependent and cause a confrontation in the inmates' and clinicians' agendas. The most important recommendation is to understand what the inmates are really seeking in their demands. This information can be used to develop appropriate alternatives in terms of human support and well-being facilities. The therapeutic and security roles of health care workers should be separated, in order to increase the trust that is central to the therapeutic relationship between them and inmates.

Un programa de mejora de la calidad asistencial de los problemas de salud mental en prisión: Evaluación de resultados después de 6 años (2000-2005)

We describe the results of a program to improve the quality of mental health care amongst inmates after six years (2000-2005). We designed a series of studies lasting one to two years and used them as a basis for the program. In 2000 we studied demand for primary health care in the treatment of mental health problems in the prison health centre. In 2001 compulsive demand for psychotropic medication was studied. In 2002 the existence of mental disorders in a random sample of 60 inmates. In 2003 and 2004 we studied the relationship between mental disorder and adjustment problems, first by relating sanctions for aggressive behaviour with mental disorders using a random sample of 60 inmates and then relating inappropriate adjustment behaviours with use of psychotropic medication in a random sample of 520 inmates. In 2005 we studied the functioning of the prison health care centre as a resource in the treatment of inmates with severe mental illness by taking data from admissions over a seven month time period. 50% of the primary health care consultations were related in one or another with a mental health problem. 59% of the inmates showed symptoms of some type of mental disorder, 56.6% of those being addictive disorders while the other 30% were Personality Disorders. 20% of the inmates required referral to the consultant psychiatrist, the most common cause of referral being inappropriate or maladjusted behaviour (46%) and the most common diagnosis Depressive Disorder associated with Addictive Disorder (psychoactive substances). We could see a correlation between the number of sanctions for aggressive conduct and the diagnosis of Personality Disorder. A similar correlation could be seen between adjustment problems marked on an objective scale and the use of psychotropic medication. 50% of the inmates in the health centre sick bay were there because of mental disorder, and 43% had been admitted directly after sentencing. A limitation of this study is that it only goes as far as describing a set of findings about the quality of mental health care and does not propose any relevant improvements. This work shall be left for later studies. There is clearly a great need for mental health care amongst prisoners. Pathologies that cause inappropriate behaviour, most commonly understood as the expression of inadequate interpersonal relationships, are the most common disorders and are generally associated with psychoactive substance abuse. The model we propose is that of the consultant psychiatrist working in close cooperation with the primary health care team as the best answer to this type of health care need. Health care centres are not sufficiently equipped to respond to the situation and have no other option but to accept patients who have usually committed some type of violent crime and who have not been admitted to specialised centres outside prison, usually because adequate security measures are lacking.

Reconceptualizing ‘Inappropriateness’: Researching Multiple Moral Positions in Demand for Primary Healthcare

In a recently completed study of the management of ‘out-ofhours’ primary healthcare for children and ways in which judgements are made about legitimate access, the construct of ‘inappropriate demand’ is investigated. This seemingly intractable health care issue has not been resolved by research that rests on a one-sided conceptualization of the ‘problem’. In practice, ‘demand’ arises within complex processes of interaction between people taking a range of moral positions in particular contexts. This is illustrated with interpretations of some ethnographic material from the study. An argument is made for an alternative research approach to such contentious issues that acknowledges multiple and latent moral orientations, and reveals moral judgements in scientific guise.

The Use of Diaries in Sociological Research on Health Experience

Diaries have been relatively neglected as a sociological research method. This paper highlights the value of diary research, drawing on the literature on auto/biographies and health service research as well as a qualitative study of need and demand for primary health care, which used diaries and linked in-depth interviews. In particular, data from the study are used to illustrate the role of the ‘diary-interview’ method in offering a means to ‘observe’ behaviour which is inaccessible to participant observation. Five key advantages of the diary-interview are discussed, namely the potential of the ‘diary-interview’ method to accommodate different response modes; the extent to which the method captured diarists’ own priorities; the importance of the research process in illuminating the contexts within which helpseeking took place; the role of diaries as both a record of and reflection on the experience of illness and the value of the diary-interview method as a means of understanding what is ‘taken for granted’ in accounts of health and illness.

Need and demand for primary health care: a comparative survey approach

To develop general practice profiles of needs and demand for primary health care. Postal survey of a stratified random sample of 3478 people registered with five general practices. Data from a single practice were compared with data from the remaining four to identify areas of comparative need. Five general practices in Lothian. Differences between the single practice and the comparison practices in terms of social and economic circumstances, limiting long term illness, specific ongoing conditions, minor illness or symptoms, psychosocial problems, discussion of lifestyle, associated use of services. Respondents from the single practice reported higher rates than those in the four comparison practices of ongoing mental health and respiratory problems and use of antidepressants, tranquillisers, or sleeping tablets. Although rates of limiting long term illness and other specific ongoing conditions were comparable, the rates of minor illness or symptoms and psychosocial difficulties were higher in the single practice. Respondents from the single practice were more likely to consult frequently, to have contacted the practice out of normal working hours, and to have discussed psychosocial difficulties with a general practitioner. For any specific ongoing condition or "minor" illness, respondents from the single practice were no more likely to consult. A comparative survey approach is a useful method of developing an understanding of patterns of need and demand among general practice populations. It has the potential to inform planning within individual general practices and the process of commissioning among general practices within a given area.

The Demand for Primary Health Care Services in the Bicol Region of the Philippines

Mortality is assumed to be strongly reduced by medical care however the effects of medical services on health are often underestimated because some of the same factors which lead to an increased demand for primary health care (PHC) services are also associated with increased morbidity and mortality. Consequently understanding the determinants of the demand for medical services is important for evaluating health outcomes. This paper estimates the parameters of a simple model of the demand for health services using data from the Bicol Multipurpose Survey data from the Philippines. The parameters of the demand for key components of PHC--outpatient prenatal delivery well-child and infant immunizations--are estimated. Findings suggest that the quality of the care may be very important but that economic factors as deterrents to using medical care--inaccessibility cash costs and lack of income--may not be of paramount importance. Finally it is shown that the provision of free services in rural areas may not insure that the services reach the poorest people. (authors modified)

Utilization of Health Services in a Defined Swedish Population

With the aid of a data registration system and person-specific information, utilization behaviour has been studied in a defined Swedish population. Information from three registers was linked together in order to produce the current results: a medical information system in primary care, a population register, and a register of property. The higher health care consumption for females is shown to occur independently of diagnosis, even if diseases of the genitourinary system, psychoneurosis and rheumatoid arthritis were more common among females. The consultation rate was inversely related to the distance to the surgery from the patient's residence. There was less demand for primary health care during the summer months, July and August. For the rest of the year there were no differences.