Diseases In Primary Health Care Research Articles

Prevencija kardiovaskularnih bolesti u primarnoj zdravstvenoj zaštiti

Prevencija kardiovaskularnih bolesti u primarnoj zdravstvenoj zaštiti

AB1418-PC Impact of the physiotherapy unit in an urban primary care health centre

BackgroundPrimary Care Physiotherapy Units attend patients derived by primary care physicians with the next care circumstances: degenerative osteomuscular disease, specially spinal osteoarthritis; but also pain located in shoulder, knee, hand...

Eliciting general practitioners' salient beliefs towards prescribing: A qualitative study based on the Theory of Planned Behaviour in Greece

Prescribing represents an important medical action especially in primary care. However, irrational prescribing is common and has an impact on clinical and economic outcomes. Therefore, there is a growing need to rationalize prescribing. Knowledge of influential factors is crucial for achieving this. The aim of the present study was to identify the behavioural, normative and control beliefs of GPs regarding prescribing in Greece. Focus group sessions were conducted in three geographically defined areas in Greece. GPs working in the private and public sector in primary care settings were invited to participate. Transcripts from focus groups were content analysed using the Theory of Planned Behaviour (TPB) as the theoretical framework. GPs acknowledged prescribing as the most important method for treating diseases in primary health care, with significant impact on patient's health and quality of life. The expectations of patients and their families were extremely influential during prescribing. Pharmaceutical sales representatives, other GPs and specialists, as well as public health authorities influenced prescribing. GPs admitted that factors such as the income of the patient, the limited time available and special situations such as prescribing through a third person or prescribing following patients' prescription requests for medicines that they have previously purchased over the counter through pharmacies may facilitate or hinder their prescribing decision. This elicitation study shed light into GPs' beliefs regarding prescribing. Factors that are not common in the usual European setting were revealed, such as the influence of the patients' family and special situations during prescribing. Thus, various issues were highlighted that should inform the development of items for inclusion in a forthcoming TPB-based questionnaire. The results of this study revealed also certain issues that can affect the design of policies aiming at the rationalization of prescribing.

Acute and Chronic Respiratory Symptoms among Primary Care Patients Who Smoke Crack Cocaine

Among inner-city populations in Canada, the use of crack cocaine by inhalation is prevalent. Crack smoking is associated with acute respiratory symptoms and complications, but less is known about chronic respiratory problems related to crack smoking. There is also a gap in the literature addressing the management of respiratory disease in primary health care among people who smoke crack. The purpose of our study was to assess the prevalence of acute and chronic respiratory symptoms among patients who smoke crack and access primary care. We conducted a pilot study among 20 patients who currently smoke crack (used within the past 30days) and who access the "drop-in clinic" at an inner-city primary health care center. Participants completed a 20- to 30-min interviewer-administered survey and provided consent for a chart review. We collected information on respiratory-related symptoms, diagnoses, tests, medications, and specialist visits. Data were analyzed using frequency tabulations in SPSS (version 19.0). In the survey, 95% (19/20) of the participants reported having at least one respiratory symptom in the past week. Thirteen (13/19, 68.4%) reported these symptoms as bothersome. Chart review indicated that 12/20 (60%) had a diagnosis of either asthma or chronic obstructive pulmonary disease (COPD), and four participants (4/20, 20%) had a diagnosis of both asthma and COPD. Majority of the participants had been prescribed an inhaled medication (survey 16/20, 80%; chart 12/20, 60%). We found that 100% (20/20) of the participants currently smoked tobacco, and 16/20 (80%) had smoked both tobacco and marijuana prior to smoking crack. Our study suggests that respiratory symptoms and diagnoses of asthma and COPD are prevalent among a group of patients attending an inner-city clinic in Toronto and who also smoke crack. The high prevalence of smoking tobacco and marijuana among our participants is a major confounder for attributing respiratory symptoms to crack smoking alone. This novel pilot study can inform future research evaluating the primary health care management of respiratory disease among crack smokers, with the aim of improving health and health care delivery.

Assessment of nutritional status and meal‐related situations among patients with chronic obstructive pulmonary disease in Primary health care – obese patients; a challenge for the future

To describe nutritional status, meal related situations, food habits and food preferences of patients with chronic obstructive pulmonary disease (COPD) in a Primary health care (PHC) setting. To date, guidelines have mainly focused on underweight patients with COPD, as a low body mass index (BMI) is a risk factor for mortality. However, in recent years there has been an increase in the number of overweight patients with COPD, and therefore nutritional management must be developed to cover problems related to both under and overweight. Descriptive. One hundred and three patients from PHC centres representing COPD stages 2 and 3 were included. The Mini Nutritional Assessment (MNA) was used to collect nutritional status data while semi-structured interviews provided information on food and meal related situations. Mean age was 69 (± 5)years and 45% were women. Among all patients mean BMI was 27 and 14% had a BMI ≤ 21 kg/m(2) . More women (31%) than men (26%) had a BMI ≥ 30 kg/m(2) . According to the MNA screening score, 86% of the patients were assessed as normal or not at risk of malnutrition. The total MNA assessment score revealed that 10 patients were at risk of malnutrition or malnourishment. Problems with meal related situations were mostly associated with eating, and only a small number reported difficulties with shopping or preparing food. In PHC, more patients with COPD were obese than malnourished and their self-reported nutritional status was not always accurate. It is challenging to identify the patient's nutritional status, individualize nutritional care and educate obese patients with COPD at PHC centres. It is necessary to develop screening instruments to assess the risk of both obesity and malnutrition.

Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease

The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care. Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant. A questionnaire survey. The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease. Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality-of-life scores, women with incontinence had lower physical state scores (37·6 ± 10·4 vs. 41·4 ± 9·9; p < 0·001) and mental state scores (44·3 ± 10·2 vs. 47·1 ± 10·5; p < 0·007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality-of-life scores, men with incontinence had lower mental state scores than did men without incontinence (46·0 ± 9·7 vs. 49·8 ± 9·7; p < 0·001). The present results indicate that cough and urinary incontinence lead to poor quality of life in women and men with chronic obstructive pulmonary disease. In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.

The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice

There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12-15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

Telemedicine can help to ensure that patients receive timely medical care

We describe a case illustrating that telephone consultations can help to lower the psychological threshold for accessing medical care in people who are not aware of the seriousness of their symptoms, or who might otherwise be reluctant to access face-to-face care. A 69-year-old male patient called a teleconsultation service at the weekend because of acute fever. The patient was scheduled to have a hip replacement and the usual pre-operative check-up done the day before had been normal. However, a careful medical history taken during the teleconsultation revealed potentially serious symptoms. We therefore referred the patient to the emergency room immediately with the suspicion of severe infection, possibly due to colon cancer. The patient was subsequently diagnosed with septicaemia and adenocarcinoma of the sigmoid. This demonstrates that teleconsultation is not only a powerful tool for triage and diagnosis, but can also help to reduce delay in diagnosing severe diseases in primary health care.

SP6-58 Determinants of Village Health Volunteer's behaviour on recording and reporting diarrhoea cases in Temanggung district, 2010

IntroductionDiarrhoea is the second biggest disease in top ten diseases in primary healthcare in Temanggung. Monitoring diarrhoea is one of Village Health Volunteer's Integrated Service Pos duty. This research aimed...

The prevalence of urinary incontinence among women and men with chronic obstructive pulmonary disease in Sweden

The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with chronic obstructive pulmonary disease in primary health care. Information on the prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease is scant. Such knowledge may be important to the development of care for patients with chronic obstructive pulmonary disease. A questionnaire survey. The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered, evidence-based questionnaire for incontinence was used. A response rate of 66% was obtained, of which 89·3% had spirometry-confirmed chronic obstructive pulmonary disease, and most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease. The prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease was 49·6 and 30·3%, respectively. Women and men with urinary incontinence had a significantly higher body mass index than did women and men without urinary incontinence. The most common type of incontinence in women was stress incontinence (52·4%) and in men postmicturition dribbling (66·3%). Women with urinary incontinence had a higher presence of a symptomatic cough than did women without urinary incontinence (p < 0·001). On the whole, incontinence affected women more than men concerning experienced bothersomeness of incontinence (p < 0·001). More women than men with urinary incontinence refrained from activities (p < 0·021) and had sought help for incontinence (p < 0·012). The present results indicate that urinary incontinence content should be included in care plans for patients living with chronic obstructive pulmonary disease. In addition, the results imply that nurses and physicians working in primary health care should ask patients with chronic obstructive pulmonary disease about urinary incontinence and then offer appropriate assessment and management of it. In the context of primary health care, assessing and managing urinary incontinence should be included in care plans for patients living with chronic obstructive pulmonary disease.

Evaluation of Use Biochemical Diagnostics in Primary Health Care: Example of Quality Assesment

Problem: Laboratory medicine, medical-biochemical diagnosis in primary health care is much represented. By organization of family medicine medical-biochemical diagnosis is defined as a branch of diagnostic services in primary health care. For these actions is necessary in the morning prior to admission of users and their demands that all jobs are properly prepared. On previous day should be provided and prepared: accessories, reagents and machines. Morning daily routine work of preceding control and calibration equipment, methods and process quality control of work in the laboratory. Only after the fulfillment of the procedures followed overview of search control of samples. After validating the results of daily quality control and after they met the criteria can be analytically examined samples from users. These procedures are not sufficiently familiar to users and doctors, for that are very often necessary the direct telephone communication between them. To make the results of laboratory tests needed are huge material resources. This is evident in the economic analysis where laboratory tests are valued with a score of: search by type and material resources expended for analytical examination. These technical and financial performances of laboratory medicine are not appropriately classified as blatant as that in other industries, technology and other primary health care (PHC) and family medicine (FM). Goal: The overall objective of the research is to define a model of efficiency (or effectiveness) of medical-biochemical diagnosis for users with the requirements of units of family medicine (FM), in a representative sample of patients in the unit for the laboratory diagnosis of the Primary Health Care Center Gracanica. Confirm what is the usefulness of the application of laboratory diagnosis in family medicine. Determine the frequency of the need for laboratory tests in the therapeutic treatment of major diseases. Evaluate the need for using laboratory diagnostics to try to prevent major diseases. Material and methods: The study included a total of 1000 respondents. All subjects were users of primary health care in Primary Health Care Center Gracanica (Tuzla Canton) in primary health care units have received requests for laboratory diagnosis. This paper is an analysis of the representation requirements for the laboratory diagnosis by doctors in primary health care and the most frequent diseases in primary care. An analysis is made of laboratory test results, based on requests for laboratory diagnosis by doctors and illnesses in primary care. Made is analysis of the presence of normal and pathological laboratory test results from the request for the laboratory diagnosis by doctors in primary health care. Made is an analysis of the most common laboratory tests requests, and based on requests for laboratory diagnosis by doctors in primary health care and the most frequent diseases in primary health care. Incorporated is the economic analysis of labor

The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care

The number of patients with chronic obstructive pulmonary disease (COPD) is increasing. These patients need nursing care, including education in self-care, which has a positive effect on their physical and psychoemotional well-being. The aim of this study was to describe the experiences of asthma/COPD nurses' in primary health care (PHC) of educating patients with COPD. A descriptive, qualitative study was conducted, with interviews of 12 asthma/COPD nurses. The data were analysed using qualitative content analysis. The findings are presented in two themes: Theme 1, receiving support results in a feeling of security, which enables the development of patient education; and Theme 2, a lack of support results in a feeling of insecurity, which makes it difficult to develop patient education. The asthma/COPD nurses were individual orientated with individualization of care, but the patient's mood, the varying support of those around and the nurses' varying degrees of security affected the education. The conclusion is that the asthma/COPD nurses' experience of patient education fluctuated between insecurity and security. The nurses' feeling of insecurity in their patient education can be strengthened through support from colleagues and by increased knowledge in promoting the learning of others. Collaborative teamwork with a well-functioning asthma/COPD clinic in PHC can facilitate and improve patient services; these initiatives can enable the asthma/COPD nurses to reach their full potential.

Multidisciplinary program for stress-related disease in primary health care

To describe a multidisciplinary program, given by an occupational therapist and a physiotherapist, for patients with stress-related disease in primary health care and to measure the effect of this program in terms of self-perceived health, degree of burnout, physical activity, symptoms, recreational activities, and psychological and physical well-being. Retrospective study. At measures after three months, the thirteen patients included in this study had improved in self-estimated health, measured with EuroQol-5D Visual Analogue Scale (p = 0.000), and in degree of burnout, measured with the Shirom-Melamed Burnout Questionnaire (p = 0.001). There was also a decrease in presence of headache, in physical activity and in satisfaction with leisure time, although not statistically significant. After six months, the improvements remained for all measures except physical activity. The patients were also satisfied with the program to a high degree, measured with Client Satisfaction Questionnaire (median 3.7). This descriptive study shows that a stress-management program, provided by a team including an occupational therapist and a physiotherapist in primary health care, is both feasible and effective in terms of self-estimated health, degree of burnout, and patient satisfaction.

Obtaining the family history for common, multifactorial diseases by family physicians. A descriptive systematic review

Objective: To summarize the knowledge on the use of comprehensive family history taking for common, multifactorial diseases in primary health care. Design and data sources: Systematic review of MEDLINE (1966–2008), EMBASE (1986–2008) and Cochrane Library. Methods: Search terms reflected ‘primary care’, ‘family history’ and ‘genetics’. Included were original studies, published in the English language, from a primary care setting, investigating family history taking for multifactorial disorders. Methodological criteria (design, size, response rate) were not used to exclude papers. Out of 116 potentially eligible papers, 27 papers were selected: nine studies on opinions, eight studies on actual practice, seven studies on family history tools, and three studies on the patient perspective. Two authors independently extracted the data, and consequently discussed and summarized them. Given the heterogeneity of the studies, outcomes were presented in a qualitative way. Results: Among family physicians, the general opinion was that taking a family history is the task of the primary care physician. However, observational studies of consultations and analyses of medical records showed wide variability and low regular updating. There are no family history tools yet, that are sufficiently feasible and reproducible. Patients and doctors may perceive a positive family history differently, which may cause miscommunication.Conclusion: There is a need for research into feasible and high quality tools for detailed family history taking for multifactorial disorders.

Can non-physician health-care workers assess and manage cardiovascular risk in primary care?

To ascertain the reliability of applying the WHO Cardiovascular Risk Management Package by non-physician health-care workers (NPHWs) in typical primary health-care settings. Based on an a priori 80% agreement level between the NPHWs and the "expert" physicians (gold standard), 649 paired (matched) applications of the protocol were obtained for analysis using Kappa statistic and multivariate logit regression. Results indicate over 80% agreement between raters, from moderate to perfect levels of agreement in almost all of the sections in the package. The odds of obtaining a difference between raters and a benchmark are not statistically significant. Applying the WHO Cardiovascular Risk Management Package, NPHWs can be retrained to reliably and effectively assess and manage cardiovascular risks in primary health-care settings where there are no attending physicians. The package could be a useful tool for scaling up the management of cardiovascular diseases in primary health care.

Care of patients with chronic obstructive pulmonary disease in primary health care

This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved. A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease. In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments. The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.

Secondary Prevention of Coronary Heart Disease in Primary Health Care

Significant increase in mortality from coronary heart disease (CHD) has been seen in Bosnia and Herzegovina in the past decade. Little is known about current secondary preventive practices and treatments among patients with CHD in primary health care. The aims of this study were to evaluate the components of secondary prevention for CHD and to detect possible gender differences. This trial included 70 patients, aged 40-70 years, with established CHD from Family Medicine Teaching Center Tuzla. We evaluated components of secondary prevention (serum total cholesterol and blood pressure levels, smoking habits, body mass index, using aspirin, ACE inhibitors and lipid lowering drugs) in all participants. Results showed that significantly more men than women had diagnosis of CHD. 26/70 (37.14%) patients had myocardial infarction, with significantly higher number of men than women, but more women had angina only. Mean systolic blood pressure was 148.09+/-20.22 and diastolic 91.62+/-10.17 mmHg; mean total cholesterol level was 6.23+/-1.33 mmol/l; mean BMI was 27.9+/-3.32 kg/m(2). Blood pressure was managed according to guidelines in 19 (27.14%), and lipid concentrations in 11 (15.71%) patients. 55/70 (78.71%) patients took aspirin, only 18/70 (25.71%) patients took lipid lowering therapy, and 20/23 (86.96%) patients with heart failure took ACE inhibitors. 16/70 (22.86%) patients were current smokers, only 19/70 (27.14%) patients had healthy body mass index, while 21/70 (30%) patients were obese. Results of this study show a suboptimal secondary prevention in primary health care, which indicate more effective public health messages and changes in the healthcare system that promotes preventive strategies.

C-Reactive Protein: A New Rapid Assay for Managing Infectious Disease in Primary Health Care

Quantitative C-reactive protein (CRP) measurement has become increasingly valuable as a test for rapid diagnosis of infections in hospital medicine. CRP has not obtained the same importance in primary health care. This has, at least partly, been due to methodological difficulties, with no simple or rapid tests with quantitative results available. A new immunometric semi-quantitative assay, NycoCard CRP, has recently been developed. CRP was analysed at the local health centres by the new assay in 288 consultations where patients came because of infections. Parallel CRP values were obtained by an established reference method. The two procedures had an acceptable correlation (r = 0.85). The primary care doctors also registered the clinical information they obtained from each CRP result. CRP was helpful in indicating the presence, or absence of bacterial infection in more than half the consultations due to new infections. CRP was thought to yield more clinical information than the erythrocyte sedimentation rate in almost every case.

Preparación de Solución Hidratante Oral en el Hogar

In order to ascertain the convenience of setting up a program for oral rehydration with solutions prepared athome, 100 mothers attending an out patient clinic located in a low income urban area were randomly assigned totwo groups: Group 1 received precise oral (spoken) instruction; Group 2 received the same kind of instructionsplus practical demostrations about the procedure to be employed. Both groups of mothers were requested to dilute20 g. of glucose contained in a small plastic sealed envelope into one liter of water in order to obtain a 111 mmol/1.solution. In 95%of the cases, the expected concentration ± 20% was obtained, this range being considered safe. Inthe remaining 5 % excesively diluted samples were found, representing an eventual decrease in effectivity but not areal risk for patient's health. The differences in glucose concentration were not related to maternal age, nor degreeof literacy neither the number of children within the family. The importance of complementing oral informationwith practical demonstrations is stressed since the variance analysis showed a significantly lesser dispersion ofglucose concentration values in the solution prepared by mothers of Group 2 (p •'CO.OS), in spite of very similarmean glucose concentrations from both groups. A program of oral rehydration with home prepared solutionsappears as a feasible alternative in the treatment of acute diarrhoeal disease in primary health care under theconditions of this study.(Key words: Home-made mixtures. Oral rehydration solutions. Parent's education).