Experts In Primary Health Care Research Articles

The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review.

The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. The results of this study are expected at the end of 2024. The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. PRR1-10.2196/55860.

[Recommendations to strengthen nutritional care in the primary care setting in BrazilRecomendaciones para el fortalecimiento de la atención nutricional en la atención primaria de salud en Brasil].

RESUMOObjetivo.Elaborar recomendações para o fortalecimento da alimentação e nutrição (A&N) na atenção primária à saúde (APS) brasileira a partir de um consenso de especialistas.Métodos.Realizou-se estudo descritivo e exploratório utilizando a técnica Delphi. De 172 especialistas em A&N na APS convidados a participar, 116 aceitaram o convite e 72 participaram da primeira rodada. A segunda rodada teve 56 participantes das cinco macrorregiões brasileiras, entre gestores, profissionais de saúde, representantes da sociedade civil e pesquisadores. As recomendações foram construídas por análise temática das respostas a perguntas abertas sobre obstáculos, estratégias, ações e iniciativas de cinco componentes técnicos da Política Nacional de Alimentação e Nutrição (vigilância alimentar e nutricional, atenção e coordenação do cuidado nutricional, promoção da saúde, intersetorialidade e gestão das ações de A&N). Na segunda rodada, os especialistas classificaram cada item proposto quanto à sua pertinência e relevância para fins de recomendação.Resultados.Os especialistas elaboraram 35 recomendações, organizadas em seis categorias: estrutura; agenda de A&N na APS; organização em rede e organização da APS; processos de trabalho de A&N na APS; planejamento, monitoramento e avaliação das ações de A&N na APS; e sistema de informação. As categorias foram organizadas em dois blocos: “ações estruturantes da APS para o fortalecimento da A&N” e “ações estruturantes da A&N para o fortalecimento da APS”.Conclusões.As recomendações foram produzidas por pessoas experientes que acompanham a trajetória da A&N e da APS por diferentes pontos de vista, sendo úteis para a gestão e proposição de políticas públicas rumo ao fortalecimento da A&N nas APS brasileira.

Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: A qualitative analysis

ObjectiveTo learn from primary health care experts’ experiences from the COVID-19 pandemic across countries. MethodsWe applied qualitative thematic analysis to open-text responses from a multinational rapid response survey of primary health care experts assessing response to the initial wave of the COVID-19 pandemic. ResultsRespondents’ comments focused on three main areas of primary health care response directly influenced by the pandemic: 1) impact on the primary care workforce, including task-shifting responsibilities outside clinician specialty and changes in scope of work, financial strains on practices, and the daily uncertainties and stress of a constantly evolving situation; 2) impact on patient care delivery, both essential care for COVID-19 cases and the non-essential care that was neglected or postponed; 3) and the shift to using new technologies. ConclusionsPrimary health care experiences with the COVID-19 pandemic across the globe were similar in their levels of workforce stress, rapid technologic adaptation, and need to pivot delivery strategies, often at the expense of routine care.

Public Health Crisis during COVID-19 pandemic

During the COVID pandemic, biomedicine and the rapid development of anti-COVID vaccines has been widely praised, while the global public health response has been questioned. Fifteen United States based combined experts in primary healthcare and public health responded to an open question focusing on this issue. Eleven of these experts responded. Four major themes emerged from their answers, including: fragmentation between public health and biomedicine; underfunding of public health; lack of centralized public health authority; business interests over the public good and well-being.

Strengthening the primary health care response to COVID-19: an operational tool for policymakers.

The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia. PHC has the potential to play a fundamental role in countries' responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document - Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 - that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions. The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia's PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area).The data collected were analyzed to identify underlying challenges limiting PHC providers' ability to effectively and efficiently respond to COVID-19 and maintain essential health services. The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia's national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges - at both the facility and health system level - that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

Relationship between the perceived strength of countries' primary care system and COVID-19 mortality: an international survey study.

BackgroundStrong primary health care (PHC) is the cornerstone for universal health coverage and a country’s health emergency response. PHC includes public health and first-contact primary care (PC). Internationally, the spread of COVID-19 and mortality rates vary widely. The authors hypothesised that countries perceived to have strong PHC have lower COVID-19 mortality rates.AimTo compare perceptions of PC experts on PC system strength, pandemic preparedness, and response with COVID-19 mortality rates in countries globally.Design & settingA convenience sample of international PHC experts (clinicians, researchers, and policymakers) completed an online survey (in English or Spanish) on country-level PC attributes and pandemic responses.MethodAnalyses of perceived PC strength, pandemic plan use, border controls, movement restriction, and testing against COVID-19 mortality were undertaken for 38 countries with ≥5 responses.ResultsIn total, 1035 responses were received from 111 countries, with 1 to 163 responders per country. The 38 countries with ≥5 responses were included in the analyses. All world regions and economic tiers were represented. No correlation was found between PC strength and mortality. Country-level mortality negatively correlated with perceived stringent border control, movement restriction, and testing regimes.ConclusionCountries perceived by expert participants as having a prepared pandemic plan and a strong PC system did not necessarily experience lower COVID-19 mortality rates. What appears to make a difference to containment is if and when the plan is implemented, and how PHC is mobilised to respond. Many factors contribute to spread and outcomes. Important responses are first to limit COVID-19 entry across borders, then to mobilise PHC, integrating the public health and PC sectors to mitigate spread and reduce burden on hospitals through hygiene, physical distancing, testing, triaging, and contract-tracing measures.

Tackling adverse health effects of climate change and migration through intersectoral capacity building in Sub-Saharan Africa.

The international community increasingly acknowledges that climate change is not only spurring environmental degradation and health deterioration,1 it is also an important direct and indirect driver of migration, conflict, and human rights violations. This is particularly true for Sub-Saharan Africa (SSA), the region where people — in contrast to high-income countries and high energy consuming industries, which emit the most greenhouse gasses on a global scale — are relatively more vulnerable to climate change, because their precarious socioeconomic status, lack of resources, and weak health systems constrain their adaptation capacity.2 Still, debate and research on the explicit interactions between climate change, migration, and health are scarce, and prevailing research and policies disproportionally neglect the voice of the global South, such as that of SSA. During the African conference of the World Organisation of Family Doctors (WONCA) and the African Primary Care and Family Medicine Education Network (Primafamed) meeting in Kampala, Uganda (4–6, June 2019), we organised focus groups with primary health care experts and family physicians (FPs) from twelve SSA countries, to explore these interactions. Although the climate research community underrepresents FPs, the latter are excellent sources of information. Their position in the centre of the community gives them insight …

Assessment of Clinical Governance in Primary Health Care Services: A Case Study on Dakahlia Governorate, Egypt

Background: universal health coverage and the health-related sustainable development goals can only be achieved with a stronger emphasis on Primary Health Care (PHC). In spite of the essential role of clinical governance (CG) in enhancing quality of services provided by PHC facilities, a scientific framework with precise criteria for evaluating them has not been developed so far in Egypt. Objective: to assess the CG in PHC in Egypt considering PHC of Al-Dakahlia governorate as a case study and to clarify the barriers for implementing CG at PHC. Subjects and Methods: a cross sectional study was conducted over a period of one year at 8 PHC facilities in selected two districts; Al-Sinbelawin and Aga in Al-Dakahlia governorate, Egypt. The assessment of CG indicators was through multi-level approaches from different perspectives of 327 PHC utilizers, 40 PHC providers, 10 PHC executive directors who were drawn from the selected districts. Thirteen experts in PHC and CG in Egypt were also participated. Results: CG index for PHC facilities was scored higher percentage degree by PHC directors (91.0%) than by PHC utilizers, providers and the experts (70.0%, 59.6% & 53.3% respectively). The CG indicators showed disparities between the participating groups. Experts reported several challenges for CG implementation as shortage of clear policies, lack of awareness about governance culture and lack of experience in this field. Conclusion: the successful CG framework should be based on plan & implement as a team and create better relationships between directors and all stakeholders.

Governance of Iranian Primary Health Care System: Perceptions of Experts

Despite huge advances in improving most health indicators, Iranian primary health care (PHC) has faced several problems in improving the quality of care inside the health care system. Developed countries with similar problems have used various models of PHC governance for improving quality in their PHC system. This study aimed to obtain health professionals' perspectives about the suitable pillars and components of Iran's PHC governance model. A purposeful sampling method was used to select seven participants who had a minimum of five years of experience in PHC and background education in the field of medical sciences. Between Jan and Jun 2015, three focus group discussions (FGD) were conducted with seven PHC experts in Tabriz. Data were analyzed using the conventional content analysis method. The eight main categories including quality improvement, management and leadership, community involvement and customer participation, effectiveness of PHC, human resource development, safety, health care evaluation and audit, and health information management plus 51 sub-categories were identified according to participants' expects about the essential pillars and components for Iranian PHC governance model. Pillars that suggested for designing Iran's PHC governance model are presented according to internal informed expert's opinions and taking into account PHC system real status. By adding the degree of importance for each component and proper performance indicators to this collection, assessing the progress of the PHC system towards excellence will be possible and it will prevent any mental judgments about system performance.

Future Trends of the Primary Healthcare System in Iran: A Qualitative Study.

Background:Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran.Methods:The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews.Results:The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system.Conclusions:The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly.

The Use of a Modified Delphi Technique to Inform the Development of Best Practice in Interprofessional Training for Collaborative Primary Healthcare

Background: Primary healthcare (PHC) education and training is directed to a diverse range of health professionals at undergraduate, postgraduate, and professional levels. Increasing emphasis is being placed on PHC professionals working together in delivering better care and improving patient outcomes. This article reports on using a modified Delphi technique to determine the level of consensus on a series of statements across four domains of interprofessional education (IPE) for collaborative practice: big picture, organization, capabilities, teaching, and learning. Methods and Findings: The modified Delphi technique used three Delphi rounds: the first round comprising workshops, interviews, or online survey; the remaining rounds used online surveys. A panel of 56 PHC medical, nursing, allied health, and workforce experts participated. There was consensus on a set of capabilities for interprofessional learning outcomes and on a range of teaching and learning strategies. Areas for further consideration included identifying interprofessional training opportunities through continuing professional development, and tailoring team-based approaches to diverse PHC settings. Conclusion: The modified Delphi technique used in this project demonstrated a successful engagement of a heterogeneous panel of PHC experts. The principles of IPE for collaborative practice and strategies for delivering interprofessional training could apply across various PHC settings.   

Posicionamiento de SEMERGEN para el abordaje de los trastornos por consumo de alcohol en atención primaria

The present manuscript is based on the recommendations of a panel of health care professionals, including several experts in primary health care, psychiatry and addictions. The participants are recognized specialists in the treatment of alcohol use disorder. The panel met in Barcelona on 2015 April 22 with the aims of evaluating the current management of alcohol use disorder in primary health care and developing a strategy to address this problem, basing on the evidence and the recommendations of the scientific societies and national and international organizations.

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.

Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective

BackgroundPrimary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To analyze the extent to which important PHC attributes are covered in validated instruments measuring quality of care from the patient perspective.MethodWe systematically identified validated instruments from the literature and by consulting experts. Using a Delphi consensus-building process, Canadian PHC experts identified and operationally defined 24 important PHC attributes. One team member mapped instrument subscales to these operational definitions; this mapping was then independently validated by members of the research team and conflicts were resolved by the PHC experts.ResultsOf the 24 operational definitions, 13 were evaluated as being best measured by patients, 10 by providers, three by administrative databases and one by chart audits (some being best measured by more than one source). Our search retained 17 measurement tools containing 118 subscales. After eliminating redundancies, we mapped 13 unique measurement tools to the PHC attributes. Accessibility, relational continuity, interpersonal communication, management continuity, respectfulness and technical quality of clinical care were the attributes widely covered by available instruments. Advocacy, management of clinical information, comprehensiveness of services, cultural sensitivity, family-centred care, whole-person care and equity were poorly covered.ConclusionsValidated instruments to evaluate PHC quality from the patient perspective leave many important attributes of PHC uncovered. A complete assessment of PHC quality will require adjusting existing tools and/or developing new instruments.

Measurement of Primary Healthcare Attributes from the Patient Perspective

This special issue of Healthcare Policy/Politiques de Sante presents a series of papers reporting on the concurrent validation of instruments that assess primary healthcare (PHC) delivery from the patient's perspective. The study was funded in 2004 by the Canadian Institutes of Health Research (CIHR) at the height of the Primary Health Care Transition Fund, an $8-million investment by Health Canada to catalyze a renewal of the PHC system in Canada. In planning the evaluation for initiatives, it became evident that program evaluators and researchers had little guidance for selecting among available instruments. For example, although various instruments purported to measure accessibility, it was not obvious that all measured the same underlying construct. Nor was it clear how to compare results collected with different instruments in different jurisdictions or at different times. This research program consists of three studies. The first is a consensus consultation of PHC experts across Canada to formulate operational definitions of attributes to be evaluated (Haggerty et al. 2007). Second, we mapped the operational definitions to validated instruments (available at www.programmeprecise.ca/en/publications). Third, we administered six instruments back-to-back in Nova Scotia and Quebec to adults with a regular source of care to examine and compare how well the instruments measure essential attributes of primary healthcare. We selected six instruments in the public domain that assess usual care rather than a single visit, that are generic (not limited to a specific patient group or dimension of care) and that had been most proposed or used in Canada: Primary Care Assessment Survey (PCAS) (Safran et al. 1998); Primary Care Assessment Tool – Short Form, adult (PCAT-S) (Shi et al. 2001); Components of Primary Care Index (CPCI) (Flocke 1997); First version of the European general practice evaluation instrument (EUROPEP-I) (Grol et al. 2000); Interpersonal Processes of Care – 18-item version (IPC-II) survey (Stewart et al. 2007); Veterans Affairs National Outpatient Customer Satisfaction Survey (VANOCSS) (Borowsky et al. 2002).

Canadian Experts' Views on the Importance of Attributes within Professional and Community-Oriented Primary Healthcare Models

The aim of this study was to rate the importance of primary healthcare (PHC) attributes in evaluations of PHC organizational models in Canada. Using the Delphi process, we conducted a consensus consultation with 20 persons recognized by peers as Canadian PHC experts, who rated the importance of PHC attributes within professional and community-oriented models of PHC. ATTRIBUTES RATED AS ESSENTIAL TO ALL MODELS WERE DESIGNATED CORE ATTRIBUTES: first-contact accessibility, comprehensiveness of services, relational continuity, coordination (management) continuity, interpersonal communication, technical quality of clinical care and clinical information management. Overall, while all were important, non-core attributes - except efficiency/productivity - were rated as more important in community-oriented than in professional models. Attributes rated as essential for community-oriented models were equity, client/community participation, population orientation, cultural sensitivity and multidisciplinary teams. Evaluation tools should address core attributes and be customized in accordance with the specific organizational models being evaluated to guide health reforms.

Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts

In 2004, we undertook a consultation with Canadian primary health care experts to define the attributes that should be evaluated in predominant and proposed models of primary health care in the Canadian context. Twenty persons considered to be experts in primary health care or recommended by at least 2 peers responded to an electronic Delphi process. The expert group was balanced between clinicians (principally family physicians and nurses), academics, and decision makers from all regions in Canada. In 4 iterative rounds, participants were asked to propose and modify operational definitions. Each round incorporated the feedback from the previous round until consensus was achieved on most attributes, with a final consensus process in a face-to-face meeting with some of the experts. Operational definitions were developed and are proposed for 25 attributes; only 5 rate as specific to primary care. Consensus on some was achieved early (relational continuity, coordination-continuity, family-centeredness, advocacy, cultural sensitivity, clinical information management, and quality improvement process). The definitions of other attributes were refined over time to increase their precision and reduce overlap between concepts (accessibility, quality of care, interpersonal communication, community orientation, comprehensiveness, multidisciplinary team, responsiveness, integration). This description of primary care attributes in measurable terms provides an evaluation lexicon to assess initiatives to renew primary health care and serves as a guide for instrument selection.