Primary Health Care Factors Research Articles

Prevalence of obstructive sleep apnea and its associated factors in primary health care in Morocco.

Obstructive sleep apnea is a common respiratory disorder that is still underdiagnosed in Morocco. This study aims to determine the prevalence of obstructive sleep apnea and its associated factors in primary healthcare. In this cross-sectional study, 815 adults aged 18 years and older consulting in the primary health care services in Marrakech, Morocco, were included. We evaluated the risk of obstructive sleep apnea syndrome using the modified STOP-BANG questionnaire. The prevalence of the high risk of obstructive sleep apnea in our sample is 24.8% (CI 95%: 21.7 - 27.6%). The variables independently associated with the high suspicion of obstructive sleep apnea were: gender male (p = 0.001), age ≥ 45 years (p = 0.001), high blood pressure (p = 0.005), hyperlipidemia (p = 0.042), daytime sleepiness (p = 0.003), snoring (p = 0.001), tiredness (p = 0.001) and mandibular retrognathia (p = 0.025). This survey revealed a significant prevalence of obstructive sleep apnea in Morocco. Therefore, we propose to generalize the screening of obstructive sleep apnea in hypertensive patients who report symptoms including daytime sleepiness, snoring, nocturnal choking, and tiredness that are unexplained by other known factors.

Evaluation of eHealth Literacy Level and its Associated Factors in Primary Health Care of Peru

Evaluation of eHealth Literacy Level and its Associated Factors in Primary Health Care of Peru

Analysis of lipid-lowering therapy depending on socio-demographic factors in primary health care: data from the ARGO study

Aim. To study the relationship of socio-demographic factors with lipidlowering therapy in primary health care.Material and methods. This cross-sectional noncomparative study on the prevalence of hypercholesterolemia (ARGO study) included patients aged ≥0 years who visited primary care physicians and cardiologists in the period 2013-2014 with diagnoses of stable coronary artery disease, hypertension, peripheral artery disease, carotid atherosclerosis, aortic aneurysm or having any type of revascularization or ischemic stroke in history. The study, which was conducted in 59 Russian cities, involved 768 doctors from 217 polyclinics.Results. The analysis included 18273 patients. Of the total number of patients, 7829 (42,9%) people took statins, while 10421 (57,1%) people did not receive it. The maximum percentage of statin use was in the age group of 70-79 years — 52,12%, and the minimum in the age group of 30-39 years — 13,24% (p<0,001). Most often, statins were taken by people with disabilities — 67,67%, and least often, by working people — 32,59% (p<0,001). In terms of marital status, widowed persons were significantly more likely to take statins, 50,36% (p<0,001); least of all in the group, single persons — 32,29%, while in the group of divorced persons, statins were taken by 37,76%, and in the group of married — 43,07%. According to the education level, patients with secondary professional education are the most adherent to statin treatment — 43,75%, while patients with incomplete secondary education were the least likely to take statins — 41,26% (p<0,054).Conclusion. Taking into account the socio-demographic factors that a person has when prescribing treatment will help develop a strategy for interacting with the patient and will help improve the quality and effectiveness of therapy in this group of patients.

The Prevalence of Postpartum Depression and the Related Risk Factors in Primary Health Care, Al-Madinah, Saudi Arabia.

BackgroundThe onset of depressed symptoms within six weeks of childbirth is described as postpartum depression (PPD). When compared to developed countries, resource-constrained countries have a higher prevalence of PPD. The purpose of this study was to determine the prevalence of PPD and the factors linked to it in primary health care in Al-Madinah, Saudi Arabia.MethodsThis descriptive cross-sectional study was carried out at the Academy of Family Medicine, Al-Madinah Almunawarah, between June 2021 and December 2021. The Arabic version of the validated Edinburg Postnatal Depression Scale was used to measure postpartum depression. SPSS version 26 (IBM Corp., Armonk, NY) was used to record and analyze the data.ResultsA total of 243 participants were included in this study. The mean age of the participants was 28.21±11.54 years. Most of the participants, 116(47.7%), were in the age group of 22-30 years. Most of the babies 176 (72.4%) were born via normal vaginal delivery (NVD) while only 67 (27.76%) were born via caesarian section. Most of the participants had an income of <5000 riyals in our study. In our study, the majority of the babies, 137 (56.4%), were breastfed. In our study, major depression was found in 77 (31.68%) participants while mild depression was present in 50 (20.57%) participants. The comparative analysis showed that previous children (p <0.001), support in caring (p = 0.02), income status (p = 0.003), and child health issues (p<0.001) were statistically significant.ConclusionThe prevalence of postpartum depression was relatively high in our study. The number of prior children, child health, income status, and family support all have a positive association. In short, healthcare providers must pay special attention to the mental health needs of pregnant women in our settings.

FATORES RELACIONADOS À FRAGILIDADE MULTIDIMENSIONAL EM PESSOAS IDOSAS

Objective: to analyze the sociodemographic and health factors related to multidimensional frailty in elderly people living at home. Method: cross-sectional study that evaluated 300 elderly people enrolled in a Health Unit in the north of Portugal through a form. The sociodemographic and health conditions of the elderly were analyzed and the Tilburg Frailty Index, Falls Efficacy Scale International 7 items, Barthel Index and Lawton and Brody Scale were applied. Results: sample (81.34±6.748 years) mostly female (60.33%) and married (58%). The prevalence of frailty was 60.33%, correlating with gender, marital status, self-perceived health status, pathological history, polymedication, falls, fear of falling and a higher level of dependence. Conclusion: multidimensional frailty is a prevalent condition, and when the predictive factors in primary health care are analyzed early, it is possible to intervene in order to delay this syndrome.

Evaluation of early non-cognitive markers of dementia

Population aging is inextricably linked to an increase in the prevalence of dementia, which are one of the main causes of loss of autonomy in old age. However, early detection of cognitive decline is critical to proactively implementing interventions to slow the progression of cognitive decline and maintain the ability to live independently of outside help. Therefore, early detection of cognitive decline is one of the primary tasks of the general practitioner.&#x0D; The aim of the lecture is to present a low gait speed, frailty, neuropsychiatric symptoms, sleep disorders and hearing loss as biomarkers of high risk to development of dementia risk and suggest ways measuring these risk factors in primary health care.

Status of preventive services against coronary risk factors in primary healthcare for patients undergoing coronary artery bypass grafting

Status of preventive services against coronary risk factors in primary healthcare for patients undergoing coronary artery bypass grafting

Prevalence and factors associated with lower limb amputation in individuals with type II diabetes mellitus in a referral hospital in Fortaleza, Ceará, Brazil: A hospital-based cross-sectional study

AimsTo analyze the association between demographic, socioeconomic, clinical, epidemiological, and primary healthcare factors with the severity of lower limb amputations (LLAs) in individuals with type II diabetes mellitus (DM-II) at a reference hospital in Fortaleza, Ceará, in Northeast Brazil. MethodsA cross-sectional study was performed with a representative sample of individuals hospitalized with DM-II and the degree of LLA severity: (1) toes; (2) transmetatarsal or infrapatellar; (3) suprapatellar; (4) disarticulation or bilateral. Potentially associated factors with the outcome degree of amputation severity were identified in a semi-structured evaluation during hospitalization. The prevalence ratios of the degree of amputation severity as a function of associated factors were calculated with robust variance Poisson regression models. ResultsThe prevalence of high degree of severity in amputations (suprapatellar, with disarticulation or bilateral) was high in the total sample of 385 patients, revealing to be 49% (187/385). Prevalence ratios (PR) indicated a higher prevalence of DM-II amputation severity in patients who lacked of specific guidance on DM-II amputation in primary care (PR = 1.52, 95% CI: 1.05–2.21). ConclusionsLLAs in DM-II were associated with age above 67 years, male gender, cardiovascular disease, and low support for guidance at the primary healthcare level.

Characteristics of recovery from near misses in primary health care nursing: A Prospective descriptive study.

To describe the frequency and types of near misses and the recovery strategies employed by nurses in primary health care. Insufficient data are available on the role of nurses in near miss events and related factors in primary health care. A prospective descriptive study was carried out at one Urban Primary Health Care Centre, within the Málaga-Guadalhorce Health District (Malaga, Spain), from January to December 2018. Four of the ten nurses volunteered to take part. The nurses recovered 185 near misses, prevailing administrative or communication-related errors, followed by medication-related errors. No near misses were reported on the centre's anonymous error information platform. A significant number of near misses occurred which could have been avoided with better communication among health care personnel. A striking finding is the failure to inform the health centre, which suggests that improvements in safety culture are needed. It is the responsibility and the duty of nursing management to be aware of the characteristics and frequency of near misses in primary health care, to implement strategies for improvement and to foster a culture in which the necessary information on actual or potential errors is supplied.

An investigation of the effect of accessibility to General Practitioner services on healthcare utilisation among older people

Equity in access to healthcare services is regarded as an important policy goal in the organisation of modern healthcare systems. Physical accessibility to healthcare services is recognised as a key component of access. Older people are more frequent and intensive users of healthcare, but reduced mobility and poorer access to transport may negatively influence patterns of utilisation. We investigate the extent to which supply-side factors in primary healthcare are associated with utilisation of General Practitioner (GP) services for over 50s in Ireland. We explore the effect of network distance on GP visits, and two novel access variables: an estimate of the number of addresses the nearest GP serves, and the number of providers within walking distance of a person's home. The results indicate that geographic accessibility to GP services does not in general explain differences in the utilisation of GP services in Ireland. However, we find that the effect of the number of GPs is significant for those who can exercise choice in selecting a GP, i.e., those without public health insurance. For these individuals, the number of GPs within walking distance exerts a positive and significant effect on the utilisation of GP services.

Primary health care social work in Aotearoa New Zealand: An exploratory investigation

INTRODUCTION: The social work profession has a long-standing history of contributing to health care in Aotearoa New Zealand. Traditionally, hospitals have been the stronghold for the profession. However, both international and national evidence demonstrates that social workers have also been integrated in primary health care practices (PHCPs). Primary health care (PHC) provides care in the community and is recognised for its potential to achieve health equity across all population groups. This article reports on a small, qualitative research project which explored the perceptions of key stakeholders about social work integration into PHC and the experiences gained by social workers working within PHCPs regarding their contributions to the achievement of national aspirations for PHC.METHODS: Semi-structured, one-to-one interviews with 18 participants representing three groups (social workers, other PHC professionals and key informants) were undertaken in 2012. The interviews took place in various locations in Aotearoa New Zealand. A general inductive approach was used to identify key themes. FINDINGS: Three key themes were identified from the data: these are issues of context, namely social work professional factors, organisational factors in PHC and lastly, wider factors in the health care system. The integrated social workers enhanced the access of populations to coordinated care, increased engagement with communities, and strengthened the workforce, among other things. These unique contributions towards the PHC vision were well recognised by all groups, with participants calling for the establishment of integrated social work positions on a larger scale. CONCLUSION: The study evidences the successful integration of social workers into PHC practices in Aotearoa New Zealand. This viable model should be of special interest for key stakeholders regarding the design of local, holistic, PHC services which serve populations most affected by health and social inequalities. Importantly, “health for all”, as anticipated by the PHC vision needs long-term and real commitment especially by financial decision-makers.

Prescribing indicators in primary health care in Belo Horizonte, Brazil: associated factors.

Background The prescription is one of the factors that influences rational use of medicines. The evaluation of prescribing indicators should contribute to organization of primary health care services. Objective The aim of this study was to evaluate prescribing indicators and associated factors in primary health care in the northeast health district, Belo Horizonte, Brazil. Setting Twenty primary health care units in the Northeast Health District, Belo Horizonte, Brazil. Method The study was cross sectional. Indicators proposed by World Health Organization were used to evaluate rational use of medicines. Main outcome measure Indicators evaluated were average number of medicines per prescription, proportion of medicines with antibiotic, injectable, medicines prescribed by generic name and medicines present in the essential medicines list. Results Three hundred and ninety-nine patients were interviewed. The average number of medicines per prescription was 3.5 (SD 2.2). The proportion of medicines with antibiotic, injectable, medicines prescribed by generic name and medicines present in the essential medicines list was 17.8, 9.8, 94.9, 91.4%, respectively. Patient age ≥60years was positively associated with number of medicines per prescription (P=0.00). Conclusion In the northeast health district of Belo Horizonte, the proportion of prescriptions of antibiotics and injections, the adoption of prescribing by generic name and the prescribing of essential medicines were satisfactory in this study considering reference values for these indicators and international scientific literature. However, the mean number of prescribed medicines requires a more in-depth evaluation.

Adherence to Psychotropic Medications and Associated Factors in Primary Health Care

The study aims were to analyze patients’ adherence to psychotropic medications and its association with sociodemographic factors, therapeutic regimen, presence of common mental disorders, and illness factors. A descriptive cross-sectional study was carried out in ten Primary Health Care units in Brazil. The tools were the Measurement of Treatment Adherence Test and the Self Reporting Questionnaire. Nonadherence to psychotropic drugs was 88.9%. There was association between adherence and age and among patients positive for Common Mental Disorders (97.8%). In the multivariate analysis this association was not maintained. Findings indicate strategies are needed to improve medication adherence in the Primary Health Care services. However, no strategy will be effective if patients and their families are not involved in the process.

Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda

ObjectiveTo examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced...

Prevalência do uso de psicotrópicos e fatores associados na atenção primária à saúde

Objetivo Investigar a prevalência de uso de psicotrópicos e fatores associados na atenção primária à saúde com fatores sociodemográficos, farmacoterapêuticos, histórico de saúde e Transtornos Mentais Comuns. Método Estudo transversal que incluiu 430 pacientes de atenção primária à saúde. O instrumento de pesquisa foi o Self-reporting Questionnaire e prontuários. Para análise, utilizou-se teste qui-quadrado na análise univariada e regressão logística na multivariada. Resultados A prevalência de uso de psicotrópicos foi de 25,8%. Houve associação entre uso de psicofármacos e transtornos mentais comuns, uso de medicamentos não psicofármacos, número de medicamentos prescritos, número de comprimidos/dia, patologias clínicas, idade e escolaridade. Na análise multivariada os preditores para uso de psicofármacos foram: transtornos mentais comuns, patologias clínicas e escolaridade. Conclusão A prevalência de uso de psicofármacos e os fatores associados variaram conforme a análise uni ou multivariada.

Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study

BackgroundHospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little...

Explaining the variation in the management of lifestyle risk factors in primary health care: A multilevel cross sectional study

BackgroundDespite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC.MethodsA prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors.ResultsThere was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers.ConclusionThe findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices.

"Should I and Can I?": A mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care

BackgroundPrimary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.MethodsA cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management.ResultsRole congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels.ConclusionPHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice.

Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care

Objective - To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care. Design - Cross-sectional survey of consecutive patients with treated hypertension in 1999. Setting - 17 primary care centres in Sweden. Subjects - 512 patients (mean age 67; SD 11 years). Main outcome measures - Antihypertensive treatment, cardiovascular risk factors. Results - Patients with high diastolic BP ( S 100 mmHg) and systolic BP ( > 180 mmHg) values were few. The proportions with diastolic BP < 90, BP < 160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and S 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smok ers were 10%, 23% had diabetes, and many had overweight BMI = 25 kg/m2, 72%. Conclusion - Although two-thirds had diastolic BP < 90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention.

Intervention against ischaemic heart disease risk factors in primary health care in a semi-rural community. The population study "50-year-old people in Kungsör".

To see whether a program for screening and intervention against ischaemic heart disease (IHD) risk factors could be integrated into the ordinary work of a primary health care centre. Longitudinal population study with baseline screening, intervention, and one-year follow up. Kungsör, a semi-rural community in mid-Sweden. All 50-year-old men and women in Kungsör. Feasibility, participation rate, change of traditional IHD risk factors and self-assessed well-being measures. Blood pressure and serum cholesterol were significantly reduced. Smoking rates and BMI were not affected. The advice given had the same effect, whether given by the doctor or the nurse. Videotaped information had no further effect on the risk factor levels. There was no obvious evidence of negative psychological effects of screening and intervention. Primary health care provided an excellent base for the study and the project could be performed within the ordinary setting. The risk reduction was of a similar magnitude to that in the large-scale preventive trials without any evidence of negative psychological effects of screening and intervention.