Family Health Clinic Research Articles

Innovation Management in Family Health Clinics in Israel: The Contribution of Customer Needs’ Assessment

In recent decades, the concept of innovation has become a vital and cardinal process in any organization that strives for renewal, remaining relevant in an era with quick and tremendous changes. It is considered to be a critical component of productivity and competitive survival in healthcare as well. It is also important concept in the public health nursing. The public family health clinics are central axis of the preventive care provided to young families in Israel. This article presents a process of assessing the needs of parents of children aged 3-6, from the family health clinics (FHCs) in accordance with a changing reality as a key to defining necessary innovation to be implemented in FHCs services. Objective: To explore parents' needs from FHC and define means of narrowing the gap between the needs of young families and the services currently provided. Methods: A qualitative study was conducted. Semi-structured interviews were used to collect data from 18 families that received treatment at FHC in Tel Aviv and the central Israel regions. Results: Data revealed the contribution of an in-depth costumer needs’ assessment to the required service innovation. Parents noted the importance of a personalized service adjusted to their unique family needs, as opposed to generalized instructions. Conclusions: The findings provide further insight into various aspects that may help public health managers to improve the service in terms of attitude, professional service and added value at each encounter. Additional consideration and efforts should be given to Service marketing methods as well.

The relationship of socio-demographic characteristics and knowledge of breast cancer on stage of behavioral adoption of breast self-examination.

Background/aimIn Malaysia, breast cancer is the most common cancer among women. As such, early diagnosis and screening practices are important to increase the survival rate. Breast self-examination (BSE) is one of the main screening methods for breast cancer. Socio-demographic characteristics and knowledge of breast cancer are amongst the crucial roles in determining women's behavioral adoption in performing BSE. This study aims to assess the relationship of socio-demographic factors and knowledge of breast cancer on the stage of behavioral adoption of BSE among Malaysian women in Kuantan, Pahang.Materials and methodsA cross-sectional study was conducted on 520 women from three different government health clinics in Kuantan and IIUM Family Health Clinic from February to April 2018. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of breast cancer and its effect on the behavioral adoption of BSE.ResultsSignificant difference was found between socio-demographic characteristics and behavioral adoption of BSE. However, only breast screening and the best time for screening were found to be significant with the behavioral adoption of BSE and knowledge of breast cancer.ConclusionIt is found that most women in Kuantan, Pahang perform BSE but were still unaware of the importance of performing BSE for early breast cancer detection. This study was expected to enhance women's awareness of the benefits of performing BSE.

Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study

The general practitioner shortage in the United States coupled with a growing number of Americans living with disability has fueled speculation of non-physician providers assuming a greater role in musculoskeletal healthcare. Previous physician shortages have been similarly addressed, and expanding physical therapy (PT) scope of practice may best serve to fill this need. Resistance to expanding PT practice focuses on patient safety as PTs assume the roles traditionally performed by primary care providers. While studies have shown advanced practice PT to be safe, none have compared safety events in advanced practice PT compared to primary care to determine if there are increased patient risks. Therefore, the purpose of our study is to examine the rate of safety events and utilization of services in an advanced practice PT clinic compared to a primary care clinic. A secondary aim of our study was to report safety events associated with spinal manipulation and dry needling procedures. Productivity and safety data were retrospectively collected from Malcolm Grow Medical Center from 2015 to 2017 for the Family Health Clinic (FHC) and an advanced practice Physical Therapy Clinic (PTC). Chi-square tests for independence, risk ratios (RR) and 95% confidence intervals (95%) were used to compare the relationship between the frequency of (1) patient encounters and clinical procedures and (2) clinical procedures and safety events. Seventy-five percent (12/16) of safety events reported in the PTC were defined as near misses compared to 50% (28/56) within the FHC (RR 1.5; 95% CIs: 1.0 to 2.2). Safety events were more likely to reach patients in the FHC compared to the PTC (RR 1.9; 95% CIs: 0.8 to 4.7). Safety events associated with minor harm to patients was n = 4 and n = 3 in the FHC and PTC respectively. No sentinel events, intentional harm events, nor actual events with more than minor harm were reported in either clinic. Significant relationships indicated that prescriptions, laboratory studies, imaging studies and referrals, were all more likely to be ordered in the FHC than the PTC (p < 0.01). The PTC ordered one diagnostic imaging study for every 37 encounters compared to one in every 5 encounters in the FHC. The PTC similarly referred one patient to another healthcare provider for every 52 encounters, fewer than the one per every 3 encounters in the FHC. There was a significant relationship between encounters and diagnoses, indicating a higher number of diagnoses per encounter in the FHC, though the difference of 0.31 diagnoses per encounter may not be clinically meaningful (p < 0.01). A total of 1,818 thrust manipulations and 2,910 dry needling procedures were completed without any reported safety events. These results suggest advanced practice PT has a similar safety profile to primary care. The authority to order musculoskeletal imaging and refer to other clinicians were among the most commonly utilized privileges and may be of primary importance when establishing an advanced practice PT clinic. These results support research showing advanced practice PT may lead to reductions in specialty referrals, diagnostic imaging, and pharmaceutical interventions.

FACTORS ASSOCIATED WITH HIGH FERTILITY IN”BHAKKAR GABOOL GOTH”: CASE STUDY

Pakistan is holding only 0.67 percent of the whole world’s area but has 2 percent of world population. In 1951 it ranked at 14th position in the world’s populous countries. In 2015-16 its population jumped to 195.4 million approximately five times higher. With this high population it has become the 6th most high populated country in the world. Human fertility is not a personal decision but it is a mixture of factors, and the factors differ among places, according to specific conditions of particular areas &amp; cultures. The aim of current research is to determine major factors that encourage high child ever born in urban slum area of Karachi” Bhakkar Gabool Goth” questionnaire was filled up from 100 ever married house hold women through simple sampling method based on formation on socio economic determinants like respondent’s age and their husband’s income/education level/place of childhood residence, etc etc. The analysis were based on descriptive analysis through percentages and number distribution of respondents .The median or average number of kids were greater than 5 and out of 23 variables discussed in questionnaire , only 14 variables show significant relation with fertility level which were respondent current age, education status of respondent/ her husband, work status of respondent and her husband, types of work, age at first marriage/first birth, infant/child mortality, contraception, sex preferences and willingness of respondent/ her husband to have more kids. more and more family health clinics should be established particularly in slum areas, female education should be increased to encourage delayed marriages and contraception use should also be enhanced through media or health visitors.

Family Health Clinics as a Source of Social Capital

PurposeTo examine the extent to which Family Health Clinics (FHCs) contribute to the formation of social capital among mothers, and determine whether it is influenced by socioeconomic factors. In FHCs, social capital can be gained by relationships between mothers (bonding social capital), by relationships between mothers and FHCs team, or between mothers of different origins/culture (bridging social capital) and health services institutional bodies (linking social capital). DesignThis is a mixed method study. For the quantitative part, data were collected from 673 mothers using a questionnaire. The qualitative part was conducted with six focus groups. ResultsThe FHC constitutes a source of social capital in all dimensions. Bridging social capital was most prominent and is formed by interactions between mothers and FHC nurses. The factors that explain the formation of social capital were: mothers' spoken language being Arabic, participation in group training, and lower level of education. The focus groups revealed that participation in group training increased the social capital. Mothers noted that FHC nurses supplied updated information about their children's care. Regarding linking social capital, mothers perceive FHC nurses as mediators between them and the local and national health services. ConclusionsFHC clinics are a source for gaining social capital. The FHC services should be adapted to mother's needs. ImplicationsFHC nurses should try to create conditions for mothers to meet to create bonding social capital, relate to mother's needs for the creation of bridging social capital, and provide culturally adapted care for the formation of linking social capital.

Nursing actions for overweight and obese children in the Family Health Strategy

Objective: to analyze the actions of nurses in the follow-up of the growth and development of overweight and obese children in the Family Health Strategy. Methods: qualitative research, developed through a semi-structured interview with 12 nurses from five Family Health Clinics whose data were submitted to thematic analysis. Results: nurses carry out anthropometric follow-up and analysis of these data in the health booklet, provide guidance on breastfeeding and the importance of a balanced diet for children and families, and their actions are carried out in Family Health Clinics, schools and homes. Conclusion: the nursing actions are focused on the child and the family’s self-care in order to prevent or minimize the effects of overweight and obesity in childhood and its repercussions for adult life.

The use of blogs as health management supporting tool at the local level.

In public health, blogs as data communication and dissemination tools have been widely used since the mid-2010s. This study aimed to describe the implementation of the blog tool by the Family Health Teams (ESF) of the municipality of Rio de Janeiro, which received the support of a Network of Local Observatories of the Municipal Health Secretariat, as a health communication and information vehicle for managers, health professionals and the population of Rio de Janeiro. We opted for a qualitative, descriptive and exploratory approach, with data and information collected directly from the media objects, as well as the literature review. Concerning total access to blogs of the Family Health Clinics and Municipal Health Centers, a total of almost seven million views were achieved. Finally, it should be emphasized that initiatives such as the ESF blogs' network should increasingly be analyzed, disseminated and known to understand, among other factors, the propensity of users, workers, and managers regarding the availability of channels of interaction and communication between them, their scope and their significance. After all, the power of a network is directly related to how it is being used.

“Practice What You Teach” Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): Program Evaluation

Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.

Communication Preferences and Satisfaction of Secure Messaging Among Patients and Providers in the Military Healthcare System.

Use of electronic secure messaging (SM) is rapidly growing in various healthcare settings. However, there is a large number of patients that choose not use SM or use it minimally. Thus, understanding preferences for patient-provider communication modalities is critically important, particularly among military healthcare beneficiaries. The purpose of this study was to assess preferences for patient-provider communication modalities (in person, telephone, SM, or mail) among a sample of patients, providers, and staff located at five Air Force military treatment facilities across the USA. We recruited patients, providers, and staff, from five family health clinics to complete a short survey. We measured participants' preferences for communication modality for various healthcare concerns, such as responses to non-urgent medical questions, test results, and medication renewal information. We also measured satisfaction with MiCare, the Air Force's SM system. We conducted chi-square analyses and Fisher's exact tests to assess differences in communication preferences by patients, providers, and staff and we computed frequencies in satisfaction responses. We found that while providers and staff (N = 70) prefer to communicate with patients about various healthcare concerns online through MiCare, patients (N = 1,260) prefer to communicate in-person or through the telephone. Patients were generally satisfied with MiCare; however, there was a large proportion of patients who were undecided about MiCare's impact on the quality of care they received (40.3%). Additionally, although the majority of providers and staff believed MiCare improved their efficiency (58.0%) and communication with patients (72.3%), 65.7% of providers and staff believed MiCare had increased their workload. MiCare is a promising tool to improve patient-provider communication. However, future studies are needed to better understand why patients within the military healthcare system prefer communication modalities other than MiCare and to identify strategies to decrease provider and staff workloads while using MiCare.

Unexpected Effects of a System-Distributed Mobile Application in Maternity Care: A Randomized Controlled Trial.

As pregnant mothers increasingly engage in shared decision making regarding prenatal decisions, such as induction of labor, the patient's level of activation may influence pregnancy outcomes. One potential tool to increase patient activation in the clinical setting is mobile applications. However, research is limited in comparing mobile apps with other modalities of patient education and engagement tools. This study was designed to test the effectiveness of a mobile app as a replacement for a spiral notebook guide as a patient education and engagement tool in the prenatal clinical setting. This randomized controlled trial was conducted in the Women's Health Clinic and Family Health Clinic of three hospitals. Repeated-measures analysis of covariance was used to test intervention effects in the study sample of 205 patients. Mothers used a mobile app interface to more frequently record information about their pregnancy; however, across time, mothers using a mobile app reported a significant decrease in patient activation. The unexpected negative effects in the group of patients randomized to the mobile app prompt these authors to recommend that health systems pause before distributing their own version of mobile apps that may decrease patient activation. Mobile apps can be inherently empowering and engaging, but how a system encourages their use may ultimately determine their adoption and success.

Prevalence of Trichomonas vaginalis in women of reproductive age at a family health clinic.

Trichomonas vaginalis is considered the most prevalent curable sexually transmitted infection, and its occurrence exceeds that of gonococcal and chlamydia infections. This parasite has been identified as responsible for the increased risk of transmission of HIV and has also been associated with prostate and cervical cancer. Many carriers of T. vaginalis are asymptomatic and, when experiencing a health problem, they most often have nonspecific symptoms. The aim of this research was to estimate the presence of T. vaginalis and the associated factors in women of childbearing age at a primary health care clinic in the Federal District of Brazil. A cross-sectional study was conducted with consecutive sampling of an outpatient population of women of childbearing age (excluding minors and pregnant women). The women answered a questionnaire and were examined. After vaginal pH measurement and whiff testing, a vaginal secretion sample was obtained for inoculation in TYM, a specific T. vaginalis culture medium. The presence of T. vaginalis was identified in 16% of the sample. Fewer lifetime sexual partners and consistent condom use were identified as factors of protection against the infection. Complaints of dyspareunia were proportionally higher among women with positive cultures for T. vaginalis. The prevalence of T. vaginalis infection was high in the sample studied. The infection was positively associated with the number of lifetime sexual partners, and consistent condom use was a protective factor. Vaginal complaints were more common among women with T. vaginalis, but only dyspareunia had significant association.

THE STUDY OF THE EFFECTIVENESS OF TRAINING THE PRINCIPLES OF IMPROVING THE RELATIONSHIPS BASED ON GOTTMAN'S METHOD ON COUPLES' MARITAL SATISFACTION IN TEHRAN

Background and Aims: marital satisfaction is one of the most important factors of progress and achieving life goals which is affected by couples' emotional stability. Therefore, the purpose of this research was to study the effectiveness of training the principles of improving the relationships based on Gottman's method on couples' marital satisfaction in Tehran. Materials and Method: It was a quasi- experimental research with pretest-posttest and control group. Statistical population involved all the couples without child that at least two years have passed since their marriage and they referred to psychotherapy and family health clinics in Tehran in 2013 and 2014. The sample included 40 couples who referred to these clinics to get marital counseling and they were selected by random cluster sampling. Then, they randomly divided into control and experimental groups (20 couples in each group). ENRICH couple scale (1997) and Gottman's couples' therapy scale (2009) was used to collect data in both pretest and posttest. The experimental group exposed to the independent variable (training the principles of improving the relationships based on Gottman's method) for two sessions of five hours. Statistical analyses performed to analyze data included ANCOVA test. Findings: The findings showed that training the principles of improving the relationships based on Gottman's method had no significant effect on couples' marital satisfaction (P > .05); but has been effective on its subscales (emotional relationships, quality of sexual relationships s, trust, compromise and commitment) (P ≤ .05). Results: The results showed that training the principles of improving the relationships based on Gottman's method can be a very effective way to increase marital satisfaction subscales and improve the couples' relationships.

Predictors of antiretroviral therapy failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia

6 www.thelancet.com/lancetgh Published Online April 8, 2016 Icahn School of Medicine at Mount Sinai, New York, NY, USA (K Niemeyer, A King MPH, N Henning MD); WWO/AHF Family Health Clinic, Addis Ababa, Ethiopia (S Mengistu MD) Correspondence to: Katherine Niemeyer, 50 E 98th Street, New York, NY 10029, USA katherinem.niemeyer@gmail. com Predictors of antiretroviral therapy failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia Katherine Niemeyer, Akilah King, Sophie Mengistu, Nils Hennig Abstract Background With the federal scale-up of antiretroviral therapy (ART) in Ethiopia, survival and quality of life for people with HIV/AIDS has increased. However, some patients do not respond to ART. Failure to suppress viral replication leads to increased morbidity and mortality, making early diagnosis of treatment failure imperative for the reduction of negative outcomes for patients. In this quality improvement project, we aimed to fi nd predictors of treatment failure that can be used, with clinical and immunological monitoring, to guide diagnosis of fi rst-line ART failure.Background With the federal scale-up of antiretroviral therapy (ART) in Ethiopia, survival and quality of life for people with HIV/AIDS has increased. However, some patients do not respond to ART. Failure to suppress viral replication leads to increased morbidity and mortality, making early diagnosis of treatment failure imperative for the reduction of negative outcomes for patients. In this quality improvement project, we aimed to fi nd predictors of treatment failure that can be used, with clinical and immunological monitoring, to guide diagnosis of fi rst-line ART failure. Methods We undertook a retrospective chart review and analysed baseline characteristics of 55 male and female patients, aged 2–54 years, on second-line ART and 55 control patients matched for age, gender, and treatment who continued to respond to fi rst-line ART at the World Wide Orphans/AIDS Healthcare Foundation (WWO/AHF) Family Health Clinic in Addis Ababa, Ethiopia. We used bivariate analyses, and included signifi cant variables in logistic regression modelling. Findings Three factors were signifi cant predictors of treatment failure: the presence of at least 1 month of fair or poor adherence (OR 15·7, 95% CI 1·8–136·7; p=0·01); previous treatment at another clinic before the WWO/AHF Family Health Clinic (1·4, 1·2–13·7; p=0·02); and tuberculosis symptoms at baseline (3·6, 1·1–12·3; p=0·04). In adult patients (n=58), two separate factors were signifi cant predictors of treatment failure: non-use of soft drugs, such as marijuana and khat (0·02, 0·001–0·445; p=0·02), and low baseline CD4 count (0·985, 0·972–0·999; p=0·03) Interpretation Predictors of ART failure can be used for early identifi cation of patients at high risk of fi rst-line treatment failure. Subsequent rapid transition to second-line therapy could result in better outcomes and care for these patients at the WWO/AHF Family Health Clinic in Addis Ababa, Ethiopia. The association between non-use of soft drugs and failure of fi rst-line ART should be explored further. Funding Arnold Institute for Global Health, Icahn School of Medicine at Mount Sinai. Copyright © Niemeyer et al. Open Access article distributed under the terms of CC BY. Declaration of interests We declare no competing interests.

Prevalence of Trichomonas vaginalis and Candida albicans among Brazilian Women of Reproductive Age.

There are no studies assessing the simultaneous occurrence of Candida albicans (C. albicans) and Trichomonas vaginalis (T. vaginalis) in the primary health care in Brazil. Despite different conditions to establishment of each one, the co-detection of both has been reported by some authors in previous studies from other regions. To compare the prevalence of T. vaginalis and C. albicans in correlation with associated variables. A cross-sectional study conducted in a family health clinic in the Federal District of Brazil, between November 2014 and March 2015. Vaginal swabs were collected from 201 women of the reproductive age selected from women registered at the family health clinic. Minors and pregnant women were excluded. The rates of T. vaginalis and Candida albicans prevalence were evaluated with vaginal pH, the whiff test, sexual practices and other social and demographic variables. Difference between proportions was assessed by Z-Test. C. albicans was present in 20% of the women, while 16% of them had T. vaginalis. The simultaneous occurrence of the agents was found in 1.5%. Significant differences were found between prevalence rates for the variables race/skin colour, practice of anilingus and lifetime number of sexual partners. The prevalence of T. vaginalis exceeds C.albicans among women with higher numbers of sexual partners. The prevalence of C. albicans was higher than T. vaginalis among white women and those who practice active and receptive anilingus. The simultaneous occurrence of the two microorganisms was uncommon.

Comparative study between adult and elderly patients as regards adherence to antihypertensive medication

Objectives The aim of this study was to compare adherence to antihypertensive medication between adult and elderly patients and factors affecting it. Background Poor medication adherence is the most important cause of uncontrolled blood pressure. It is estimated that 50-70% of people do not take their antihypertensive medication as prescribed. Therefore, understanding barriers to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes. Literature and methods This was a cross-sectional study conducted in Munshaat Sultan family health center, Menoufia governorate. A total of 120 hypertensive patients who attended the family health clinics during the period of the study were included. They were classified on the basis of age into adult patients aged 21-59 years and elderly patients aged 60 years or older and into adherent and nonadherent on the basis of adherence. A predesigned questionnaire was used to assess their adherence to medication using the Morisky scale and factors affecting it, such as patient, physician, disease, and drug. Results An overall 60.34% of elderly patient were adherent to medication, which was higher compared with adherence among adult patients (29.03%). There was statistically significant difference between the two groups as regards sex, education, and presence of family members helpful in reminding about medication, patients' belief about medication causing addiction, patient satisfaction toward healthcare providers and facility, frequency of drug doses, duration of hypertension, presence of another chronic illness, and hypertension complication. Conclusion In both groups, adherence was higher among patients who were married, patients having family members helpful in reminding medication, those receiving antihypertensive medication once daily, and those who had acceptable waiting time; therefore, interventions enhancing doctor - patient communication and empowering the patient have the potential to improve the adherence of hypertensive patients' medication and can consequently reduce hypertension-related costs.

Vaginismus in Iran: A Single Center Report of 7 Years Experience.

Background:Vaginismus is a sexual disorder that can cause painful intercourse. Although several studies have shown a relationship between higher education and socio-economic level of women with vaginismus, the relationship between demographic characteristics and other variables remains unclear.Objectives:The present study was conducted to determine the demographic characteristics of women with vaginismus, coming to family health clinic, between 2007 and 2013.Patients and Methods:This study is a cross-sectional study that was conducted on 115 clinical records, from early 2007 until the end of 2013, that have received a diagnosis of vaginismus. In these clinical records, the data on female and male age, education and employment, duration of marriage, type of marriage (traditional, virtual, etc.), being a virgin, erectile dysfunction of husband, information of families, sexual satisfaction, marital satisfaction, residential, non-medical types of medical treatment and hymenectomy were derived.Results:The results showed that the average age of women was 29 ± 5 years and the average age of the spouses was 33 ± 6 years. Undergraduate education most prominent among women (52%) and spouses (42%). In terms of employment status, most women were housewives (54%) and the majority of male were employees (54%). The most frequent form of marriage was traditional (80%). The maximum elapsed time of marriage was between 1 - 3 years (43%). In most women, the first attempt for intercourse was from the second day of marriage to the end of the first week (73%). Hymenectomy was done by 9% of women. Totally, 45% of the men, the wives of whom were suffering from vaginismus, experienced erectile dysfunction. In 37% of couples, their sexual life was satisfactory. The most referred specialist for treatment was the urologist (17%). In 27% of women with vaginismus, numerous references to a variety of medical specialists and psychologists were also recorded. Of the total, 7% of couples experienced traditional and non-academic treatments.Conclusions:As vaginismus can affect the stability of marriage, it is necessary to assess sexual dysfunction from all directions, including demographic characteristics and variables that affect the incidence of vaginismus. Therefore, based on the data obtained, we can diagnose and properly treat sexual dysfunction, in time, and teach couples how to deal with it.

Beyond birth: Women's concerns about post-birth care in an Australian urban community.

The provision of post-birth care in the community is changing substantially in many parts of Australia including Queensland, where there has been a burgeoning of clinics in private retail outlets such as pharmacies. Little is known about women's experiences of post-birth care in community pharmacies, nor of how their experiences compare with those in publicly-funded Child and Family Health Clinics (CFHC). To provide qualitative insights into women's experiences of the different forms of post-birth care in the community, and identify where improvements could be made to service provision. A purposive sample of mothers of infants aged under 12 months was recruited to maximise variation in the use of private and public postnatal care services. Semi structured interviews were conducted with fifteen mothers whose antenatal, birthing and post-birth experiences varied across public and private sectors and birthing providers. Concerns about lack of information and psychosocial support following discharge from hospital were widely reported, particularly by women who had given birth in a private facility under the care of a private obstetrician. Women used both pharmacy nurses and CFHCs. Pharmacy nurses were generally preferred for their accessibility, psychosocial support for mother, and continuity of care. However, these services are unregulated and without quality assurance mechanisms. Mothers found CFHCs regimented, focused on infant surveillance rather than support for mothers, and difficult to access. There is a clear need for community post-birth care that will provide mothers with the information and psychosocial support they need. Currently, private, home-birth midwives and pharmacy nurses are providing women-centred care more effectively than nurses in publicly funded CFHC or GPs. This seems to be linked to continuity of carer, and to service priorities, resulting in inequities and systematic variations in the quality of post-birth care. Further research on this important health care issue is recommended.

Desafios Organizacionais para Fortalecimento da Atenção Primária à Saúde em Portugal

RESUMO Este artigo analisa os principais aspectos da Reforma da Atenção Primária à Saúde (APS) em Portugal, que culminaram na implantação das Unidades de Saúde Familiar (USF), ampliação do acesso e melhoria no processo de coordenação dos cuidados. Identifica avanços e limites da reforma na APS portuguesa, que, apesar do contexto social e histórico distinto, podem subsidiar as políticas de saúde no Brasil. Realizou-se um estudo de caso com abordagem qualitativa, em Portugal, elegendo-se quatro USF na Região Norte, uma USF na Região de Lisboa/Vale do Tejo e dois Agrupamentos de Centros de Saúde (Aces) na Região Norte. Foram realizadas 20 entrevistas semiestruturadas, com observação sistemática e análise documental. O sucesso da reforma destaca-se na dimensão micropolítica, ou seja, na criação das USF como processo voluntário de adesão dos profissionais de saúde, o que permite certa estabilidade mesmo em tempos de crise. A Reforma da APS em Portugal é considerada um “evento extraordinário”, um exemplo bem-sucedido de intervenção nas reformas organizacionais na Europa em favor da coordenação dos cuidados por médicos generalistas.

SÍFILIS SECUNDÁRIA E DOENÇA INFLAMATÓRIA PÉLVICA NA ATENÇÃO PRIMÁRIA

We present the case of a young woman who was attended to in a family health clinic. The patienthad genital lesions and lower abdominal pain, and was diagnosed with syphilis and acute pelvicinflammatory disease. Our aim is to share this experience, which occurred in a basic health unit.

Sustaining vision: Tracking and monitoring both visual acuity and access to follow-up ophthalmologic care at the WWO/AHF family health clinic in Addis Ababa, Ethiopia

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