Field Of Primary Care Research Articles

Professional identity in community care: The case of specialist physicians in outpatient services in Italy

Due to changes in social and health needs, the reorganisation of health systems towards community and primary care requires the redefinition of different professional identities and practices. This paper focuses on the specialists in the system: the physicians who work in outpatient services (local health authorities, hospitals, and other institutions) not as dependents but under private contract. This doctor has to balance the professional culture (in terms of autonomy and indipendence of judgment) with the bureaucratic logic that rules the organisations for which he or she works. Our research objective was to identify the identity variables characterising the specialist doctor (“ideal profile”) and analyse the extent to which these differed from the doctor's actual identity (“actual profile”). From a methodological perspective, 1) we used a consensus method approach to identify the variables that define the specialist's identity, and 2) using a national web survey, we checked the distance between such characteristics and these professionals' actual identities. Involving different experts in the field of primary care, we identified 27 identity variables that appear to be at the core of specialist expertise. We then asked a representative sample of specialists to indicate how important and feasible these variables were in their work contexts and identified four main factors characterising their identities. The results demonstrate that, among experts, there is a clear perception of the need to build an identity that is linked to integration and to adopt a heuristic approach through teamwork and networking. However, this differs considerably from the logic of the specialists working in outpatient services: What emerges is the perceived difficulty of operational translation due to organisational problems or, otherwise, the constitutive elements of professional identity.

What determines immigrant caregivers' adherence to health recommendations from child primary care services? A grounded theory approach.

To investigate the diversity and specificity of the determinants of immigrant caregivers' adherence to child primary care (CPC) health recommendations. Immigrant caregiver's adherence to CPC health recommendations is of utmost importance to minimize their children's health-related vulnerabilities. Some research has been conducted on the determinants of immigrants' access to health services, but much less is known about the determinants of their adherence to health professionals' recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps. Interviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers' understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology. 'Adherence to CPC health recommendations' is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children's health, usefulness of recommendations, perceived health-care professionals' competence, central role of vaccination in CPC and caregivers' socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children's care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers' adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers' adherence to CPC health recommendations and for child protection will be discussed.

Percepções de gestantes acerca do cuidado pré-natal na atenção primária à saúde

To understand the perceptions of pregnant women about the care received during prenatal care, in the field of primary health care. Qualitative study, based on Grounded Theory. Data collection was performed from August to December 2016, through a semi-structured interview with 12 pregnant women who received prenatal care in the city of Florianópolis/SC/Brazil. Data collection and analysis were performed concomitantly. Data analysis was performed using open and axial coding. Three categories were elaborated: Care before and during gestation, Participation in groups of pregnant women, and Quality care during pregnancy. The perceptions of the pregnant women about the care received during the prenatal care is related to the care given, humanized reception, consideration of the pregnant woman's subjectivity and support in the difficult moments that make this period satisfactory.

Medical-social risk factors of cervical cancer development among women of reproductive age

Cervical cancer is one of the widespread diseases that have a negative impact on the reproductive health. However, medical-social risk factors which provoke this pathology aren't studied sufficiently yet. We have identified the most significant medical-social risk factors of cervical cancer's development and progression based on data analysis of a sociological study. Thus, it was found that cervical cancer can't be associated with predominantly late reproductive age of women in conditions of the Republic of Belarus: most of the patients with this pathology (more than 53%) were under the age of 35 years old. The group of patients suffered from cervical cancer was quite homogeneous in their social status, which was average and relatively stable in a large majority of them (more than 90%), despite employment in various sectors of the national economy. Social functioning of these patients wasn't significantly different from the main population of women in reproductive age. Thus, early sexual activity and random early sexual relations weren't characteristic for the majority of them: 86.1±4.46% (the control group – 87.3±5.51%, the comparison group – 78.2±3.96%) and 83.5±4.72% (the control group – 89.1±4.28%, the comparison group – 75.2±2.36%). Moreover, the married patients of the main group had the most ordered sexual behavior (p<0.01; tau=0.572) which determined the low prevalence of artificial abortions among them, including menstrual cycle regulation (less than 8%). However, the revealed different defects of health-saving behavior in the main group of patients (more than 70%), including an insufficient level of valeological knowledge, the presence of common harmful habits and low medical activity, indicate that there are significant reserves for improvement of the preventive activities of medical stuff in the field of primary medical care for the development of a healthy lifestyle among female population of reproductive age and providing clinical examination among this contingent of females in reproductive age with the purpose of cervical cancer prevention.

Development of Mother's Postnatal Sense of Security.

Introduction:Although sense of security in mothers is not clearly specified in literature, most important factors that make it up in women that do not have issues in pregnancy are social support, prenatal health care and partner’s support. Psychological factors play a key role in recognizing fear of childbirth, distinguishing anxiety from clinical depression. Recognizing risk factors and adequate intervention support would significantly reduce fear.Aim:to analyze development of mother’s sense of security during the postnatal period and establish the differences between two study groups.Methods:The Cross section study was conducted in 2017 in the Public Institute for Health care Protection of Women and Maternity in Canton Sarajevo. Using random method in the study were included 395 mothers. The research instrument was PPSS-instrument and modified questionnaire.Results:Postnatal sense of security in n=395 of the mothers on average was 49, 61±7, 6. Mothers’ sense of security during the first week after their child’s birth differed significantly (p=0.004) between mothers whose husband actively participated in psychophysical preparation for childbirth. Development of parents sense of security is in direct connection with psycho-physical preparations of pregnant women for labor only when both partners took active part in preparations for labor.Conclusion:Postnatal sense of security in parents is a term that has not been researched enough and it requires further studies. Bachelor degree in health care/graduated nurse/midwife, especially in primary health care field, according to her competencies would be able to independently create and work on promoting prevention programs through holistic approach with individuals and families.

Estudio de satisfacción del paciente ante la realización de una ecografía en atención primaria

ObjectiveTo analyse the level of patient satisfaction when undergoing a diagnostic ultrasound by a family doctor. Material and methodA cross-sectional descriptive observational study was conducted in two health centres in Madrid, between December 2015 and March 2016. An anonymous questionnaire was used, consisting of two parts: one in-house prepared that included the socio-demographic variables, and an adaptation to the study objectives of the “survey of satisfaction of users of health centres” included in the document “Evaluation of the satisfaction of users of public health care services of the Community of Madrid” by the General Directorate of Coordination for Citizen Services and Humanisation of Health Care, Ministry of Health of Madrid, 2014. PopulationPatients on whom their family doctor performed an ultrasound for diagnostic purposes. Patients completed the questionnaire after 15 to 30 days, thus minimising the authority bias. The sample was obtained by consecutive non-probabilistic sampling. ResultsThe level of “satisfied-very satisfied” reached 95%, with the approval of the family doctor compared with the hospital specialist performing the ultrasound. The health centre would be chosen by 92% if they had to undergo an ultrasound for a second time, 96% would recommend it to third parties, and 95% considered that their expectations were met. ConclusionsThe performance of a diagnostic ultrasound by family doctors was evaluated with a high level of satisfaction by the patients. There are no comparable studies in the Primary Care field, and multicentre studies would be needed in order to generalise the results obtained.

Career Regret Among Physician Assistants: A Comparative Survey of Primary and Specialty Care Careers

Purpose: This study investigated if career regret varies among physician assistants (PAs) practicing in primary and specialty care fields. This information may assist practicing and aspiring physician assistants when selecting or changing their career path. Methods: A survey was emailed to 5,000 primary and specialty care physician assistants. Items indicating career regret were compared between primary and specialty care groups. Results: Eight hundred and thrity-four (16.7%) completed surveys were received back. Career regret is similar between primary and specialty care physician assistants, with low reports from both groups. No statistical significance was found between primary care and specialty care groups with regards to career regret or student loan debt. The primary care group noted a less sustainable work/ life balance and higher perceived burnout. Specialty care physician assistants reported higher annual gross income. Regret and disappointment correlated highly with burnout. Conclusions: Physician assistants and prospective physician assistants should carefully consider their career path as regret and disappointment correlated highly with burnout.

Residency Specialty Choice Trends Over 24 Years

Studies have shown a decrease in the match rate in general medical and primary care-focused specialties among US medical school graduates and an increase in that of subspecialties with “controllable lifestyles.” We evaluated the percentage of Harvard Medical School graduates who matched into high-income controllable lifestyle, low-income controllable lifestyle, and noncontrollable lifestyle specialties from 1994 to 2017. Using linear regression, we found that the percentage of students matching into high-income and low-income controllable lifestyle specialties has increased over time, while those matching into noncontrollable lifestyle specialties – comprised largely of primary care fields – decreased. Such trends may impact the US physician workforce composition over time, with growth of residency positions into fields such as internal medicine exceeding the matriculation of U.S. medical graduates into these positions. We examine whether future policies should focus on incentivizing students to pursue such noncontrollable lifestyle specialties by highlighting controllable lifestyle elements within these fields and emphasizing alternative rewards which may attract candidates to these pursuits. Keywords: RESIDENCY SPECIALTY CHOICE TRENDS, CONTROLLABLE LIFESTYLE, INCOME LEVEL, CAREER CHOICE

Health as a right in Colombia's post-conflict period

To explore the elements that should be considered in post-conflict zones to guarantee the right to health of populations immersed or living in areas near the concentrations of former combatants. A retrospective study was carried out by searching databases, obtaining 26 relevant articles. The literature review made evident that not only the legal or normative framework is important, but also the needs and interests of the people of the community, of both the civilian population and the victims of war. The right to health in these areas also involves the exercise of power, of dialogue of knowledge, forgiveness, non-repetition and respect. In addition, health promotion and disease prevention services, treatment and rehabilitation based on the primary care strategy should be offered, that is, they should be adapted to the cultural realities, the environments and the interests of the communities. The challenge lies in the way how these goals can be achieved within a context of a weak health system, in financial, administrative and technical terms. Basic multidimensional elements in the field of primary health care are proposed to face this challenge for the Colombian public health.

The interclerkship ambulatory care track: attributes of a longitudinal integrated clerkship that inspire medical students to pursue careers in primary care and work with underserved.

This article was migrated. The article was marked as recommended. Few longitudinal integrated clerkships (LICs) have increased the proportion of students who choose to go into primary care or work with underserved populations. A mixed-methods questionnaire was developed and sent to alumni (2006-2016) of the Interclerkship Ambulatory Care Tract (InterACT), a third-year clerkship in which students apply evidence-based medicine and chronic care model principles to outpatient longitudinal care. A likert scale was utilized for quantitative questions. Descriptive and thematic analyses were performed on the qualitative responses using a constant comparative approach. A majority (80%; 49/61) responded. Of the 44 physicians who responded to questions about current specialty, 75% indicated pediatrics, family medicine, or internal medicine. The majority of respondents (89%) reported that they care for patients considered to be medically underserved. Alumni overwhelmingly felt that the clerkship impacted the following: their specialty choice (71%, 34/48), and the population of patients they chose to take care of (80%, 39/49). The following attributes emerged from the qualitative questions as key determinants of future decisions regarding specialty and patient population: holistic patient care, strong mentorship, longitudinal patient relationships, and care of the homebound. These key attributes, if implemented in other LICs, may be a means to increase the number of medical students that choose to work in primary care fields and/or with underserved populations.

Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level

Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration.

The review of health system of the Kingdom of Denmark and United Kingdom

The paper deals with the functioning and development of national health systems in the Kingdom of Denmark, which is a very stable member of the European Union (EU) and United Kingdom, regardless of its recent outbreak (Brexit) from a large European family. The main goal is to make a review of the necessity of creation of professional health personnel, their mobility, financing of business processes and medical procedures, and also on general problems that the health systems are facing every day. As these are highly developed European economies, it is known that the creators of their health policies are continuously working on the improvement of health systems, ensuring adequate health care and raising and maintaining a high level of collective health for the population. Lately, in these kingdoms, many people believe that for the proper functioning of health sector in general, the way of obtaining of necessary financial resources, their amounts and sustainability of the sources have no big importance, while as far more significant emerge the influences of globalization processes which like hurricane destroy systems (insufficient professional staff) without legal and economic-medical arrangements. Given that the authors are not fully in agreement with this statement, they pledge to the invited authorities to pay more attention on the policy of financing, human capital, its improvement and elimination of health inequality, especially in the field of primary health care.

Les soins primaires : une définition du champ pour développer la recherche

BackgroundResearch in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l’offre de soins). Material and methodsThe RECaP (Research in Clinical Epidemiology and Public Health) network is a French research network supported by Inserm, which recently implemented a specific working group focusing on research in primary care, based on a multidisciplinary approach. Researchers from different specialties participate in this group. The first aim of the group was to reach a common definition of the perimeter and of the panel of healthcare professionals and structures potentially involved in the field of primary care. For this purpose, a selection of different data sets of sources defining primary care was analyzed by the group, each participant collecting a set of sources, from which a synthesis was made and discussed. ResultsA definition of primary care at different levels (international, European and French) was summarized. A special attention was given to the French context in order to adapt the perimeter to the characteristics of the French healthcare system, notably by illustrating the different key elements of the definition with the inclusion of primary care actors and the type of practice premises. ConclusionIn conclusion, this work illustrates the diversity of primary care in France and the potential offered for research purposes.

Mapa de la enfermedad de Alzheimer y otras demencias en España. Proyecto MapEA

IntroductionIn the current context of increased life expectancy and progressive aging of the population a very significant increase in the number of people with cognitive impairment and dementia is expected.Consequently, Spain will face an enormous social and health problem in the next decades. The Mapa de la enfermedad de Alzheimer y otras demencias en España project aims to analyse plans, prevention and early diagnosis activities, process of care and resources available across the 17 Spanish regions for the management of cognitive impairment and dementia in order to identify improvement areas, as well as to provide a list of recommendations. MethodsThe working group consisted of an Advisory Committee of 5 national experts and a Committee of Experts from each region made up of professionals in the field of Neurology, Geriatrics, Psychiatry, and Primary Care, as well as representatives of Family Associations of People with Alzheimer's and other dementias. The Expert Committee of each region held meetings in which the current situation of care was reviewed. ResultsPlans available in Spain for dementia management are mostly obsolete or have not been implemented. Prevention and early detection activities are generally not carried out. There is great variability of care process that patients must follow for the diagnosis, treatment, and follow-up of the disease, and not all diagnostic test are available in different regions. In general, resources are considered scarce and unknown. ConclusionsThe Mapa de la enfermedad de Alzheimer y otras demencias en España study has been able to detect the main points that require changing n the management, organisation, and coordination of resources, such as information and training of the personnel involved. Furthermore, the study has revealed that, in Spain, the necessary conditions are in place in Spain, such as the availability and capacity of professionals involved, as well as there being the potential diagnostic and health care resources to address this room for improvement through the approval and development of a National Alzheimer's Plan, supported by a deep and truthful political commitment, which will be the ideal framework for the development of these possibilities.

Difficulties in nutritional counseling and child growth follow-up: from a professional perspective.

Nutritional counseling and growth follow-up are priorities when providing care to children; however, these have not been completely incorporated into primary health care. To know the difficulties for providing nutritional counseling and child growth follow-up, from a professional healthcare perspective. Qualitative study, using Donabedian as theoretical framework, developed by 53 professionals in the field of primary health care. Data was obtained from focal groups and submitted to content analysis. The main difficulties for nutritional counseling were clustered in the category of 'perceptions and beliefs related to child feeding'. The 'problems of infrastructure and healthcare' and 'maintenance of the hegemonic medical model' are the main difficulties for following-up growth. Besides investments in infrastructure, healthcare training is indispensable considering beliefs and professional experiences, so in fact, nutritional counseling and child growth follow-up are incorporated in primary health care. Aconselhamento nutricional e acompanhamento do crescimento são prioritários na assistência à criança, porém, ainda não estão plenamente incorporados na atenção básica. Conhecer as dificuldades para realizar aconselhamento nutricional e acompanhamento do crescimento infantil, na perspectiva de profissionais de saúde. Estudo qualitativo, fundamentado no referencial de Donabedian, desenvolvido com 53 profissionais de saúde da atenção básica. Dados foram obtidos por grupos focais e submetidos à análise de conteúdo. As principais dificuldades para o aconselhamento nutricional reuniram-se na categoria 'percepções e crenças relacionadas à alimentação infantil'. Para o acompanhamento do crescimento, as categorias 'problemas de infraestrutura e funcionamento dos serviços de saúde' e 'manutenção do modelo médico hegemônico' representaram as principais dificuldades. Além de investimentos na infraestrutura, é imprescindível que capacitações em serviço considerem crenças e experiências dos profissionais para que, de fato, o aconselhamento nutricional e acompanhamento do crescimento infantil sejam incorporados na atenção básica.

Blunt Scrotal Trauma in Soldiers-Epidemiology and Outcome.

Blunt scrotal trauma (BST) is common among soldiers but its incidence and outcome are unknown. The purpose of this study was to estimate the incidence, clinical findings, and outcome of BST in soldiers referred to a primary care field physician. The medical records of soldiers in their military services who sustained BST and were evaluated by primary care field doctors over a 10-year period were reviewed. Anamnestic data, physical findings, primary care physician decisions, hospitalization, and surgery rates as well as final outcomes were analyzed. The medical records of 382,036 soldiers were reviewed and 668 cases (0.175%) of BST were identified. All patients complained of scrotal pain and 10% of dysuria. The most common physical findings included: scrotal tenderness (71.7%), scrotal edema (16.2%), and scrotal hematoma (4.8%). In 11.8% of the visits microhematuria was found in urine dip stick. A total of 243 patients (36.4%) were referred to emergency department, but only 9 (3.7%) were hospitalized. Of these, 3 patients underwent surgical exploration due to suspected testicular rupture in ultrasonography. Finally, testicular rupture was found only in 1 patient. This testis was sutured. In another patient testicular torsion was found and orchiectomy done. 168 patients (25.1%) developed prolonged scrotal pain lasting for more than 2 weeks after the trauma. Blunt testicular trauma is not an uncommon phenomenon among soldiers. Surgical intervention is rarely needed and in 99.6% of cases seen by general practitioners supportive management is suffice. The phenomenon of prolonged post-traumatic testicular pain, developing in a quarter of the patients after BST pain deserves more research.

Political, Institutional, and Economic Conditions for New Industry Emergence: Retail Clinics

What conditions predict new organizational entry and growth in an emergent industry? We investigate regulatory and economic market conditions associated with new entry and integration of retail health clinics–a radically new organizational form–into the organizational field of primary care in the U.S. While prior literature examines, separately, economic, institutional, and political predictors of new industry emergence, we use fuzzy set qualitative comparative analysis (fsQCA) to identify configurations of field conditions on the three dimensions simultaneously that are associated with clinics presence and growth. We find all three dimensions played a role in the initial growth of the new organizational form across U.S. states up to 2008, the industry’ subsequent growth from 2008 to 2013. Most important, we find that regulatory barriers of professional license, which research on professions and occupational licensure would predict to be a key hurdle for new entrants, did not matter for retail clinics proliferation, when political and economic was favorable for entry.

Barriers and facilitators in the integration of oral health into primary care: a scoping review

ObjectiveThis scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care.MethodsGrounded in...

Internamiento no voluntario del paciente psiquiátrico: normas legales y aspectos críticos

Traditionally, medical care received by psychiatric patients involved their separation from the society through their isolation in closed institutions, thereby setting a stigmatising trend on the sick, and by extension on mental illness, a practice that somehow has remained until now.The profound changes in the field of psychiatry have been important and are reflected in the therapeutic field, as well as in the legislative one, and have contributed to establish changes concerning the social opinion about psychiatric patients.The purpose of this article is to review, from the critical perspective, the current legislative framework concerning the situation of involuntary psychiatric commitment as a therapeutic measure in the psychiatric patient, as well as the legal medical practice which indicates the lack of legal skills and ethical and professional conduct arising in the field of primary care.

The Latin American School of Medicine (Elam): Admissions, Academics and Attitudes

With the Cuban health system hailed as one of the best in the world, its doctors have a high reputation in the field of primary care in less-developed countries. This article provides an insight into the Latin American School of Medicine (Escuela Latinoamericana de Medicina (ELAM)) as a means of helping our understanding of the process involved in creating a medical workforce that is suited to the developing world. The article reviews the available peer-reviewed literature and evaluates additional media to make an assessment of the curriculum and teaching and learning experience at ELAM. The findings reveal an insightful way of selecting students from low-income backgrounds and teaching that mimics curricula seen at medical schools in the UK, with the addition of modules in homeopathic medicine and a focus on placements in primary care. The article reveals some problems for students who have struggled to adapt their skills to fit the healthcare systems in their home countries. Attitudes towards students are generally positive, though there are a number of reports on student welfare issues. The article concludes that the overwhelming impression is that students are happy to compromise on small comforts in exchange for a subsidised medical education.