Health Problems In Primary Care Research Articles

O cuidado colaborativo auxilia no tratamento da ansiedade na atenção primária?

Objective : Anxiety disorders represent an important part of mental health problems in primary care. This literature review seeks to find out whether collaborative care (called “matrix support” in Brazil) assists the treatment of anxiety disorders and/or anxiety symptoms. Methods: We performed a literature search with no time period restriction using PubMed, ISI, and LILACS PSYCINFO databases. The descriptors sought were “collaborative care”, “shared care”, “primary care”, “anxiety”, “generalized anxiety disorder”, “panic disorder”, “phobia”, “social phobia”, “post-traumatic stress disorder”, “obsessive compulsive disorder” and “anxiety disorder, Not Otherwise Specified - NOS.” Results: A total of 106 articles were found and after the application of exclusion criteria, seven articles were selected for the present analysis. Conclusion: Despite the different types of collaborative care used, results show greater improvement in anxiety symptoms in patients that received collaborative care compared with those in the control groups, who did not receive such intervention.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype

BackgroundGPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people’s reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care.MethodsWe conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project’s Exit Interview.ResultsOf the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care.ConclusionsWe conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care.Trial registrationClinicalTrials.gov NCT00794222

Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study

ObjectivesThe aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model. MethodA quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes. ResultsSix to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes. ConclusionsTraining professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.

Managing Microbe-associated Health Problems in Primary Care

General MedicineVolume 14, Issue 1 p. 4-6 EditorialOpen Access Managing Microbe-associated Health Problems in Primary Care Takeshi Morimoto MD, PhD, MPH, Corresponding Author Takeshi Morimoto MD, PhD, MPH Editor, General Medicine tm@hyo-med.ac.jp Author responsible for correspondence : Takeshi Morimoto, MD, PhD, MPH Division of General Internal Medicine Hyogo College of Medicine 1–1 Mukogawa, Nishinomiya, Hyogo 663–8501, Japan Phone +81–798–45–6809 FAX +81–798–45–6920 E-mail address: tm@hyo-med.ac.jpSearch for more papers by this author Takeshi Morimoto MD, PhD, MPH, Corresponding Author Takeshi Morimoto MD, PhD, MPH Editor, General Medicine tm@hyo-med.ac.jp Author responsible for correspondence : Takeshi Morimoto, MD, PhD, MPH Division of General Internal Medicine Hyogo College of Medicine 1–1 Mukogawa, Nishinomiya, Hyogo 663–8501, Japan Phone +81–798–45–6809 FAX +81–798–45–6920 E-mail address: tm@hyo-med.ac.jpSearch for more papers by this author First published: 05 July 2013 https://doi.org/10.14442/general.14.4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1van Nood, E.; Vrieze, A.; Nieuwdorp, M.; Fuentes, S.; Zoetendal, E. G.; de Vos W. M.; Visser, C. E. et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013, 368: 407– 415. 2Takayama, N. et al. Oral environments of pregnant women and factors associated with the risk of caries development. Gen Med. 2013, vol. 14, p. 48 3Iwata, K. et al. Gingyo Gedokusan vs oseltamivir for the treatment of uncomplicated influenza and influenza-like-illness: An open-label prospective study. Gen Med. 2013, vol. 14, p. 13 Volume14, Issue1July 2013Pages 4-6 ReferencesRelatedInformation

Ethical problems in geriatrics: Views of Turkish primary healthcare professionals

Primary healthcare professionals frequently encounter ethical issues in the care of older adults. These issues might particularly appear in the context of "age discrimination", "respect for autonomy", "respect for privacy" and "decision-making competency". The aims of this study were to determine the frequency rates of various geriatric ethical problems and to evaluate the importance given to these problems in primary healthcare. In order to evaluate the opinions, a questionnaire tool was formulated. The participants were asked to review the list of geriatric ethical issues, to state the frequency of encountering them and to identify the importance ratings for each issue. The sample consisted of 86 primary healthcare professionals (50 physicians and 36 nurses) aged between 24 and 50 years. Based on the results, the most frequently encountered ethical issues were on "decision-making competency" and these issues respectively were "decision-making with relatives instead of elder patients", "not informing elders due to the lack of tolerance" and "not informing elders due to the lack of comprehending". The most important geriatric ethical issues were "ignoring respect for privacy", "ignoring patient's complaints" and "rejecting detailed examination or treatment because of age". Overall, the results show that the nurses and physicians in primary healthcare frequently encounter geriatric ethical problems related to the decision-making process, which is a common issue for Turkey as a paternalistic society. The findings show that primary healthcare professionals are sensitive to geriatric ethical issues; however, this sensitivity does not prevent the emergence of these issues.

Course prompts optimistic outlook.

Nurses who took a module on mental health problems in primary care as part of their master's degree were more likely to believe that intervention would improve patient outcomes after taking the course than before.

Reasons why patients with primary health care problems access a secondary hospital emergency centre

Many patients present to an emergency centre (EC) with problems that could be managed at primary healthcare (PHC) level. This has been noted at George Provincial Hospital in the Western Cape province of South Africa. In order to improve service delivery, we aimed to determine the patient-specific reasons for accessing the hospital EC with PHC problems. A descriptive study using a validated questionnaire to determine reasons for accessing the EC was conducted among 277 patients who were triaged as green (routine care), using the South African Triage Score. The duration of the complaint, referral source and appropriateness of referral were recorded. Of the cases 88.2% were self-referred and 30.2% had complaints persisting for more than a month. Only 4.7% of self-referred green cases were appropriate for the EC. The three most common reasons for attending the EC were that the clinic medicine was not helping (27.5%), a perception that the treatment at the hospital is superior (23.7%), and that there was no PHC service after-hours (22%). Increased acceptability of the PHC services is needed. The current triage system must be adapted to allow channelling of PHC patients to the appropriate level of care. Strict referral guidelines are needed.

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial

BackgroundMedically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month.Methods/designThis study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.DiscussionThis study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations.Trial registrationThe trial was registered with ClinicalTrials.gov, number NCT01484223 [ http://ClinicalTrials.gov].

Who seeks primary care for sleep, anxiety and depressive disorders from physicians prescribing homeopathic and other complementary medicine? Results from the EPI3 population survey

ObjectivesTo describe and compare patients seeking treatment for sleep, anxiety and depressive disorders (SADD) from physicians in general practice (GPs) with three different practice preferences: strictly conventional medicine (GP-CM), mixed...

The impact of the medical speciality in primary health-care problem solving in Belo Horizonte, Brazil: homeopaths versus family doctors: a preliminary quantitative study

This research project examined influence of the doctors' speciality on primary health care (PHC) problem solving in Belo Horizonte (BH) Brazil, comparing homeopathic with family health doctors (FH), from the management's and the patients' viewpoint. In BH, both FH and homeopathic doctors work in PHC. The index of resolvability (IR) is used to compare resolution of problems by doctors. The present research compared IR, using official data from the Secretariat of Health and test requests made by the doctors and 482 structured interviews with patients. A total of 217,963 consultations by 14 homeopaths and 67 FH doctors between 1 July 2006 and 30 June 2007 were analysed. The results show significant differences greater problem resolution by homeopaths compared to FH doctors. In BH, the medical speciality, homeopathy or FH, has an impact on problem solving, both from the managers' and the patients' point of view. Homeopaths request fewer tests and have better IR compared with FH doctors. Specialisation in homeopathy is an independent positive factor in problem solving at PHC level in BH, Brazil.

Avoidant personality problems—their association with somatic and mental health, lifestyle, and social network. A community-based study

AimThe aim of the study was to explore the associations between the presence of avoidant personality problems (APPs) and 5 areas of impairment: demography, somatic issues, mental health, lifestyle, and social issues. MethodsAvoidant personality problem was defined by confirmation of the 2 avoidant personality disorder items of the Iowa Personality Disorder Screen and and the Social Phobia Inventory (SPIN) short version (MINI-SPIN) screening assessment for generalized social anxiety disorder sum score of 6 or more. The questionnaires were administered in a Norwegian population survey (the Oslo Health Study-HUBRO). Cases consisted of 280 individuals with APP and 5 randomly selected controls without APP (n = 1400). ResultsThe APP group more frequently reported living alone, lower level of education, and lower income than controls. Poor self-rated health, presence of somatic disease, muscular pain, frequent use of analgesics, and visits at a general practitioner were significantly more common in the APP group than among controls. The APP group had significantly higher proportion of caseness of mental distress, low general self-efficacy, and insomnia, and this result held up in multivariate analyses. The APP group showed statistically significant higher proportions of physical inactivity, obesity, daily smoking, and alcohol problems compared with controls. As for social impairment, a significantly higher proportion of the APP group reported “not having enough good friends,” “high powerlessness,” and low community activism, and the 2 former variables held up in multivariate analyses. ConclusionIn this population-based study, we found that high levels of APP, defined closely to avoidant personality disorder, were significantly associated with demographic, somatic, and mental impairment; low general self-efficacy; and insomnia affecting work ability. In addition, APP showed associations with negative lifestyle, alcohol problems, and social impairment reporting lack of good friends and lack of empowerment. Avoidant personality problem is associated with clinically significant impairment in several areas, which underlines the importance of recognizing these problems in primary health care.

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial.

BackgroundOver 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review.MethodsWe conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale.ResultsOf the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes.ConclusionsMonitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole.Trial RegistrationClinicalTrials.gov NCT00794222.

Educating Trainees About Common Mental Health Problems in Primary Care: A (Not So) Modest Proposal

Educating Trainees About Common Mental Health Problems in Primary Care: A (Not So) Modest Proposal

Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice

In 2009, a conference at Imperial College London brought together experts on the primary care provision of child and adolescent mental health. The following paper highlights various themes from the conference, and particularly focuses on general practice. Despite international and national guidance, child and adolescent mental health provision in primary care is limited in the UK and globally. We argue that primary care services are in fact well placed to assess, diagnose, and manage child and adolescent mental health problems. The barriers to such provision are considered from the perspective of both service users and providers, and the possible ways to overcome such challenges are discussed. The paper is informed by various epidemiological and intervention studies and comparisons between different countries and health systems are explored.

Acupuncture for ‘frequent attenders’ with medically unexplained symptoms

Paterson et al 1 conclude from their randomised controlled trial (CACTUS study) that an addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing. We were immediately attracted to their article by the clinical relevance of investigating treatment in patients with medically unexplained physical symptoms (MUPS). MUPS are an interesting and relevant problem in primary health care, because these patients are often ‘frequent attenders’ and this leads to high medical costs, frustrated doctors, …

The Relationship between Asthma and Depression in Primary Care Patients: A Historical Cohort and Nested Case Control Study

Background and ObjectivesAsthma and depression are common health problems in primary care. Evidence of a relationship between asthma and depression is conflicting. Objectives: to determine 1. The incidence rate and incidence rate ratio of depression in primary care patients with asthma compared to those without asthma, and 2. The standardized mortality ratio of depressed compared to non-depressed patients with asthma.MethodsA historical cohort and nested case control study using data derived from the United Kingdom General Practice Research Database. Participants: 11,275 incident cases of asthma recorded between 1/1/95 and 31/12/96 age, sex and practice matched with non-cases from the database (ratio 1∶1) and followed up through the database for 10 years. 1,660 cases were matched by date of asthma diagnosis with 1,660 controls. Main outcome measures: number of cases diagnosed with depression, the number of deaths over the study period.ResultsThe rate of depression in patients with asthma was 22.4/1,000 person years and without asthma 13.8 /1,000 person years. The incident rate ratio (adjusted for age, sex, practice, diabetes, cardiovascular disease, cerebrovascular disease, smoking) was 1.59 (95% CI 1.48–1.71). The increased rate of depression was not associated with asthma severity or oral corticosteroid use. It was associated with the number of consultations (odds ratio per visit 1.09; 95% CI 1.07–1.11). The age and sex adjusted standardized mortality ratio for depressed patients with asthma was 1.87 (95% CI: 1.54–2.27).ConclusionsAsthma is associated with depression. This was not related to asthma severity or oral corticosteroid use but was related to service use. This suggests that a diagnosis of depression is related to health seeking behavior in patients with asthma. There is an increased mortality rate in depressed patients with asthma. The cause of this needs further exploration. Consideration should be given to case-finding for depression in this population.

Telemedicine and Primary Health: The Virtual Doctor Project Zambia

This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. The paper presents this problem and how it is addressed by 'The Virtual Doctor Project,' emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization (WHO). This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any 'real-world' articulation of this technology must confront.

Developing, evaluating and implementing alcohol brief interventions in Europe

This article traces the history of research on the development, evaluation and implementation of alcohol brief intervention (BI) in Europe. Narrative and historical review. BI originated in Europe and, following a definition of opportunistic BI, early pioneering studies are summarised. The role of European scientists in the series of studies making up the WHO Collaborative Project on Detection and Management of Alcohol-related Problems in Primary Health Care (1982-2006) is then described, followed by a short account of a current EU-funded project (Primary Health European Project on Alcohol) with the aim of achieving a widespread, routine and enduring implementation of BI in EU member states. In addition to involvement in these two major projects, a great deal of research on BI has been carried out in a range of European countries and some of this research is noted. Several European governments are now taking the rolling out of BI in routine services very seriously as a policy measure. There is no necessary conflict between widely available BI and alcohol control measures. While much remains to be done regarding practical implementation, the mood of those interested in the promotion of BI as a means of reducing alcohol-related harm, in Europe as elsewhere, is cautiously optimistic.

Polypharmacy and patterns in drug prescribing at a primary healthcare centre in the Riyadh region of Saudi Arabia

To elucidate the various patterns in drug prescribing in a non-Ministry of Health-affiliated primary healthcare centre model (Riyadh Kharj Military Hospital) in Saudi Arabia. A retrospective analysis of pharmacy records of the Riyadh Kharj Military Hospital was undertaken. A total of 4781 prescriptions archived over a period of 6 months (January-June 2001) were statistically analysed using Statistical Package for the Social Sciences (SPSS). Number, types, therapeutic duration and distribution of drugs were evaluated. Age distribution and documentation adequacy were also reviewed and monitored. Therapeutic classification of drugs was carried out according to the British National Formulary system. Of the total prescriptions, 47.8% were for male patients and 50.1% for females. Prescriptions for the paediatric population accounted for 19.5% whereas 13.7% of drugs were prescribed to the geriatric cohort. A mean of 2.7±1.6 drugs were prescribed per patient. In multidrug prescriptions, 32.3% contained two drugs and 22.1% prescriptions had four drugs or more. Mono-drug prescriptions accounted for 21.6% of prescriptions. Paracetamol (13.9%) was the most commonly prescribed drug followed by multivitamins and cough syrups with 5.0 and 3.7%, respectively. The most common therapeutic classes of drugs prescribed were analgesics, antipyretics, antihistamines, and vitamins and minerals, making up a third of all prescriptions. Dosage form, dose and routes of administration were not present in 21.7, 8.8 and 99.6%, respectively. Polypharmacy appears to be a problem in primary health care, which requires stricter pharmacovigilance and constant reviewing. We recommend the establishment of an efficient local prescribing policy through an effective practice-based Pharmacy and Therapeutic Committee, training in prescribing to be introduced in medical schools and the lending of support to continuous education programmes targeting prescribing skills.

Conjunctivitis: Systematic Approach to Diagnosis and Therapy

Conjunctivitis is a common problem in primary health care. Inflammation of the conjunctiva may result from infection or noninfectious causes. Microbial conjunctivitis may be caused by bacteria, viruses, or parasites. Although usually a benign, self-limited disease in healthy individuals, serious complications (eg, keratitis) may be sight-threatening. Accurate diagnosis and specific treatment of conjunctivitis remain challenging. History taking and physical examination are occasionally insufficient for correct diagnosis, thus laboratory testing may play a vital role in identification of specific pathogen(s). However, diagnostic testing has several limitations, including time-consuming methods, increased cost, and requirement for expertise in performance and interpretation. Treatment with empirical topical antibiotics for suspected infectious conjunctivitis is controversial. Although antibiotic treatment can diminish risk of adverse events and shorten the course of disease, drug resistance, toxicity, and expense are important considerations in management of acute infectious conjunctivitis.