Primary Health Care Providers Research Articles

Effectiveness of specialist involvement in case discussion conferences with primary healthcare providers on the management of type 2 diabetes patients: a study protocol for a cluster randomized controlled trial

BackgroundIn supporting primary healthcare in delivering high-quality care for individuals with type 2 diabetes mellitus (T2DM), previous research emphasized strategies to facilitate communication and collaboration between primary healthcare providers and hospitals. This study aims to evaluate the effectiveness of case discussion conferences between specialists from hospitals and primary healthcare providers in China on the optimization of diabetes management and the improvement of patient health outcomes.MethodsThis study will be a parallel cluster randomized controlled trial in which primary healthcare institutions in Shouguang city and Shangsi County will be randomly allocated to the intervention and control groups. The intervention will involve regular case discussion conferences where attendants will meet to discuss complex cases with patients diagnosed with type 2 diabetes mellitus, exchange experiences, and seek and provide expert advice. Family doctor teams from primary healthcare institutions and specialists from secondary or tertiary hospitals will engage in these conferences. Data will be collected at baseline and at the 6- and 12-month follow-ups. The primary clinical outcome measures will focus on the changes in the HbA1c and FBG levels of patients under management. The secondary outcomes will include other physiological indicators, such as blood pressure, BMI, and cholesterol. The evaluation will extend to changes in the capabilities and behaviors of primary healthcare providers. Furthermore, the feasibility and adherence of this intervention will be thoroughly assessed.DiscussionThis study is designed to generate robust evidence on the effectiveness of case discussion conferences, an interprofessional collaboration strategy, in enhancing diabetes care delivery in primary healthcare, with the ultimate goal of improving patient health outcomes.Trial registrationChinese Clinical Trial Registry ChiCTR2300078829. Registered on December 19, 2023. https://www.chictr.org.cn/showproj.html?proj=210293

HPV vaccination in Croatia (2016-2023): Increased vaccine uptake and declining sex disparities

Abstract Background The Human papillomavirus (HPV) is a known cause of cervical cancer, and is associated with the development of vaginal, vulvar, anal, penile, and head and neck cancer. The availability of the HPV vaccine has enabled generations of young people to be protected from HPV-related cancers. In 2016, a national immunization program targeting 14-year-old girls and boys has been initiated in Croatia. To date, systematic data on HPV vaccination coverage (VC) in Croatia is lacking. This study aims to determine HPV VC, examine trends in HPV vaccination in Croatia from 2016 to 2023 in the context of the national vaccination program, and assess differences between sexes. Methods The study is designed as a retrospective analysis covering the data from 2016 to 2023, collected from primary healthcare providers. HPV VC within 2000-2008 birth cohorts (BC) are analyzed for all vaccinated with at least one dose and assessed by sex. The trend in HPV vaccination is shown using joinpoint regression. The chi-square for trend is used to compare the vaccination coverage of females (FVC) and males (MVC). The rate ratio between FVC and MVC is calculated. Results HPV VR increased significantly among observed BCs from 6,44 % in 2000 BC to 44,22 % in 2008 BC (FVC rose from 10,67 % to 52,78 %, and males MVC from 2,47 % to 36,05 %). Joinpoint analysis revealed a statistically significant increase in all birth cohorts, while the steeper increase is seen in 2000-2006 BCs (APC = 35,47, P < 0,05) than in 2006-2008 BCs (APC = 13,93, P < 0,05). FVC is significantly higher than MVC in all birth cohorts (Extended Mantel-Haenszel chi-square for linear trend = 809.23, P < 0,001). The highest FVC/MVC rate ratio was observed in the initial 2000 BC (4,31), and the lowest in the last 2008 BC (1,46). Conclusions In Croatia, HPV VC continuously increases among observed BCs. The positive trend is present in both sexes, and the rate ratio between female and male cohorts is decreasing. Key messages • The study presents a systematical overview of HPV vaccination coverage in Croatia from the beginning of the national immunization program, which is crucial for monitoring progress. • In the following years, if the revealed trends persist or advance, Croatia could be closer to reaching Europe’s Beating Cancer Plan concerning eliminating HPV-related diseases.

Strengthening the quality of primary healthcare services and interdisciplinary collaboration

Abstract Background Political organisations stress the need for preventive strategies to reduce the amount of avoidable hospital admissions, i.e. admissions that could have been avoided given timely and adequate care in the primary healthcare setting. Interdisciplinary collaboration has been suggested as a means to prevent hospitalizations, but effective implementation remains a challenge. Thus, there is a need for evidence-based strategies to prevent avoidable admissions and support interdisciplinary collaboration. The aim was to develop an evidence-based framework for preventive and coordinated interventions strengthening the quality of primary healthcare services and supporting interdisciplinary collaboration. Methods The project consists of three sub-studies: 1) a mixed methods systematic review following the JBI methodology; 2) a focus group study with primary healthcare providers in the Central Denmark Region, including general practitioners, physiotherapists, occupational therapists, home care providers, registered nurses and nurse specialists; and 3) a study using participatory design, where a framework for coordinated interventions were developed based on the results from study 1 and 2, supported by all stakeholders. Results Findings suggest that some hospitalizations can be prevented by intervening on mental factors, e.g., through trustful relations, and social factors, e.g., living situation. Also, a strong collaboration between healthcare providers from different disciplines and healthcare services is needed to improve the care pathway and prevent hospitalization. The collaboration may be strengthened if the health providers share a common language regarding the citizens’ health status. Conclusions Stakeholders at all levels should be informed about the relevance of considering mental, social and physical factors to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration. Key messages • By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some admissions. • Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration.

A canine onchocercosis report from the portuguese west region in 2024: implications for Public Health

Abstract Issue/problem Onchocerca lupi parasitosis, known as onchocercosis, affects dogs, sporadically cats and humans, posing a public health concern due to possible vectors in the environment. This neglected tropical disease(NTD), has no known human cases outside endemic areas. However, recent reports in non-endemic areas raise concerns about future implications. Climate change has increased the potential risk of disease vectors establishing themselves in previously unaffected areas. Description of the problem A case of canine onchocercosis in the West Region of Portugal, made the pet owner look for medical counselling. Primary health care providers contacted the Public Health Unit(PHU) for guidance and actions. There had been no previous reports in this region. In this case report, we explore the potential public health implications, through a one-health approach. Results History of the disease was collected, and travel history of the dog revealed that he had lived in the Algarve during 11 years with only a one-and-a-half-month travel to Italy in this period. Literature review revealed reports of previous cases of oncochercosis in the Iberian Peninsula. Collaboration between the PHU, research institutes, and veterinary authorities led to the assumption of probable transmission in the Algarve. Lessons Increased vector surveillance is needed, especially in areas associated with animal onchocercosis. Proactive measures reduce transmission risks, protecting both humans and animals. Tracking animal cases is vital for understanding regional environmental factors. PHU’s must conduct thorough risk evaluations and maintain assertive risk communication strategies to address public and pet owner concerns effectively. Adopting a One Health approach improves the understanding of the disease dynamics and enables targeted interventions. Key messages • NTD’s transmitted by vectors pose a potential future challenge. This report underscores the need for a One Health approach, with collaborative multidisciplinary efforts to address these challenges. • Furthermore, systematic interaction and reporting between human, animal, and environmental health authorities are crucial to ensure comprehensive surveillance and mitigation strategies.

Behavioral incentives on pay-for-performance schemes in primary health care: a scoping review

Abstract Background Incentivizing healthcare professionals through pay-for-performance (P4P) schemes has become an essential strategy to enhance healthcare quality and efficiency. In Portugal, a P4P framework was put in place in Primary Health Care (PHC). Understanding how these incentives influence healthcare delivery is crucial for optimizing P4P effectiveness. Objectives This scoping review aims to compare the impacts of intrinsic and extrinsic incentives of P4P schemes within PHC teams. Methods We are conducting a comprehensive scoping review following the PRISMA-ScR guidelines. The databases PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO are being searched to identify experimental and quasi-experimental studies. Eligible studies focused on PHC providers organized in teams, examining the role of intrinsic and extrinsic incentives under both public and private healthcare settings. Results Preliminary findings include a Dutch study demonstrating significant improvements in adherence to prescribing guidelines through electronic health records based P4P indicator. In Ethiopia, performance-based non-financial incentives led to enhanced data quality and evidence utilization among health workers. Conversely, a study from Burkina Faso highlighted mixed results in antenatal care quality improvement despite incentive implementation. In Scotland, studies on the removal of financial incentives indicated potential declines in certain quality care metrics, suggesting the complexities involved in the direct and indirect effects of incentive withdrawal. Conclusions The preliminary evidence indicates that both intrinsic and extrinsic incentives can significantly impact the effectiveness of P4P schemes, though the nature and magnitude of these impacts vary considerably. The findings underscore the necessity of a nuanced approach to designing and implementing incentive mechanisms in PHC to foster sustainable improvements in healthcare quality. Key messages • Intrinsic and extrinsic incentives significantly influence P4P scheme effectiveness in PHC. • Designing P4P incentives requires nuanced consideration of varying impacts on healthcare quality.

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.

Strategies for primary healthcare in Ukraine: An integrated response to gender-based violence

Abstract Issue/problem Survivors of gender-based violence (GBV) and conflict-related sexual violence (CRSV) in Ukraine face significant challenges in accessing appropriate healthcare services. Despite governmental commitment, acknowledgment and regulatory frameworks, including the ratification of the Istanbul Convention, gaps persist in integrating comprehensive GBV/CRSV services into primary healthcare (PHC) settings, exacerbated by the ongoing conflict with Russia. Description of the problem An analysis of healthcare providers’ knowledge has revealed deficiencies in effectively supporting GBV/CRSV survivors. Barriers include workload pressures, lack of inter-sectoral cooperation and case-management protocols, and insufficient training opportunities on survivor support. In collaboration with the World Health Organization, the global Clinical Management of Rape (CMR) guidelines was adapted for Ukrainian context. Among findings from CMR trainings attended by 443 PHC providers in 2022-2023 (213 participants in 2022 and 230 participants in 2023), the results underscore gaps in PHC workers’ basic knowledge and readiness to effectively support survivors during the war. Results Data from WHO training sessions underscored significant gaps in knowledge among healthcare professionals regarding legal protocols, available resources, and best practices in PHC service delivery. Identified barriers emphasized the urgent need for targeted interventions to enhance PHC workers’ capacity in GBV/CRSV response. Lessons Recommendations focus on systemic enhancements including revising regulatory frameworks, developing standardized protocols, and institutionalizing and providing comprehensive training programs. Innovative approaches like online courses, mentoring programs, and integrated service models are crucial for addressing multifaceted challenges. Key messages • A holistic GBV/CRSV response is an essential component in PHC. • This intersectoral survivor-centered approach provides safe spaces that can be adapted to other contexts in Europe.

Using Stay Interviews as a Quality Improvement Tool for Healthcare Workforce Retention

Background and Objectives: The novel coronavirus of 2019 (Covid-19) pandemic exacerbated already persistent health care workforce issues—eg, overwhelming workloads, chronic understaffing, and burnout—associated with turnover intent and actual turnover. While turnover may be inevitable, strategies that help organizations anticipate and mitigate its impact require knowledge about how employees are experiencing their work (not just performing) on an ongoing basis. Unlike performance appraisals, “stay interviewsing” is a proactive management approach to assess the organizational and personal factors that influence current employees’ retention in their roles (ie, why they stay). We describe our process of developing and using a stay interview guide with current Women’s Health Patient-Aligned Care Teams (WH-PACT) employees and comment on the feasibility of conducting these interviews, their acceptability by participating employees, and their potential application to inform retention strategies in learning health systems (LHS) like the Veterans Health Administration (VA). Methods: We conducted 24 stay interviews with current WH-PACT employees, including women’s health primary care providers (WH-PCPs, n = 7), registered nurses (RNs, n = 6), licensed practical nurses (LPNs, n = 6), and medical support assistants (MSAs, n = 5) with established tenure (greater than 3 years for MSAs and LPNs, and greater than 5 years for RNs and WH-PCPs) at VA medical centers and community-based outpatient clinics. Using rapid qualitative analysis, we summarized interview transcripts for preliminary insights that describe the utility of stay interviews to collect feedback on clinician and non-clinician employees’ experiences of work in VA women’s health primary care. Results: The responses and feedback from our participants indicate that stay interviews are potentially feasible for LHS to use as a retention tool and are acceptable to employees for sharing their perspectives. Conclusion: We discuss who should conduct stay interviews and the potential ethical implications organizations must consider before conducting them.

Eosinophil count testing in patients with asthma varies by healthcare provider type in the US: a retrospective study

BackgroundPatients with asthma with an eosinophilic phenotype may be eligible for additional treatment options to improve disease control; however, the prevalence and frequency of eosinophil testing is unknown. This study assessed blood eosinophil count testing prevalence in patients with asthma by exacerbation frequency and healthcare provider (HCP) type.MethodsThis was a retrospective, longitudinal, real-world study (GSK ID: 214470) utilizing the Merative Explorys® Universe electronic health records database. Eligible patients had ≥ 2 asthma diagnostic codes (January 2016–December 2018) (Index date: first asthma diagnosis). Outcomes included patient demographics and clinical characteristics (12 months pre-index [baseline]), and prevalence of blood eosinophil count testing, stratified by exacerbation frequency (infrequent exacerbations [< 2]) or frequent exacerbations [≥ 2] or primary HCP (Allergist/Pulmonologist, a primary care physician [PCP] or other HCP) during the 12 months post-index (follow-up).ResultsOf 400,254 patients included (mean age: 51.2 years; 70.8% female), the most common provider type at baseline was a PCP (76.8%). A higher proportion of patients with frequent exacerbations had blood eosinophil count tests at baseline (55.4–69.5%) and follow-up (67.9–75.1%), compared with patients with infrequent exacerbations (55.5–63.7%, 62.4–67.3%). Significantly more patients in the Allergist/Pulmonologist subgroup had ≥ 1 blood eosinophil count test result compared with patients in the PCP subgroup at both baseline (59.9% vs. 50.7%; p < 0.001) and follow-up (59.0% vs. 56.2%; p < 0.001). In the total population, the mean (SD) number of tests ordered was 3.4 (5.3) and 4.1 (6.4) during the baseline and follow-up periods, respectively. A greater mean number of tests were ordered for patients with frequent exacerbations, most apparently in the Allergist/Pulmonologist subgroup during baseline and follow-up (7.4 vs. 4.9). For patients with frequent exacerbations and blood eosinophil count test results, the mean (SD) number of tests ranged from 3.1 (4.6) to 5.8 (8.3) at baseline and 5.1 (8.5) to 7.4 (10.6) during follow-up.ConclusionsThe prevalence of blood eosinophil count testing in patients with asthma remains suboptimal. Routine blood eosinophil count testing should be considered by HCPs for patients with asthma to increase identification of the eosinophilic asthma phenotype, which may inform the decision to advance to targeted biologic therapy.

Combatting opioid misuse, overuse and abuse: a systematic review of pharmacists' services and outcomes.

Aim: To examine the range of services pharmacists provide and their impact on patient outcomes, harm reduction, and appropriate opioid use.Methods: Six databases were searched (MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL and Cochrane Methodology Register) from inception to March 2023. The protocol was registered in PROSPERO (CRD42023401895).Results: Twenty-nine studies identified five key areas of pharmacist interventions in opioid management-naloxone programs and opioid de-escalation, patient and primary healthcare providers' education and motivational interview, prescription monitoring and opioid risk screening, clinical pharmacy interventions (pharmacotherapy, medication review, prescribing, adherence monitoring), and collaborative healthcare approaches to promote optimal opioid use. Outcomes assessment indicated harm reduction, improved safety, increased non-opioid analgesic use, decreased opioid consumption, and enhanced pain management.Conclusion: This review underscores pharmacists' vital role in tackling opioid misuse, overuse and abuse, providing a foundation for evidence-based policies to minimize harm and promote optimal opioid use.

Changes in healthcare seeking behaviors among caretakers of children in the previously occupied ISIS territory: Hadeetha, Anbar, Iraq: a cross-sectional survey of 415 households.

The western province of Anbar, and the district of Hadeetha, have suffered direct impacts from the second United States led invasion (2003) through the ISIS invasion (2014-2017). With the primary health care centers being closed or inaccessible, the remaining population experienced changes in health seeking. The area of Anbar, Iraq remains largely remote from the discourse of health system recovery post-conflict. The objective of this study was to describe changes in health seeking behaviors of caregivers of children ages 12-72months of age in Hadeetha, Anbar, Iraq from the conflict period of ISIS (Islamic State of Syria and Iraq), 2014-2017, to the post-conflict period, 2021. This was a mixed-methods study composed of a cross-sectional 415 household survey and focus groups in Hadeetha, Anbar, Iraq. Caretakers of children were interviewed from February to April 2021. Children were sampled from a list of children who missed at least one vaccination appointment without a return for follow-up from the birth cohorts of 2014 to 2020. Healthcare workers focus groups and key informant interviews occurred from 2019 to 2021 centered around experiences from the 2014 to 2021 period. In the post-conflict period, there were no differences in health seeking based upon provider type between respondents. Physicians were primary healthcare providers in the post-conflict period for 79% of respondents versus only 47% in the conflict period. Healthcare workers described major barriers to delivering services in Hadeetha during the ISIS occupation due to infrastructure damage, threats of violence, decreased medical personnel, lack of compensation and disruptions in medical supplies from 2014 to 2017. This study provides insight into health seeking challenges among the many individuals who remained in Hadeetha during the ISIS occupation. Health use patterns by provider type mirror the concerns the healthcare providers shared: limited availability, efflux of professional workers, limited resources and security challenges to providing care. Positive trends toward increased access to physicians during periods of peace are an encouraging marker for continued population resilience during the post-conflict period. Recovery efforts continue to be hampered by internal sectarian discord within Iraq as well as insufficient resources to maintain health services as well as provide catch-up health services, such as immunizations.

Decision Support Tool to Improve Decision-Making for HIV Pre-Exposure Prophylaxis (PrEP): Development Process and Alpha Testing.

African, Caribbean, and Black (Black) communities in Canada are disproportionately affected by the HIV epidemic. Pre-exposure prophylaxis (PrEP) is a highly effective option for the prevention of HIV. However, the use of PrEP for HIV prevention among eligible Black clients in Canada remains far below the thresholds necessary to achieve the goal of zero new HIV infections. In a recent study in Toronto, PrEP-eligible Black clients were found to have decisional conflict and unmet decisional needs, which affected the quality of their decision-making process regarding the initiation and adherence to PrEP. There is evidence that decision support tools (DSTs) can improve the quality of a decision, the quality of the decision-making process, the implementation or continuation of the chosen option, and the appropriate use of health services. Despite these benefits, there is currently no DST for PrEP-eligible Black clients being asked to consider PrEP for HIV prevention. Our study aimed to develop a DST to improve PrEP decision-making for Black clients and to evaluate the tool's acceptability and usability. We developed and evaluated the PrEP DST for Black patients using the 7-step process outlined in the Ottawa Decision Support Group Guideline for the development and evaluation of DST. To facilitate the implementation of the Ottawa Decision Support Group guideline, we assembled a multidisciplinary team of primary health care providers, researchers, community members with lived experiences, and digital content designers to serve as the steering committee. First, we assessed patients' and primary health care providers' views on decisional support needs, after which we determined the content, design, and distribution plan for the DST. Subsequently, we conducted evidence synthesis, reviews, and appraisal before developing the PrEP DST prototype. The final tool was reviewed by steering committee members for completeness before acceptability and usability testing with potential Black clients and PrEP providers. The web-based DST yielded 27 pages divided into 6 distinct sections. The six sections include (1) an introduction of the DST, (2) clarify your decision, (3) knowledge, (4) a value clarification exercise, (5) support system, and (6) next steps. Both Black clients and PrEP providers reported ease of task performance, general satisfaction, and usefulness of the tool to support decision-making for Black clients. Feedback on usability centered on the need to add a user guide to increase usability. All feedback was incorporated into the final tool. A PrEP DST for Black clients developed using a systematic process and a multidisciplinary steering committee was acceptable and usable by both Black clients and PrEP providers. Further study (eg, randomized controlled trials) may be needed to evaluate the efficacy of the PrEP DST.

Predictors of moderate-to-severe side-effects following COVID-19 mRNA booster vaccination: a prospective cohort study among primary health care providers in Belgium

BackgroundCOVID-19 vaccine effectiveness declines months after vaccination. Therefore, it is likely that during the next few years, people may be repeatedly offered a booster vaccine to enhance humoral immunity levels. A growing number of people are questioning whether the benefits of a booster vaccine outweigh the side-effects.ObjectiveThis study aims (1) to identify the most frequently reported side-effects after different doses of COVID-19 mRNA vaccines, (2) and the longest lasting symptoms; and (3) to predict the likelihood of having moderate-to-severe side-effects after a booster COVID-19 mRNA vaccine given individual- and vaccine-specific characteristics.Design, setting, and participantsSecondary analysis of a prospective cohort study in primary health care providers (PHCPs) in Belgium conducted between December 2020 and December 2021, and in February-March 2023.MethodsIn nine subsequent surveys over a period of 2 years vaccine dose-number and side-effects after COVID-19 vaccines were collected. A Generalized Estimation Equations approach on the data of the first and second booster dose was used to investigate the probability of having moderate-to-severe side-effects after mRNA booster vaccination. Predictive performance of a binary classifier was assessed by looking at discrimination (i.e., quantified in terms of the area under the receiver operating characteristic curve). The final prediction model was validated using data with regard to the third booster by assessing misclassification rate, sensitivity and specificity.ResultsIn total, 11% of the PHCPs had moderate-to-severe side-effects after their booster COVID-19 mRNA vaccine. The most common side-effects of COVID-19 mRNA doses included fatigue, local pain at the injection site, general pains, and headache. These side-effects typically lasted for a median of 1 to 2 days. The final model included five predictors: sex, alcohol consumption, history of moderate-to-severe side-effects after any previous dose, recent COVID-19 infection, and the booster dose-number (first, second). Having experienced moderate-to-severe side-effects after any previous dose was the strongest predictor of moderate-to-severe side-effects following an mRNA vaccine booster, with an odds ratio (OR) of 3.64 (95% CI: 2.80–4.75). The OR for female sex was 1.49 (95% CI: 1.21–1.84) implying that females have a higher odds of moderate-to-severe side-effects following booster vaccination. The differences in effect for booster dose-number, alcohol consumption and recent COVID-19 infection was not significant.Conclusion and relevanceCOVID-19 mRNA booster vaccination implies a low prevalence of moderate-to-severe side-effects among PHCPs, with a short median duration of symptoms if any. The strongest predictors are a history of moderate-to-severe side-effects after any previous dose and being female. These reassuring findings can help addressing concerns about booster vaccination and encourage their uptake.Trial RegistrationNCT04779424 (registration date: 2021-02-22).

Mapping local evidence on early recognition and management of people with potential cancer symptoms: a narrative review

Aim Early cancer detection has potential to improve outcomes. However, many patients in South Africa present when the disease is at an advanced stage. The World Health Organization recommends two approaches to early cancer detection: screening asymptomatic individuals, and early recognition and management of symptomatic individuals. This paper focuses on the latter. For people with potential cancer symptoms, the journey to diagnosis is complex and influenced by multiple factors. Most symptomatic people will self-present to primary health care clinics, where primary health care providers are pivotal in triage. Methods This article presents local insights into cancer awareness measurement tools: community-level cancer symptom awareness, lay beliefs, and symptom appraisal; factors influencing the journey from symptom discovery to diagnosis; primary health care provider challenges in assessing symptomatic individuals, and interventions to support symptom assessment and help-seeking. It draws on findings from the African Women Awareness of CANcer (AWACAN) project and a narrative review of relevant published articles on journeys to cancer diagnosis in SA (2013-2023). Findings Very few cancer awareness measurement tools have been locally validated, hampering comparison and limiting opportunities for intervention development and evaluation. The AWACAN study developed and validated a local cancer awareness measurement tool for breast and cervical cancer. Studies show that most people in SA need information on cancer risk, symptoms, and pathways to care. Barriers to accessing health care include financial, infrastructural, safety, stigma, and previous health facility experiences. Primary health care providers require support for symptom assessment and referral systems. There is limited local work on developing and evaluating interventions to improve timely cancer diagnosis. Conclusions This paper underscores the importance of prioritising early recognition and management of people with symptomatic cancer as part of a comprehensive cancer control plan, providing insights for improving the journey to diagnosis.

Impact of primary care and public health integration of chronic conditions in China: a protocol for a prospective multicentre cohort study

IntroductionThe prevalence of chronic conditions is increasing. Given that the majority of chronic patients are managed by primary healthcare providers, there is a need to integrate primary care with public...

THE ROLE OF GENERAL PRACTITIONER IN POST-TRAUMATIC DISORDER CASES

Introduction – Post-traumatic stress disorder (PTSD) is a mental illness whose criteria are listed in DSM-5 and ICD 11 marked by an inability to recover after experiencing or watching a horrific event that lasts more than 1 month. PTSD should be considered in any patient who has experienced a significant tumultuous occasion. Methods – The author makes this article based on several kinds of literature that discuss PTSD, the role of GP in PTSD patients, psychological first aid, and psychological, and pharmacological treatment for PTSD patients. The literature used is limited from 2009 to 2021. Results – Approximately 3% of the adult population suffers from PTSD. Often the first point of contact, General Practitioners are positioned to assist patients who have contemporarily experienced a traumatic life event and who are at risk for developing PTSD. Discuss –Post-traumatic stress disorder (PTSD) is a mental illness whose criteria are listed in DSM V and ICD 11 marked by an inability to recover after experiencing or watching a horrific event that lasts more than 1 month that can be treatable. As primary healthcare providers, general practitioners are the first healthcare practitioners accessible to individuals who have experienced a horrifying episode. Conclusion – General practitioners take an important part in recognizing people with PTSD and giving psychological first aid, managing their care with psychological or pharmacological treatment, and referring them for specialized care when needed. Keywords: post-traumatic stress disorder, general practitioner, psychological.

Co-Design Model of Support for Child and Family Health Nurse Practice with Culturally and Linguistically Diverse Families

Culturally and linguistically diverse (CALD) mothers with young children face multiple inequities in accessing primary health services, such as language barriers, social isolation, low health literacy, and the availability of appropriate interpretation services. These inequities are persistent and indicate that child and family health nurse (CFHN) services, the providers of primary healthcare in many developed countries, require better support to address the needs of these families. This study engaged with CFHNs and healthcare interpreters to co-design a model of support for practice using workshops that included individual and collective brainstorming and visual representations. Transcripts of the discussion were analysed using thematic analysis. CFHNs and interpreters were able to articulate their perfect service model: a central multidisciplinary team of CFHNs, interpreters, and bilingual educators who could facilitate nurse–interpreter and nurse–interpreter–client relationships, allowing CFHNs and interpreters to do their jobs properly. This central structural component would support and be supported by rapport, trust, client choice and access, continuity of care, and cultural comfort. The study concluded that CALD mothers’ access and engagement require CFHNs to have support for their cultural comfort through the mechanism of bilingual educators and the expansion of healthcare interpreters’ role and scope in working with CFHNs in the delivery of services.

Cross-cultural Adaptation and Psychometric Evaluation of the Malay Version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS-Malay) Tool in a Sample of Malaysian Primary Healthcare Providers

Cross-cultural Adaptation and Psychometric Evaluation of the Malay Version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS-Malay) Tool in a Sample of Malaysian Primary Healthcare Providers

Первичное звено государственной системы здравоохранения в Российской Федерации: организационно-правовой статус

Primary care is the backbone of the healthcare system. The main function of primary care is the provision of primary health care to the population on a territorial-precinct basis through “first contact” doctors. There is a gap between the importance of primary health care and low public satisfaction with it. One of the main reasons for this current state of affairs is the inadequate organizational and legal status of primary care. The declared formation of a three-tier healthcare system must be based on a more understandable architectural network of healthcare units. It is necessary to harmonize between the types of objects and the types of care they provide, the conditions of provision and forms of medical care.

It's all about relationships: Developing nurse-led primary health care in rural communities.

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse-led primary health care in this context. Based on a focus group with nursing executives and semi-structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de-valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.