Health Care Centers Research Articles

PP494 Topic: AS21–Post-PICU: Patient and Family Outcomes/Chronic Critical Illness/Post Intensive Care Syndrome in Pediatrics (PICS-p)/Post-discharge Care Delivery Models/Other: POST-PEDIATRIC INTENSIVE CARE HEALTHCARE UTILIZATION: A RETROSPECTIVE COHORT STUDY

PP494 Topic: AS21–Post-PICU: Patient and Family Outcomes/Chronic Critical Illness/Post Intensive Care Syndrome in Pediatrics (PICS-p)/Post-discharge Care Delivery Models/Other: POST-PEDIATRIC INTENSIVE CARE HEALTHCARE UTILIZATION: A RETROSPECTIVE COHORT STUDY

Prevalence of Acute Low Back Pain after Cesarean Delivery in Health Care Centers

Background: Low back pain is the common problem faced by mothers after cesarean delivery under spinal anesthesia. Application of spinal anesthesia leads to severe acute and chronic low back pain post-delivery. Physiotherapy plays an important role during and after pregnancy as it helps in reducing the incidence of low back pain and others musculoskeletal pain post-delivery. The aim of the study was to determine the prevalence of acute low back pain after cesarean section and to assess the percentage of population aware about antenatal and postnatal physiotherapy and percentages had taken the treatment in Heath care centers. Materials and methods: Study population comprised of 162 caesarean delivery females out of which 104 were selected of age between 19 to 35 having acute low back pain in postnatal cesarean ward of Heath care centers. Population was chosen through convenient sampling. Data collection tools were modified questionnaire. The data collected was analyzed through SPSS software Version 29.0.2.0(20). Prevalence and awareness were measured through descriptive statistics. Result: 64.1% postpartum caesarean section females had low back pain under spinal anesthesia.18.2% had mild pain,34.6% had moderate pain,30.7% had severe pain and 16.4% had very severe pain. Only18.3% were aware of antenatal and postnatal physiotherapy out of which only 6.7% had taken treatment.81.7% were unaware and 93.3% had not taken physiotherapy treatment. Low back pain is dependent upon Occupation and daily activity of the patient, awareness about antenatal and postnatal treatment is dependent upon educational level and patient age is seen as an associative factor for the patient dependency. Conclusion: Majority of postpartum caesarean delivery females complained of acute low back pain and very less had taken physiotherapy treatment during and after delivery. The majority were unaware about the antenatal and postnatal physiotherapy as they were not recommended by the gynecologist doctors. KEYWORDS: Acute back pain, Caesarean delivery, Spinal anesthesia, Antenatal, Postnatal, Physiotherapy, Awareness.

Bioethical and Medical-Legal Challenges in Multimodal Cancer Treatment: Addressing Misinformation and Informal, Unregistered Advice

This article addresses the bioethical and medico-legal challenges in the multimodal treatment of cancer, emphasizing the growing gap between therapeutic advances and their clinical implementation. Many patients remain uninformed or lack access to advanced therapies, such as immunotherapy or targeted treatments, due to outdated practices in their healthcare centers. This situation often leads to frustration, as patients feel that not all potential treatment options have been explored. The right of patients to receive clear, informed, and transparent guidance on their treatment is highlighted, as well as the necessity for proper documentation of medical decisions to ensure traceability and protect both the patient and the medical professionals involved. The lack of information or bias directly impacts patient autonomy, limiting their ability to make well-founded decisions. The article also highlights the significant benefits of multimodal therapies, such as cytoreductive surgery and personalized immunotherapy, which have been shown to improve outcomes and quality of life in advanced cancer cases. It calls for treating physicians to act as guides or, when necessary, defer to specialized centers with proven expertise, thus avoiding limiting patients to conventional protocols. The need for a multidisciplinary approach is clear, with a committee of clinical oncologists, radiation-oncologists, surgical oncologists, and pathologists, alongside immuno- oncopathology specialists, being essential to the development of personalized, biologically driven therapies. Advances in cancer treatment confirm the importance of this integrated approach, particularly through collaboration between pathologists and clinical oncologists who have specialized in biotechnology and precision medicine.

Characteristics of pulse wave velocity and its correlation with cardiovascular disease risk factors in healthy individuals.

Cardiovascular disease (CVD) is a major cause of human mortality and has become the leading cause of death worldwide. Existing studies indicate that structural and functional damage to the main arteries represents a significant risk factor for early vascular lesions and many CVDs. This study aimed to explore characteristics of carotid-femoral pulse wave velocity (cfPWV) and its correlation with cardiovascular disease risk factors in healthy individuals. Convenience sampling was used to collect demographics, risk factors, and laboratory examinations from 501 healthy individuals who underwent health checkups at our healthcare center from August 2020 to January 2021. Pearson correlation coefficients were used to examine the correlations between cfPWV and various parameters in both sexes. Multiple linear regression analysis was used to investigate the factors potentially influencing cfPWV. A statistically significant difference in cfPWV between sexes was observed only in the age group of subjects 38-47 years old. The results of the univariate analysis showed that in males, cfPWV was positively correlated with age, blood pressure, heart rate, and alcohol consumption and was negatively correlated with tehe resistive index. In females, cfPWV was positively correlated with age, blood pressure, heart rate, alanine aminotransferase, urea, creatine, uric acid, fasting blood glucose, triglycerides, total cholesterol, and heart rate. The results of multivariable analysis indicated that age, systolic blood pressure, heart rate, and alcohol consumption were influencing factors for cfPWV in males, while age, systolic blood pressure, heart rate, and creatinine were influencing factors for cfPWV in females (P <0.05 for all). In healthy individuals, the distribution patterns of cfPWV values vary by sex and age. In the elderly population, especially elderly women, enhanced monitoring and regular follow-ups are recommended to prevent the development and progression of CVDs in high-risk individuals at an early stage.

Virulence genes and antibiotic susceptibility patterns of Escherichia coli isolated from nosocomial urinary tract infections in the northwest of Iran during 2022-2023: A cross-sectional study.

Urinary tract infections (UTIs) are prevalent among hospitalized patients, constituting the most frequent health-care infections. Uropathogenic Escherichia coli (UPEC) is leading causative agent of UTIs. The present study was aimed to examine the susceptibility of UPEC isolates obtained from nosocomial cases to antibiotics, as well as their biofilm formation capability and frequency of virulence genes. A total of 100 UPEC isolates were collected from nosocomial UTIs at Imam Reza Hospitals in Tabriz, Iran, spanning from April 2022 to January 2023. The antimicrobial susceptibility patterns were evaluated using the disk diffusion method, along with the detection of broad-spectrum β-lactam enzymes (ESBLs) and carbapenemases. The ability of isolates to form biofilms was assessed using the microtiter-plate method, while the PCR method was employed to identify the presence of virulence genes. The highest resistance was observed toward piperacillin (82%), followed by aztreonam and ciprofloxacin (81%), while the lowest resistance was found against piperacillin/tazobactam (12%) and meropenem (9%). ESBLs were detected in 62% of the isolates. The microtiter-plate results revealed strong, moderate, and weak biofilm formation abilities in 32%, 33%, and 24% of the isolates, respectively. The most prevalent virulence gene was fimA (74%) followed by hlyF (68%), papA (44%), papC (32%), iroN (26%), and cnf (20%). The elevated levels of resistance to multiple antimicrobial agents, coupled with the co-presence of virulence genes and biofilm formation abilities, contribute to the persistence of UPEC-related infections, particularly in hospitalized patients. These findings underscore the necessity of implementing an effective program to control nosocomial UTIs caused by UPEC in the healthcare centers.

Challenges to the Digital Inclusion of Women in a Vulnerable Area in ColombiaDesafios da inclusão digital das mulheres em uma área vulnerável na Colômbia

To identify women's technological capabilities and describe their appropriation and use of technology in a community in a vulnerable area of Colombia. Observational cross-sectional study conducted in the subregion of Urabá, Colombia. A survey was conducted in primary health care centers, in which 1478 women between 18 and 49 years of age responded to questions about their technological capabilities, their experience with the use of web-based information, and their appropriation of technology. Access to and use of information and communication technologies (ICTs) varied according to age, educational level, and socioeconomic stratum, with observed differences in preferences and critical consumption of information. The women in this study faced multiple access barriers to appropriate use of ICTs for health promotion. The appropriation of these tools in Colombia, specifically in the Urabá subregion, is a complex challenge that requires a comprehensive and multidimensional approach.

Knowledge, attitudes, and referral practices for smokers to a state tobacco quitline in a federally qualified healthcare center: Healthcare provider perspectives.

Federally qualified healthcare centers (FQHC) treat a large population of low-income patients disproportionately burdened by tobacco use. This study investigated healthcare providers' knowledge, attitudes, and referral patterns of patients who smoke to a state tobacco quitline. The study used a descriptive-qualitative design. In-depth interviews were conducted in 2021 with a sample of healthcare providers recruited from a federally qualified healthcare center (FQHC) in a large city in the Midwest. The interviews were guided by a standardized moderator's guide and lasted 30-45 minutes. Written informed consent was obtained before each interview, and participants completed a brief self-administered survey. Among the 25 participants, 92% were female and 44% were Black. Participants included medical providers (52%), behavioral health providers (16%), and other types of providers (32%). Participants' age and work experience averaged 41.5 and 5.25 years, respectively. Only 32% of providers reported having specialty training in smoking cessation or addiction counseling. Over half (52%) of the participants never or rarely referred patients to the Illinois Tobacco Quitline (ITQL). Providers reported several barriers to referring patients to the ITQL, including limited knowledge about services offered, time constraints, difficulties with the referral process, and lack of feedback between providers and the ITQL. Further, providers described patient-related barriers, including low motivation to quit smoking, language barriers, and failure of patients to respond to calls from the quitline. Recommendations were described for improving patient and provider education, referral processes, and increasing bi-directional communication between providers and the quitline. Providers identified numerous barriers to referring patients for smoking cessation treatment. Addressing the identified barriers requires a multi-faceted approach involving education, streamlined processes, supportive infrastructure, and patient-centered interventions to strengthen provider use and satisfaction with the available resources.

Factors Influencing the Skill Level of Primary Healthcare Workers in Managing Paediatric Emergencies

Paediatric emergencies continue to be a significant public health concern in Nigeria, particularly in rural areas where primary healthcare centers (PHCs) often serve as the sole source of medical care. The ability of healthcare workers in these settings to effectively manage paediatric emergencies is crucial for improving child health outcomes. This study aimed to assess the factors influencing the skill level of primary healthcare workers in managing paediatric emergencies in Zaria, Nigeria. A cross-sectional descriptive study was conducted among 139 randomly selected healthcare workers in Sabon Gari and Zaria Local Government Areas. A pre-tested questionnaire was used to collect data on socio-demographic characteristics, work experience, and skills in managing paediatric emergencies. Data were analyzed using SPSS version 21. The results revealed that healthcare workers in PHCs in Zaria exhibited varying levels of skills in managing paediatric emergencies. Several factors were identified as influencing their skill levels. Healthcare workers with higher academic qualifications demonstrated significantly better skills in managing paediatric emergencies. This suggests that formal education plays a crucial role in developing the necessary competencies. While experience can be a valuable asset, the study did not find a strong association between years of experience and skill levels. This may indicate that experience alone is not sufficient for developing the necessary skills, and additional training and support may be required. Healthcare workers who had received recent training or participated in continuing medical education (CME) programs related to paediatric emergency management tended to have higher skill levels. This highlights the importance of ongoing professional development in maintaining and improving skills. The findings of this study suggest that a combination of factors influences the skill level of primary healthcare workers in managing paediatric emergencies. While academic qualifications are important, ongoing training and access to resources are also essential. It is crucial to address these factors through targeted interventions to improve the skills of healthcare workers and enhance the quality of care provided to children in need. This study highlights the critical need for targeted interventions to improve the skills of primary healthcare workers in managing paediatric emergencies in Zaria, Nigeria. By addressing factors such as academic qualifications, training, resource availability, and work environment, policymakers and healthcare providers can significantly enhance the quality of care provided to children in need.

Statistical methods for clinical trials interrupted by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic: A review.

Cancellation or delay of non-essential medical interventions, limitation of face-to-face assessments or outpatient attendance due to lockdown restrictions, illness or fear of hospital or healthcare centre visits, and halting of research to allow diversion of healthcare resources to focus on the pandemic led to the interruption of many clinical trials during the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic. Appropriate analysis approaches are now required for these interrupted trials. In trials with long follow-up and longitudinal outcomes, data may be available on early outcomes for many patients for whom final, primary outcome data were not observed. A natural question is then how these early data can best be used in the trial analysis. Although recommendations are available from regulators, funders, and methodologists, there is a lack of a review of recent work addressing this problem. This article reports a review of recent methods that can be used in the setting of the analysis of interrupted clinical trials with longitudinal outcomes with monotone missingness. A search for methodological papers published during the period 2020-2023 identified 43 relevant publications. We categorised these articles under the four broad themes of missing value imputation, modelling and covariate adjustment, simulation and estimands. Although motivated by the interruption due to SARS-CoV-2 and the resulting disease, the papers reviewed and methods discussed are also relevant to clinical trials interrupted for other reasons, with follow-up discontinued.

Investigating the Use and Sustainable Adoption of Digital Health Tools for Public Health Emergencies in Primary Healthcare Centres in Northern Nigeria

Investigating the Use and Sustainable Adoption of Digital Health Tools for Public Health Emergencies in Primary Healthcare Centres in Northern Nigeria

The Hope Therapy Effect Toward Depression, Anxiety, and Stress of Tuberculosis Patients with Multi-Drug Resistance at Jayapura’s Healthcare Center, Papua

Background: Indonesia is the third country with a high-rate case of tuberculosis with multi-drug resistance, for a percentage of 5% per 100.000 population. In Papua, TB-MDR becomes the main problem of health with a successful percentage of medication at 68.7%, an indicator of WHO higher than 85%. The complexity and the prolonged occurrence make the patients to have mental health illnesses, such as depression, anxiety, and stress. The field data of depression cases consisted of 65 patients. 50% with had mild depression, 20% with moderate, and 25.55 with severe. Patients with anxiety ranged from 16.7% to 37.29%. Patients with severe stress consisted of 20%. The mental illness health problems for TB-MDR patients required the roles of the nurses, such as counseling based on HOPE therapy. Purpose: Analyzed the effects of HOPE therapy to manage depression, anxiety, and stress levels. Methods: Quasi-experimental research applied a systematically assigned control group. The population consisted of patients with TB-MDR receiving medication at Jayapura's healthcare center, 40 individuals. Results: HOPE therapy effects for depression, stress, and anxiety levels applied the Wilcoxon test. The obtained result was a p-value lower than 0.05. The results indicated the effect of HOPE therapy medication on depression, stress, and anxiety levels. The intervention group had decreased depression, stress, and anxiety levels with p-values of 0.043 and 0.012. The results contradicted the control group. The obtained p-value was higher than 0.05, indicating no effect. The p-values were 0.721, 0.532, and 0.670. Conclusion: HOPE therapy was useful for TB-MDR patients with mental illness. The administered HOPE therapy for patients could improve their confidence and hopes to live better and recover.

Assessment of Managerial Skills Among Healthcare Provider Managers

The primary objective of this research is to assess the managerial skills of managers working in healthcare and hospital centers (primary healthcare) within Isfahan province. This cross-sectional study was carried out in 2023, encompassing a sample size of 1,420 healthcare providers operating in these healthcare and hospital centers. The research utilized the Cameron and Whetten questionnaire, which employs a Likert scale for measurement. Data analysis was conducted using Pearson correlation coefficient and linear regression tests. The findings revealed that 53.4% of managers demonstrated effective skills in writing, oral communication, and listening. Additionally, 62.8% of managers exhibited proficiency in time management. However, only 39.12% were adept at avoiding troublesome decisions, 30.2% were skilled in persuading higher-level individuals, and 30.8% showed competence in planning. A significant relationship was identified between the ability to persuade higher-level individuals to perform tasks and teamwork among managers with more work experience. The results also highlighted a higher incidence of troublesome decision-making among women and individuals with extensive managerial experience. In conclusion, the study suggests that managers of healthcare providers in healthcare and hospital centers (primary healthcare) in Isfahan province require more focused attention and training in certain key managerial skills to enhance their effectiveness. This includes improving their abilities in decision-making, persuasion, and planning, which are crucial for their roles. Therefore, targeted training programs and interventions are recommended to address these gaps and improve the overall managerial capabilities within these healthcare settings.

Geographical Access to Point-of-care diagnostic tests for diabetes, anaemia, Hepatitis B, and human immunodeficiency virus in the Bono Region, Ghana

BackgroundDiabetes mellitus, human immunodeficiency virus (HIV), hepatitis B and anaemia are major global public health issues according to the World Health Organization (WHO). Access to diagnostic testing is essential for their prompt detection and treatment. The WHO has recommended a list of essential in-vitro diagnostics for testing at all levels of care. However, a survey preceding this study showed limited availability of point-of-care (POC) tests for these conditions in the Bono Region (BR) of Ghana. This study assessed the geographical access to diabetes, anaemia, hepatitis B, and HIV POC testing in the BR, Ghana for targeted improvement.MethodsWe gathered the geolocated data of 137 facilities (CHPS, Clinics, healthcare centres, and hospitals) in the BR that were providing glucose, haemoglobin (Hb), Hepatitis B Surface Antigen (Hep B), and HIV POC testing services in July 2022. We used ArcGIS 10.1 to quantify the geographical access (distance and travel time) to the nearest available testing site for each test and show places with inadequate access, for targeted improvement. The journey time was calculated assuming a speed of 20 kilometres (km)/h. ArcMap 10.1 was employed to run spatial autocorrelation (Moran Index (MI)) to determine the spatial distribution of the facilities providing the tests investigated.ResultsOf the 137 facilities, the glucose test was available in 67 (49%), the Hb test in 55 (40%), the Hep B test in 44 (32%), and the HIV test in 73 (53%). The mean (standard deviation (SD)) for obtaining glucose tests in the region was 7.4 ± 3.7 km, Hb was 8.1 ± 4.06 km, Hep B was 8.2 ± 4.1 km, and HIV test was 7.3 ± 3.7 km by a motorised cycle. The mean SD travel time in the region to obtain the glucose test was 94.4 ± 47.2 min compared to 95.7 ± 47.8 min for Hb, 95.9 ± 47.93 min for Hep B, and 92.7 ± 46.3 min for the HIV test. Three districts (Berekum East, Dormaa East, and Jaman North) recorded shorter distances (< 10 km) and a shorter travel time to the glucose, Hb, Hep B, and HIV tests compared to the Banda district, which recorded more than 10 km for all tests investigated. Positive IM values were recorded for all the POC tests, suggesting that the health facilities providing the glucose, Hb, Hep B, and HIV tests in the BR were spatially distributed at random.ConclusionsThe findings revealed moderate access to all the tests in districts across the region. However, geographical access to glucose, Hb, Hep B, and HIV POC testing was poor (distance ≥ 10 km and travel time of ≥ 93 min), in the Banda district. This study showed the need to prioritise the Banda district for targeted improvement for all the tests. A further study is recommended to identify potential solutions to addressing the POC testing implementation in the BR, as demonstrated by this study.

Perception of parents on barriers and facilitators of treatment outcomes among children and adolescents attending psychotherapy services in a primary health care centre in Belize

Background: The study assessed the perception of parents on barriers and facilitators treatment outcomes among children and adolescents attending psychotherapy services in a primary health care centre. Methods: A cross sectional descriptive study using both quantitative and qualitative methods. The quantitative method used retrospective review of records of 65 children and adolescent clients who accessed psychotherapy services between January 2022 and December 2023 at Port Loyola Health Centre in Belize city. The qualitative method used in-depth interviews of twenty parents of the patients randomly selected from the clinic registers. Univariate and bivariate analyses was used for the quantitative data while thematic analysis was used for the qualitative data. Results: 25 (38.5%) of the patients completed their treatment and 34 (52.3%) dropped out, with half dropped out after the first visit. The identified parental perceived barriers and facilitators are organized into four main themes. The first theme was related to knowledge and understanding of mental health problems by the parents which showed that respondents had good knowledge about mental health problems. The second theme identified attitudes towards treatment as a major factor to completion of treatment. The third theme was related to structural factors like transportation cost and parents’ work schedule identified as key barriers. The fourth theme was related to inconvenient appointment time and lack of flexibility in the scheduling of appointment at the clinic. Conclusions: The study highlights key areas of interventions to minimize barriers to completion of treatment among children accessing mental health services.

PHC visits trends effects on control of blood pressure for hypertensive patients following up in PHCs in Makkah, Saudi Arabia

Hypertension is a major risk factor for cardiovascular disease, stroke, and kidney disease. In Saudi Arabia, the prevalence of hypertension is estimated to be 14%. Primary health care centers (PHCCs) play a major role in the diagnosis, treatment, and follow-up of hypertensive patients in Saudi Arabia. This study employed a cross-sectional design to collect data from medical records of hypertension patients registered with primary health care centers (PHCCs) in Makkah, Saudi Arabia. The data was obtained through a comprehensive review of these medical records. Out of the 16,623 patients included in the study, the average annual visit frequency was 5.5 for females and 6 for males. 65.6% (10,910 patients) completed all four annual visits. There was no statistically significant difference in visit completion rates between males and females. The visit count was found to be negatively correlated with Systolic BP (-0.151, 95% CI [-0.195, -0.165]), Diastolic BP (-0.137, 95% CI [-0.147, -0.117]), and MAP (-0.176, 95% CI [-0.191, -0.161]), with a P-value &lt; 0.001 for all parameters. Our findings indicate that the number of visits to Makkah Primary Health Centers positively influences blood pressure control in hypertensive patients.

Nirmatrelvir plus ritonavir reduces COVID-19 hospitalization and prevents long COVID in adult outpatients

Nirmatrelvir plus ritonavir received Emergency Use Authorization for treating mild to moderate COVID-19 in high-risk patients. Its efficacy against the Omicron variant of SARS-CoV-2 remains uncertain. This retrospective cohort study assessed the effect of nirmatrelvir–ritonavir in preventing severe disease progression and long COVID symptoms after acute COVID-19 in non-hospitalized adults. SALAMA medical records from Dubai’s COVID-19 healthcare centers between May 22, 2022, and April 30, 2023, were used to identify 7290 eligible patients, 9.6% of whom received nirmatrelvir–ritonavir. Treatment was associated with a notable reduction in COVID-19-related hospitalizations (adjusted hazard ratio [HR] of 0.39; 95% CI, 0.18–0.85) by day 28 of symptom onset. Moreover, nirmatrelvir–ritonavir was associated with fewer long COVID symptoms (adjusted HR of 0.42; 95% CI, 0.19–0.95). This suggests the significant effectiveness of nirmatrelvir–ritonavir against the Omicron variant, reducing both severe and long-term COVID-19 symptoms.

1.Q. Round table: Primary healthcare workforce crisis in Europe: global policy discourse and national implementation

Abstract Background Primary healthcare (PHC) has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. Recent WHO efforts have underscored the challenges in aligning the global PHC-oriented model with national health systems, highlighting the need for tailored approaches to fulfil diverse needs and contexts. Although significant progress has been made in advancing PHC, some gaps persist, particularly surrounding the integration of PHC and healthcare workforce debates and its prioritisation within national health agendas. These gaps lead to disconnects between PHC policy implementation and workforce considerations, exasperating the existing workforce crisis and obstructing effective service delivery. Objectives This workshop bridges the gap between PHC workforce policy and the ongoing healthcare workforce crisis, focusing on the European region and different types of health systems, socio-economic conditions, health labour markets and workforce compositions. We apply a health system and multi-level governance approach, arguing the need for greater attention to the implementation of global policy concepts and the diverse national and regional conditions, interests, and needs. The workshop begins with an overview of the PHC workforce situation, presenting novel results drawn from European comparative research and nine selected country case studies, followed by a panel discussion. The panellists provide in-depth evidence on various PHC workforce challenges and introduce illustrative examples of policy interventions and good-practice models coming from the case countries. Insights from the WHO Centre for Primary Health Care advance the debate by highlighting strategies and capacity for transformative PHC workforce policies, and the need for further investigation to critically align global and national approaches. The policy recommendations emerging from the panel will be critically reflected in a plenary discussion. The workshop will stimulate debate and improve knowledge exchange across countries, in particular in the WHO European region, as well as between research, policy and practice. It will strengthen both the PHC model and the healthcare workforce, and finally advance the building of resilient health systems. Key messages • Shift the primary healthcare debate from idealistic attributes to actionable implementation strategies, emphasising policy dynamics, political contexts, and diverse stakeholder interests. • Understand the various PHC-oriented models and their dynamics to determine the necessary quantity, competencies, and composition of HCWs and how they can be governed effectively to implement PHC.

The primary healthcare workforce crisis: a comparative assessment of the European region

Abstract Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark and the Netherlands, and to a lesser extent also Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. The WHO primary healthcare model only marginally informs policy decisions, but it may receive some more attention in Kazakhstan. Conclusions We conclude that aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas. Speakers/Panelists Tiago Correia NOVA IHMT, Lisbon, Portugal Viola Burau Aarhus University, Aarhus C, Denmark Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Anna Sagan WHO European Centre for Primary Health Care, Almaty, Kazakhstan

Guidance on health promoting and climate-friendly hospitals and health services

Abstract The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards. Key messages • Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals. • Climate-friendly approaches yield significant health, economic, and social co-benefits.

The effect of team-model on healthcare usage and treatment levels among people with type 2 diabetes

Abstract Background In North Karelia Finland, a team-based service model was implemented in some municipalities’ primary healthcare (PHC) centers during 2020. In this team-model, a healthcare customer contacts a nurse who initiates the service process immediately. Nurses can also consult or direct customers to other healthcare professionals and arrange physical appointments if needed. The aims of the model are improved customer and personnel experience and satisfaction, and improved quality and effectiveness of care. We assess the effect of this team-model on treatment levels, measurement activity, and health care usage among patients with type 2 diabetes (T2D). Methods Patients with T2D were identified using the ICD-10 code E11 from the regional electronic health records. The data include all patients diagnosed by 2016 who were alive and residing in North Karelia in 2023 (N = 6312). Diabetes-related contacts with nurses or doctors in outpatient PHC and specialized healthcare (SHC) were considered, along with measurement activity and levels of glycated hemoglobin (HbA1c) and low-density lipoproteins (LDL) between the years 2017 and 2022. Annual differences between areas were analyzed using logistic and linear mixed models. Results In 2017, patients’ mean age was 66 and age range 20-93. The proportion of men was 55% and 45% resided in team-model areas in 2023. The team-model increased T2D-related outpatient PHC remote contact with nurses for a couple of years. But eventually they decreased to a lower level than before. Additionally, the team-model reduced the number of other contacts. An increased difference between areas in measurement activity on HbA1c and LDL levels was also observed. But the difference between areas in proportion of those who achieved treatment targets stayed unchanged. Conclusions In the long-term, the team-model reduced the number of T2D-related contacts and increased the measurement activity of HbA1c and LDL, but it had no effect on treatment levels. Key messages • Team-based service models might potentially reduce service use in the long term. • More research and evidence are needed on the effectiveness and cost-effectiveness of team-based service models.