Implementation Of Primary Health Care Research Articles

Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model.

BackgroundThe purpose of this study was to examine factors associated with the implementation of case management (CM) interventions in primary health care (PHC) and to develop strategies to enhance its adoption by PHC practices.MethodsThis study was designed as a systematic mixed studies review (including quantitative and qualitative studies) with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012) to identify quantitative (randomized controlled and nonrandomized) and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool.ResultsTwenty-three studies (eleven quantitative and 12 qualitative) were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up), large caseload (more than 60 patients per full-time case manager), and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills) and their responsibilities in PHC need to be clearly delineated.ConclusionOur systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC.

Actions geared to tobacco control: a review of their implementation in Primary Health Care

This survey examined the status of the implementation of policies for tobacco control in a medium-sized municipality through an assessment of actions recommended by the National Tobacco Control Program (NTCP) promoted by Primary Health Care (PHC) units. The coordinator of the local NTCP and professionals from 44 PHC units of Juiz de Fora in the state of Minas Gerais were interviewed, between May and July 2011. It was observed that the actions of treatment and health promotion were being duly executed, the highlight being the training of professionals to implement treatment in PHC. In 40.9%, there is the provision of treatment for smokers, and in 88.6% the actions are concentrated in activities in waiting rooms, groups and individual consultations. Limitations identified are probably not restricted to the municipality, such as inadequate structuring of units, high turnover, the varying degree of involvement of professionals in implementing the service and also the lack of mechanisms to enable them to implement and give continuity to care among their other responsibilities. The major challenge for tobacco control is to conduct intersectoral actions and in primary health care. The results can serve for the formulation of strategic health actions in other parts of the country.

Strengthening primary healthcare through community involvement in Cross River State, Nigeria: a descriptive study.

IntroductionIn preparation for implementation of primary healthcare (PHC) services in Cross River State, a study to identify perceptions of communities and health systems concerning such interventions was conducted.MethodsExisting PHC practices were documented through observation and document reviews, including facility checklists at frontline levels. Perceptions of consumers and providers on PHC were elucidated through 32 Focus Group Discussions (FGDs) and 78 semi-structured questionnaires.ResultsThere was some level of implementation of the Nigerian PHC policy in the study districts. However, this policy emphasized curative instead of preventive services. Private partners perceived healthcare programmes as largely donor driven with poor release of allocations for health by government.ConclusionBoth providers and consumers presented similar perceptions on the current PHC implementation and similar perspectives on services to be prioritized. These common views together with their on-going participatory experience are important platforms for strengthening community participation in the delivery of PHC.

Challenges of implementing a primary health care strategy in a context of a market‐oriented health care system: the experience of Bogota, Colombia

Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

An examination of the factors affecting people’s participation in future health examinations based on community health exam interventions

Community-based intervention health examinations were implemented at a health care facility to comply with the government’s primary health care promotion policy. The theory of planned behavior model was applied to examine the effect that community-based health examinations had on people’s health concepts regarding seeking future health examinations. The research participants were individuals who had received a health examination provided at two branches of a hospital in central Taiwan in 2012. The hospital’s two branches held a total of 14 free community-based health examination sessions. The hospital provided health examination equipment and staff to perform health examinations during public holidays. We conducted an exploratory questionnaire survey to collect data and implemented cross-sectional research based on anonymous self-ratings to examine the public’s intention to receive future community-based or hospital-based health examinations. Including of 807 valid questionnaires, accounting for 89.4% of the total number of questionnaires distributed. The correlation coefficients of the second-order structural model indicate that attitudes positively predict behavioral intentions (γ = .66, p < .05), and subjective norms also positively predict behavioral intentions (γ = .66, p < .01). By contrast, perceived behavioral control has no significant relationship with behavioral intentions (γ = −.71, p > .05). The results of the first-order structural model indicated that the second-order constructs had a high explanatory power for the first-order constructs. People’s health concepts regarding health examinations and their desire to continue receiving health examinations must be considered when promoting health examinations in the community. Regarding hospital management and the government’s implementation of primary health care, health examination services should address people’s medical needs to increase coverage and participation rates and reduce the waste of medical resources.

Evaluation of cardiovascular and cancer diseases screening programmes implementation in primary health care

Background Since cardiovascular and cancer diseases are the most common causes of death in Lithuania, one of the most effective interventions reducing the morbidity and mortality rates from these diseases are screening programmes. However, latest data showed that the coverage of screening programmes participants is less than 80% and does not meet the Europe Council recommendations. The aim of this study was to evaluate …

Repenser la place des soins de santé primaires en France – Le rôle de la médecine générale

Primary healthcare is poorly structured in France while it is well defined at the international level: it is the point of first medical contact of the population with the healthcare system. General practice is the clinical specialty oriented to primary healthcare. Data in the scientific literature highlight the need of refocusing the health system on primary care known to improve both morbi-mortality and care efficiency. In France, health authorities acknowledge general practitioners as playing a key role in the health care system: its time to move from intention to action. Structural changes are needed to achieve this reinforcement of primary healthcare: to re-orientate medical studies towards primary care; to develop research in primary care; to promote cooperation between care providers; to ease the daily workload of practitioners; to diversify methods of payment; to propose a guide for patient's use of primary care. The transformation of the healthcare system in France requires a real strategy of primary healthcare implementation. Regardless of financial constraints, it is possible to redistribute the resources towards ambulatory care. Strengthening the role of general practice and favoring its societal recognition will be the major stages of this change.

The views of health-care personnel about video consultation prior to implementation in primary health care in rural areas

The aim of this study was to describe the views of health-care personnel about video consultation (VC) prior to implementation in primary health care in rural areas. For people living in rural areas, it is often a long distance to specialist care, and VC could be an opportunity for increased access to care. Therefore, this study was to investigate what views primary health-care personnel had on VC as a working method in the distance between primary and specialist care. The development of technology in society and the introduction of technology in health care mean that the working methods must be adapted to a new approach. It is therefore important that in the initial phase of the introduction of new working methods to capture the personnel views regarding this. Focus group (FG) discussions with health-care personnel from five primary health-care centres in northern Sweden. The transcribed FG discussions were analysed with qualitative content analysis. The analysis revealed four main categories: a patient-centred VC; the importance of evaluating costs and resources; new technology in daily work; technology gives new possibilities in future health care.

Širdies ir kraujagyslių bei onkologinių ligų prevencinių programų įgyvendinimo organizaciniai ypatumai pirminėje sveikatos priežiūros grandyje

One of the most effective public health interventions reducing the incidence and mortality rates from cardiovascular and cancer diseases are screening programmes.The aim of this study is to assess the organizational peculiarities of cardiovascular and cancer screening programmes (SP) implementation in primary health care (PHC). The survey involved data from anonymous questionnaires of Lithuania’s physicians and focus group discussion of Vilnius city primary health care institutions’ administrators.The research revealed existing screening programmes implementation barriers in PHC: due to lack of physicians time, financial support and software (that helps to identify and account the provided programmes services) in PHC institutions, they do not use various interventions that promote public awareness and increase the coverage of participants; most of them neither plan nor evaluate the SP implementation results; half of them analyse the test results later than they get them. Furthermore, the results revealed that organizational screening programmes implementation peculiarities in PHC affect different programmes implementation between the PHC institutions and cause unequal provision of screening programmes services in Lithuania. In order to improve screening programmes implementation in Lithuania, it is recommended to conduct a more detailed research that identifies the organizational interventions used in PHC units and evaluates their effectiveness.

Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

BackgroundColombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables.MethodsA longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index.ResultsThe high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant.ConclusionsDespite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.

Identifying challenges and barriers in the delivery of primary healthcare at the district level: a study in one Thai province

In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified.

The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá-Colombia: an ecological analysis.

BackgroundColombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá.MethodsAn ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007.ResultsIn both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities.ConclusionThe PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.

Primary Health Care and the Millennium Development Goals

Member countries of the World Health Organization (WHO) met in Alma Ata (8-12 September 1978) to define and advocate the implementation of primary health care (PHC) worldwide, above all, in developing countries, which had a real need to review their strategies for meeting the health needs of their populations. They did not suspect that 20 years later the vision they displayed would remain undeniably relevant. Here we examine the similarities and points of convergence of their declaration about PHC with the Millennium Development Goals that seek today to reduce poverty across the world. An exhaustive and analytic literature review was conducted to collect those similarities. Further analysis of the definitions, objectives, principles and recommendations of the Alma Ata Declaration and the Millennium Declaration reveals multiple dependencies and fundamental points of similarity between these two representations. Almost all states have pledged to achieve the eight MDG by 2015: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. The Alma Ata conference defined primary health care as essential health care, based on practical methods and techniques that are both scientifically sound and socially acceptable, universally accessible to all individuals and all families of the community, through their full participation and at a cost that the community and countries can afford at all stages of their development in the spirit of self-reliance and self-determination. It is an integral part of economic and social development. The following principles are involved in the achievement of both primary health care and the MDG: social equity, community participation, and intersectorality. Public health is an essential condition of poverty eradication and MDG achievement. Public health issues are central to the problem of sustainable development and must therefore remain the focus of attention. It is increasingly urgent to break the vicious circle created by the close correlation between environmental degradation, poor health, and poverty.

Barriers and Enablers to Implementation of a New Zealand‐Wide Guideline for Assessment and Management of Cardiovascular Risk in Primary Health Care: A Template Analysis

The aim of this study was to identify the enablers and barriers to guideline implementation in a primary healthcare setting by employing the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a template for data analysis and interpretation. The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable, and, in spite of much investigation, remains resistant to explanation of what works and why. Optimising the enablers and minimising the barriers to implementation of a guideline for reducing cardiovascular disease risk has the potential to significantly reduce the burden of disease. The PARIHS framework has been successfully applied in a number of clinical contexts and has been found useful in illuminating the barriers and enablers to evidence implementation. This qualitative study involved focus groups with 20 primary healthcare nurses, 4 general practitioners, 5 managers, and individual interviews with 3 funder/planners who discussed their contribution to the use of a guideline for the assessment and management of cardiovascular risk. Template analysis based on the PARIHS framework was applied to semi-structured narrative data to provide an in-depth analysis of the barriers and enablers to implementation of the guideline. The lack of facilitation of the guideline into practice was a major barrier to implementation. Implementation plans that address the concerns and complexities of everyday practice are an essential aspect of guideline development. The PARIHS framework was found to be comprehensive and accommodating of the complexity of everyday practice associated with guideline implementation in primary health care. The pertinence of the framework confirms its usefulness as a tool to guide implementation.

Comprehensive Primary Health Care in South America: contexts, achievements and policy implications

This article summarizes an extensive review of South American experiences with primary health care since the Declaration of Alma-Ata. It aims to address the following specific questions: What are the enabling and constraining historical and structural conditions for primary health care policies and practices? How has health care reform supported or undermined primary health care? What evidence exists on the effectiveness of primary health care? What strategies are common to best practices? What evidence exists on the roles of citizen participation and intersectoral action? And finally, what are the policy lessons to be learned from these experiences? Narrative synthesis was used to identify and examine patterns in the data consistent with these questions. Conditions that were found to promote successful implementation of primary health care are outlined, together with features of effective primary health care systems that help create more equitable health services and health outcomes.

Reforma da Saúde Familiar em Portugal: avaliação da implantação

Primary healthcare in Portugal is undergoing a major reform, of which family health units (FHU) are one of the more visible results. This study aimed to evaluate the FHU implementation process from 2006 onwards. Methods from a previous study of primary healthcare implementation in Brazil were used. Dimensions studied included comprehensiveness of care, organization of care, and the political-institutional perspective. The main improvements identified included better availability of care, team work, technical quality of care, innovative management practices, sustainability of the model, working conditions and infrastructure improvements. Main challenges remaining include integration with hospital care, political and institutional gray areas, need for better information systems, integration within health centers and workflow organization. These data may be useful for management decision-makers when making adjustments and corrections in the reform process.

Implementing alcohol disorders treatment throughout the community

Alcohol is the world's third leading cause of ill-health and premature death. Alcohol has been found to be the most harmful drug, when considering harm to the individual and to others. With a prespecified search strategy we looked for relevant articles concerning screening, brief interventions and referral to treatment of patients with hazardous or harmful alcohol use, with a special focus on the primary healthcare implementation of these effective interventions. The evidence on the efficacy and effectiveness of brief interventions in primary care continues to grow and is confirmed by many recent studies, even in specific populations. The implementation of those effective interventions continues to be difficult, but successful experiences have been reported. The use of brief interventions in other healthcare settings and to address problems other than risky drinking is promising, but the evidence is far from conclusive. Some specific age groups (elderly, women and youth below 16) may deserve specifically tailored interventions. Alcohol is a major public health problem and brief interventions are one of the cost-effective measures that can be taken at a community level. Nevertheless, implementation of those measures is difficult. Further research is needed to identify the best implementation strategies.

Taking Stock of Alma-Ata Primary Health Care/Health for All: Moving Toward New Directions in Global Preventive Health

“Health for All by 2000,” first declared at Alma-Ata in 1978, revolutionized primary health care (PHC) policy and planning based on a set of guiding values and principles of health services organization: equity, social justice, and health for all; community participation; appropriate use of resources; and intersectoral action. Primarily, the historic significance of the Alma-Ata/Health for All (HFA) was to put preventive health on equal footing as curative medicine. A decade into the new millennium, it is time to take stock of the infamous Primary Health Care and Health for All policy, as more than 30 years after, we are confronted with almost similar challenges that plagued health policy makers in 1978. Emerging and reemerging infectious diseases (eg, H5N1 avian influenza and HIV/AIDS), political instability/conflict, and worsening poverty as indicated by the world’s 1.4 million poor and their impact on primary health care are some of the pressing challenges currently. Since 1978, health policy priorities have shifted toward the poverty elimination Millennium Development Goals (MDG) set in 2000. The healthrelated MDGs being MDG 4, Child Survival; MDG 5, Maternal Health; MDG 6, HIV, TB, and Malaria. Yet progress toward MDGs has faltered. For instance, weak health systems have affected efforts to improve maternal, newborn, and child health. New epidemics of chronic diseases reverse the small gains achieved as it increases the burden of long-term care on health systems and budgets. Increasingly, disease prevention and public health promotion are in settings where most risk factors lie outside the direct control of biomedicine and the health sector that require equity, efficiency, and intersectoral action. Such trends have underscored the relevance of the 1978 HFA and Alma-Ata values. In 2008, the director general of the World Health Organization, in a revisit of HFA, reiterated that any “gaps or inequalities in health outcomes are indicators of policy failure” and stressed the relevance of “HFA/PHC—a model for health system that acts on underlying social, economic, and political causes of ill health.” To achieve the MDGs by 2015, and time is fast running out, countries need to strengthen their health systems through implementation of effective PHC. Interest in HFA and PHC have thus been reawakened by health experts and global health institutions to seek for reforms that can equip health systems to respond to health challenges of unparalleled complexity today.

The community pharmacist as a member of a primary health care team in South Africa — perceptions of pharmacists, doctors and nurses

AbstractThe growing emphasis on primary health care (PHC) has drawn increased attention to disease prevention and health promotion activities from many health professionals, among them pharmacists. This paper explores the role of the community pharmacist as a member of the PHC team in South Africa, through the perceptions of pharmacists, nurses and doctors. Data were collected by survey and interviews. The results reveal a scenario where pharmacists are eager to engage in PHC activities, whereas nurses and doctors are more cautious in their support. Although they see pharmacists as health professionals, and are of the opinion that they should play a part in the PHC team, doctors and nurses strongly protect their own domains when it comes to allocation of potential tasks. This raises some difficulties with regard to the effective implementation of PHC. Based on the South African reality and a literature review, suggestions are made to develop models of PHC centres which would potentially overcome some of the problems raised.

Oh What a Year 2010 Was! Impact on Telemedicine and e-Health

Telemedicine and e-HealthVol. 17, No. 1 EditorialOh What a Year 2010 Was! Impact on Telemedicine and e-HealthCharles R. Doarn and Ronald C. MerrellCharles R. DoarnSearch for more papers by this author and Ronald C. MerrellSearch for more papers by this authorPublished Online:6 Feb 2011https://doi.org/10.1089/tmj.2011.9997AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Oh What a Year 2010 Was! Impact on Telemedicine and e-Health." , 17(1), p. 1FiguresReferencesRelatedDetailsCited ByEye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design18 November 2015 | International Journal for Equity in Health, Vol. 14, No. 1The views of health-care personnel about video consultation prior to implementation in primary health care in rural areas12 February 2013 | Primary Health Care Research & Development, Vol. 15, No. 02Can Postdischarge Follow-Up Contacts Prevent Suicide and Suicidal Behavior?Crisis, Vol. 34, No. 1Nuevas herramientas en saludMedicina Clínica, Vol. 139, No. 8 Volume 17Issue 1Jan 2011 InformationCopyright 2011, Mary Ann Liebert, Inc.To cite this article:Charles R. Doarn and Ronald C. Merrell.Oh What a Year 2010 Was! Impact on Telemedicine and e-Health.Telemedicine and e-Health.Jan 2011.1-1.http://doi.org/10.1089/tmj.2011.9997Published in Volume: 17 Issue 1: February 6, 2011PDF download