Improvement Of Primary Health Care Research Articles

Quality Coordinators' Perspectives on Quality Improvement in Primary Healthcare in Kosovo: A Qualitative Study.

This qualitative descriptive study provides insights into the experiences of quality coordinators (QCs) in primary healthcare to inform policy and practice actions and empower QCs to enhance healthcare quality. We conducted focus group discussions with purposefully selected QCs to understand their motivations, job experiences, factors influencing healthcare quality, and suggestions for quality improvement. Content analysis and deductive coding were used to scrutinize the responses and answer the research questions. The QCs thought highly about their job performance and were motivated by both extrinsic and intrinsic factors. Clinical audits, collegial reviews, and managerial support positively affected QCs' performance. In contrast, a lack of managerial support, limited working hours, and changes in organizing work caused the opposite. Empowerment and external support positively influenced healthcare quality, whereas lack of resources, managerial support, or training had a negative influence. Suggestions to improve quality include the role of QCs, external supervision, and centralization of the QCs' network. Appointing QCs alone does not guarantee quality improvement. It is essential to ensure that QCs have the appropriate skills, tools, management support, and open communication channels. Further research is required to evaluate the effects of sex and age on QCs' performance.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China.

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China. An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform. After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09). The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review.

The quality of health care remains generally poor across primary health care settings, especially in low- and middle-income countries where tertiary care tends to take up much of the limited resources despite primary health care being the first (and often the only) point of contact with the health system for nearly 80 per cent of people in these countries. Evidence is needed on barriers and enablers of quality improvement initiatives. This systematic review sought to answer the question: What are the enablers of and barriers to quality improvement in primary health care in low- and middle-income countries? It adopted an integrative review approach with narrative evidence synthesis, which combined qualitative and mixed methods research studies systematically. Using a customized geographic search filter for LMICs developed by the Cochrane Collaboration, Scopus, Academic Search Ultimate, MEDLINE, CINAHL, PSYCHINFO, EMBASE, ProQuest Dissertations and Overton.io (a new database for LMIC literature) were searched in January and February 2023, as were selected websites and journals. 7,077 reports were retrieved. After removing duplicates, reviewers independently screened titles, abstracts and full texts, performed quality appraisal and data extraction, followed by analysis and synthesis. 50 reports from 47 studies were included, covering 52 LMIC settings. Six themes related to barriers and enablers of quality improvement were identified and organized using the model for understanding success in quality (MUSIQ) and the consolidated framework for implementation research (CFIR). These were: microsystem of quality improvement, intervention attributes, implementing organization and team, health systems support and capacity, external environment and structural factors, and execution. Decision makers, practitioners, funders, implementers, and other stakeholders can use the evidence from this systematic review to minimize barriers and amplify enablers to better the chances that quality improvement initiatives will be successful in resource-limited settings. PROSPERO registration: CRD42023395166.

Peer groups for medical professionals in Ukraine: experience of implementing an innovative format of continuing professional development

The training of medical professionals does not end with graduation – continuing professional development (CPD) should be integrated in the professional life of each medical professional. Peer groups, an innovative format of CPD, were launched in the Netherlands in 1979. Subsequently, in 1980-1990, this format spread to other European countries and became an important method of quality improvement in primary health care. Research on peer groups is rare, and especially for Eastern Europe. The purpose of this study, which is unique for the region and Ukraine, is to describe the context and results of implementation and functioning of the first peer groups in Ukraine among doctors, nurses, and primary care managers. The methodology of the study is a case study, which was implemented through (a) data analysis – a description of the experience that was independently prepared by the facilitators of the newly created peer groups, reflected in text and graphic information on posters, and voiced their stories orally during the Congress of Peer Group Facilitators (October 2021), (b) analysis of facilitators’ publications on social media that highlight their experience, (c) analysis of semi-structured interviews during supervision and organizational meetings on the implementation and development of peer groups, (d) analysis of an expert interview with a Swiss medical doctor who was also involved in the development of peer groups in Ukraine. The results of the study are as follows: more than half of the trained facilitators have created their own peer groups; such groups have been functioning for several years despite COVID-19 and Russia’s full-scale invasion of the sovereign territory of Ukraine. Facilitators and participants of peer groups emphasize not only the educational contribution of peer groups to their profession, but also the social and psychological one. Barriers to the creation and sustainability of peer groups include lack of management support, lack of time, motivation and formal incentives (CPD points). Peer groups as one of the approaches to continuous professional development are gradually creating a culture of learning in healthcare facilities, bringing more trust in the interaction of professionals with each other and improving the quality of care provided.

Review of foreign healthcare systems and ongoing reforms in China and Vietnam

The article is devoted to the review of some aspects of health care reform abroad, the emphasis is placed on the study of measures to achieve universal health coverage (HEU) in China and Vietnam. There is a significant similarity of problematic issues in the health care of most countries, which include ensuring equal access to quality medical care, shortage of medical personnel, financing of medical care. A review of the studied reforms showed that those that are addressed to a specific health problem achieve greater success, especially in the field of public health reform. The experience of reforms in China and Vietnam in the field of increasing the availability of medical care demonstrates the importance of improving the financing of the medical industry in the implementation of most reforms. Both countries have implemented reforms in the field of health insurance, but in China basic health insurance was introduced, while in Vietnam more attention was paid to vulnerable groups of the population. Despite the fact that the two countries have made progress in health coverage, inequality in access to medical care has been significantly reduced in Vietnam. It is concluded that the effectiveness of reforms will be more successful if such measures as the use of strategic procurement, improvement of primary health care, improvement of the quality of services, provision of political support and increased financing of health care are implemented.

Intersectoral Cooperation Between the Strategic Plan for Vaccination Against COVID-19 in Argentina and the Bachelor's Degree in Nursing for the Improvement of Primary Health Care

Intersectoral Cooperation Between the Strategic Plan for Vaccination Against COVID-19 in Argentina and the Bachelor's Degree in Nursing for the Improvement of Primary Health Care

Adaptation and validation of the Ugandan Primary Care Assessment Tool.

Health systems based on primary health care (PHC) have better outcomes at lower cost. Such health systems need regular performance assessment for quality improvement and maintenance. In many low- and middle-income countries (LMICs), there are no electronic databases for routine monitoring. There is an urgent need for valid and reliable tools to measure PHC performance. This study aimed to adapt and validate the Primary Care Assessment Tool (PCAT) in the Ugandan context. The experts that participated in the Delphi process were recruited from almost all over the country. The study utilised a Delphi process with a panel of 20 experts (14 district health officers, 4 academics in primary care and 2 ministry of health [MOH] technical staff) who responded to iterative rounds of questionnaires in order to reach consensus (defined as 70% agreement). Consensus was reached after two rounds of the Delphi. In round one, four items in the comprehensiveness domain (services available) were removed and five items needed rephrasing. A new domain on person-centredness with 13 items was suggested. In round two, the new domain with each and every single one of its items and the items for rephrasing all achieved consensus. The final Ugandan version of the PCAT (UG-PCAT) has 12 domains and 91 items. The South African Primary Care Assessment Tool (ZA PCAT) was adapted and validated with an additional domain on person-centredness to measure primary care performance in the Ugandan context, and can now be used to measure the quality of core functions of primary care in Uganda.Contribution: The PCAT could fulfil the need for such a tool in a wider LMIC context. The UG-PCAT will be used to measure the quality of these core functions in Uganda and to assist with the improvement of PHC.

Developing Iranian sub-national Primary Health Care Measurement Framework: a study protocol.

Developing an effective system for measurement and improvement of primary health care (PHC) based on the conditions and characteristics of the countries' health systems is one of the World Health Organization (WHO) recommendations. This study will aim to develop a framework to assess the Iranian sub-national PHC system performance using the WHO measurement framework for PHC. This is a mix-method study with a triangulation design. The Iranian sub-national PHC Measurement Framework (PHCMF) will be developed through a review of the WHO's PHC measurement conceptual framework (for selecting key performance indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with national experts, and the Delphi technique for finalizing the framework. The required data for calculating selected KPIs is expected to encompass qualitative and quantitative data. Discussion: Iranian PHC system performance is not measured based on the holistic and scientific framework and international standards. The information obtained from this project will guide managers and policymakers to be aware of the current situation and the success rate of the PHC system in achieving the desired goals, as well as identify strengths and weaknesses of the PHC system and provide the solution to better policy formulation.

Health care quality model of family physician program in Iran (mixed method).

There has been a growing international evolution of the role and purpose of quality improvement in primary health care. The present study aimed to develop a quality model of the Family Physician program in Iran. In the qualitative part of these mixed-method studies, grounded theory was used according to the systematic method of Strauss and Corbin. Semi-structured interviews were conducted with recipients and providers of Family Physician cares in the pilot provinces of Iran in 2020 to 2021 and continued until the theoretical saturation based on the purposive technique. The qualitative evaluation of the model was performed and approved. Structural equation modeling and Amos software were used to quantify the model. The results of the structural equation analysis showed that the conceptual model of the research with chi-square test was 2.96 and RMSEA= 0.066, GFI=0.860 are well fitted. Structure, context, process, accountability, attitude, and empowerment factors directly and indirectly provide good predictors for the quality of care in the family physician program. The most important research findings in the field of quality improvement in the family physician's cares included factors such as developing the attitude and vision of society, providers and policymakers in health subject and health needs, simultaneously corrections in all levels of the referral system, attention and adaptation to the context of society, developing the infrastructures and improving the related processes, systematic appraisal, and accountability and pay attention to the empowerment. To achieve the quality of care in the family physician program, we need change and development in our attitudes, context, infrastructures and processes, accountability and empowerment systems, and overall modification .

EXPERIENCE OF PARTICIPATION OF THE DEPARTMENT OF PEDIATRIC DENTISTRY OF ODESA NATIONAL MEDICAL UNIVERSITY IN THE PREPARATION AND CONDUCT OF THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE-2) FOR STUDENTS OF DENTAL AND INTERNATIONAL FACULTIES

The training of dentists at the modern European level is one of the important prerequisites for reducing the main dental diseases in the population of Ukraine. Dentistry is one of the important components in the direction of development and improvement of primary health care for the population of our country. Therefore, the purpose of this work was to analyze the experience of the Department of Pediatric Dentistry of the Odesa National Medical University in the preparation, conduct and ways of improving OSCE-2 among students of dental and international faculties. During the fall semester, the department prepared methodological support for OSCE, namely passports of two stations, tasks, algorithms and checklists. All tasks were adapted to the technical capabilities of the clinical base of the department. OSCE was carried out for 3 days. The students of the academic groups were divided into examination groups of 10 people each. During the exam there was a constant video and audio recording of students' answers. The assessment of the student was based on a checklist. A certain number of points was assigned to each point of the algorithm, depending on the complexity. The specific weight (number of points) of each item could be different depending on the number of items and the complexity of the implementation of a particular item. As a result of this work, the following was established: an objective structured clinical examination allows the most objective assessment of the knowledge, skills and practical skills of students; during the examination of the OSCE, the students of the dental and international faculties demonstrated a fairly high level of practical skills and abilities in pediatric dentistry acquired during the training period; in order to improve the quality of training of young specialists, it is necessary to constantly conduct trainings for students. Key words: dentistry, teaching, students, state exam.

Patient satisfaction survey: A gateway to quality improvement in primary healthcare in the IAF

Patient satisfaction is an important indicator to assess and improve quality of healthcare services. In Armed Forces Medical Services, studies on patient satisfaction are scant and mainly hospital based. Hence, a study was conducted with an objective to assess patient satisfaction in seven Primary Healthcare Delivery Centers (PHDCs) in one of the operational commands in the Indian Air Force (IAF). Patient Satisfaction Questionnaire Short Form 18 (PSQ-18), a simple tool, was used for the survey. The study was unique in the sense that few centers in the survey were remotely located from tertiary care hospitals and the Medical Officers in these PHDCs were relatively inexperienced. The analysis of the survey clearly brought out distinct differences in certain dimensions of patient satisfaction across the PHDCs. In addition, utility of the Hindi translated version of PSQ-18 was ascertained. Based on the results of the study, few important conclusions were drawn; (a) patient satisfaction could be assessed using simple questionnaire such as PSQ-18, (b) the Hindi translated version of PSQ-18 can also be used as a useful tool depending on the participants’ preference, and (c) the observed dimensions affecting patient satisfaction could be addressed through specific interventions. Similar survey is recommended to be conducted across primary, secondary, and tertiary healthcare establishments in the IAF.

Determination of the Level and Trend of Fertility in Four Provinces in South Africa

Relevance of the research: Th e study of fertility and mortality is of great importance because it shows the dynamics of the population and the need for eff ective planning measures required to be put in place to avert catastrophe. It is therefore important for South Africa also to check whether its fertility is heading toward the same trajectory seen in these developed countries. Purpose of the article: This study seeks to determine the level and trend of the fertility in South Africa using four provinces, Mpumalanga, Kwazulu-Natal, North West and Limpopo, for the years 2011, 2012, 2013 and 2014, as case studies. Th us, the study aims to determine: (a) Whether the fertility rate was changing in the provinces during the years 2011, 2012, 2013 and 2014. (b) What is the trend? And; (c) Whether the fertility is falling below replacement level or not. Scientifi c novelty of the article: Th e study shows that fertility in South Africa has indeed declined with some provinces having the level of fertility below replacement level. Th e decline seen in this study is mainly due to the fertility of the black majority population. Th e high population growth rate was mainly due to the fertility of the blacks, therefore, when recent fertility levels in the country are low, the implication is that the fertility of the blacks has gone down, and in fact this is what this study is showing, and advises that unless measures are put in place, the fertility of the blacks or fertility in South Africa will go down below replacement level. Fertility levels have declined worldwide, including South Africa. But the extent to which South Africa’s fertility has declined is not very clear because data from two previous censuses on fertility and mortality were very poor. South Africa (SA) had reliable data on the White popula-tion of the country, but with the new dispensation since 1994, data collection, especially from the black population that forms majority, has not been easy. Th e quality of data from the black population that accounts for over 80 percent of the population has not been good and reliable, probably because of the low level of education of this segment. Fertility and mortality data from the two previous censuses, 2001 and 2011, were not reliable when compared with data from vital statistics and national population register. Th us, estimates made from these censuses’ data on these events are questionable. South Africa, however, has data from the General Household Surveys (GHS), and this study uses data from these surveys to attempt to fi nd the level and trend of fertility. Th e GHS is an annual household survey which measures the living circumstances of South African households. Demographic and statistical methods are used to calculate measures, like the UN age ratio scores, to assess the quality of the data from four provinces, namely, North West, Kwazulu-Natal, Mpumalanga and Limpopo provinces, for the period 2011 to 2014. Th e four provinces are selected as a case study to compare rural and urban fertility characters. Th e results show that the quality of the survey data is fairly good and reliable with KwazuluNatal province having the most reliable data. Th e fertility levels were lowest in the more urbanized and educated provinces of Kwazulu-Natal and North West, and highest in the less educated and rural provinces of Limpopo and Mpumalanga. Th e study further shows that fertility in all the provinces has been declining since 2012, with the gross reproduction rate falling below replacement level; with implication that the fertility of the black population is declining fast. Th e decline in the fertility level could be attributed to quite a number of factors including education, urbanization, and improvement in primary health care. Because of the sharp decline in the fertility level in the recent years, the study calls for proper policy intervention to avoid population “extinction”.

PRIMARY HEALTH CARE IMPROVEMENT

AbstrakEksistensi hak kesehatan sebagai fundamental right yang dimiliki oleh setiap individu telah diakui secara kontitusional. Hakikatnya, kesehatan harus dijamin dengan adanya suatu kepastian hukum melalui upaya peningkatan kualitas kesehatan. Namun, beberapa daerah masih memiliki keterbatasan akses pelayanan kesehatan dasar di puskesmas. Hambatan tersebut terlihat dari minimnya jumlah puskesmas dan kesenjangan fasilitas antardaerah, kurangnya berbagai faktor penunjang, serta terbatasnya kuantitas tenaga kesehatan yang akan mempengaruhi capaian kesehatan masyarakat. Pemberlakuan jam operasional dalam rangka mengurangi angka penyebaran covid-19 mengakibatkan terjadinya dua kondisi yang kontras. Kondisi pertama menimbulkan overcapacityyang berisiko memicu kerumunan, sedangkan kondisi kedua menyebabkan penurunan jumlah kunjungan masyarakat ke puskesmas. Hal ini perlu menjadi fokus pemerintah, guna meningkatkan pemerataan pelayanan kesehatan pada daerah terdampak. Penelitian ini menggunakan metode penelitian hukum normatif dengan pendekatan peraturan perundang-undangan dan studi kepustakaan. Hasil penelitian ini menunjukkan bahwa perlu strategi oleh pemerintah dalam mengatasi dinamika kesehatan sebagai suatu penyempurnaan kerangka kebijakan dalam mewujudkan target Sustainable Development Goals (SDGs) pada sektor pelayanan kesehatan di daerah. Untuk itu, penulis beranggapan perlu adanya kepastian jaminan melalui Primary Health Care Improvement sebagai solusi alternatif yang tepat, guna meningkatkan kualitas pelayanan puskesmas di daerah terdampak dalam memitigasi covid-19.&#x0D; Abstract&#x0D; The existence of the right to health as a fundamental right that every individual owns has been recognized constitutionally. In essence, health must be guaranteed by the presence of a legal certainty through efforts to improve the quality of health. However, some areas still have limited access to essential health services at community health centres. These obstacles can be seen from the minimal number of community health centres and the gap in facilities between regions, the lack of various supporting factors, and the limited quantity of health workers that will affect public health outcomes. The implementation of operating hours to reduce the spread of COVID-19 resulted in two contrasting conditions. The first condition causes overcapacity, which risks crowds, while the second condition causes a decrease in the number of community visits to the community health centres. These conditions need to be the government's focus to increase the distribution of health services in affected areas. This study uses a normative legal research method with an approach to legislation and literature study. The results of this study indicate that the government needs a strategy in overcoming the dynamics of health as a refinement of the policy framework in realizing the Sustainable Development Goals (SDGs) targets in the regional health service sector. For this reason, the authors think that there is a need for guarantees through Primary Health Care Improvement as an appropriate alternative solution to improve the quality of community health centres services in affected areas in mitigating COVID-19.

Implementation research on measuring quality in primary care: balancing national needs with learning from the Eastern Mediterranean Region.

Universal Health Coverage (UHC) is a core element of ensuring healthy lives, marking the third Sustainable Development Goal. It requires providing quality primary health-care (PHC) services. Assessment of quality of care considering a wide variety of contexts is a challenge. This study lists practical indicators to enhance the quality of PHC. Demonstrating quality indicators for PHC that are feasible, comprehensive and adaptable to wide array of health systems and resource settings. We applied the research framework: Exploration, Preparation, Implementation and Sustainment. Exploration included a scoping review to identify quality indicators. Preparation included an eDelphi to refine the primary indicators' list. A panel of 27 experts reviewed the list that was later pilot tested in PHC facilities. The outcomes were presented to two further expert consultations, to refine indicators and plan for broader testing. Implementation included testing the indicators through a five-step process in 40 facilities. A regional consultation in May 2016 discussed the testing outcomes. Initial efforts identified 83 quality indicators at the PHC level that were then refined to a 34-indicator list covering the six domains of quality. A toolkit was also developed to test the feasibility of each indicator measurement, data availability, challenges and gaps. Pilot testing provided insight into modifying and adding some indicators. Wide variability was encountered within and in between facilities, and timely initiation of antenatal care, for example, ranged 31-90% in Oman and 11-98% in Tunisia. Indicators were highly feasible, and 29 out of 34 were measured in 75% of facilities or more. While challenges included gaps in capacity for data collection, the tool showed high adaptability to the local context and was adopted by countries in the Eastern Mediterranean Region (EMR) including Libya, Oman, Iran, Pakistan, Sudan and Palestine. Stakeholders agreed on the high relevance and applicability of the proposed indicators that have been used to inform improvement. A cross-regional set of 34 quality indicators of PHC in the EMR was developed and adopted by a diverse group of countries. The toolkit showed high feasibility in pilot testing reflecting the practicality needed to encourage local uptake and sustainability. The core quality indicators are highly adaptable to different local and regional contexts regardless of current PHC strength or available resources. Continuous evaluation and sharing lessons of implementation and use are needed to ascertain the indicators' effectiveness in driving improvements in PHC and to refine and strengthen the evidence supporting the set of indicators for wider adoption.

The impact of primary health care and specialist physician supply on amenable mortality in Mexico (2000–2015): Panel data analysis using system-Generalized Method of Moments

The study had a three-fold objective: (i) to estimate the amenable mortality rates and trends at a national and state level between 2000 and 2015 in Mexico; (ii) to estimate the contribution and trends of various causes of death to overall amenable mortality; and (iii) to determine the association between health system inputs and amenable mortality for the period 2000–2015. We used a panel dataset for the period 2000–2015. The following health care inputs were used in the analysis: density of general practitioners, specialists and nurses, as well as density of hospital beds. We find that amenable mortality fell from 136 per 100,000 in 2000, to 124.1 per 100,000 in 2015 nationally, with significant heterogeneity in the trends across states. Mortality due to infectious diseases, diseases of childhood, and cardiovascular diseases decreased, while deaths due to other non-communicable diseases, such as diabetes, increased. There was a significant negative association between the density of general practitioners and specialist physicians, and amenable mortality. Our results indicate that reducing the burden of non-communicable diseases must be a health system priority. Improvements in primary health care could lead to improved disease detection and earlier diagnosis which could further reduce amenable mortality in Mexico.

Aborto espontâneo: uma análise em relação à prevalência no norte de Minas Gerais

Objetivo: Analisar a prevalência de aborto espontâneo de mulheres internadas em regime público ou privado no Norte de Minas Gerais, no período de 2008 a 2016. Métodos: Estudo de caráter descritivo, retrospectivo e delineamento quantitativo. Os dados foram obtidos a partir do DATASUS. As variáveis estudadas foram as sociodemográficas e clínicas. Utilizou-se o software Excel 12.0 (Office 2007) para gerenciamento e análise de dados. Resultados: 12.134 abortos espontâneos no Norte de Minas Gerais entre 2008 e 2016, maior prevalência na microrregião Montes Claros/Bocaiúva. Percebe-se maior prevalência na faixa etária de 20-29 anos em todas as microrregiões do Norte de Minas Gerais. Quanto à cor/raça, as mulheres pardas predominam. Em relação aos gastos, o setor privado apresenta um maior percentual total comparado aos gastos públicos. Conclusão: Houve uma diminuição no número total de casos de aborto espontâneo no Norte de Minas Gerais de 2008 a 2016, podendo ser justificado por uma melhora na Atenção Primária da Saúde, através, principalmente, do aumento das Estratégias de Saúde da Família nas diversas microrregiões. O aborto espontâneo é uma causa comum de morbimortalidade da mulher, devendo-se, portanto, haver uma atenção especializada para a mulher gestante.

The satisfaction of parents with ambulatory polyclinic care of children in conditions of the region

To identify the most effective areas of out-patient care of children, an in-depth sociological study was carried out in the Kabardino-Balkaria Republic. The questionnaire allowed to get answers on satisfaction of parents with the quality, volume and availability of out-patient care, as well as to study the social status of respondents. The survey included 495 mothers aged of 18-45 years. Out of them, 70.0% had 1-2 children, 30.0% had 3 or more children. The orientation of the majority of families to the birth of 1-2 children formed one of the lowest in the republics of the North Caucasus total fertility rate of 1.61. The results of the study of parental satisfaction with the level of medical care of children in out-patient settings established that the main problem is sufficiently correlated with the data of similar studies in different regions of Russia. According to the data obtained, 61.0% of the respondents were satisfied with the overall health care in the clinic, and only 12.0% of the respondents were fully satisfied. At the same time, a quarter of the respondents expressed their dissatisfaction with various aspects of medical care. The main reasons for dissatisfaction are the low level of examination, organizational issues that need to be addressed, a significant workload of doctors, often the lack of doctors of narrow specialties. According to parents opinion, the clinic is lacking continuity in the work and dynamic monitoring of a sick child, as well as awareness of patients about the ongoing therapeutic and preventive measures. The low efficiency of preventive work is established. The dissatisfaction with the availability and quality of medical care of children is the basis for the necessary measures to improve functioning of the children's clinic, including introduction of new and effective organizational and medical technologies, improvement of material and technical equipment, improvement of the professionalism of medical personnel. The prerequisite for the success of the clinic is also compliance with ethical principles in Pediatrics. The results obtained on the basis of the analysis of the parents' opinion are valuable for development of the perspective programs of development and improvement of primary health care of children in the Republic of Kabardino-Balkaria.

Epidemiology of haemodialysis patients and haemodialysis performance in Nauru.

There is limited literature on haemodialysis in island countries in the Central Pacific. The primary aim of this study was to report on the epidemiology of haemodialysis patients and haemodialysis performance in Nauru. We obtained registry data from the haemodialysis unit in Nauru to calculate the incidence rate, prevalence, and survival probability of haemodialysis patients in Nauru. We also reviewed medical records from January 2015 to February 2017 to evaluate the haemodialysis performance in Nauru. In total, 177 patients received long-term haemodialysis in the Nauru dialysis unit from 1987 to 2017. The 1-year, 2-year, and 5-year survival probabilities during the 30-year study period were 76.5%, 58.3% and 25.9%, respectively. From 2011 to 2014, the incidence rate and prevalence of treated end-stage renal disease in Nauru were significantly higher than Australia. From 2015 to 2017, there were 36 patients with a median age of 55 years who received long-term haemodialysis. Of these, 25 patients (69.4%) had diabetes. The median haemoglobin, serum albumin, and urea reduction ratio were 9.6 mg/dL, 35 g/L, and 64.7%, respectively. Multivariate analysis showed that lower serum albumin and lower urea reduction ratio were associated with mortality. To our knowledge, this is the first study to report the haemodialysis status in Nauru. The epidemiology of haemodialysis patients in Nauru is unique in the Central Pacific. Improvement of primary health care in disease detection and prevention of progression should be considered to decrease the need for dialysis and optimise the care of haemodialysis patients in Nauru.

Assessment of the Integration between Primary Health Care and Public Health in Almaty

This article presents the results of the study on assessing the degree of integration between primary health care (PHC) and public health (PH) in Almaty. The purpose of the study is to assess the degree of integration between PHC and PH in Almaty in accordance with the European framework for action on integrated health services delivery (EFFA IHSD). The relevance of the studylies in a comprehensive analysis from the position of integration between PHC and PH in Almaty. Research team: Kazakhstan School of Public Health, with the methodological support of the European Regional Office of the World Health Organization (WHO EURO), conducted a study. The EFFA IHSD of WHO has formed the basis for its development. Methodology: We conducted an analytical review and interviews with key informants. The analytical review included an analysis of the indicators characterizing the healthcare system. In the study we used the following research methods: bibliographic, analytical and interviewing. For the interviews with key informants we used the Interview protocol for key informant interviews, developed by WHO EURO in a step-by-step guide for developing profiles on health services delivery transformations. Results: We evaluated the morbidity of the population of Almaty with priority (infectious and non-infectious) socially significant diseases: diseases of the circulatory system, diabetes mellitus, tuberculosis, oncology, injuries. Evaluating the morbidity and mortality, it should be stated that the introduction of an integrated approach with the development and improvement of PHC and PH yielded improved health outcomes in Almaty. According to the existing model of integration between PHC and PH in the Republic of Kazakhstan, we have identified and conducted several interviews with key informants on initiatives. Conclusion: This study shows trends and an overall picture in the integration between PHC and PH. The results of our study showed that PHC and PH have as a series of specific and a number of overlapping functions.

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae- A scoping review.

Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.