Innovations In Primary Health Care Research Articles

Reforms and innovations in primary health care in different countries: scoping review.

The World Health Organization (WHO) recommends focusing on primary health care (PHC) as the first strategy of countries to achieve the improvement of the health level of communities and has emphasized it again in 2021. Therefore, we intend to take a different look at the PHC system with reform, innovation, and initiative by using the experiences of leading countries and identify practical and evidence-based solutions to achieve greater health. This is a scoping review study that has identified innovations and reforms related to PHC since the beginning of 2000 to the end of 2022. In this study, Scopus, Web Of Science, and PubMed databases have been searched using appropriate keywords. This study is done in six steps using Arkesy and O'Malley framework. In this study, the framework of six building blocks of WHO was used to summarize and report the findings. By searching in different databases, we identified 39426 studies related to reforms in primary care, and after the screening process, 106 studies were analyzed. Our findings were classified and reported into 9 categories (aims, stewardship/leadership, financing & payment, service delivery, health workforce, information, outcomes, policies/considerations, and limitations). The necessity and importance of strengthening PHC is obvious to everyone due to its great consequences, which requires a lot of will, effort, and coordination at the macro-level of the country, various organizations, and health teams, as well as the participation of people and society.

Improving the quality of life for premature infants through the continuity of care approach: A literature review

<p><strong><em>Background:</em></strong><em> The agenda for strengthening the global health architecture is to improve quality of life for premature infants. Premature births increase the morbidity and mortality of newborns, necessitating innovation in primary health care. </em></p><p><strong><em>Objectives:</em></strong><em> This study was conducted to examine innovation programs with a continuity of care approach in primary health care for premature infants in an effort to strengthen the global health architecture. </em></p><p><strong><em>Methods:</em></strong><em> A literature review method was used to analyze articles obtained using databases such as Science Direct and Google Scholar. The researcher used the key words “continuity of care” and “premature infants”. The inclusion criteria were full-text journal articles published from January 2020-December 2022 in English-language journals. </em></p><p><strong><em>Results:</em></strong><em> This study obtained ten articles that correspond to the continuity of care approach for premature infants. The articles included four qualitative studies, three quantitative studies, one mixed-method study, one literature review, and one systematic review. There are three themes related to the continuity of care for premature infants, including (1) Primary healthcare with information continuity, relationships continuity, and management continuity; (2) Continuity of care in the antenatal, natal, and postnatal periods; (3) The continuity of care on premature infant approach improves the outcome of premature infant care, the ability of parents, and health service quality. </em></p><p><strong><em>Conclusions:</em></strong><em> A continuity of care approach can increase the achievement of adequacy, equity, efficiency, and effectiveness in primary health care for premature infants. Joint synergy between the community, health services, and health policymakers is essential in efforts to strengthen the quality of life for premature infants.</em></p>

Legacy of COVID-19 Innovations: Strengthening African Primary Health Care through Pandemic Innovations

The COVID-19 pandemic led to a global surge of health care innovations aimed at curbing the pandemic. Some of the innovations were newly developed whereas others were modifications of existing technologies to suit the COVID-19 response. With the world achieving some level of normalcy, the question is what will become of these innovations. This study reviewed and analysed 1003 innovations that were utilised for the COVID-19 response to assess if they are still being utilised to strengthen health systems. The paper goes on to identify, profile and showcase 48 innovations and trace their evolution to support and strengthen Primary Health Care. Through this analysis and narration, four strategic pillars of collaboration, governance, innovation design and strategy emerge as factors that help explain the successful integration of these innovations in Primary Health Care. Under these pillars emerged nine key aspects of strategic inter-industry collaborations, standardisation and supportive policies, minimalistic and modular designs, off-grid capabilities, interoperability, data infrastructure, interoperability, data analytics including security and privacy, and the design of technology around ecosystems and platforms. The overall aim of this study is to inform the dynamics around the improvement of scaling and increase the sustainability of innovations across the African region to strengthen health systems and promote innovation.

Implementing Team-Based Innovation in Primary Health Care in British Columbia

Improving health services integration for patients with complex needs is a national priority in Canada. Health systems in all provinces grapple with the rising complexity of patients and the services they need. Team-based primary health care (PHC) models have been implemented in diverse ways to improve patients' experiences, increase the coordination of care, improve population health and reduce costs. While some provinces have more than two decades of experience with PHC teams, others such as British Colombia (BC) have made changes more recently. We conducted an in-depth analysis of 12 provincial policy documents produced since 2011 to study the evolution of interprofessional models in PHC. BC has integrated team-based care through overarching policy support and funding from the provincial government. Structural practice changes to support team-based care, such as Primary Care Networks (PCNs), were designed to address the quadruple aim, a framework designed to improve health system performance through integrated primary care. Policies have addressed the vision and goals of team-based care, but discussion of processes that support teams, such as a strategy for capitation-based funding and team composition, were non-specific. Finally, there is a significant need for a provincial strategy for continuous quality improvement and evaluation of reforms.

Innovations in Primary Healthcare: A Review of Initiatives to Promote Maternal Health in Tamil Nadu

One of the key factors that has helped the state of Tamil Nadu to make significant progress in the health sector, especially in maternal health, is an enabling political environment in the state that has prioritised programmes for the welfare of women and children, irrespective of the party in power. This article reviews 10 key innovations in maternal health and tribal health introduced in the state of Tamil Nadu from 2005–2006 to 2020–2021. The specific questions addressed are as follows: what are the special innovative schemes introduced by the state of Tamil Nadu to promote maternal health? Whether and to what extent utilisation of public delivery system for maternal services has increased over the past 15 years or so? The overall impact of these initiatives on the maternal health of the state is assessed by analysing two indicators: trends in maternal mortality ratio (MMR) and financial burden due to delivery in public and private facilities. MMR in the state of Tamil Nadu is steadily falling—from 111 in 2004–2006 to 60 in 2016–2018. While average out-of-pocket expenditure (OOPE) during delivery in the public sector has increased from ₹2,454 in 2014 to ₹3,465 in 2017–2018, in the private sector, it has increased from ₹32,182 in 2014 to ₹34,635 in 2017–2018. OOPE in private facilities is nearly ten times higher than OOPE in public facilities, in both rural and urban areas. While the overall status of maternal health has improved significantly in the state, there are wide variations within and across districts. However, significant improvements in the overall health status can be achieved only if such inequities are reduced systematically, and efforts are being made to reduce such inequities.

Evaluation of a Dragons' Den-inspired symposium to spread primary health care innovations in Quebec, Canada: a mixed-methods study using quality-improvement e-surveys.

Background:On May 24, 2017, the Quebec College of Family Physicians held an innovation symposium inspired by the television show Dragons’ Den, at which innovators pitched their innovations to Dragon-Facilitators (i.e., decision-makers) and academic family medicine clinical leads. We evaluated the effects of the symposium on the spread of primary health care innovations.Methods:We conducted a mixed-methods evaluation of the symposium. We collected data related to Rogers’ innovation-decision process using 3 quality-improvement e-surveys (distributed between May 2017 and February 2018). The first survey evaluated spread outputs (innovation discovery, intention to spread, improvements) and was sent to all participants immediately after the symposium. The second evaluated short-term spread outcomes (follow-ups, successes, barriers) and was sent to innovators 3 months after the symposium. The third evaluated medium-term spread outcomes (spread, perceived impact) and was sent to innovators and clinical leads 9 months after the symposium. We analyzed the data using descriptive statistics, content analysis and joint display.Results:Fifty-one innovators, 66 clinical leads (representing 42 clinics) and 37 Dragon-Facilitators attended the symposium. The response rates for the surveys were 61% (82/134) for the immediate post-symposium survey of all participants; 68% (21/31) for the 3-month survey of innovators; and 49% (48/97) for the 9-month survey of clinical leads and innovators. Immediately after the symposium, clinical leads and Dragon-Facilitators reported a high likelihood of adopting an innovation (mean ± standard deviation 8.02 ± 1.63 on a 10-point Likert scale) and 87% (53/61) agreed that they had discovered innovations at the symposium. Nearly all innovators (95%, 20/21) intended to follow up with potential adopters. After 3 months, 62% (13/21) of innovators had followed up in some way. After 9 months, 72% of clinical leads (18/25) had implemented at least 1 innovation, and 52% of innovators (12/23) had spread or were in the process of spreading innovations.Interpretation:The innovation symposium supported participants in achieving the early stages of spreading primary health care innovations. Replicating such symposia may help spread other health care innovations.

Innovations in primary health care

This review is devoted to a number of important innovations and their role in modern medical practice of a family practitioner. We have discussed benefits, restrictions and controversies related to their use. We have also reviewed the evidence base on the practical implementation of these innovations. This review is devoted to a number of important innovations and their role in modern medical practice of a family practitioner. We have discussed benefits, restrictions and controversies related to their use. We have also reviewed the evidence base on the practical implementation of these innovations.

Universities as Partners in Primary Health Care Innovation.

Universities have a unique role in the health ecosystem as providers of trained staff and discoverers of health innovations. However, often they sit in silos waiting for their rare blockbuster discoveries to change clinical care or seeing health services simply as future employers of their graduates or clinical trial sites. It is a transactional and targetted relationship. This present case study is of a primary health service Access Health and Community (AccessHC) in Australia and its university partner Swinburne University of Technology. Together they established a Kickstart Program which was to provide seed funding for small joint innovation projects generated by both organisations. One project exemplifies the approach. Swinburne who has a Design School was encouraged through the Kickstart Program to design a clinical waiting room of the future. This project started with a needs analysis. The written report was to inform the design. University staff linked with their internal University animations expertise to better communicate the needs analysis. The “Access me Not” animation was created, unknown to the staff at AccessHC. At initial presentation, the way the animation communicated was not imaginable by AccessHC. “Access me not” was submitted for the 2018 International Design Awards and received an honourable mention. However, the AccessHC staff saw other uses for the approach and contacted Swinburne to design a client journey animation for the newly introduced National Disability Scheme (NDIS). The co design produced an animation of immense help to parents in navigating the scheme for complex and chronic disability care and for AccessHC the scripting served as a framework to develop it new internal NDIS care systems and processes. The Swinburne team is now producing health navigation animations for the State Department of Health and Human Services. The Kickstart Program was an engagement strategy that has produced a set of health communication tools that the health service could not have envisaged and which the University could not have imagined an application. Small low risk seed funding can indeed introduce innovations and create beneficial relationships between health services and universities.

Pandemic 2020: Economic pressure and evaluation of a primary health care innovation programme for type 2 diabetes mellitus treatment

Background: The COVID-19 pandemic has affected two vital sectors: the economy and health. Subsequently, people with type 2 diabetes mellitus (T2DM) face the dilemma of risking having a severe prognosis or non-compliance treatment. Aim: This study determines the relationship problems between the economic aspects and compliance behaviour in T2DM patients during the pandemic and how community health centres solve them. Methods: Data were collected from interviews with 20 T2DM patients and nine health workers in the Central Bogor region. The data were transcribed verbatim and analysed thematically. Results: Most patients tended to prioritise their economic condition. Besides, the community health centre has innovated an internet-based health service with particular policies to solve the problems. Conclusion: Economic pressure due to the COVID-19 pandemic has changed patients’ mindsets. Community health centres respond with particular policies to sustain patient treatment adherence.

Laboratory for innovation in Primary Health Care: implementation and results.

This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.

Innovation in Primary Healthcare in the Twenty-first Century

COVID-19 once again has shown the world the importance of an urgent need for revitalising the health system based on a strong primary healthcare foundation. It is clear that without a community-based grassroots level care delivery system, Test, Trace and Isolation may not be an effective operational possibility. Politics of health with consequent austerity programme and dependence on secondary hospital care–based system has proved to be ineffective and costly in meeting the changing demands for healthcare of the population. Demographic and epidemiological transition with the increasing burden of chronic care; unfinished agenda of Millennium Development Goals (MDGs) and the new challenge of achieving Sustainable Development Gaos (SDGs), including Universal Health Care; improving quality along with access to care; and addressing the existing inequity in healthcare service, politicians and public health leaders must realise and invest in people-centred, need-based primary healthcare. Significant and sustained productivity gains can be made through various innovations that can change how quality services are delivered and reduce inequity. In order for primary healthcare to become fit for purpose, it must improve its allocative, technical and service delivery efficiencies; effectiveness and responsiveness of care; access, quality and equity of care; and have an inbuilt monitoring and accountability framework. The system must create a conducive political, social and service delivery environment for innovations. Today, developing countries, as well as developed countries, are all strengthening their primary healthcare system through various innovations to maximise the use of scarce resources to reach all people who need care and minimising cost, wastage and inefficiencies.

Technosociality in the daily lives of primary care professionals and health promotion: scoping review

ABSTRACT This study aimed to map the available evidence on technosociality in the daily lives of primary care professionals to promote the health of people/families. This is a scoping review based on the Joanna Briggs Institute and Prisma-ScR. The PCC strategy (participants, concept and context) was used. The sample comprises 25 articles. The predominant language was English, the year, 2018, the strength of evidence, 5 and the quality of evidence, high and moderate. Technologies are part of the daily life of PHC professionals and include health control, curative and medication measures. They are sources of communication between professionals and professionals and users. For the use of technologies, it is essential that professionals are trained, using evidence-based practices to achieve the objectives in view of the needs of each one. The use of technologies to promote the health of people/families represents a technological innovation in Primary Health Care, with the possibility of impacting health conditions and promoting healthier life choices.

Practising person-centred care. Selected abstracts from the virtual 26th WONCA Europe conference, 6–10 July 2021

Background From 6 to 10 July 2021, WONCA Europe and the Dutch College of General Practitioners as host organiser welcomed 1,266 family physicians/general practitioners, teachers, researchers, and students from 66 countries interested in sharing knowledge, experience and innovations in primary healthcare. Methods In cohesive sets of plenary presentations, round table sessions, and research masterclasses, aspects of patient care, research, and education around Practicing Person-Centred Care were presented and discussed. Actual topics in primary care such as covid-19, e-health and professional health, were covered in oral presentation sessions, one slide 5-minutes presentations, case presentations by young doctors and the e-poster gallery. All sessions were recorded and available on-demand for registrants until three months after the conference. All accepted abstracts have been published in the abstract book [https://www.woncaeurope.org/page/past-conference-abstract-books]. For this Journal, we selected the top 20 abstracts based on reviewers scores (mean of 3.5 or higher on a scale of 4) and consensus among members of the Scientific Committee. Results The selected abstracts are divided into the following themes: (1) clinical topics often encountered in primary care, such as acute chest pain, urinary tract infections, dementia, and covid-19 (N = 5); (2) personalised care and related issues such as addressing multimorbidity (N = 2); shared decision making and patient empowerment (N = 4); (3) overdiagnosis and overtreatment, focusing on deprescribing (N = 2); (4) health promotion and prevention, including mental health (N = 2); (5) quality and safety (N = 2); (6) professional development and education (N = 1); (7) research and innovation, including teleconsultation (N = 2).

Primary Health-Care Innovations with Superior Allusion to Family Health Centers.

The present case study discusses about the Primary Health Care system of Kerala and the Government's innovative step to promote the Primary Health Centres to Family Health Centres. The case study also deliberates about the FHC working model and its superiority over the current PHCs in the areas of manpower, OP time, lab services, nursing services, social security projects etc. and the transformation of PHCs to a well-functioning PHC, thereby it can become a model for other states.

Changing nursing practice within primary health care innovations: the case of advanced access model

BackgroundThe advanced access (AA) model has attracted much interest across Canada and worldwide as a means of ensuring timely access to health care. While nurses contribute significantly to improving access in primary healthcare, little is known about the practice changes involved in this innovative model. This study explores the experience of nurse practitioners and registered nurses with implementation of the AA model, and identifies factors that facilitate or impede change.MethodsWe used a longitudinal qualitative approach, nested within a multiple case study conducted in four university family medicine groups in Quebec that were early adopters of AA. We conducted semi-structured interviews with two types of purposively selected nurses: nurse practitioners (NPs) (n = 6) and registered nurses (RNs) (n = 5). Each nurse was interviewed twice over a 14-month period. One NP was replaced by another during the second interviews. Data were analyzed using thematic analysis based on two principles of AA and the Niezen & Mathijssen Network Model (2014).ResultsOver time, RNs were not able to review the appointment system according to the AA philosophy. Half of NPs managed to operate according to AA. Regarding collaborative practice, RNs were still struggling to participate in team-based care. NPs were providing independent and collaborative patient care in both consultative and joint practice, and were assuming leadership in managing patients with acute and chronic diseases. Thematic analysis revealed influential factors at the institutional, organizational, professional, individual and patient level, which acted mainly as facilitators for NPs and barriers for RNs. These factors were: 1) policy and legislation; 2) organizational policy support (leadership and strategies to support nurses’ practice change); facility and employment arrangements (supply and availability of human resources); Inter-professional collegiality; 3) professional boundaries; 4) knowledge and capabilities; and 5) patient perceptions.ConclusionsOur findings suggest that healthcare decision-makers and organizations need to redefine the boundaries of each category of nursing practice within AA, and create an optimal professional and organizational context that supports practice transformation. They highlight the need to structure teamwork efficiently, and integrate and maximize nurses’ capacities within the team throughout AA implementation in order to reduce waiting times.

Challenges and innovations in Primary Health Care in the Amazon: A Scoping Review

Abstract Background The Amazon region crosses the territorial borders of nine countries with a vast complexity of ecological and social relations. Outside of large and medium cities, this region comprises a mosaic of ranches, villages, farms, isolated houses and small towns scattered over a vast territory, in large part accessed only by waterway. Working with health in this region requires specific strategies that respect the dynamics of this place. This research aimed to reveal the challenges and innovations of Primary Health Care (PHC) in places outside the largest cities in the Amazon. Methods The scoping review methodology was applied to peer-reviewed articles. Six databases were searched to identify scientific papers published in English, Spanish and Portuguese between January 2000 and November 2019. The analytical strategy was to combine descriptive statistics and qualitative content analysis to extract from each article all the content related to the research questions. Results This review included 26 papers. The most frequent challenges reported in the studies were related to the way of working (8), specific training for professionals (5), leadership and governance (4) and infrastructure improvement (2). A smaller number of studies were dedicated to innovative experiences, which approached training and methodologies for health agents recruited in the communities (4), technologies to the services (2) and a river unit as a model to work in Amazon(1). Conclusions The challenges presented in this review indicate the need to build services that are more sensitive to Amazonian locations and the need to train professionals for this region. Also, it revealed innovations with positive impacts which can be taken as key lessons regarding the functioning of PHC in the Amazon. Key messages This research fills a knowledge gap about PHC in the Amazon. The challenges and innovations presented in the review provide insights to assist PHC policy makers and managers with the design and delivery of health services in the Amazon.

Innovation in Primary Healthcare

Health systems everywhere are facing significant challenges – demand pressures from an ageing population, a rise in chronic health conditions, and greater community expectations as more new health treatments are developed. There are three possible responses to this: increasing health funding (increasing inputs), rationing health services (restricting outputs) or increasing productivity through innovation (doing things differently and more efficiently). This article looks at innovation in New Zealand’s primary healthcare sector and recent attempts to measure its impact across the health system.

Applying the consolidated framework for implementation research to identify barriers affecting implementation of an online frailty tool into primary health care: a qualitative study

BackgroundFrailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls. Frailty can be better managed with early screening and intervention, ideally conducted in primary health care (PHC) settings. This study used the Consolidated Framework for Implementation Research (CFIR) as an evaluation framework during the second stage piloting of a novel web-based tool called the Frailty Portal, developed to aid in the screening, identification, and care planning of frail patients in community PHC.MethodsThis qualitative study conducted semi-structured key informant interviews with a purposive sample of PHC providers (family physicians, nurse practitioners) and key PHC stakeholders who were administrators, decision makers and staff. The CFIR was used to guide data collection and analysis. Framework Analysis was used to determine the relevance of the CFIR constructs to implementing the Frailty Portal.ResultsA total of 17 interviews were conducted. The CFIR-inspired interview questions helped clarify critical aspects of implementation that need to be addressed at multiple levels if the Frailty Portal is to be successfully implemented in PHC. Finding were organized into three themes 1) PHC Practice Context, 2) Intervention attributes affecting implementation, and 3) Targeting providers with frail patients. At the intervention level the Frailty Portal was viewed positively, despite the multi-level challenges to implementing it in PHC practice settings. Provider participants perceived high opportunity costs to using the Frailty Portal due to changes they needed to make to their practice routines. However, those who had older patients, took the time to learn how to use the Frailty Portal, and created processes for sharing tasks with other PHC personnel become proficient at using the Frailty Portal.ConclusionsStructuring our evaluation around the CFIR was instrumental in identifying multi-level factors that will affect large-scale adoption of the Frailty Portal in PHC practices. Incorporating CFIR constructs into evaluation instruments can flag factors likely to impede future implementation and impact the effectiveness of innovative practices. Future research is encouraged to identify how best to facilitate changes in PHC practices to address frailty and to use implementation frameworks that honor the complexity of implementing innovations in PHC.

Remembering Alma-Ata: challenges and innovations in primary health care in a middle-income city in Latin America.

ABSTRACTThe year 2018 is an opportune time to explore health system reforms and primary health care (PHC) in Brazil, given the anniversaries of the Alma-Ata Declaration (40 years) and of the Constitution of Brazil (30 years), the basis of the Unified Health System (SUS). In this context, health system analysis in the municipal setting is an important instrument for acknowledging achievements and innovations, as well as weaknesses and threats. Due to the principle of decentralization of SUS, municipalities have assumed a leadership role in health policy development and implementation. The cities also come first in expressing the failures of the health system and the consequences of austerity measures. Thus, analysis of health system transformations at the municipal level are fundamental to studying PHC achievements and gaps.This report identifies the challenges and innovations of PHC implementation in Curitiba, beginning with a brief history of the city's health system development. The city was a pioneer in linking urban planning with health system design, improving access to health care, and obtaining better health outcomes over the past 30 years. This report covers those years, as well as the challenges and strategies implemented during the most recent political cycle (2013 – 2016). There are substantial lessons that can be garnered from the experience of this middle-income city in Latin America, lessons that may be useful as the region moves toward the Sustainable Development Goal of Universal Health Coverage by 2030.

In This Issue: Social Context; Disease Causes

This issue of Annals provides new insights into the social and systems context of practice, and the etiology of disease. In this issue we also call for diverse readers to help foment a revolution by sharing on-the-ground innovations in primary health care.[1][1] The degree to which mobile