Integration Of Primary Health Care Research Articles

Evaluation of Mental Health Integration in Primary Health Care in View of Participants and Rural Health Workers of Dezful, Khuzestan

Results: The amount of physicians’ knowledge was about 50%, while the rate of health workers’ knowledge was 62%. The rate of health workers’ attitude was 92%, while the rate of participants’ knowledge was 50% and the rate of participants’ attitude was 19%. Consequently, the integration of mental health in primary health care system of rural areas of Dezful district has been relatively successful. Conclusions: The integration of mental health into primary health care is an important priority in the Iranian health system. Monitoring and evaluation of this strategic project to remove its weaknesses is essential.

A lesson learned from Middle East respiratory syndrome (MERS) in Saudi Arabia

Middle East respiratory syndrome (MERS) caused by novel Corona virus hit Kingdom of Saudi Arabia (KSA) and resulted in hundreds of mortality and morbidity, fears and psychosocial stress among population, economic loss and major political change at Ministry of Health (MoH). Although MERS discovered two years ago, confusion still exists about its origin, nature, and consequences. In 2003, similar virus (SARS) hit Canada and resulted in a reform of Canada's public health system and creation of a Canadian Agency for Public Health, similar to the US Centers for Disease Control (CDC). The idea of Saudi CDC is attractive and even “sexy” but it is not the best option. Experience and literature indicate that the best option for KSA is to revitalize national public health systems on the basis of comprehensive, continuing, and integrated primary health care (PHC) and public health (PH). This article proposes three initial, but essential, steps for such revitalization to take place: political will and support, integration of PHC and PH, and on-job professional programs for the workforce. In addition, current academic and training programs for PHC and PH should be revisited in the light of national vision and strategy that aim for high quality products that protect and promote healthy nation. Scientific associations, medical education research chair, and relevant academic bodies should be involved in the revitalization to ensure quality of process and outcomes.

Making Integrated Care a Reality: Lessons Learned From Heartland Health Outreach's Integration Implementation

The health care challenges of people experiencing homelessness are complicated and complex. Programs that provide integrated primary and behavioral health care may best treat this population's medical, mental health, and substance use problems. However, these services are often siloed within and across organizations, resulting in uncoordinated care. Using the conceptual framework proposed by Heath and colleagues (2013), we describe the successful primary and behavioral healthcare integration implementation efforts of Heartland Health Outreach, a national leader in health care services for people experiencing homelessness. Factors that help and hinder integration implementation and lessons learned are discussed.

A hidden jewel: social work in primary health care practice in Aotearoa New Zealand.

The New Zealand (NZ) Ministry of Health's Primary Health Care Strategy (2001) has an overall vision of better health for all and the reduction of health inequalities between different population groups. This goal can be achieved by comprehensive, integrated primary health care (PHC) service delivery. One useful approach is to place social workers within PHC practices. This study aimed to explore the perceptions about, and the experiences gained by, such integrated social workers regarding their contributions towards the PHC vision. This qualitative study focused on three participant groups, namely social workers, PHC professionals and key informants. Overall, 18 one-to-one, semi-structured interviews were undertaken in various locations in NZ. Key themes were identified via a general inductive approach. Three key themes emerged from the data: wider factors, organisational factors and social work factors. The last theme encompassed the social workers' professional understanding, knowledge and approaches. The organisational factors (a community needs focus and provision of a supportive work environment) and the wider factors identified (funding and issues experienced by communities) had variable impact on these social work positions. Participants viewed social workers as facilitating appropriate access to and engagement by people with services; enhancing ongoing, coordinated, safe service provision; and contributing to staff development. The potential of the social work profession within PHC practices was well recognised by non-social worker participants. This study provides initial insights into the unique contributions made by social workers towards achieving NZ Ministry of Health's PHC vision.

Achieving primary care integration: Learning from the co-location of community health services and general practice in Northern New South Wales, Australia

Introduction: This paper describes an initiative to incorporate Community Health Services into General Practice based care across the New South Wales North Coast Medicare Local (NCML) region which has arisen as a result of recognised weaknesses in primary health care integration in the region. Short description of practice and context: The project involves 8 demonstration sites exploring the integration of specialist allied health and nursing staff into general practice teams. The teams are based in sites across the Northern New South Wales Local Health District (NNSWLHD). Description of change implemented: The project aimed to achieve the following changes: Improved patient experience in receiving the required multidisciplinary care they need; improved integration of care from the patient and clinician perspectives; facilitate skills transfer between specialist allied health and nursing staff and the general practice team and vice versa; test the feasibility of partnership arrangements for co-location of LHD allied health in private general practice; evaluate these project goals to inform decisions on wider adoption or adaptation of this form of service integration; practice participation in team care plan reviews and case conferencing; establish shared governance between NCML and LHD with Community Allied Health Manager involvement. Objective of the change: This paper describes the contexts, barriers and facilitators for achieving primary care integration in an Australian, regional, primary health care context. Targeted population: The patient population is people with chronic illness. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116608– http://www.ijic.org/ Stakeholders engaged: Stakeholders included clinicians and managers from the host organisations, university partners. Timeline: The pilot project runs from April 2014 until April 2015 Theory/Methods used: The nature and extent of integration between organisations is examined in terms of cooperation, coordination and collaboration, or the “3Cs”, matching the level of relationship, commitment and intervention to suit the purposes sought. The evaluation draws on the principles of realistic evaluation, which explores what works for whom in what circumstances. Highlights (innovation, impact and outcomes): This project unpacks the complexity of integrating services from different jurisdictions and funding models with the goal of optimising access and outcomes for service users. Comments on sustainability / transferability: The context of primary care is likely to change, however we identify a series of principles that can be used to enhance primary care integration in the Australian context. Conclusions (comprising key findings): Primary care service integration required buy-in from general practitioners, change in nursing and allied health practice, and the introduction of new systems to support the integration. There is evidence of increased skill-sharing and case conferencing across practitioners, and better patient-centred models of care. Discussions / Lessons learned: Complex service change requires high level support, but with grass-roots engagement from practitioners.

Participatory health research within a prison setting: a qualitative analysis of 'Paragraphs of passion'.

The purpose of this research was to engage, empower and enhance the health and well-being of incarcerated women. The integration of primary health care, community-based participatory research, a settings approach to health promotion, and transformative action research guided the design of this study. A partnership between incarcerated women who became peer-researchers, correctional staff, and academic researchers facilitated the equitable contribution of expertise and decision-making by all partners. The study was conducted in a short sentence (two years or less), minimum/medium security Canadian women's correctional centre. Of the approximately 200 women that joined the research team, 115 participated in writing a 'paragraph of passion' while incarcerated between November, 2005 and August, 2007. Participatory, inductive qualitative, narrative and content analysis were used to illuminate four themes: expertise, transformation, building self-esteem, as well as access and support. The women organized monthly health forums in the prison to share their new knowledge and life experience with other incarcerated women, correctional staff, academics, and community members, and in doing so have built bridges and relationships, some of which have lasted to the present day.

Interprofessional curriculum on environmental and social determinants of health in rural Kenya: Aga Khan University East Africa-University of California San Francisco Integrated Primary Health Care Program

Interprofessional curriculum on environmental and social determinants of health in rural Kenya: Aga Khan University East Africa-University of California San Francisco Integrated Primary Health Care Program

An Organisational Level Approach to Integrated Care: Models and Mechanisms

Introduction: A major challenge for any health system is to enable health care to be integrated across different service providers in diverse organizations. A number of models of integration in have been developed to facilitate integrated care. This study aimed to identify the models of integrated primary health care and the mechanisms contained within effective models. Methods: A literature review was undertaken using a range of electronic databases and websites. A snowballing technique was used to identify additional material. Results: Common mechanisms in the Australian and International models of organizational level integration in primary health care included: partnerships, memoranda of understanding, alliance contracting, co-location and communication strategies. Discussion: The siloed structures of the past, built in part to preserve professional autonomy, are often difficult to align with the inter-professional and inter-organizational approaches required by systems thinking. However, while many challenges exist, there are also several promising approaches to enabling integration across primary health care organizations, both in Australia and elsewhere.

Primary health care as a philosophical and practical framework for nursing education: Rhetoric or reality?

At least three decades after primary health care (PHC) took nursing by storm it is time to re-examine the philosophical shift to a PHC framework in pre-registration nursing curricula and overview factors which may hinder or promote full integration of PHC as a course philosophy and a contemporary approach to professional practice. Whilst nurse education has traditionally focused on preparing graduates for practice in the acute care setting, there is continuing emphasis on preparing nurses for community based primary health roles, with a focus on illness prevention and health promotion. This is driven by growing evidence that health systems are not responding adequately to the needs and challenges of diverse populations, as well as economic imperatives to reduce the burden of disease associated with the growth of chronic and complex diseases and to reduce the costs associated with the provision of health care. Nursing pre-registration programs in Australia and internationally have philosophically adopted PHC as a curriculum model for preparing graduates with the necessary competencies to function effectively across a range of settings. Anecdotal evidence, however, suggests that when adopted as a program philosophy PHC is not always well integrated across the curriculum. In order to develop a strong and resilient contemporary nursing workforce prepared for practice in both acute and community settings, pre-registration nursing programs need to comprehensively consider and address the factors impacting on the curricula integration of PHC philosophy.

Medical Practices and Attitudes of Dual-Licensed Medical Doctors in Korea

Unique dual medical system in Korea has resulted in the emergence of dual-licensed medical doctors (DLMDs) who have both traditional Korean medicine (KM) and Western medicine (WM) licenses. There have been few studies on DLMDs in spite of their growing number and importance within the medical system. We surveyed the current status and attitudes of DLMD to assess their role in integrative medicine. Questionnaires were administered to the members of the association of DLMD. Data from 103 DLMD were collected and statistically analyzed. 41.4% of DLMD were copracticing both WM and KM at a single clinic, preferring the WM approach for physical examinations, laboratory tests, and education for patients—and the KM approach for treatment and prescription. Musculoskeletal, gastroenterologic, and allergic diseases were considered to be effectively treated with co-practice. DLMD highly agreed on the efficiency of copractice for disease control and patients' satisfaction. On the other hand, they regarded the lack of health insurance coverage for copractice and increased medical expenditure as major problems in providing co-practice. To expand the role of DLMD as mediators of integration in primary health care, the effectiveness of their co-practice should be evaluated and a corresponding health insurance reimbursement system should be established.

Integration of Primary Health Care and Public Health During a Public Health Emergency

We have provided a detailed evaluation of how collaboration between an Ontario public health unit and its primary care providers facilitated an optimal response to the 2009 H1N1 influenza pandemic. Family health teams (integrated, interdisciplinary teams that provide a range of care options) provided flu assessment centers, with public health as a partner providing infection control advice, funding, coordination, antiviral medication, clinical care guidelines, supplemental nurse staffing, and arrangement of communication strategies with the public. The family health team structure offers a new capacity for timely, coordinated, and comprehensive response to public health emergencies, in partnership with public health, and provides a promising new direction for healthcare organization.

A model for the integration of primary health-care services in the province of KwaZulu-Natal, South Africa

To analyse integrated primary health care and ultimately develop a model for integrated care. In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization. However, the problem with the policy arises in the implementation of integrated primary health care as there is no agreed understanding of what this phenomenon means in the South African context. A cross-sectional study, using Strauss and Corbin's grounded theory approach was utilised. Policy makers as well as primary health care nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews comprised 38 participants. Integrated primary health care was understood either as comprehensive health care, supermarket approach or one-stop shop. It was concluded that integrated primary health care meant different things in different contexts. Integrated primary health care, if implemented, would advance health equity in all countries rich and poor and, as a result, promote human and national development. This model could be used to guide policy formulation and implementation of integrated primary health care at provincial and national levels.

Working toward financial sustainability of integrated behavioral health services in a public health care system.

The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

Depression Screenings during Routine Visits in a Reproductive Healthcare Setting: Identifying Depressive Symptoms in African American Adolescent Males

Depression is a disorder which affects many youth, and only one third of adolescents receive mental health treatment for their depression. Yet, approximately 90% of adolescents visit their primary care providers on average 2 - 3 times per year. This number suggests the important role that primary care settings can play regarding the early diagnosis and treatment of depression during adolescence. This paper presents findings of clinically significant depressive symptoms in African American male adolescents receiving routine health care services within an adolescent reproductive health clinic. The adolescent reproductive health clinic is housed within a large urban, university-affiliated teaching hospital. 49 African American male adolescents (ages 13 to 19) completed the Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 1977), a brief depression screening questionnaire, as a part of their clinic visit. Results revealed higher rates of depressive symptoms in this subsample of African American male adolescents when compared to estimated prevalence rates of depression for adolescents as reported by large-scale studies and meta-analysis data. This supports the notion that primary and reproductive healthcare settings are viable settings for the identification of depressive symptoms, particularly among low-income, African American male adolescents. Risk factors, symptom presentation, and mental health stigma associated with this population are discussed. Psychosocial interventions and recommendations for the integration of primary healthcare and behavioral health consultation services are presented.

Community of Practice: A Nurse Practitioner Collaborative Model

A study was undertaken with nurse practitioners (NPs) in 2008-2009 to examine post-legislation role development in British Columbia. The authors used a participatory action research approach to engage NPs in social investigation, education and action, and to explore, from the participants' perspective, how collaboration advances NP role integration in primary healthcare. A particular discovery of the study was the Interior Health Authority Community of Practice (CoP) established in collaboration with health leaders and NPs. The purpose of this paper is to report on the CoP and the five characteristics describing this collaborative CoP model, including sanctioned social structure, knowledge exchange network, practice discovery and innovation, generating meaning and value, and power sharing for strategic improvement. The CoP helped NPs to build collegial and collaborative relationships, enhance practice learning and competence, extend and apply new knowledge, enrich professional identities, and shape health organizational policy and politics. Because healthcare research about CoPs is limited, principles of a collaborative CoP model are offered for broader healthcare use. The authors conclude that a collaborative CoP model addresses the internal interests and needs of participating members while attending to the external concerns of the organization, and thus contributes to healthcare improvement.

Immunization and equity in the Regional Initiative of the Mesoamerican Health Initiative

National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.

Integration of Primary Health Care & Wellness Services Into a Community Mental Health Center

Integration of Primary Health Care & Wellness Services Into a Community Mental Health Center

Creating synergies for health systems strengthening through partnerships in Pakistan - a case study of the national eye health programme

Blindness and visual impairment are major causes of noncomrnunicable diseases in Pakistan. Two national population-based blindness surveys conducted in 1988 and 2002-04 demonstrated a reduction in prevalence of blindness from 1.78% to 0.9% with a significant drop in cataract blindness as a result of accelerated nationwide interventions and eye care integration in primary health care. In addition, between 2006 and 2008, 88 facilities were upgraded as a result of the national eye health programme. These measures resulted in a 279% increase in eye outpatient attendances and a 375% increase in eye surgeries performed. Investment in human resources development and policy change contributed significantly to the sustainability of the programme. Key challenges facing the programme include aligning national eye health strategies with health system strengthening informed through health systems research. This paper attempts to document this extraordinary success.

Socio-demographic data sources for monitoring locality health profiles and geographical planning of primary health care in the UK

Aim: the aim of this article is to provide UK-based primary health care research and development workers with a review of the current range of published, aggregated socio-demographic indicators that can be combined with health and health care datasets, for the purposes of monitoring locality health profiles and planning primary health care. Non-UK readers should nevertheless find the review of some relevance to their own national contexts. Background: there is an increasing range of resources available for such purposes and many of these datasets are equally useful outside of geographic work. The 2001 census introduced important changes to what routine data are available, as will the 2011 census. These changes have been paralleled by developments in the availability of socio-demographic indicators and the increasing popularity of geographic information systems. Health data can now be combined with those from socio-demographic more efficiently to produce what are termed value-added datasets. Methods: we review recent and planned developments in key data sources currently available in the UK and examine they can be used to monitor inequalities in primary health care inequalities and their role in the integration of primary health care needs mapping and forecasting with the spatial planning of areas undergoing regeneration. Conclusions: recent and planned developments in the availability of both socio-demographic datasets in tandem with parallel developments in spatial technologies have provided a flexible, potent geographical methodology for primary health care research and development. The current consultation process for the 2011 census provides those involved with primary health care research and development an opportunity to influence future developments

Primary health care: applying the principles within a community-based participatory health research project that began in a Canadian women’s prison

the purpose of this research was to determine the feasibility of engaging incarcerated women in community-based participatory research and to identify, by and with the women, the health concerns to be addressed. the integration of primary health care, community-based participatory research, a settings approach to health promotion and transformative action research guided the overall design of this study. Incarcerated women, correctional centre staff and academic researchers participated collaboratively. Setting. The study was conducted in the main short sentence (two years or less) minimum/medium security women's correctional centre in a Canadian province. In-depth interviews were conducted with 16 incarcerated women; in-depth group interviews were facilitated with 16 correctional centre staff. Twenty-one themes, which emerged from participatory, inductive and content analysis of the data, were presented at a face-to-face meeting attended by 120 incarcerated women, 10 correctional centre staff and 5 academic researchers. Underlying values and principles for the project were identified prior to a discussion of the results. During the course of this meeting, the themes were converged into five major categories: addictions and mental health; HIV, hepatitis and infections; health care in prison; life skills and re-entry into society (including homelessness and housing); and children, family and relationships. Numerous suggestions for health interventions and participatory projects were generated, each relating to one of the five major categories. this study was unique in that, to our knowledge, no other studies have utilized community-based participatory research methods in which incarcerated women played a role in designing the research questions and tools, collecting the data, analyzing the data, interpreting the data and authoring the publications and presentations. This study demonstrated that it is feasible for incarcerated women to engage in developing and utilizing community-based participatory research methods and that these methods can be grounded in a settings approach to whole prison health promotion.