Primary Health Care Management Research Articles

Low back pain management in primary healthcare: findings from a scoping review on models of care

IntroductionModels of care (MoCs) describe evidence-informed healthcare that should be delivered to patients. Several MoCs have been implemented for low back pain (LBP) to reduce evidence-to-practice gaps and increase the...

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners.

Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

Utilizing Group Model Building to Identify Barriers and Facilitators of Hypertension Management in Primary Health Care, China.

Group Model Building (GMB) is a qualitative method that refers to a participatory process. This project aims to identify barriers and facilitators of hypertension management in primary health care in China, through which, the leverage point for intervention may be found. The GMB was used to identify the factors influencing hypertension management. Graphs over time and causal loop diagram (CLD) were main tools of GMB. To propose the influencing factors, key stakeholders were invited to participate in a workshop. During the workshop, stakeholders were encouraged to plot the graphs over time of the variables about research issues and give a descriptive explanation. And based on this, a CLD was initially developed to establish a model of the interaction of factors. After the workshop, the research group further improved the CLD through repeated mutual discussions, and gave feedback to the participants. The Vensim PLE 9.0 software package was used to build CLD. A total of 14 key stakeholders were invited to participate in the workshop. Finally, 26 influencing factors were identified, which were divided into three dimensions, including the institutional, the community health workers (CHWs), and the patient level. And 5 reinforcing loops and 4 balancing loops were formed in the CLD. Promoting the building of the Medical Community/Regional Medical Association, implementing the family doctor contract service (FDCS), and enhancing the motivation of CHWs may be potential leverage points for hypertension management in China. By using GMB, we have identified key factors in the management of hypertension in primary health care and provided comprehensive suggestions to overcome the obstacles.

Tetanus Update: Latest Diagnosis and Management

Tetanus still contributes to a large number of deaths with a case fatality rate (CFR) of 11.76% in 2019. The increase in the number of cases and inadequate reporting are the reasons why tetanus management remains an important part of reducing patient mortality. Tetanus almost always occurs in patients who are not immune, partial or immune is inadequate. The diagnosis is made only from clinical manifestations, where the rigidity and spasm can be generalized (including neonatal tetanus) or local. Management of tetanus is divided into general management - with the administration of human tetanus immunoglobulin (HTIG) or serum anti-tetanus (ATS), antibiotics, magnesium, and wound care - and special management - which conforms to Ablett's classification system: mild, moderate, severe, and very heavy. Meanwhile, management in primary health care still adjusts the guidelines given by taking into account the availability of drugs. Prevention is carried out by giving immunizations to pregnant women, neonates and babies, as well as giving a booster every time an injury occurs.

Barriers Impact the Primary Healthcare Providers When Dealing With Emergency Cases: A Cross-Sectional Study in Al-Ahsa, Saudi Arabia.

Introduction Being the first in-line care providers, primary healthcare (PHC) physicians may encounter all forms of medical emergencies, ranging from minor complaints to major life-threatening events; therefore, this study aims to assess the PHC physicians' knowledge and attitude related to the diagnosis and management of emergency cases as well as their preferences for emergency medicine training courses and their preferred methods of training. Methods A descriptive cross-sectional study was conducted among physicians working at PHC in Al-Ahsa, Saudi Arabia, between November and December 2023, excluding those who do not work at PHC. The minimum required sample size was 192. A self-administered online questionnaire was developed using Google Forms and distributed conveniently through social media platforms. It consists of 22 items categorized into four sections:The first section focused on demographic information; the second section assessed knowledge related to the diagnosis and management of emergency cases commonly encountered in PHC, along with actual management experiences; the third section gauged physicians' attitudes, and the fourth section explored participants' preferences for emergency medicine courses and their preferred methods of training in this field. The Kruskal-Wallis rank sum and Wilcoxon rank sum tests were employed to identify predictors of knowledge and attitude. Results The study involved 193 participants, with 96 (50%) females and a median age of 30 years. The participants included 43 (22%) consultants, 69 (36%) family residents, 30 (16%) general practitioners, and 50 (26%) specialists. Participants reported a median of 4.0 years of experience in PHC in Saudi Arabia. The majority, 69 (36%), reported working in the hospital emergency department, with a reported median duration of three months. Roughly 84% of PHC physicians had a positive attitude toward emergency cases diagnosis and management, while 92% showed fair diagnostic knowledge of emergency cases, and 73% showed fair management knowledge. Higher knowledge in the diagnosis and management of PHC was linked to increasing age, being consultants, being employed in the emergency department, and having higher years of experience in PHC (p < 0.05). A positive attitude towardPHC was found to be associated with working as a consultant and being employed in the emergency department (p < 0.05). Approximately 133 (68.9%)expressed a preference for a course in wound care trauma, followed by central nervous system emergencies (n = 124, 64.2%), coronary artery disease emergencies (n = 116, 60.1%), and obstetrics/gynecologic emergencies (n = 114, 59.1%) with 160 (82.9%) favored training through practice in PHC under supervision of qualified staff. Conclusion While many PHC centers are well equipped and prepared for early stabilization and management of emergency cases, PHC physicians showed low competency in dealing with emergency cases. This indicates a great need for enhancing physician's knowledge and skills regarding emergency situations. Nevertheless, courses like basic life support (BLS) and advanced trauma life support (ATLS) should be the bare minimum requirements for PHC physicians. Mote advance training and lectures should be organized to enhance PHC physician competencies to deal with different emergencies.

Barriers and facilitators to the delivery of age-friendly health services in Primary Health Care centres in southwest, Nigeria: A qualitative study.

With the rapid growth of Nigeria's older population, it has become important to establish age-friendly healthcare systems that support care for older people. This study aimed to explore the barriers and facilitators to the delivery of age-friendly health services from the perspectives of primary healthcare managers in Lagos State, Nigeria. We conducted 13 key informant interviews including medical officers of health, principal officers of the (Primary Health Care) PHC Board and board members at the state level. Using a grounded theory approach, qualitative data analysis was initially done by rapid thematic analysis followed by constant comparative analysis using Dedoose software to create a codebook. Three teams of two coders each blind-coded the interviews, resolved coding discrepancies, and reviewed excerpts by code to extract themes. The main barriers to the delivery of age-friendly services included the lack of recognition of older adults as a priority population group; absence of PHC policies targeted to serve older adults specifically; limited training in care of older adults; lack of dedicated funding for care services for older adults and data disaggregated by age to drive decision-making. Key facilitators included an acknowledged mission of the PHCs to provide services for all ages; opportunities for the enhancement of older adult care; availability of a new building template that supports facility design which is more age-friendly; access to basic health care funds; and a positive attitude towards capacity building for existing workforce. While we identified a number of challenges, these offer opportunities to strengthen and prioritize services for older adults in PHCs and build on existing facilitators. Work is needed to identify and test interventions to overcome these challenges and improve the responsiveness of the PHC system to older adults through the delivery of age-friendly health services in PHCs in Lagos, Nigeria.

The assessment of readiness to change among head managers of primary healthcare centers in Makkah, KSA

BackgroundKSA is currently undergoing significant changes in its healthcare system, with a particular emphasis on enhancing the role of primary healthcare centers (PHCs) to elevate patient experience and overall healthcare quality. At the forefront of this transformation are head managers in PHCs, who play a crucial role in implementing these changes effectively. The readiness of these managers is paramount to the successful execution of the envisioned transformation and the subsequent improvement of patient experience. ObjectiveThis study aims to assess the readiness to change among head managers of primary healthcare centers in Makkah, KSA. MethodologyCross-sectional study utilized the ADKAR model questionnaire, consisting of 22 Likert scale questions, to assess PHCs head managers' awareness, desire, knowledge, ability, reinforcement, and overall change readiness. ResultsThe study found a significant association between higher educational levels and increased awareness (β = 0.214, p = 0.030), along with greater desire (β = 0.207, p = 0.029) among primary healthcare (PHC) managers. Additionally, a positive association was found between age (≥41 years) and knowledge among PHC managers (β = 0.138, p = 0.030). However, managers with 11 or more years of experience showed a negative association with change readiness (β = −0.112, p = 0.001). ConclusionThe ADKAR model outlines five dimensions that are useful for identifying the readiness and willingness of head managers in PHCs in Makkah cluster to undergo change. Assessing change readiness is crucial for organizational transformation, with head managers playing a significant role. Factors such as age, education, and experience influence managers' readiness for change in primary healthcare centers (PHCs) in Makkah.

Dysmenorrhoea: An update on primary healthcare management.

Dysmenorrhoea is the most common gynaecologic condition affecting people assigned female at birth and has significant effects on immediate and long‑term quality of life. Effective treatments are widely available at lowcost but often have poor uptake. Thereisgrowing evidence that a significant proportion of people with severe dysmenorrhoea will develop otherpersistent pain syndromes anddysmenorrhoea might be a key contributor to the development of thoseconditions. The aim of this article is to provide an update on dysmenorrhoea and its management in a primary care setting, including evaluation and treatment. Treatment decisions should incorporate shared decision making and account for the preferences and goals of the patient, including fertility plans. First-line treatments include non-steroid anti-inflammatory drugs and hormonal therapies. Various non-pharmacologic therapies and lifestyle modifications can complement first-line medical therapies or be used as alternatives when medical therapies are contraindicated or declined.

Nursing care management in primary health care

Background: Nursing management in PHC is essential to achieve quality care and patient satisfaction. Objective: Analyze the management of nursing care in Primary Health Care. Methods: Qualitative and descriptive approach, semi-structured interviews were carried out with a group of male and female nurses who work at the PHC level. The interviews focused on exploring their perceptions and experiences in relation to nursing management. The data obtained were analyzed using content analysis to identify emerging themes and patterns. Results: They revealed several interesting perspectives on nursing management in the context of PHC, solid cognitive and attitudinal competencies to face the challenges of work, and highlighted the need to practice compassion as an integral part of nursing care in this environment. Conclusions: It is vitally important to strengthen and support nursing staff in the management of primary health care, emphasizing the need to promote training and professional development in these areas to improve the quality of care and outcomes. health in the Primary Health Care.

Challenges of using evidence in managerial decision-making of the primary health care system

BackgroundManagerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes.MethodA systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed.ResultsA total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement.ConclusionThe primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.

Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals

Objective Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored. Design This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research. Setting and participants The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals. Results Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice. Conclusion To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation. Trial registration ClinicalTrials.gov NCT04799860

Adaptability of Integrated Community Care models in Moldova to overcome compounded crisis, including supporting refugees.&amp;nbsp;

Introduction: The Healthy Life Project in Moldova works and collaborates with local authorities across all sectors, including civil society organisations, community members and NCD patients to promote integrated, person-centered care. The aim is to ensure vulnerable people, including refugees, have access to health and social care. Overall, Moldova has received nearly 698,000 Ukrainian refugees, of which 96,646 currently remain in the country.&#x0D; Methods: Through intersectoral capacity building community teams developed local integrated care work plans, including joint assessments of people with NCDs and coordinated individual care across different sectors and community resources. The plans also involved a focus on responding to the needs of Ukrainian refugees. Within this continued implementation support, the project included questions of access to health and social care along the migratory cycle to maintain management of chronic conditions. Around 97% of refugees are residing in the host community, most of them require particular support in accessing their rights in practice, being women (59%), children (48%) and the elderly (21%).&#x0D; Results: Request for health care services from refugees (28,30%) is one of the forms of assistance expected in addition to cash handouts (76,84%) and in-kind support (35,79%). Therefore, in addition to building capacities for monitoring and management of NCDs, and the application of integrated care, the project considered specific actions for refugees. Training on managing NCDs within the refugee crisis was provided to Primary Health Care (PHC), hospital, Public Health, and emergency care management teams in 20 districts. To support and ensure mobility of PHC practitioners in responding to increased community needs due to hosted refugees, 835 medical kits were purchased and distributed, alongside protective equipment and disinfectants for both the health and social workers. A guide for community social workers on supporting refugees was developed in partnership with the National Social Assistance Agency and has since been embedded in the curricula of the social assistance faculty within the State Pedagogical University. &#x0D; During 2022, 20 integrated community care centers have reached 8,464 persons with NCDs, with 77% having their wellbeing jointly assessed by a community nurse and social worker. As a result, most of them were included in preventive measures and supported to manage NCDs (7851 persons). The most vulnerable were identified and assisted, including 15% of NCD patients (675 persons) and supported to gain access to social benefits, while people with complex needs (663 persons) received access to home health and social care. Considerable progress has been made to promote integrated working locally, between health and social care. As everywhere, collaboration is reliant on personal motivation and local relationship building, and some teams take longer than others.&#x0D; Conclusions: Such community approaches are playing an important role in coordination of efforts to support the most vulnerable, as Moldova continues to face a refugee crisis. This continuous support to build capacity and ensure implementation of common approaches, facilitated by a jointly held normative framework supports a more integrated approach to service provision at community level, coordinated by local authorities thus making more efficient use of scarce resources.&#x0D;

Barriers to school-based health programs implementation in basic schools in Ghana: education stakeholders' perspective.

School health has been identified as a neglected aspect of primary health care in Ghana, leading to compromised health, well-being and life satisfaction among students. To address this concern, this study identified the barriers hindering the implementation of school-based health programs in Ghana. It employed a qualitative approach, including 116 respondents who participated in interviews. The collected data were analyzed using thematic analysis with the aid of NVivo software. In line with the research objective, findings show that the implementation of school-based health programs faces several teething challenges that serve as barriers to the success and sustainability of the programs. These barriers included resource constraints; a lack of adequate parental and community participation and a lack of adequate collaboration between stakeholders' management and leadership issues, governance issues and political issues. The findings from the study have a relevant and innovative contribution to achieving good health and well-being and quality education as part of the 2030 Agenda for Sustainable Development Goals and shaping primary healthcare management in the context of a developing country. It recommends that policymakers and health practitioners pay special attention to school-based health programs as a key strategy for primary health care management in developing countries.

Evaluating financial management competency in primary healthcare managers of Kondoa, Iramba, and Sumbawanga District Councils, Tanzania

Background : Examining the financial managerial competency of primary healthcare facility managers is very important. Despite its importance, empirical investigation is limited in this area. To contribute mpirical evidence on this subject this study looked at Tanzania's public primary healthcare facility managers. Materials and Methods : The study was conducted in Kondoa, Iramba and Sumbawanga District Councils in Tanzania. This research adopted a cross-sectional research design. A census sampling strategy was employed to obtain primary data from 102 public primary healthcare facility managers. The Statistical Product and Service Solution (SPSS) Version 25 was used to analyse the data. Results : Findings reveal that slightly more than half (57.85%) of managers were competent whereas (42.15%) of them were less competent in acting on the financial statements. In monitoring financial performance (47.53%) were less competent and (52.47%) were competent. Also, in developing budgets following organisational objectives, (50.97%) were less competent and (49.03%) were competent. Additionally, in managing budgets by organisational objectives, (45.09%) were less competent and (54.91%) were competent. Furthermore, in establishing and maintaining the organisation's insurance contracts and financial relationships, (53.92%) were less competent and (46.08%) were competent. Conclusions : Nearly half of the facility managers in selected Tanzanian District Councils demonstrated competence in financial statement analysis, performance monitoring, budget development, and managing insurance contracts and financial relationships. Recommendations : This study recommends improving the financial managerial competency of facility managers in all areas of financial management roles as a key area of investment in efforts to improve the management of primary healthcare facilities.

Family Vulnerability Scale: validity evidence in primary health care.

Investigate evidence of validity of the Family Vulnerability Scale (EVFAM-BR) as an instrument to support population-based management in primary health care (PHC), in the scope of Health Care Planning (PAS). This is a psychometric study to assess any additional evidence of the internal structure of EVFAM-BR using confirmatory factor analysis (CFA) and network analysis (NA). A preliminary version of the scale with 38 items was submitted to patients of PHC facilities that use the PAS methodology, distributed across the five regions of Brazil. For the primary CFA data, factor loadings and predictive power (R2) of the item were used. Seven model adjustment indices were adopted and reliability was measured by three indicators, using Bayesian estimation. The preliminary version of the scale was applied to 1,255 patients. Using the AFC, factor loadings ranged from 0.66 to 0.90 and R2 from 0.44 to 0.81. Both the primary indicators and the model adequacy indices presented satisfactory and consistent levels. According to the NA, the items were appropriately associated with their peers, respecting the established dimensions, thus demonstrating sustainability and stability of the proposed model. The evidence of validity presented by EVFAM-BR indicates, for the first time in Brazil, a concise instrument that is able to assertively measure family vulnerability, potentially supporting population-based management.

Practical Approach to Care Kit: Innovation for nurses' clinical practice in HIV management.

to analyze the use of the Practical Approach to Care Kit as a technology adopted in nurses' clinical practice for HIV management in Primary Health Care. an exploratory and descriptive research study anchored in the methodological framework of the Constructivist Grounded Theory. The participants were defined through initial sampling, with 12 nurses, and theoretical sampling, with five managers, totaling 17 participants. The data were collected by means of intensive interviews and documentary analysis, and they were analyzed in two stages: 1) Initial coding; and 2) Focused coding. the professionals identified the Practical Approach to Care Kit as a technological innovation that contributed to expanding the clinical practice and to empowering nurses in the clinical management of HIV infection. They also highlighted its importance as a tool for guiding the different responsibilities and duties while sharing care, contributing to the provision of evidence-based practices. The Practical Approach to Care Kit is a technological innovation that has transformed nurses' clinical practice in HIV management, expanding their scope of activities in carrying out the diagnosis, assessing the health condition and counseling, evaluating adherence to the treatment, adverse effects and prescription of exams, medications, and immunobiological.

Implementation of a digital tool for population management in Primary Health Care.

Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. Three hundred thirty-four professionals participated in the study. In the first step, territory management's main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

OP07 Eleven Years Of Conitec: Advances And Challenges Of Patient And Public Involvement In The Brazilian Health Technology Assessment Process

IntroductionPatient and public involvement (PPI) is a core element of the health technology assessment (HTA) process. Since its creation in 2011, the National Committee for Health Technology Incorporation (Conitec) has promoted initiatives to include stakeholders in HTA for the Brazilian Public Health System (SUS). This work aimed to present a report on the advances and challenges related to PPI in 11 years of Conitec.MethodsA retrospective analysis of PPI actions carried out at Conitec was conducted, based on an analysis of minutes and records of meetings and discussions held internally and documents published on Conitec´s website.ResultsEvents and meetings were held over the years with different actors interested in the HTA process. Since 2015, a plain-language version of the technical report has been made available to the public during public consultations for each HTA topic. Recently, a register of patients, specialists, and SUS managers was created to form a database and establish a network with the stakeholders. Since 2020, SUS users have been allocated time to speak at Conitec´s meetings. Qualitative analysis of public consultation documents started in 2021 and a pilot qualitative evidence synthesis was carried out in 2022. These initiatives, although not directly focused on PPI, increase the consideration of the perspectives of patients, family members, and caregivers in the HTA process.ConclusionsPPI actions implemented at Conitec have significantly promoted inclusiveness and exchanges among stakeholders, contributing to a greater transparency regarding Conitec’s actions. Nonetheless, we have important challenges on our horizon, such as strengthening connections with primary healthcare managers and professionals and social movements. It is also strategic to expand the technical and scientific discussion on PPI and qualitative approaches with HTA researchers and the voting members of Conitec. Finally, another aim is to improve knowledge of HTA and public health policy among law professionals and the pharmaceutical industry in Brazil.

Sustainability of integrated hypertension and diabetes with HIV care for people living with HIV at primary health care in South Ethiopia: implication for integration

BackgroundPeople living with human immunodeficiency virus (PLWH) have an increased risk of developing noncommunicable diseases (NCDs) compared with people without HIV. The multimorbidity of NCDs and HIV increases the need for integrated care. However, there is a paucity of evidence on the implementation of integrated sustained hypertension and diabetes with HIV care to address the multiple chronic care needs of PLWH in Ethiopia.ObjectiveThis study aimed to determine the sustainability of integrated hypertension and diabetes within HIV care for PLWH in primary healthcare (PHC) in southern Ethiopia.MethodsThe National Health Service Institute for Innovation and Improvement Sustainability Model (NHS- SM) self-assessment tool was used to assess sustainability. HIV care and NCD team members from five PHC facilities in South Ethiopia were included. Participants completed the self-administered NHS-SM assessment tool independently.ResultThe overall mean sustainability was 43.74 (95% CI: 42.15–45.33). All facilities had an overall sustainability score of less than 55. The perceived benefit beyond helping the patient, the likelihood of adaptability, and perceived alignment with the organizational goal were identified as potential factors promoting sustainability. The perceived lack of an effective system to monitor progress, staff behavior, inadequate staff involvement and training, inadequate senior leadership support and clinical leadership engagement, and infrastructure limitations could negatively affect sustainability.ConclusionsIntegrating hypertension and diabetes with HIV care sustainably at PHC requires staff involvement and training, staff behavior change communication, ensuring PHC management and clinical leadership (doctors and senior clinicians) engagement, and addressing infrastructure limitations.

Local knowledge, practices, challenges of ethnopharmacologically used medicinal plants in Benin and implications for brain illnesses.

Traditional medicine (TM) is a significant resource for primary healthcare management all over the world, and principally in Africa. Quality improvement activities that promote evidence-based practices and the integration of traditional medicine into primary healthcare systems can help improve the quality of patient care. In the Republic of Benin (West Africa), traditional medicine practitioners (TMPs) provide different treatments and ways of use, depending on the ailments and the medicinal plants used. The present study aimed at documenting the knowledge, attitudes and practices of Beninese TMPs regarding the use of medicinal plants and the challenges associated with their activities. A focus group survey was conducted using semi-structured interviews with a sample of 91 TMPs in 8 departments of the Republic of Benin. The respondents had an average age of 50years old and belonged to various categories of TMPs. Medicinal plants are harvested depending on the season and time of the day, and are dried in the shade before being used as decoctions or infusions. Nevertheless, the majority of TMPs do not conduct the necessary tests for quality control, efficacy or toxicity of the proposed remedies, which raises several scientific interrogations, particularly for the treatment of mental and brain-related disorders. Among ~ 110 plants used in the treatment of several pathologies, 66 were revealed as threatened species. The challenges faced by TMPs are mainly material, financial and technical difficulties. The present study reports the importance of intervention to modernize TM practices in Benin. Quality improvement could enhance healthcare delivery and provide support for evidence-based interventions aimed at addressing behavioral, social, and environmental determinants of health.