Primary Health Care Management Research Articles

Estimating undetected Ebola spillovers

The preparedness of health systems to detect, treat, and prevent onward transmission of Ebola virus disease (EVD) is central to mitigating future outbreaks. Early detection of outbreaks is critical to timely response, but estimating detection rates is difficult because unreported spillover events and outbreaks do not generate data. Using three independent datasets available on the distributions of secondary infections during EVD outbreaks across West Africa, in a single district (Western Area) of Sierra Leone, and in the city of Conakry, Guinea, we simulated realistic outbreak size distributions and compared them to reported outbreak sizes. These three empirical distributions lead to estimates for the proportion of detected spillover events and small outbreaks of 26% (range 8–40%, based on the full outbreak data), 48% (range 39–62%, based on the Sierra Leone data), and 17% (range 11–24%, based on the Guinea data). We conclude that at least half of all spillover events have failed to be reported since EVD was first recognized. We also estimate the probability of detecting outbreaks of different sizes, which is likely less than 10% for single-case spillover events. Comparing models of the observation process also suggests the probability of detecting an outbreak is not simply the cumulative probability of independently detecting any one individual. Rather, we find that any individual’s probability of detection is highly dependent upon the size of the cluster of cases. These findings highlight the importance of primary health care and local case management to detect and contain undetected early stage outbreaks at source.

Chronic disease management in primary health care: The role of rehabilitation professions

Chronic disease management in primary health care: The role of rehabilitation professions

Validation of an Expanded Measure of Integrated Care Provider Fidelity: PPAQ-2.

This study aimed to validate the factor structure of the expanded Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ-2), which is designed to assess provider fidelity to both the Primary Care Behavioral Health (PCBH) and collaborative care management (CCM) models of integrated primary care. Two-hundred fifty-three integrated care providers completed self-reports of professional background, perceptions of clinic integration and related practice barriers, and the PPAQ-2. Confirmatory factor analyses were conducted to assess the theorized factor structure and criterion validity was assessed through correlational analysis. Factor analyses demonstrated adequate fit with the data and acceptable to excellent composite reliabilities across five PCBH domains and five CCM domains. Validity was demonstrated by correlations between adherence scores and measures of clinic integration and barriers to fidelity. The PPAQ-2 is a psychometrically sound measure that can be used in future integrated care dismantling studies to identify provider behaviors that best predict patient outcomes.

Barriers to hypertension and diabetes management in primary health care in Argentina: qualitative research based on a behavioral economics approach.

Despite efforts to improve detection and treatment of adults with hypertension and diabetes in Argentina, many public healthcare system users remain undiagnosed or face barriers in managing these diseases. The purpose of this study is to identify health system, provider, and user-related factors that may hinder detection and treatment of hypertension and diabetes using a traditional and behavioral economics approach. We did qualitative research using in-depth semistructured interviews and focus groups with healthcare providers and adult users of Public Primary Care Clinics. Health system barriers included inadequate care accessibility; poor integration between primary care clinics and local hospitals; lack of resources; and gender bias and neglect of adult chronic disease. Healthcare provider-related barriers were inadequate training; lack of availability or reluctance to adopt Clinical Practice Guidelines; and lack of counseling prioritization. From a behavioral economics perspective, bottlenecks were related to inertia and a status quo, overconfidence, and optimism biases. User-related barriers for treatment adherence included lack of accurate information; resistance to adopt lifelong treatment; affordability; and medical advice mistrust. From a behavioral economics perspective, the most significant bottlenecks were overconfidence and optimism, limited attention, and present biases. Based on these findings, new interventions that aim to improve prevention and control of chronic conditions can be proposed. The study provides empirical evidence regarding the barriers and bottlenecks in managing chronic conditions in primary healthcare settings. Results may contribute to the design of behavioral interventions targeted towards healthcare provision for the affected population.

Stakeholder Perception of the Impacts of Communication for Development in NGO-Supported Organizational Capacity Building: A Case of Yobe State Primary Health Care Management Board

Utilization of communication for development (C4D) in organizational capacity-building support provided by foreign aid-assisted developmental programs run by non-governmental organization (NGOs) has been shown to improve primary health care (PHC) services in both urban and rural communities, especially the latter. This study investigated stakeholder perceived benefits of organizational capacity-building support provided by NGOs toward the improvement of PHC services in Yobe State. Adopting a case study approach with key informant interview (KII), the responses of four key management staff of Yobe State Primary Health Care Management Board (YSPHCMB) were captured and analyzed using the organizational capacity assessment tool model and critical discourse analysis. The key findings revealed that two critical C4D techniques namely, advocacy and behavior-change communication have impacted significantly toward the strengthening of both YSPHCMB and improvement of PHC services in rural areas of the state more than it did in urban centers; organizational capacity-building support provided by NGOs have significantly strengthened the capacity of YSPHCMB effectively more than both the State and Federal Governments (the primary funders of PHC services) did; and perceived sustainability crisis (PSC) in the event of the expiration of the tenure of some NGOs and developmental programs has been identified as a critical challenge that may affect the tremendous successes achieved by the programs/NGOs negatively should they close as anticipated. To avert the occurrence of PSC in the aftermaths of the closure of an NGO, both the State and Federal Governments should ensure enough and timely release of PHC counterpart funding. Keywords: C4D, communication for development, Nigerian primary health care services, NGO, OCAT, organizational capacity assessment tool, PHC, DOI : 10.7176/NMMC/79-04 Publication date : April 30 th 2019

Leadership and management competencies required for Bhutanese primary health care managers in reforming the district health system.

ObjectiveThis study aims to identify the required management competencies, current competency levels, and strategies for improving the management competencies of Bhutanese primary health care (PHC) managers.MethodsA quantitative method with a cross-sectional survey using self-administered questionnaires. This study recruited 339 PHC managers across Bhutan. The data were analyzed using statistical software.ResultsThis study identified three competency domains and seven key sub-domain competencies. People domain was perceived to be the highest required competency with a mean score of 4.2376, followed by execution (4.1851), and the transformation (4.0501) domains. For the seven key sub-domains, the communication sub-domain (4.3220) was perceived as the highest required competency, followed by professionalism (4.2967), managing change (4.1776), relationship building (4.1686), analytical thinking (4.1091), leadership (4.0980), and innovative thinking (3.9794). The current competency levels of PHC managers in domains and sub-domain competencies were the people domain (3.7322), execution (3.6471), and the transformation (3.5554). For the sub-domains, communication (3.8092), professionalism (3.7939), relationship building (3.6603), analytical thinking (3.6396), leadership (3.5805), managing change (3.5723), and innovative thinking (3.4543).ConclusionFindings of Bhutan health managers’ competencies are consistent with the findings of other international contexts. This study suggests that agencies responsible for health system need to focus more on the competencies defined by the study to positively influence health leadership and management development interventions.

Effectiveness of the Diagnose-Intervene- Verify-Adjust (DIVA) model for integrated primary healthcare planning and performance improvement: an embedded mixed methods evaluation in Kaduna state, Nigeria

ObjectivesThis study evaluates the real-world effectiveness of Diagnose-Intervene-Verify-Adjust (DIVA), an innovative quality improvement mode, in improving primary healthcare (PHC) bottlenecks impeding health system performance in Kaduna, a northern Nigerian state.DesignAn...

Stakeholder Perception of the Impacts of Communication for Development Techniques in NGO-Supported Organizational Capacity Building: A Case of Yobe State Primary Health Care Management Board

Utilization of communication for development (C4D) techniques in organizational capacity-building support provided by foreign aid-assisted developmental programs run by non-governmental organization (NGOs) has been shown to improve primary health care (PHC) services in both urban and rural communities, especially the latter. This study investigated stakeholder perceived benefits of organizational capacity-building support provided by NGOs toward the improvement of PHC services in Yobe State. Adopting a case study approach with key informant interview (KII), the responses of four key management staff of Yobe State Primary Health Care Management Board (YSPHCMB) were captured and analyzed using the organizational capacity assessment tool model and critical discourse analysis. The key findings revealed that two critical C4D techniques namely, advocacy and behavior-change communication have impacted significantly toward the strengthening of both YSPHCMB and improvement of PHC services in rural areas of the state more than it did in urban centers; organizational capacity-building support provided by NGOs have significantly strengthened the capacity of YSPHCMB effectively more than both the State and Federal Governments (the primary funders of PHC services) did; and perceived sustainability crisis (PSC) in the event of the expiration of the tenure of some NGOs and developmental programs has been identified as a critical challenge that may affect the tremendous successes achieved by the programs/NGOs negatively should they close as anticipated. To avert the occurrence of PSC in the aftermaths of the closure of an NGO, both the State and Federal Governments should ensure enough and timely release of PHC counterpart funding. Keywords: C4D, communication for development, Nigerian primary health care services, NGO, OCAT, organizational capacity assessment tool, PHC, DOI : 10.7176/DCS/9-3-03 Publication date :March 31 st 2019

PATIENTS’ KNOWLEDGE, ATTITUDES, AND PRACTICES ON UNCOMPLICATED MALARIA MANAGEMENT IN PLATEAU STATE, NORTH-CENTRAL NIGERIA

Objectives: This study aimed to assess patients’ knowledge, attitudes, and practices (KAP) on uncomplicated malaria management in primary health-care (PHC) facilities of Plateau state, Nigeria.
 Methods: A validated self-reported scale known as patients’ KAP instrument for uncomplicated malaria with Cronbach’s alpha reliability of 0.74 was administered to 956 patients that consented to participate in the study across 24 PHC facilities in the state between May and July 2017. The collated data were analyzed using Microsoft Excel and IBM Statistical Package for the Social Sciences (SPSS®) version 23 software.
 Results: There were more female participants (53.5%) compared to the males (46.5%), and majority (33.4%) within the age range of 28 and 37 years with 26.5% falling within the age range of 18–27 years and children of <18 years of age constituted 13.8% of the study population. About 42.1% of the respondents were married, and many either had secondary (37.3%) or primary (30.0%) education as their highest qualifications. With overall mean (±standard deviation [SD]) attitudes’ score of 34.55 (±7.20), majority (50.8%) were categorized as having average positive attitudes toward disease and its management, and many of them (55.2%) also had good knowledge (mean [±SD] score=4.59 [±1.44]) and practices (67.1%) (mean [±SD] score=14.98 [±3.44]) on the disease and its management.
 Conclusion: The study indicated respondents’ knowledge and practices on uncomplicated malaria as good, while their attitudes toward the disease and its management were average.

Exploring the feasibility of using mobile phones to improve the management of clients with cervical cancer precursor lesions

BackgroundCancer screening programs hold much potential for reducing the cervical cancer disease burden in developing countries. The aim of this study was to determine the feasibility of mobile health (mHealth) phone technology to improve management and follow-up of clients with cervical cancer precursor lesions.MethodsA sequential mixed methods design was employed for this study. Quantitative data was collected using a cross-sectional survey of 364 women eligible for a Pap smear at public sector health services in Cape Town, South Africa. Information was collected on socio-demographic status; cell phone ownership and patterns of use; knowledge of cervical cancer prevention; and interest in Pap smear results and appointment reminders via SMS-text messages. Descriptive statistics, crude bivariate comparisons and logistic regression models were employed to analyze survey results. Qualitative data was collected through 10 in-depth interviews with primary health care providers and managers involved in cervical cancer screening. Four focus group discussions with 27 women attending a tertiary level colposcopy clinic were also conducted. Themes related to loss of mobile phones, privacy and confidentiality, interest in receiving SMS-text messages, text language and clinic-based management of a SMS system are discussed. Thematic analyses of qualitative data complemented quantitative findings.ResultsPhone ownership amongst surveyed women was 98% with phones mostly used for calls and short message service (SMS) functions. Over half (58%) of women reported loss/theft of mobile phones. Overall, there was interest in SMS interventions for receiving Pap smear results and appointment reminders. Reasons for interest, articulated by both providers and clients, included convenience, cost and time-saving benefits and benefits of not taking time off work. However, concerns were expressed around confidentiality of SMS messages, loss/theft of mobile phones, receiving negative results via SMS and accessibility/clarity of language used to convey messages. Responsibility for the management of a clinic-based SMS system was also raised.ConclusionsResults indicated interest and potential for mHealth interventions in improving follow-up and management of clients with abnormal Pap smears. Health system and privacy issues will need to be addressed for mHealth to achieve this potential. Next steps include piloting of specific SMS messages to test feasibility and acceptability in this setting.

PRIMARY HEALTHCARE MANAGEMENT: WHAT IS DISCUSSED IN THE LITERATURE

ABSTRACT Objective: to identify what is discussed in studies published in Brazilian and international literature in the last ten years on Primary Health Care management. Method: an integrative review with a search carried out from 2006 to 2016, in the SciELO®, LILACS®, Scopus®, PubMed® and CINAHL® databases in the Portuguese, English and Spanish languages. The review followed the steps: formulation of the research question, definition of the inclusion and exclusion criteria, identification and selection of the studies, and summary of the subjects found in the studies. Resources from The Atlas.ti® software was used for data organization and analysis. Results: the corpus include 90 studies which predominantly originated from LILACS® and were performed in Brazil. The themes covered in the publications were: health policy and management in Primary Health Care, material resources management, human resources management, financial management, quality management, planning, characterization of managers, management role/ activities, challenges/difficulties in management, potentialities/facilities in management. There was a prevalence of studies that dealt with Primary Health Care management in the context of reflections on health policies and those dealing with the challenges/difficulties faced in Primary Health Care management. These findings demonstrate that the Primary Health Care model is complex and challenging, both for policymakers and for those managing it. Conclusion: the number of studies on Primary Health Care management is significant in the current literature and the predominance of health policy and difficulties in performing management issues reinforce the recognition of the centrality of the management for effective Primary Health Care.

A five-step approach for developing and implementing a Rural Primary Health Care Model for Dementia: a community-academic partnership.

This study is aimed at developing a Rural Primary Health Care (PHC) Model for delivering comprehensive PHC for dementia in rural settings and addressing the gap in knowledge about disseminating and implementing evidence-based dementia care in a rural PHC context. Limited access to specialists and services in rural areas leads to increased responsibility for dementia diagnosis and management in PHC, yet a gap exists in evidence-based best practices for rural dementia care. Elements of the Rural PHC Model for Dementia were based on seven principles of effective PHC for dementia identified from published research and organized into three domains: team-based care, decision support, and specialist-to-provider support. Since 2013 the researchers have collaborated with a rural PHC team in a community of 1000 people in the Canadian province of Saskatchewan to operationalize these elements in ways that were feasible in the local context. The five-step approach included: building relationships; conducting a problem analysis/needs assessment; identifying core and adaptable elements of a decision support tool embedded in the model and resolving applicability issues; implementing and adapting the intervention with local stakeholders; and sustaining the model while incrementally scaling up. Developing and sustaining relationships at regional and PHC team levels was critical. A comprehensive needs assessment identified challenges related to all domains of the Rural PHC Model. An existing decision support tool for dementia diagnosis and management was adapted and embedded in the team's electronic medical record. Strategies for operationalizing other model elements included integrating team-based care co-ordination into the decision support tool and family-centered case conferences. Research team specialists provided educational sessions on topics identified by the PHC team. This paper provides an example of a community-based process for adapting evidence-based practice principles to a real-world setting.

Health Professionals’ Perceptions on the Integration of Medical Students’ Training in Family Health Care Units

ABSTRACT Introduction The Centro Universitário de Votuporanga (UNIFEV) medicine course was implemented in 2012 according to the 2001 National Curricular Guidelines for Undergraduate Medical Courses. The practical module of Community Service Education Integration is the curricular unit that places students into Primary Health Care (PHC) scenarios from the first period of the course until the internship period, breaking with the traditional model of hospital-centered training, which is segmented into specialties. The module of medical skills and attitudes training also leads the student, in some cases, to PHC services, but with focus on the basic clinical procedures in controlled scenarios, which may be those from typical clinical practice, simulations or even those performed in laboratories. During internship, the student continues in PHC as an intern in general, family and community medicine. In this context, the integration of community-education-service plays a major role in the transformations undergone in undergraduate training in health, which are also aimed at modifying the current healthcare model. Objectives To understand the perception of professionals from the Family Health Care Units regarding medical student work placement and to interpret the results of this integration as far as the service, the community and the medical training are concerned. Methodology Qualitative research carried out with health professionals who work in three Family Health Care Units of Votuporanga, São Paulo, Brazil. They were invited to participate in focus groups to express their opinions about thought-provoking questions. The recorded material was transcribed, organized and analyzed according to Bardin’s content analysis, which allowed categories of analysis to emerge based on what the participants said. Results and discussion: The opinions that have emerged allow to identify the following aspects: teaching-service-community integration contributes to medical education; student presence promotes team integration and self-learning and promotes the work process; student integration has impact on the community. Among the student’s contributions, participants highlighted the academic and health care reflective practices, health education actions and complementary activities that support the health team in solving local problems. Participants also identified some situations of difficulty, such as: students in the early periods of the course need to acquire affective domains for an adequate professional posture at PHC units; the embarrassment of patients in the medical consultation with the presence of students; and the short length of stay of the students for the necessary bond building. Conclusion For PHC professionals, the inclusion of students in these scenarios contributes to the development of the service, medical training and community support. Due to the solidary relations existing between the educational institution and the PHC management, this research may contribute to promote the necessary adaptations and prepare the community and professionals for the presence of students in PHC.

Health Professionals’ Perceptions on the Integration of Medical Students’ Training in Family Health Care Units

ABSTRACT Introduction The Centro Universitário de Votuporanga (UNIFEV) medicine course was implemented in 2012 according to the 2001 National Curricular Guidelines for Undergraduate Medical Courses. The practical module of Community Service Education Integration is the curricular unit that places students into Primary Health Care (PHC) scenarios from the first period of the course until the internship period, breaking with the traditional model of hospital-centered training, which is segmented into specialties. The module of medical skills and attitudes training also leads the student, in some cases, to PHC services, but with focus on the basic clinical procedures in controlled scenarios, which may be those from typical clinical practice, simulations or even those performed in laboratories. During internship, the student continues in PHC as an intern in general, family and community medicine. In this context, the integration of community-education-service plays a major role in the transformations undergone in undergraduate training in health, which are also aimed at modifying the current healthcare model. Objectives To understand the perception of professionals from the Family Health Care Units regarding medical student work placement and to interpret the results of this integration as far as the service, the community and the medical training are concerned. Methodology Qualitative research carried out with health professionals who work in three Family Health Care Units of Votuporanga, São Paulo, Brazil. They were invited to participate in focus groups to express their opinions about thought-provoking questions. The recorded material was transcribed, organized and analyzed according to Bardin’s content analysis, which allowed categories of analysis to emerge based on what the participants said. Results and discussion: The opinions that have emerged allow to identify the following aspects: teaching-service-community integration contributes to medical education; student presence promotes team integration and self-learning and promotes the work process; student integration has impact on the community. Among the student’s contributions, participants highlighted the academic and health care reflective practices, health education actions and complementary activities that support the health team in solving local problems. Participants also identified some situations of difficulty, such as: students in the early periods of the course need to acquire affective domains for an adequate professional posture at PHC units; the embarrassment of patients in the medical consultation with the presence of students; and the short length of stay of the students for the necessary bond building. Conclusion For PHC professionals, the inclusion of students in these scenarios contributes to the development of the service, medical training and community support. Due to the solidary relations existing between the educational institution and the PHC management, this research may contribute to promote the necessary adaptations and prepare the community and professionals for the presence of students in PHC.

Stakeholder Perception of the Impacts of Communication for Development in NGO-Supported Organizational Capacity Building: A Case of Yobe State Primary Health Care Management Board

Utilization of communication for development (C4D) in organizational capacity-building support provided by foreign aid-assisted developmental programs run by non-governmental organization (NGOs) has been shown to improve primary health care (PHC) services in both urban and rural communities, especially the latter. This study investigated stakeholder perceived benefits of organizational capacity-building support provided by NGOs toward the improvement of PHC services in Yobe State. Adopting a case study approach with key informant interview (KII), the responses of four key management staff of Yobe State Primary Health Care Management Board (YSPHCMB) were captured and analyzed using the organizational capacity assessment tool model and critical discourse analysis. The key findings revealed that two critical C4D techniques namely, advocacy and behavior-change communication have impacted significantly toward the strengthening of both YSPHCMB and improvement of PHC services in rural areas of the state more than it did in urban centers; organizational capacity-building support provided by NGOs have significantly strengthened the capacity of YSPHCMB effectively more than both the State and Federal Governments (the primary funders of PHC services) did; and perceived sustainability crisis (PSC) in the event of the expiration of the tenure of some NGOs and developmental programs has been identified as a critical challenge that may affect the tremendous successes achieved by the programs/NGOs negatively should they close as anticipated. To avert the occurrence of PSC in the aftermaths of the closure of an NGO, both the State and Federal Governments should ensure enough and timely release of PHC counterpart funding. Keywords: C4D, communication for development, Nigerian primary health care services, NGO, OCAT, organizational capacity assessment tool, PHC, DOI : 10.7176/NMMC/79-04 Publication date : April 30 th 2019

A BUROCRACIA CORDIAL: A IMPLANTAÇÃO DA ESTRATÉGIA DE APOIO INSTITUCIONAL NA POLÍTICA NACIONAL DE ATENÇÃO BÁSICA EM SAÚDE

Resumo O artigo analisa o papel dos apoiadores institucionais como sujeitos responsáveis pela condução das políticas públicas. Busca, desse modo, compreender a forma de construção de relações institucionais desde a base do Estado brasileiro, mediante ao estabelecimento de dinâmicas relacionais entre agentes públicos, especialmente no enfrentamento das complexas questões sobre as relações federativas brasileiras. O estudo foi realizado na Coordenação Geral de Gestão da Atenção Básica, do Departamento de Atenção Básica do Ministério da Saúde. Configura uma pesquisa ancorada na epistemologia qualitativa, com a realização de pesquisa documental, observação, entrevistas em profundidade e grupos focais entre novembro de 2015 e junho de 2017. Os resultados permitiram a identificação de dois elementos estruturantes do trabalho dos apoiadores - vínculo e conhecimento do território -, os quais subsidiaram a construção de uma tipologia da estratégia de atuação desenvolvida e operada pelos apoiadores, a saber: aplicação, adaptação e cooperação. Conclui-se que o avanço da implantação da estratégia de apoio institucional foi possível fundamentalmente em função da dinâmica relacional e presencial entre sujeitos, e seus resultados indicam possibilidades concretas de avanço na garantia do direito à saúde, não obstante as dificuldades e contradições que caracterizam o federalismo brasileiro.

An Exploratory Study on the Roles of Bhutanese Primary Health care Managers in Responding to childhood Obesity

An Exploratory Study on the Roles of Bhutanese Primary Health care Managers in Responding to childhood Obesity

Gestão na atenção primária: implicações nas cargas de trabalho de gestores

To identify which aspects of primary health care management, evidenced in current literature, can influence manager workloads. Integrative literature review with data collection conducted in April 2016, in five databases, with articles published in English, Spanish and Portuguese between 2006 and 2016. The results of the 78 studies were organized into two macro categories: increased workloads, especially due to the challenge of managing a new care model and deficits in working conditions; and workloads reduction related to the training of the teams and managers, the autonomy and the support for the managers. In addition to identifying factors that increase and decrease the workloads of managers, this study highlights the promising line of research, given the importance of management for the health sector and effectiveness of Primary Health Care.

Reducing ear, nose and throat (ENT) waitlists: Implications of a referral audit

Introduction: Many specialist waitlists in Australian hospitals are long. One reason anecdotally reported for this is poor alignment of referrals with current recommended guidelines. This paper reports the findings of an audit undertaken in 2017 for ear, nose and throat (ENT) surgeon referrals submitted by primary health centres within Cape York, Australia.Materials and methods: 54 long-wait ENT referrals were reviewed against referral criteria for ENT presentations using the Clinical Prioritization Criteria (CPC) and two routinely applied clinical primary health care guidelines; with findings reported alongside patient demography.Results: All of the long wait ENT referrals in the sample were for remote living Indigenous Australians, most were children (93%). One fifth of referrals fulfilled all referral criteria and were appropriate (22%); one third required further informaiton to support the referral, either audiology or clinical history (30%); and half were inappropriate referrals (48%).Conclusion: Although many referral submissions did not adhere to CPC or routine guidelines, this audit enabled the identification of improvements to the referral system including the development of a checklist and flow-chart, plus patient information resources aimed at improving patient adherence. A case can be made for a new service delivery model that provides ongoing primary health education and facilitates improved ENT access. These strategies may improve ENT referral quality and decongest current ENT specialist waitlists, while offering improved primary health care management of ear presentations.

Recursos asistenciales en atención primaria para manejo del asma: proyecto Asmabarómetro

ObjectiveThe objective of this study was to describe the current provision of basic resources for asthma management in Primary Health Care (PHC). DesignCross-sectional study, with an ad hoc quantitative survey. Location and participantsA total of 380 primary healthcare physicians in Spain. Interventions and main measurementsAnalysis of perceptions of management and use of basic human, organisational and material resources to ensure appropriate care provision to asthma patients. ResultsSurvey respondents stated that their centre did not have a consultant doctor (64%) or nurse (62%) in respiratory disease. Almost all (92%) of the centres have spirometers, of which 70% have peak flow meters, and 93% have placebo inhalers. In the last year, respondents have received specific theoretical/practical training from the centre (46%), and by third parties (83%). More than three-quarters (78%) of the centres has educational material available for patients. There is no specific healthcare protocol in 36% of the centres, and 43% had no referral protocol. A clinical interview is conducted to monitor the patient (90%), but there are no validated questionnaires to measure therapeutic adherence (85%), or a checklist to check inhalation technique (83%). Differences are observed in the relevant variables in the analysis of each Spanish Autonomous Community. ConclusionsAccess to certain resources in the care of patients with asthma is limited in aspects of coordination between levels, varied according to Spanish Autonomous Community, and improved in most health resources in Asthma.