Health Center Research Articles

Innovations in primary healthcare in Slovenia 2011-2020: Exploring the stepwise process behind effective implementation.

Countries worldwide seek to strengthen their primary healthcare systems often through introducing health promotion and disease prevention, multidisciplinary teams, group practices and community approaches to advance universal health coverage. These strategies are underpinned by scientific evidence and international standards. Slovenia's primary healthcare system reflects many of these features, with universally accessible, multidisciplinary, and integrated health services, emphasizing health promotion, disease prevention, and equity. Municipal primary healthcare centres serve as hubs within local communities. Slovenia's efforts to strengthen the delivery model are continuous and follow a controlled stepwise implementation process. This approach has strong policy support and organizational and implementation capacities. This paper describes Slovenia's primary healthcare model and three innovations between 2011 and 2020: (1) family medicine model practices, (2) health promotion centres, and (3) mental health centres. These innovations are used both to showcase the efforts of Slovenia to enhance primary healthcare and as a lens to explore Slovenia's established primary healthcare innovation implementation approach. The three innovations have had a positive impact on health outcomes in the short- to medium-term, but mixed health system and implementation outcomes. Slovenia's experience can inspire other countries looking to sustainably integrate primary healthcare fully or effectively introduce single innovations in their primary healthcare systems.

Implementing Food as Medicine During COVID-19: Produce Prescriptions and Integrative Group Medical Visits in Federally Qualified Health Centers.

Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce ('Food Farmacy') with or without integrative group medical visits, alongside training for clinic staff. To describe the initial implementation of R4H in four Federally Qualified Health Centers in Northern California, using a convergent mixed-methods approach. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation science framework to assess the first two years of R4H (2020-2022). We draw from 40 interviews (26 partner organization staff, 14 patients) and program data on reach and adoption. Qualitative data were analyzed using codebook thematic analysis. Reach: From January 2020 to August 2022, 3255 patients were referred to the program; 1997 of those referred (61%) enrolled in the Food Farmacy only (N = 1681) or Food Farmacy + integrative group medical visits (N = 316). Participating patients included a wide range of ages (mean age 41.4, [SD 20]; 18% < 18 years old) and racial and ethnic backgrounds (3% American Indian or Alaska Native, 6% Asian or Pacific Islander, 19% Black, 57% Hispanic/Latine, 7% white). 69% were female; 43% primarily spoke Spanish. Adoption: 84% of trained clinic staff referred two or more patients to R4H. Implementation: Elements of successful implementation included: (1) support from county government leadership, (2) centralized coordination of the multi-sector partnership, and (3) a flexible approach responsive to organizational and COVID-related shifts. R4H implementation informed statewide Medicaid policy changes. Maintenance: To date, all four clinics continue to participate in R4H. Centralized implementation, training, and administration of Food as Medicine programs can strengthen community health centers' capacities to concurrently address chronic conditions and food insecurity. Multi-sector partnerships can support Food as Medicine program sustainability.

An Innovative Clinic-Based Intervention to Improve Adolescent Access to Sexual and Mental Health Services: The Total Teen Program.

Adolescents encounter numerous healthcare access barriers, leading to poor health outcomes. Researchers developed the Total Teen (TT) program to improve access to sexual and reproductive health (SRH) and mental health (MH) services in settings providing adolescents and young adults (12-25) health services. This pilot study assessed the TT's impact on care across three settings: school-based health clinics, a federally qualified health center, and an adolescent health clinic for 12 weeks. Sociodemographic data, including age, race/ethnicity, gender, and insurance status, were collected. MH was assessed using patient health questionnaire (PHQ)-9 and generalized anxiety disorder (GAD)-2 scales, and sexual health was evaluated based on CDC guidelines and additional evidence-based questions. One-on-one time, confidential consultations, SRH and MH micro visits, and referrals measured access. Descriptive statistics, Pearson Chi-square tests, and Kruskal-Wallis tests compared site outcomes, while logistic regression models adjusted for age, gender, race, and site. Four hundred and fifty-one participated in the TT program across the three sites. Concerning micro visits and referrals, being male was associated with lower depression rates (P = .0003) and generalized anxiety disorder (P = .0099). Being males also predicted micro visit receipt (P = .0199). Concerning SRH micro visits, higher sexual behavior scores (P < .0001) were significantly associated with a greater likelihood of utilizing SRH micro visits. Results indicate that TT improves access to SRH and MH services and referrals for at-risk adolescents. Findings underscore the importance of integrating SRH and MH services into routine adolescent care and involving health organizations and providers as key stakeholders in enhancing preventive healthcare access.

Differences in the Effectiveness of Giving Snakehead Fish (Canna Striata) and Catfish (Clariidae) in Healing Prineum Wounds in Postpartum Mothers in the Working Area of ​​the Majalaya Health Center

ABSTRACT Perineal tears are a good medium for germs to breed if they don't get proper care. This is also one of the causes of the variation in healing time for perineal wounds. Long wound healing time and inappropriate care techniques can result in postpartum infections. Non-pharmacological therapy that can be given to speed up healing includes the intervention of snakehead fish and catfish therapy. To determine the difference in the effectiveness of providing snakehead fish and catfish therapy in healing perineal wounds in postpartum mothers in the working area of the Majalaya health center. This research is a type of quantitative research. In this research, the Quasy Experiment design method was used with a Pretest and Posttest Nonequivalent Control Group research design. The population in this study was the target postpartum mothers with perineal rupture wounds in the working area of the Majalaya health center who gave birth at the end of June 2024, totaling 30 postpartum mothers. The research sampling technique used total sampling. The samples in this study were postpartum mothers who were in the working area of the Majalaya health center who gave birth with a history of 1st and 2nd degree perineal lacerations in June 2024, 15 postpartum mothers who received snakehead fish therapy intervention and 15 postpartum mothers who received catfish therapy intervention. 15 postpartum mothers. The results of the different tests were carried out using the independent T test on the post-test data for the Snakehead Fish Intervention and Catfish Intervention groups with a p-value = 0.000, which means &lt;0.05. So it can be concluded that there are differences regarding the effect of providing snakehead fish and catfish intervention therapy on the level of healing of perineal wounds in postpartum mothers in the working area of the Majalaya Health Center. There is a significant difference between giving snakehead fish therapy and catfish therapy in healing perineal wounds. Snakehead fish therapy is more effective in healing perineal wounds in postpartum mothers compared to giving catfish therapy (p value 0.00 &lt; 0.05). Keywords: Snakehead Fish Therapy, Catfish Therapy, Perineal Wounds, Postpartum Mothers

Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India.

Hypertension is one of the most prevalent NCDs in the world. Its prevalence is especially high among the elderly, a demographic group on the rise in low and middle income countries. Extant medical literature calls for early detection to prevent aggravation of problems when old. In this paper, we investigate whether diagnosis of hypertension among adults aged 45 and above, is correlated with geographic access to primary public healthcare services, after accounting for a rich set of potentially confounding covariates. Our study focuses on rural India where access to public primary health services is especially poor but hypertension rates are high. Using the first wave of the Longitudinal Ageing Survey of India (LASI) 2017-19, we find that hypertensive adults belonging to poor households, face a distance cost of public primary health facilities and are 8 percent less likely to be aware of their hypertension when Primary Health Centres are 10km away. Since almost 10 percent of villages in India are at least 10km away from PHCs, this exclusionary effect is significant. Our analysis suggests that even though public primary facilities are poorly staffed and managed in India, and private care is popular, geographical expansion of public primary facilities can still play an active role in NCDs and public primary health financing should take heed of the need for such expansion.

771 Associations between social determinants of health, obesity, and sleep health in federally qualified health center patients in Louisiana

771 Associations between social determinants of health, obesity, and sleep health in federally qualified health center patients in Louisiana

Differences in family support and maternal employment on exclusive breastfeeding in rural and urban areas in the working area of Darul Imarah Public Health Centre, Aceh Besar district

In Indonesia, exclusive breastfeeding coverage will stagnate at around 52.2% in 2022, with causal factors including lack of knowledge, maternal support, lack of breastfeeding facilities in the workplace, and promotion of formula milk. Support from the government, employers and families is needed to increase exclusive breastfeeding coverage and baby health. To analyze differences in family support and maternal employment towards exclusive breastfeeding in rural areas and urban areas in the Darul Imarah Health Center working area, Aceh Besar Regency. Quantitative research with a cross sectional study approach. Sampling used a cluster sampling technique followed by a random sampling technique with a sample size of 178 respondents. Univariate descriptive analysis using the Chi-Square test. There is no significant relationship between family support and exclusive breastfeeding in rural areas (p = 0.091) or in urban areas (p = 0.721). The results of the chi-square statistical test in rural areas obtained a value of p = 1,000, which means there is no relationship between mother's employment and exclusive breastfeeding. In urban areas, the value of P = 0.804 and C value = 0.619, which means there is a relationship between maternal employment and exclusive breastfeeding. There is no significant influence between maternal employment on exclusive breastfeeding in rural and urban areas and there is no significant influence between family support and exclusive breastfeeding in rural and urban areas.

Analysis of patient satisfaction with health services at Sei Berombang Labuhanbatu Health Center

The quality of health services is an essential factor in creating patient satisfaction and trust in health facilities. Puskesmas, as a critical health service, plays a central role in meeting the community's health needs, especially in remote areas such as Sei Berombang Labuhanbatu. However, the challenges faced by Puskesmas in providing adequate services often lead to variations in patient satisfaction levels. Lack of resources and infrastructure are barriers to improving service quality. This study aims to analyze the effect of health service quality dimensions on patient satisfaction at Puskesmas Sei Berombang in 2024. The method used was a quantitative approach with a cross-sectional analytic design involving 160 respondents from a population of 256 patients selected incidentally. Data were collected through interviews and online questionnaires and then analyzed using the Chi-Square test and multiple logistic regression. The results showed that reliability, assurance, tangibles, responsiveness, and empathy had a significant relationship with patient satisfaction, with p-values of 0.001, 0.008, 0.009, 0.002, and 0.003, respectively. The empathy variable has the most important influence on patient satisfaction, with an odds ratio (OR) of 8.256, indicating that increased empathy in service increases the chance of patient satisfaction by more than eight times. These findings highlight the importance of improving the quality of health services, especially empathy, to achieve optimal patient satisfaction. Therefore, service quality improvement strategies are recommended to focus on all five quality dimensions to effectively improve patient satisfaction in community health centers.

The role of management elements in achieving complete basic immunization in infants

Effective efforts to prevent sickness and death of children with Immunization. Immunization protects children from several diseases. The achievement of UCI Puskesmas is still below the national target of 100%. The availability of human resources, costs, facilities infrastructure, and functions management implementation immunization base influences the success of the immunization program base complete in babies. This study aimed to determine the role of management elements in achieving complete basic Immunization in infants. Quantitative research type with cross-sectional design. The population of the study was 32 immunization program holders. The sampling technique used was Total Sampling. Data collection method by interview. Data analysis with Chi-Square Test. The results showed that the elements of poor management were 15 (46.9%), good management elements were 17 (53.1%), immunization coverage was not achieved by 13 (40.6%), and immunization coverage was achieved by 19 (59.4%). There is a relationship between management elements and immunization coverage with a p-value of 0.001. It is expected that there will be the development of immunization health workers in terms of number and competence and rewards for good health workers in the immunization program to achieve immunization coverage rates in each health center area.

Determinants of pregnant women’s knowledge about antenatal care and compliance with pregnancy check-ups at Poasia Health Center

Determinants of pregnant women’s knowledge about antenatal care and compliance with pregnancy check-ups at Poasia Health Center

Optimizing NSAID Therapy in Elderly with Osteoarthritis: A Case Study from a Primary Care Setting in Indonesia

Osteoarthritis (OA) is a degenerative disease often found in the elderly population. This disease is characterized by joint cartilage damage that causes pain and disability. Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the commonly used pharmacological therapies to manage pain in OA patients. However, the use of NSAIDs in the elderly requires special attention due to the risk of side effects, including gastrointestinal, cardiovascular and renal disorders. This study aimed to assess the pattern of NSAID use in elderly OA patients at the Lasi Community Health Center. This study used a descriptive observational method with prospective data from 111 patients during March-May 2019. The results showed that ibuprofen was the most commonly used NSAID (19.8%), followed by diclofenac (10.8%). Most patients received doses according to standard therapy. However, there were some cases of mild side effects such as dyspepsia (3.6%) and constipation (2.7%). This study emphasizes the importance of close monitoring of NSAID use in the elderly to optimize therapy and minimize the risk of side effects.

Impact of health infrastructure facilities on health delivery in rural

In India, the healthcare industry has grown to be one of the biggest in terms of employment and income. Healthcare includes clinical trials, hospitals, medical equipment, telemedicine, outsourcing, medical tourism, health insurance, and medical devices. The Indian healthcare industry is expanding quickly as a result of improved coverage, improved services, and rising public and private sector spending. In the paper titled "Impact of Health Infrastructure Facilities on Health Delivery in Rural," the function of health centers, their facilities, and their effects on the provision of health services are examined, along with the difficulties faced by the residents of Mandya district. The survey method was used by the researcher, and regression analysis was used to assess the impact of the data.

Effectiveness of the implementation of the birth planning and complication prevention (P4K) program for pregnant women in supporting the optimization of the labor process in the Working Area of Poasia Health Center, Kendari City

Effectiveness of the implementation of the birth planning and complication prevention (P4K) program for pregnant women in supporting the optimization of the labor process in the Working Area of Poasia Health Center, Kendari City

Factor associated with diarrhea incidence in coastal area Bungkutoko, Kendari, Indonesia

Diarrhea is a health problem that has not been resolved until now, even this disease is the main cause of death in toddlers both globally and nationally. Diarrhea cases in the Nambo Health Center work area, Kendari City have continued to increase over the past 3 years. Bungkutoko is one of the sub-districts located in the coastal area of ​​Nambo District, Kendari City. Coastal areas include areas with inadequate sanitation access, with problems including the availability of clean water, toilets and other basic sanitation facilities that can be factors causing diarrhea. This study aims to determine the factors related to the incidence of diarrhea in the coastal area of ​​Bungkutoko. An observational analytic with cross sectional design was conducted in this study. This study was carried out in June 2024 in Bungkutoko Village, Kendari City, Southeast Sulawesi Province. The sample consisted of 70 respondents obtained using non-probability sampling, accidental sampling techniques. Data were collected using questionnaires and observation sheets, then processed and analyzed using a computer program. Data were analyzed bivariately using chi square test and fisher exact (if not eligible for chi square test) with 95% confidence level (α = 0.05). The results showed there was a relationship between water treatment before drinking and the incidence of diarrhea (p-value = 0.03), and there was no relationship between hand washing behavior (p-value = 0.09) and the condition of waste disposal sites (p-value = 0.25) with the incidence of diarrhea in the coastal area of ​​Bungkutoko, Kendari City. Therefore, it is expected that the community can process drinking water before consuming it to avoid diarrhea.

Strengthening community actions to improve diabetes mellitus care optimising public health facilitators

BackgroundDiabetes mellitus is the second leading cause of death in South Africa, and almost 90,000 people died from diabetes-related causes in the year 2019. This study aimed to investigate facilitators that can be harnessed to strengthen community actions and barriers that should be redressed in structured public health and health promotion programs for people with diabetes mellitus at a primary healthcare level.MethodsAn exploratory qualitative study was conducted using face-to-face interviews among 20 conveniently sampled participants. The Ottawa Charter was adopted to guide health promotion and strengthening actions for people with diabetes mellitus. This study was conducted at Ngangelizwe Community Health Centre. Ngangelizwe is one of the townships located about 2 km east of Mthatha Town in the Eastern Cape Province of South Africa. The thematic analysis method was used to analyse data with the assistance of Atlas ti, version 23 software.ResultsFive overarching themes were yielded and categorized as facilitators and barriers. Facilitators included enhancing the role of community healthcare workers and strengthening health education activities. Barriers included lack of support groups, food insecurity, and unavailability of community health promotion programs.ConclusionWe conclude that a collaborative health promotion intervention with the necessary competencies should be designed to assess needs and develop, implement, and evaluate relevant empowerment programs at the household and community levels. This approach involves active engagement with health promoters/ public health practitioners and community health workers at the local level, allowing individuals and communities to access motivation and knowledge regarding the control of diabetes mellitus.

Task-sharing: Abortion care access expansion through training midwives and nurses to provide first trimester abortion in a sub-Saharan setting: A multicenter pre-post study.

To determine the effect of training midwives and nurses on access to first trimester abortions and post-abortion family planning. This was a pre-post study on first trimester abortion care and post-abortion contraceptive services expansion by training midwives and nurses(task-sharing) from 14 catchment health centers of St. Paul's Hospital Millennium Medical College (Ethiopia). The study period was January 2022 to August 2023. Data were collected by reviewing records of first trimester abortion and post-abortion family planning at the health centers. Data were analyzed using SPSS version 23. Simple descriptive statistics were employed to analyze the data. Proportions and frequencies were used to present the results. A total of 2690 first abortions were performed during the study period. The number of first trimester abortions provided jumped from 790 in the pre-intervention period to 1900 in the post-intervention period (a rise of 140%), of which 624 (32.8%) were surgical (manual vacuum aspiration) and the remaining 1276 (67.2%) were medication abortions. Similarly, post-abortion family planning uptake increased from 35.3% (279/790) during the preintervention period to 71.6% (1360/1900) in the post-intervention period, an increment of 36.3%. Training midwives and nurses to provide first trimester abortion and post-abortion family planning had more than a doubling effect in expanding access to both first trimester abortion and post-abortion family planning.

Key factors associated with oral health services at Federally Qualified Health Centers.

This study aimed to investigate changes in oral health services from 2012 to 2021 and identify factors influencing the number of different types of services directly provided by all Federally Qualified Health Centers (FQHCs). Data from the 2012-2021 Uniform Data System were analyzed using multilevel mixed-effect negative binomial regression models. These models explored associations between oral health staffing, federal grant revenue, and state Medicaid dental policies for adults, and the number of different types of oral health services provided at FQHCs. Regressions were adjusted for FQHC and state characteristics, and survey year. FQHC visits for any oral health service increased significantly with each additional full-time equivalent (FTE) in all types of oral health staffing, ranging between 0.8% and 13.7% (e.g., IRR = 1.137, 95% CI = 1.126-1.148 for preventive services by dental hygienists/therapists). Preventive dental visits increased significantly by 32% (IRR = 1.320, 95% CI = 1.028-1.694) for every 1% increase in the proportion of capital development grants to the total revenue. Although not statistically significant, FQHCs in states with extensive Medicaid dental coverage had a 2%-7% increase in all types of oral health services except emergency services compared to those in states with emergency-only coverage. This study found that increasing dental staffing, particularly of dental hygienists/therapists, enhances FQHCs' ability to provide preventive services. Capital development grants also positively influence preventive dental care delivery. Expanding Medicaid dental coverage may also increase service utilization, particularly among underserved groups, reducing oral health disparities.

Advancing environmentally sustainable learning health systems: Perspectives from a Canadian health center

Advancing environmentally sustainable learning health systems: Perspectives from a Canadian health center

A serosurvey study of hand, foot and mouth disease in healthy children aged 6 to 71 months old in West Bandung and Bandung Region, Indonesia

BackgroundHand, foot, and mouth disease (HFMD) is an infectious disease that often affects children under 5 years of age. Over the past 20 years, enterovirus 71 (EV71) has become a major concern among children, especially in the Asia-Pacific region. Currently, there are no data showing the seroprevalence of HMFDs in Indonesia. This study aimed to determine the seroprevalence of antibodies to EV71 infection in rural and urban areas.MethodsThis study was an observational analysis and cross-sectional seroprevalence survey of HFMD in children aged 6 to 71 months. The sampling locations were the Padalarang health centre, which is rural, and the Garuda health centre, which is urban. The total sample included 600 children aged 6–71 months from these two locations. Blood sample testing uses enzyme-linked immunosorbent assays (ELISAs) to identify subjects who are positive for IgG EV71 and the risk factors that may influence it.ResultsIn total, 596 subjects (99.3%) were positive for the seroprevalence of EV71 IgG in rural and urban areas. Child age, sex, nutritional status, height/age, immunisation status, parental income, and father’s and mother’s educations were not statistically related in rural and urban areas (p > 0.05) because the rate of IgG EV71 seropositivity was very high.ConclusionThis study revealed that the rate of IgG EV71 HFMD seropositivity in Indonesia, especially in the Padalarang health centre and Garuda health centre, was very high. Further research is needed to investigate HFMD cases because of the lack of attention given to this disease and the need to consider whether immunisation is necessary to prevent HFMD.Trial registrationThis study is registered at clinicaltrials.gov, National Clinical Trial (NCT) No. NCT05637229.

Analysis of the Influence of Dental and Oral Health Services on BPJS Patient Satisfaction at Kaliwungu Kendal Health Center

The Kaliwungu Kendal Community Health Center provides comprehensive dental services with competent dental professionals. However, the service is still not optimal due to several patient complaints, such as waiting to see the dentist, waiting even after the dentist has arrived, not receiving immediate attention, a limited number of visits, etc. Creating quality services will undoubtedly lead to satisfaction among health service users. This study aims to determine the quality of service toward the satisfaction of BPJS patients at the Kaliwungu Kendal Community Health Center. The method used in this research is a quantitative analytical survey method with a cross-sectional study design. Data was collected with a sample size of 80 BPJS patients selected through sampling. The variables used in this study include the independent variable, service quality (X), and patient satisfaction (Y) as the dependent variable. The statistical analysis used in this study included a chi-square test and logistic regression. The results of the study show that all variables in the quality of dental and oral health service, including physical appearance, reliability, responsiveness, assurance, and empathy, have a positive and significant effect on patient satisfaction at the Dental Polyclinic of the Kaliwungu Kendal Community Health Center, with a p-value &lt; 0.05. The tangible dimension has the most dominant effect, with a significant influence (exp(B)OR 18.259), followed by empathy (exp(B)OR 11.102), reliability (exp(B)OR 7.627), and assurance (exp(B)OR 5.091). However, responsiveness obtained the lowest satisfaction percentage compared to the other dimensions, with a value of (exp (B) OR 4.474).