Primary Health Care Patients Research Articles

Beliefs about medications when treating hypertension in primary health care: results from “PERson-centredness in hypertension management using information Technology (PERHIT)”

Purpose Hypertension is a major global health concern. Despite of efficient antihypertensive medications a low percentage of patients reach a blood pressure (BP) of <140/90. Nonadherence is a great concern in hypertension treatment and patients’ beliefs about medications has been shown to have a strong impact on adherence. The objective of this study is to examine beliefs about medications and its impact on BP treatment in a group of Swedish primary healthcare patients treated for hypertension with or without an E-health platform. Materials and method In a randomised unblinded controlled trial, 949 patients with hypertension from Swedish primary health care centres were included. The intervention group used a web-based system to support self-management of hypertension for eight weeks. Beliefs about medication questionnaire (BMQ) were administered to all patients at inclusion, 8-week follow up and 1-year follow up. Results Data were collected from the 862 patients who completed the trial. No statistically significant difference was found in BMQ-scores between the intervention and the control group. An association between lower scores in the BMQ subsection ‘General-Harm’ and achieving target BP of <140/90 mmHg were noted (p = 0.021). Conclusion This study shows a significant association between beliefs about medication and BP levels, on hypertensive patients in the Swedish primary care setting, in only one out of four subsections of the BMQ. The intervention did not have a significant effect on changing patients’ beliefs about medication. Further emphasis on patients’ beliefs about medications could be useful in the clinical setting.

Intolerance-of-uncertainty therapy versus metacognitive therapy for generalized anxiety disorder in primary health care: A randomized controlled pilot trial.

This randomized controlled pilot study investigated the feasibility of a future full-scale RCT to compare the effects of intolerance-of-uncertainty therapy (IUT) and metacognitive therapy (MCT) in primary health care patients with generalized anxiety disorder (GAD). Preliminary treatment effects were also evaluated. 64 patients with GAD at a large primary health care center in Stockholm, Sweden, were randomized to IUT or MCT. Feasibility outcomes included participant recruitment and retention, willingness to receive psychological treatment, and therapists' competence in and adherence to treatment protocols. Self-reported scales were used to assess treatment outcomes, including worry, depression, functional impairment, and quality of life. Recruitment was satisfactory, and dropout was low. On a scale from 0 to 6, participants were satisfied with participating in the study (M = 5.17, SD = 1.09). Following brief training, therapists' competence was rated as moderate, and adherence was rated as weak to moderate. From pre- to post-treatment, reductions on the primary treatment outcome measure of worry were of a large effect size and statistically significant in both the IUT and MCT conditions (Cohen's d for IUT = -2.69, 95% confidence interval [-3.63, -1.76] and d for MCT = -3.78 [-4.68, -2.90]). The between-group effect size from pre- to post-treatment was large and statistically significant (d = -2.03 [-3.31, -0.75]), in favor of the MCT condition. It is feasible to carry out a full-scale RCT to compare the effects of IUT to MCT for patients with GAD in primary health care. Both protocols seem effective, and MCT seems superior to IUT, but a full-scale RCT is needed to confirm these conclusions. ClinicalTrials.gov (no. NCT03621371).

Prevalence and Factors Related to Functional Status of Older Adult Patients in Primary Health Care

Functional status means the ability to perform self-care, self-maintenance, and daily activity. Older adults are at risk of experiencing a decline in functional status regarding their condition and other factors. The study literature found no clear evidence of the factors related functional status of older adults, especially those who have comorbid and regularly come to the geriatric clinic in the Primary Health Care Center. This study aimed to identify the prevalence and factors related to the functional status of older people who visit geriatric out-patient in the primary health care center. A cross-sectional design was utilized to assess 100 samples of older adult patients in one Primary Health Care Center, in Indonesia. The functional status of the respondent was good where the mean score was 7.45 (SD = 1.07) with a minimum score was 2, and a maximum score was 8. The mean age of the sample was 66 years old, the gender was primarily women (59%), the education level of the respondents was more likely only reach elementary school (45%), and primarily they consume drugs (71%) and also more than a half of respondent have multimorbidity (60%). The model fit of multivariate analysis resulted in 44% of all the variables giving effect to the functional status where the most influential factor was balance and health status of the older adults. Discussion: More than half of the older people who regularly visit the Primary Health Care Center have an excellent functional status. This condition is in accordance with the experience of older people itself who most of them could come to the clinic independently by public or private transportation. Older people who have good health or balance status and less morbidity also show a good performance in functional status, though, their age was older. All the variables give 44% effects of older people’s functional status where the most influential factor for functional status of the older adults was balance status. Therefore, the accessibility of health services for the older adult in the community can be improved by providing more elderly-friendly health facilities.

Features of the course of stable exertional angina against the background of iron deficiency anemia in outpatient practice

Introduction. Iron-deficiency accompanies many diseases, including cardiovascular pathology, so timely diagnosis and correction of this condition is necessary. Aim. To study the features of the course of stable exertional angina against the background of iron deficiency anemia before and after correction with iron (III) polymaltose hydroxide in patients in primary health care using a computerized patient register. Materials and methods. 1210 patients with stable exertional angina aged 50–85 years (309 men, 901 women) were included. A special computer program was created for data analysis. In 500 out of 1210 patients, IDA was detected (385 women, 115 men). Mild anemia – 410 patients, moderate – 75, severe – 15. The main group – patients with stable exertional angina and Irondeficiency anemia (the first subgroup – patients treated with iron (III) polymaltose hydroxide and the second subgroup – patients who did not receive the drug iron (III) polymaltose hydroxide due to refusal of treatment or contraindications) and the control group – patients with stable exertional angina without Iron-deficiency anemia. All patients received standard therapy recommended for the treatment of stable exertional angina (the main group additionally received iron (III) polymaltose hydroxide). Results. In the first subgroup of the main group, after treatment with iron (III) hydroxide polymaltose, there was a statistically significant increase in hemoglobin levels by 11,7%, hematocrit by 5%, erythrocytes by 4%, serum iron by 112,8%, and an improvement in exercise tolerance by 48,7%, episodes of ST segment depression by 30,2%. In the second subgroup and the control group, there were no significant changes in the above parameters. Conclusion. Iron-deficiency anemia contributes to the severe course of stable exertional angina, which is confirmed by the high frequency of III-IV functional class exertional angina, a decrease in tolerance to exercise stress. Correction of Iron-deficiency anemia reduces the frequency of episodes of transient myocardial ischemia in the main group.

Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions

A trauma-informed approach is a framework for organisational (synonym system) change interventions that address the universal prevalence and impact of trauma. This mixed methods systematic review assessed the effects of trauma-informed approaches on psychological, behavioural, and health outcomes in health-care providers and adult patients in primary care and community mental healthcare. We searched five databases and grey literature and consulted experts for reports published in January 1990 to June 2021. The quantitative descriptive and qualitative framework syntheses were integrated through a line of argument and mapped onto a logic model. We included six nonrandomised studies that evaluated eight interventions with varied theoretical developments, components, and outcomes. The most common components were budget allocation, workforce development, identification/response to violence and trauma, and evaluation. Evidence for intervention effects was limited and conflicting. Four studies reported improvement in provider readiness and sense of community, while three reported conflicting effects on provider behaviour regarding delivery of trauma-informed care. Four studies reported some improvement in patient readiness for disease management and access to services; however, the evidence for patient satisfaction was conflicting. Two studies found that patients and providers felt safe. While one study reported improvement in patient quality of life and chronic pain, another found no effect on substance use, and three studies reported conflicting effects on mental health. Intervention mechanisms included a package of varied components, tailoring to the organisational needs, capacities and preferences, staff education and self-care, creating safe environments, and shared decision-making. Intervention effects were moderated by contextual (health system values, policies, governance, business models, trauma-informed movement, organisational culture, and social determinants of health) and intervention factors (buy-in from all staff, collective learning through conversations, equal attention to staff and patient well-being, and sustainable funding). No studies measured adverse events/harm, cost effectiveness, or providers’ health. We need more methodologically robust evaluations of trauma-informed organisational change interventions.

The Functioning of the Polish Health Care System During the First Wave of the SARS-CoV-2 Pandemic in the Opinion of Primary Health Care Patients

The Functioning of the Polish Health Care System During the First Wave of the SARS-CoV-2 Pandemic in the Opinion of Primary Health Care Patients

AWARENESS OF THE POPULATION ABOUT CARDIOVASCULAR FACTORS OF THE DEVELOPMENT OF DISEASES AS A RESULT OF THE APPLICATION OF A POPULATION STRATEGY

At the state level, measures have been carried out in different years to form a sustainable understanding of the importance of health as a personal value by the population. This is due to the global strategic interests of the Russian Federation in preserving and strengthening the health of the population.&#x0D; In our study, the awareness of working-age patients of primary health care about the risk factors for the development of cardiovascular diseases and their frequency of occurrence was analyzed, taking into account the standardization of statistical indicators for 5 years (2014-2018) in the office of prevention of hypertension.&#x0D; Materials and methods. The study was conducted on the basis of urban clinics of the Krasnoselsky district of St. Petersburg in two stages. At the first stage, a sociological survey was conducted using a specially designed questionnaire. At the second stage, an analysis of 807 cases of patients aged 18 to 65 years in the office of prevention of arterial hypertension was carried out.&#x0D; As a result of the sociological survey, respondents among both men and women are well informed about the influence of a number of behavioral risk factors on the occurrence and development of cardiovascular diseases.&#x0D; Conclusion. There is a high awareness of risk factors for the development of non-communicable diseases, including cardiovascular diseases, in patients of working age, which is a positive result of the implementation of a population and high-risk strategy.&#x0D; But there are significant reserves for improving behavior for those who are ready to change it in favor of choosing a healthy lifestyle.&#x0D; Within the framework of primary health care, medical examinations and preventive medical examinations are aimed at increasing the awareness of the population about risk factors for the development of non-communicable, including cardiovascular diseases through medical consultations. The work of Health Centers, prevention offices, Health Schools should be aimed at low-informed patients, examine and determine the functional reserves of their body with the possibility of subsequent correction of the identified disorders.&#x0D; In our work, low awareness was noted in 13% of respondents. Low awareness of patients creates a high risk of unfavorable outcomes of diseases. If the patient understands the essence of his illness and the importance of following the doctor’s recommendations, then the situation may change for the better.

Clinical impact of comprehensive medication management services offered to geriatric and hypertensive patients

Abstract Objectives To assess the clinical impact of comprehensive medication management (CMM) services offered to geriatric and hypertensive patients in primary health care in Brazil. Methods A quasi-experimental study was carried out with patients followed up in primary care in three Brazilian cities (n = 346). McNemar’s test was used to assess the clinical impact of the service. Key findings A total of 1308 drug therapy problem (DTPs) were identified and 581 (44.4%) were resolved. Among the DTPs, the majority were related to non-adherence to therapy (23.9%; n = 313) or the need for additional medications (18.2%; n = 238). It was observed an increase in the proportion of people who had their blood pressure controlled at the last visit when compared with the first visit. Conclusions This study indicates that the CMM service can contribute to achieving blood pressure control in geriatric and hypertensive patients. The frequency of DTPs was high in the studied population, but many DTPs were resolved by pharmacists.

Caring for Long Covid patients in primary health care: a cross-sectional study among general practitioners in Belgium and Malta

Caring for Long Covid patients in primary health care: a cross-sectional study among general practitioners in Belgium and Malta

The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study.

With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers' digital competencies-their "eHealth literacy." The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori-defined factor structure (confirmatory factor analysis). A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study

Background Most COVID-19 patients were treated in primary health care (PHC) in Europe. Objectives To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient’s clinical pathways in Europe. Methods Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. Results COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). Conclusion In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

Sense of coherence in hypertensive patients in primary health care

Sense of coherence in hypertensive patients in primary health care

Management of Depression in Chronic Care Patients Using a Task-Sharing Approach in a Real-World Primary Health Care Setting in South Africa: Outcomes of a Cohort Study.

Depressive symptoms are common in South African primary care patients with chronic medical conditions, but are usually unrecognised and untreated. This study evaluated an integrated, task-sharing collaborative approach to management of depression comorbid with chronic diseases in primary health care (PHC) patients in a real-world setting. Existing HIV clinic counsellors provided a manualised depression counselling intervention with stepped-up referral pathways to PHC doctors for initiation of anti-depressant medication and/ or referral to specialist mental health services. Using a comparative group cohort design, adult PHC patients in 10 PHC facilities were screened with the Patient Health Questionnaire-9 with those scoring above the validated cut-off enrolled. PHC nurses independently assessed, diagnosed and referred patients. Referral for treatment was independently associated with substantial improvements in depression symptoms three months later. The study confirms the viability of task-shared stepped-up collaborative care for depression treatment using co-located counselling in underserved real-world PHC settings.

Design of a Nutritional Survey to Detect High Dietary Salt Intakes and Its Usefulness in Primary Care Compared to 24-Hour Urine Sodium Determination.

Many population studies report salt intakes that exceed the WHO recommendation (2 g/day of Na+ or 5 g/day of salt). We do not have tools for detecting high salt intakes that are easy to apply in primary health care (PHC). We propose the development of a survey to screen for high salt intake in PHC patients. A cross-sectional study of 176 patients determines the responsible foods, and a study of 61 patients studies the optimal cut-off point and discriminant ability (ROC curve). We assessed the salt intake using a food frequency questionnaire and a 24 h dietary recall and used a factor analysis to identify the foods with the highest contribution to be included in a high intake screening questionnaire. We used 24 h urinary sodium as a gold standard. We identified 38 foods and 14 factors representing a high intake, explaining a significant proportion of the total variance (50.3%). Significant correlations (r > 0.4) were obtained between nutritional survey scores and urinary sodium excretion, allowing us to detect patients who exceed salt intake recommendations. For sodium excretion ≥ 2.4 g/day, the survey has a sensitivity of 91.4%, a specificity of 96.2% and an area under the curve of 0.94. For a prevalence of high consumption of 57.4%, the positive predictive value (PPV) was 96.9% and the negative predictive value (NPV) was 89.2%. We developed a screening survey for subjects with a high probability of high salt intake in primary health care, which could contribute to the reduction in diseases associated with this consumption.

Comparison of Framingham 10-year cardiovascular risks in Sweden- and foreign-born primary health care patients in Sweden

BackgroundThe prevalence of cardiovascular disease around the world varies by ethnicity and region of birth. Immigrants living in Sweden may have a higher prevalence of cardiovascular diseases than native-born Swedes, but little is known about their actual cardiovascular risk. This study aimed to examine the relationship in Sweden between 10-year cardiovascular risk and birthplace.MethodThis cross-sectional study was based on cardiovascular risk factor data obtained from the 4D Diabetes Project, a Programme 4D subproject in Sweden. Participants were recruited from two primary healthcare centres in Stockholm without a history of diabetes or pre-diabetes. The outcome variable was 10-year cardiovascular risk based on the calculation of a Framingham Risk Score with six risk factors: age, sex, LDL, HDL, BP, diabetes and smoking for each participant. Multiple linear regression was performed to generate β-coefficients for the outcome.ResultsThere was an average of 8.86% cardiovascular risk over 10 years in Sweden-born participants and a 5.45% 10-year risk in foreign-born, (P < 0.0001). Foreign-born participants were about 10 years younger (mean age 46 years vs. 56 years, P < 0.001), with a significantly higher proportion of smokers (23.9% vs. 13.7%; P = 0.001). To be born in Sweden (with parents born in Sweden) was significantly associated with a 10-year cardiovascular risk in the crude model (β- coefficient = 3.40, 95% CI 2.59–4.22; P < 0.0001) and when adjusted for education and alcohol consumption (β- coefficient = 2.70 95% CI 1.86–3.54; P < 0.0001). Regardless of the birthplace, 10-year cardiovascular risk was lower for those with higher education compared to those with less than 10 years of education.ConclusionThis study found a relationship between 10-year calculated cardiovascular risk and place of birth. Sweden-born participants had a higher association with 10-year cardiovascular risk than foreign-born participants. These results contradict previous reports of higher rates of CVD in residents of Middle-Eastern countries and Middle-Eastern immigrants living in Sweden.

Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana.

Doctor attributes contribute significantly to the quality of the doctor-patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor-patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor-patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor-patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.

Chronic Limb Ischemia: Awareness and Treatment in Primary Care

Chronic limb ischemia (CLI) is a type of peripheral arterial disease (PAD) that is still underdiagnosed and undertreated despite the increasing incidence, thus becoming a global health burden. The prevalence of PAD is quite high, approximately around 200 million globally in the adult population and increased drastically in older age population. It might be difficult to diagnose at an early stage because around 20-50% patients may be asymptomatic. More than 70% of primary physicians also did not notice that the diagnosis was already established during screening of the PAD patients. All these problems could increase the incidence of PAD in the following year. The untreated conditions will develop into a more severe form of PAD known as chronic limb-threatening ischemia (or critical limb ischemia), and patients are at a higher risk of having limb loss, and also increased morbidity and mortality. The primary physicians in the primary health facilities hold an important role in the early diagnosis and management of patients with CLI symptoms or with risk factors of CLI. Due to the limitation of diagnostic testing modality at primary health facilities, the physician can assess the ankle-brachial index (ABI) to determine the presence of CLI. Management of the disease is different for every patient and is customized based on the other comorbidities. Risk factors should be controlled in order to achieve a better outcome. A good management strategy will improve the condition. This review aims to describe how to give an early diagnosis and management for CLI patients in primary health care.

Laboratory diagnosis of COVID-19 cases from nasal and oropharyngeal swab specimens

Introduction: Indonesia first reported Covid-19 on March 2, 2020, which continued to increase and spread rapidly throughout Indonesia. WHO recommends molecular examinations for patients with suspected COVID-19 through molecular detection method or NAAT (Nucleic Acid Amplification Test), including Real Time-Polymerase Chain Reaction (RT-PCR) tests. This study aimed to describe the profile of RT-PCR test services on nasal and oropharyngeal swab specimens from patients treated at Dr. Pirngadi Hospital Medan and patients of primary health care (Puskesmas) or other hospitals referred for RT-PCR examination at the Laboratory of Dr. Pirngadi Hospital. Method: This was a retrospective, descriptive study using secondary data from medical records from August 2020 to July 2021. Using consecutive sampling, the study sample was all suspected and confirmed COVID-19 specimens collected at Dr. Pirngadi Hospital, Medan. All collected data were processed and analyzed using IBM SPSS version 20.0. Result: There were 7495 specimens of COVID-19 from Dr. Pirngadi Hospital from August 2020 to July 2021, of which 1264 (17%) were confirmed positive, and 6231 (83%) had negative results. Meanwhile, 12.274 specimens were obtained from primary health care or other hospitals, of which 2602 (2%) samples were confirmed positive, and 9672 (98%) had negative results. Based on sex, 884 men (44%) and 1108 women (56%) had confirmed COVID-19 cases. Conclusion: From August 2020 to July 2021, this study found 17% and 2% of confirmed COVID-19 cases at Dr. Pirngadi Hospital and primary health care or other hospitals, respectively. COVID-19-confirmed issues were more common in women.

Early detection methods of chronic diabetic nephropathy in diabetes mellitus patients in primary health services

Introduction: The prevalence of diabetic kidney disease increases along with the increase in the number of patients with diabetes mellitus. Early detection of diabetic nephropathy in DM patients is an essential step in preventing the incidence of diabetic kidney disease. The study aimed to obtain a method of early detection of diabetic kidney disease in DM patients in primary health care via identifying factors associated with decreased glomerular filtration rate (GFR). Methods: We conducted a case-controlled study at the public health center in Bantul. The research subjects were patients at Kasihan 1 public health center aged 18-75 years. In-depth interviews will be conducted to obtain clinical and social risk factors for GFR decreasing as an early detection tool for diabetic nephropathy (DN) incidence. The IGF-1 levels were checked using ELISA. The Pearson correlation test observed a significant association between patient risk factors and GFR. Results: This study is expected to obtain a model of the method of early detection of chronic diabetic kidney disease in diabetes mellitus patients in primary health services. The results showed that the GFR was related to systolic blood pressure, diastolic blood pressure, hyperglycemia, nicotine levels, and IGF-1 levels (P&lt;0.00). Increased nicotine levels, increased blood pressure, hyperglycemia, and decreased levels of IGF-1 are associated with decreased GFR. Identifying factors related to the glomerular filtration rate can be used to predict impaired renal function. Conclusion: Reduced glomerular filtration rates are linked to higher nicotine levels, higher blood pressure, hyperglycemia, and lower IGF-1 levels.

Nursing Care Coordination in Primary Healthcare for Patients with Complex Needs: A Comparative Case Study.

Despite nurses' substantial role in care coordination, few education programs exist to better support them in this role. Identification of a set of core care coordination activities across heterogeneous care coordination programs would facilitate the development of a standard of practice. We sought to examine care coordination activities across two care coordination programs in Family Medicine Groups in Quebec, and their relationship to the program design. We performed a comparative case study of two care coordination programs in primary care targeting frequent users of healthcare services and people with Alzheimer's disease and related disorders. Data collection included documents and semi-structured interviews with key informants. Several activities were common to both programs, such as patient identification; assessment, development of an individualized service plan; and linking patients and caregivers with professionals and services. However, their components were different due to the impact of the integrated care program design, policy environment, and the target patient populations' complex needs. The homogeneity or heterogeneity of patients' complex needs shapes their care trajectory and the intensity of their care coordination needs. As the complexity of these needs grows, so does the necessity to build the care coordinators' capacity for integrated care.