Primary Health Care Practice Research Articles

The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey

BackgroundThe COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova.MethodsWe present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic.ResultsResults highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking.ConclusionsDuring the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.

Sustainability of organisational models implementation in primary care: the CIRCE-JA approach

Abstract Fostering healthcare is the aim of EU4Health 2021-2027 agenda. To promote it the EU commission has launched calls for projects, in particular, a call for best practices (BPs) in primary healthcare (PHC). The Joint Action (JA) CIRCE-JA that was funded aims to transfer and implement PHC BPs among Member States, raising their capacity in implementing innovative care models and addressing health system transformation. To be fully effective and maintained over time a BP should be sustainable; part of the efforts of CIRCE-JA are dedicated to study and assure sustainability of the project. Sustainability is a key issue to make an intervention, although already proved of good quality, useful for the population through time. To identify factors of a sustainable implementation, a search of the literature has been done to outline a questionnaire that will be validated through DELPHI methodology and submitted to organisations already managing the BPs and the affiliated entities that will introduce the BPs in their organisations. CIRCE JA will lead to the implementation of 6 PHC BPs in 44 implementation sites located in 14 European countries. This variability calls for a solid transferring methodology to sustain the implementation. The theme of sustainability is not new and the literature search is going to provide enough material for the implementation of the questionnaire. The questionnaire will be compiled by BPs owners which have created the organisational model and the implementing sites; this will be done in order to understand the problems faced and assay the perceived issues. PHC is a priority for EU bodies. Sharing experiences and organisational models on PHC and the diffusion of BPs can be useful to improve quality and access of healthcare, also promoting the so-called European Health Union. Furthermore, a proper study of the sustainability of the interventions leads to a better and longer implementation, not causing a waste of effort, money and time. Key messages • To effectively transfer and implement an organisational model, a solid study on sustainability should be conducted. • An efficient PHC organisation and provision is crucial to improve quality and access to healthcare.

S3-4 Social prescription: a meaning for general medicine in Belgium? A qualitative exploration with patients and healthcare providers about the physical literacy counselling program

Abstract Purpose In a society where the population is aging and chronic diseases are more and more present, social determinants of health occupy a growing place in primary care medicine. As the demand for holistic care is growing, the bio-psycho-social model takes on its full meaning within primary health care.(1) The “social prescribing” model, introduced in many countries in recent years, allows the integration of non-medical care into the primary health care system without overburdening the health professional. (2) Social prescribing enables general practitioners and others primary care professionals to refer people to a range of non clinical services to support their health such as the intervention of physical activity specialists. Methods This study defines social prescribing and discusses successful aspects and challenges of the model in targeted prescription of physical activity. It also evaluates a pilot project set up in Belgium in 2022 to test the model. The pilot project aimed at promoting, through doctors and physiotherapists of the medical center, the orientation of patients to physical literacy counselling meetings leaded by a specialized physical educator. The purpose of this study was then to explore, qualitatively, patients and staff of a medical center about their opinion over a physical literacy counselling program. Interviews of patients and healthcare providers were undertaken during this project. Results The strengths of the pilot project developed include successful implementation of holistic patient-centered care, strengthening of patients’ mental and physical well-being alongside empowering their health. In addition, the project successfully foster preventive care and demonstrates how primary care may transform into primary health care. However, many challenges remain including the sustainability of the model itself, the availability of the services offered, the financial support and the low commitment of doctors and patients. Conclusions this study highlights first guidelines to introduce the model into the practice of primary healthcare in Belgium. Although the project shows limitations, the theoretical model remains promising and opens up new potential horizons for the practice of general medicine in Belgium. Funding Source This study received no external funding.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews.

To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. CRD42020198182.

Barriers and Facilitators to Cardiovascular Disease Prevention Following Hypertensive Disorders of Pregnancy in Primary Care: Cross-Sectional Surveys.

Women with a history of hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease (CVD). Guidelines recommend that women diagnosed with HDP should be advised of their increased CVD risk, have regular blood pressure monitoring by their general practitioner (GP), and adopt healthy lifestyle behaviours. However, within Australia, the current practice in primary health care is unknown. The aim of this study was to describe current practices, barriers, and facilitators to the provision of CVD preventative services for women after HDP in the primary care setting and to identify potential strategies to support GPs in providing recommended care. Separate cross-sectional online surveys were undertaken with 35 GPs and 105 women with a history of HDP. Surveys included both closed- and open-ended questions. Closed-ended questions were analysed using basic descriptive statistics, and open-ended questions were themed and tallied. The survey of GPs revealed that GPs are more likely to assess traditional CVD risk markers than lifestyle risk factors or HDP history. GPs identified a lack of resources and skills as barriers to providing CVD preventative care post-HDP. The survey with women after HDP revealed that women with a history of HDP are more likely to be assessed for blood pressure than lifestyle CVD risk factors, and that the women's barriers to obtaining care included difficulty obtaining an appointment and time required for attending appointments. Strategies to improve CVD preventative care were consistent between surveys, where 70% of GPs and 59% of women chose 'increasing women's awareness of increased CVD risk' and 67% of GPs and 55% of women chose 'improving communication between hospitals and primary care' as their preferred strategies. While the findings suggest that women with a history of HDP are receiving advice consistent with guidelines for traditional CVD risk markers, such as blood pressure, they are less likely to receive CVD preventative care for lifestyle or female-specific CVD risk factors.

Um instrumento de avaliação do interno de pediatria na Atenção Primária à Saúde

Medical students have contact with different areas and scenarios during their internship and must have their performance evaluated in each of them. However, as many students do not feel properly evaluated, our objective was to develop an instrument to evaluate the performance of Medical students, during their internship in pediatrics, to be used during their practice in Primary Health Care. A methodological research was carried out with the elaboration of an instrument and the contribution of specialists with experience in teaching, using electronic invitations. At the end of the study, through the Delphi technique, seventeen of the twenty items contained in the original instrument were accepted by the 11 specialists who participated in the two rounds of analysis. Thus, the research reached its objective and, through this article, we disseminate the proposal of an “Instrument for the evaluation of Medical interns in the pediatric internship in Primary Health Care”.

Incidence and risk factors for polypharmacy among elderly people assisted by primary health care in Brazil

BackgroundPolypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years.MethodsThis was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals.ResultsThe incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093–1.267).ConclusionsThe incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.

Primary Healthcare Center's Healthcare Providers' Perception and Practice Toward Pediatric Cow's Milk Allergy in Qassim Region, Saudi Arabia.

Cow's milk allergy (CMA) typically first manifests in the first year of life, and it is the most challenging food allergy to detect since the clinical symptoms can vary significantly in both types and severity. This study is carried out to evaluate the level of knowledge and practice of healthcare providers (HCPs) in the Qassim Region regarding CMA. This is a cross-sectional study conducted among HCPs in the Qassim Region, Saudi Arabia. A self-administered questionnaire was distributed among HCPs using face-to-face interviews compromising four governorates of Qassim such as Buraydah, Unaizah, AlRass, and Albukairyah. The questionnaire includes socio-demographic characteristics and questions to assess the knowledge and practice of HCPs regarding CMA. Among 124 HCPs, 29% were aged between 25 and 30 years,50.8% were males and 49.2% were females. Over three-quarters (77.4%) were categorized as having poor knowledge levels, while poor practice was also prevalent (83.1%). Factors associated with increased knowledge and practice were being non-Saudi, being a consultant/specialist, and having more than 10 years of experience. There was a significant positive correlation between knowledge and practice scores (p<0.001). The knowledge and practice of HCPs regarding CMA were insufficient. Non-Saudi consultants/specialists with more years of experience tend to be more knowledgeable and have better skills in managing the disease. Further longitudinal studies are required to establish the level of knowledge and practices toward CMA.

Healthcare providers’ knowledge and challenges they face regarding growth charts’ utilization in primary healthcare practice

Abstract Background: Growth charts have been used worldwide for about 40 years, but their use has always been fraught with problems. Objectives: Assessment the knowledge and challenges among healthcare providers regarding the utilization of growth charts in primary healthcare practice. Materials and Methods: A cross-sectional study was aimed to assess healthcare providers’ knowledge toward growth chart in Al-Hilla city—Babylon Governorate—Iraq, during the period from the beginning of first January till April/2022. Data were collected using a self-administered questionnaire filled by physicians and nurses enrolled in this study after obtaining their verbal consents. Results: Seventy percent health workers were studied to determine their knowledge toward growth chart utilization, 51.4 were physicians, male-to-female ratio was 1:7. Results of this study revealed that 41.4% of participants had poor knowledge. Only 54.3% of the participants were exposed to previous training courses. There were significant associations between good knowledge and age group 30–39 years and exposure to combined training (theoretical and practical). Conclusions: More than half of the studied healthcare workers had good knowledge; the levels of knowledge are significantly associated with age, number, and duration of previous training.

Exploring Clinical Nurse Specialist Impact in Primary Health Care: Exemplars From a Student's Clinical Practice.

Primary healthcare (PHC) is a clinical frontier full of opportunities for clinical nurse specialists (CNSs) to improve population outcomes, facilitate smooth care transitions, and overcome challenges through a unique lens. Clinical nurse specialist practice in primary care is exceedingly rare, and there is a paucity of literature on the topic. This article provides exemplary projects implemented by a CNS student in a primary care clinic. Primary healthcare has been described as the "front door" of the health system. It has increasingly relied on nursing to deliver health services, yet PHC and nursing practice in this setting remain poorly defined. Clinical nurse specialists are well-positioned to define these concepts, standardize processes used to deliver services, and impact patient outcomes in PHC. The CNS student successfully supported a primary care clinic in these activities. Reviewing the impact of the CNS student's experience offers a better understanding of CNS practice in PHC. Gaps exist in the literature regarding best practices and care delivery in PHC. Clinical nurse specialists are educationally prepared to address these gaps and improve patient outcomes at the health system's "front door." Utilizing a CNS's unique skill set achieves cost-effective and efficient healthcare delivery in a new way that bolsters the strategy of utilizing nurse practitioners to meet the challenge of provider shortages.

VIEWS OF PEDITRICIANS ON SPEECH AND LANGUAGE DEVELOPMENT

Pediatricians that, in addition to treating children’s diseases, deal with early growth and development, have a special responsibility in the early detection and diagnosis of speech and language difficulties. Aim of this research was to examine pediatricians’ and pediatric specialists’ familiarity with speech-language development, developmental-behavioral pediatrics, opinions on acquired knowledge at the specialist study on early growth and development and to examine the importance of multidisciplinary approach and cooperation between pediatricians and speech therapists, educators and rehabilitators and psychologists.The sample was comprised of 14 specialists pediatricians and 1 pediatrics resident, who were employed in primary and secondary health care and private practice, from different cities of the Federation of B&amp;H and Republika Srpska. Results of this research have shown that surveyed pediatricians are working with children with difficulties in speech-language development on a daily basis. Respondents have mostly correctly answered all questions related to speech-language development which indicates that they have solid knowledge in this area. Results have shown that most of the respondents is not satisfied with the knowledge obtained from specialist study on early growth and development and that they are not completely familiar with developmental-behavioral pediatrics, but all of the pediatricians have agreed that this field of sub-specialty should be included as a part of our higher education program. When it comes to a multidisciplinary approach and cooperation with speech therapists, educators-rehabilitators and psychologists, respondents support and practice a multidisciplinary approach in the detection and diagnosis of speech and language difficulties.Keywords:opinions of pediatricians, speech-language development, developmental-behavioral pediatrics.

Colorectal Cancer (CRC) Awareness among Primary Healthcare Providers

Background: According to the Ministry of Health data, cancer prevalence is growing internationally and in Saudi Arabia, particularly colorectal cancer (CRC). We also noticed several individuals with a spectrum of different clinical presentations of gastro intestinal symptoms among adults in our routine primary health care (PHC) practice. Methodology: A 379 person cross-sectional research was undertaken among PHC participants from June 2021 to December 2022. SPSS was used to enter and evaluate data. Statistical tests such as basic proportions, chi square test for categorical data, risk variables relationship with CRC, and logistic regression analysis were used. The current study found that nearly half of the individuals (50.9%) had strong CRC knowledge of common symptoms. Dietary variables, fast meals, and greasy foods were cited by nearly two-thirds of the study group (69.5%) as potential causes of CRC. Furthermore, two-thirds (68.6%) were aware of the CRC screening test. Regression analysis was used, and a significant correlation was found between risk variables of fast-food intake, daily red meat consumption, and physical inactivity with CRC knowledge (P - 0.026, 0.012, and 0.004, respectively). Conclusions: According to the findings, primary health care attendants have a low level of CRC awareness. Almost one-third (35.6%) of persons will have a FOBE test for CRC. There is a need to raise knowledge of risk factors and CRC screening, as well as to strengthen current awareness programs. More research is needed to back up the current study findings in our population

The Untapped Potential of the Quadruple Aim of Primary Care to Foster a Culture of Health.

In 2015, the Robert Wood Johnson Foundation introduced the Culture of Health (CoH) action model to inform its grantmaking decisions in the United States. The essential principles of this model fall into four action dimensions: 1) making health a shared value, 2) fostering cross-sector collaboration, 3) creating more equitable communities, and 4) transforming healthcare systems. Although considerable success has been achieved since introduction of the CoH model, the pace of progress has been slower on the fourth dimension, since work in this area involves shifting mindsets from the acute care paradigm to one that focuses on prevention, by addressing the "upstream factors", including social and behavioral determinants impacting health. Moreover, despite its academic prominence, the CoH model remains restricted to the research realm, with limited translation to practice. By comparison, the Quadruple Aim (QA) is a four-dimensional framework that has been successfully translated into primary healthcare practice. Introduced in 2008, the QA entails the adoption of four principles in delivering healthcare: 1) improved patient experience, 2) population health, 3) lower costs, and 4) care team well-being, to achieve value in healthcare. The four principles of the QA could be viewed as analogous to the four principles of the CoH, given the inherent synergies in the underlying philosophy of the two frameworks. It is also noteworthy that both healthcare leadership (physician champions) and legislative reform had significant roles to play in the successful translation of the QA into mainstream practice. This in turn suggests that the primary healthcare system has potential to play an instrumental role in accelerating the pace of progress towards a culture of health by extending the scope of influence of the QA. This paper explores the inherent synergies between the QA and CoH models, and the untapped potential of the QA to foster a culture of health in the United States.

Where are all the veterans? A mixed methods assessment of a systematic strategy to increase veteran registration in UK primary healthcare practices

ObjectivesTo identify effective initiatives to increase veteran registration in UK primary healthcare (PHC) practices.DesignA structured and systematic strategy was designed to improve the number of military veterans correctly coded within...

Prevalence of Polypharmacy of Older People in a Large Brazilian Urban Center and its Associated Factors

With the aging population comes greater risks associated with polypharmacy, a significant public health problem. This study aimed to identify the prevalence of polypharmacy and its associated factors through Comprehensive Geriatric Assessment (CGA) among older adults treated in primary health care (PHC) in a large Brazilian urban center. We conducted a cross-sectional study with a random sampling of 400 older adults using primary health care. Polypharmacy was defined as the cumulative use of five or more daily medications. An assessment of a sociodemographic and health survey, fear of falling, and physical disabilities affecting activities of daily living and instrumental activities of daily living was conducted. The mean age was 75.23 (SD: 8.53) years. The prevalence of polypharmacy and hyperpolypharmacy was 37% (n = 148) and 1% (n = 4), respectively. The adjusted logistic regression showed that participants with chronic non-communicable diseases (CNCDs) (OR = 9.24; p = 0.003), diabetes (OR = 1.93; p = 0.003), and obesity (OR = 2.15; p = 0.005) were associated with a greater propensity to use polypharmacy. Our results show that older adults with CNCDs, diabetes, and obesity were more likely to use polypharmacy. The results reinforce the importance of using CGA in clinical practice in PHC.

The prevalence of keratoconus in northern Poland: A cross-sectional study of patients from a primary healthcare practice

IntroductionKeratoconus is defined as central and/or paracentral corneal thinning and steepening with consequent irregular astigmatism. To date, no prospective study has reported its prevalence in Central Europe. This study aimed to evaluate the prevalence of keratoconus assessed with Scheimpflug imaging in a profile of general medicine practice in Poland. MethodsThis cross-sectional study collected data by inviting all patients aged 10–80 years subscribed to a single general practitioner in the Elbląg area, Poland. Corneal measurements were performed using a rotating Scheimpflug corneal tomography system. Three masked examiners established the diagnosis of keratoconus in the right or left eye. Fleiss’ kappa coefficient (κ) was used to qualitatively analyze the interexaminer agreement. ResultsOf 1,705 patients invited to the study, 771 agreed to participate (45.2%). The mean age of the 728 patients (60.6% female and 39.4% male) with gradable images in at least one eye was 53.6 ± 16.5 years. All of the examiners classified the same four cases as keratoconus (0.549%, 549 per 100,000, 95% confidence interval 150 to 1,400 per 100,000), of which two were bilateral. Fleiss’ kappa showed almost perfect agreement among the three examiners regarding the diagnostic decision (κ = 0.784, 95% confidence interval 0.750 to 0.817, p < 0.001). The keratoconus cases were all women (p = 0.106), aged 48, 69, 70, and 71 years old. ConclusionThe prevalence of keratoconus in this area was higher than that previously demonstrated in many European countries. Underestimation of the prevalence has been postulated but never demonstrated.

Effects of individual and organizational factors on job tenure of primary care physicians: A multilevel analysis from Brazil.

The short tenure of primary care physicians undermines the continuity of care, compromising health outcomes in low-, middle and in high-income countries. The purpose of this study was to investigate the contextual and individual factors associated with the tenure of physician in Primary Health Care (PHC) services. We consider individual-level sociodemographic variables such as education and work-related variables, as well as the characteristics of employers and services. This study is a retrospective cohort study of 2,335 physicians in 284 Primary Health Care Units across the São Paulo, Brazil, public health care system from 2016 to 2020. A multivariate hierarchical model was selected, and an adjusted Cox regression with multilevel analysis was employed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to report the findings from the study. The average physician tenure was 14.54 ± 12.89 months, and the median was 10.94 months. Differences between Primary Health Care Units accounted for 10.83% of the variance observed in the outcome, while the employing organizations were responsible for only 2.30%. The physician characteristics associated with higher tenure in PHC were age at hire, i.e., being between 30 and 60 years old, [HR: 0.84, 95% CI: (0.75-0.95)] and professional experience over five years [HR: 0.76, 95% CI: (0.59-0.96)]. Specialties not related to PHC practices were associated with a short tenure [HR: 1.25, 95% CI: (1.02-1.54)]. Differences between Primary Health Care Units and in the individual characteristics, such as specializations and experience, are related to the low tenure of professionals, but such characteristics can be changed through investments in PHC infrastructure and changes in work conditions, policies, training, and human resource policies. Finding a remedy for the short tenure of physicians is essential for guaranteeing a robust PHC system that can contribute to universal, resilient, and proactive health care.

A Systematic Review of Social Work in General Practice: Opportunities and Challenges

ABSTRACT Purpose This study identified the nature of social work practice in primary health care and described the reported patient outcomes, benefits, challenges, and enablers of social work in general practice [GP] settings. Method A systematic literature review applying the Prisma framework was conducted. Results A total of 26 studies met the inclusion criteria. Social work practice in GP assists in delivering positive health outcomes for patients, improved patient care, offers value for money, and supports interdisciplinary teams. Identified challenges include funding impediments, organizational barriers, and a lack of understanding of and undervaluing the social work role. Discussion and Conclusions The review outlined the benefits of social work practice in GP practices; however, these must be further evidenced. Funding for social workers in primary health care was identified as a challenge when it was lacking, and as an enabler when it was available. Further research to evidence the patient outcomes and overall benefits, the fiscal value of social work and funding pathways in primary health care is recommended.

Telehealth use in primary healthcare collaborative interprofessional practice: protocol for a scoping review

IntroductionTelehealth is a growing topic, with potential to improve access to primary healthcare. However, there is a lack of knowledge regarding how telehealth could facilitate interprofessional collaboration that is recommended...

When primary healthcare meets queerstory: community-based system dynamics influencing regional/rural LGBTQ + people’s access to quality primary healthcare in Australia

BackgroundLesbian, gay, bisexual, transgender, Queer, and people of any other minority sexuality or gender identity (LGBTQ + or “Queer”) are often marginalised from accessing quality primary healthcare (PHC) in their local community. This is largely due to Queerphobic, cis-heteronormative/sexist systems pathologising Queer life and identities. The study aims were to: (1) identify key priorities for increasing Queer people’s access to quality PHC as told by Queer people themselves, (2) identify the feedback loops that reduce or support Queer people’s access to quality PHC in non-metropolitan, regional/rural communities, and (3) identify potential action areas to improve system structures to increase Queer people’s access to quality PHC.MethodsGroup Model Building (GMB) workshops were held with a small group (n = 8) of LGBTQ + people in regional Victoria with lived experience of using PHC services. This participatory approach permits exploration and visual mapping of local structures causing behaviour patterns of community concern over time – in this case, Queer people’s ability to access quality PHC in the Geelong-Barwon region. This is the first study that specially applies GMB in Queer PHC in the non-metropolitan regional/rural context.ResultsKey community identified PHC priorities were: (a) providers’ level of Queer Literacy, (b) the responsibility of Queer Advocacy (at individual, systemic, and collective levels), (c) support from safe Queer Spaces, (d) strength from a Queer Presence, and (e) power from Intersectional Queer Life. These priorities interconnected, creating system-level feedback loops reinforcing barriers and enablers to Queer people’s access to quality PHC in the Geelong-Barwon region; with potential action areas identified.ConclusionsImproving Queer people’s access to quality PHC in the Geelong-Barwon region requires embedding principles of Queer Literacy, Queer Advocacy, Queer Space, Queer Presence, and Intersectional Queer Life within practices and service systems. The study findings were distilled into a novel, preliminary set of Queer Equity Principles. These need to be taken back to regional Queer communities for further co-design and planning for translation across PHC practices and systems, with potential applicability in other areas of the healthcare spectrum.