Primary Care Delivery Research Articles

Executive Summary of the 2024 ASHP Commission on Goals: Primary Care Delivery Transformation.

Executive Summary of the 2024 ASHP Commission on Goals: Primary Care Delivery Transformation.

Developing a Family Medicine Program in Jordan: appraisal of trainees and trainers and final assessment outcomes

Introduction Curriculum development in medical education, particularly in family medicine, is essential for preparing healthcare professionals to meet evolving patient needs. This article examines the development of a Family Medicine program in Jordan, focusing on challenges, methodologies, and outcomes. Methods The curriculum was developed through collaboration between Jordanian and European universities, emphasizing core family medicine principles, evidence-based practice, and local context. Two cohorts of trainees participated in the one-year program, which used a 'whole task learning model' covering communication, clinical knowledge, and community health. Feedback was gathered through focus group interviews with trainers and trainees, and pre- and post-test data were analyzed to assess effectiveness. Results Feedback indicated positive perceptions among trainers and trainees. Trainees valued the transition to Arabic-led lectures, improved primary care understanding, and trainer engagement. Strengths included evidence-based guidelines and patient interaction emphasis. Areas for improvement included more face-to-face training and practical opportunities. Trainers suggested enhancing practical skills training and increasing Arabic materials. Despite pretest score variations, both cohorts showed significant improvement. Challenges such as non-participation and cheating highlighted the need for regular attendance and academic integrity. Conclusion The research underscores the importance of feedback from trainees and trainers in curriculum development. Continuous improvement, comprehensive assessment, and prioritizing linguistic and cultural relevance are crucial for enhancing primary care delivery in Jordan.

Enablers and barriers of community health programs for improved equity and universal coverage of primary health care services: A scoping review

BackgroundCommunity health programs (CHPs) are integral components of primary health care (PHC) systems and support the delivery of primary care and allied health and nursing care services. CHPs are necessary platforms for delivering health services toward universal health coverage (UHC). There are limited prior studies on comprehensive evidence synthesis on how CHPs strengthen community health systems for the demand and supply of PHC services. Therefore, this scoping review synthesized existing evidence on the interlinkage between CHPs and the community health system and beyond for delivering and utilising PHC services toward UHC.MethodsWe conducted a scoping review of research articles on CHPs. We identified research articles in six databases (PubMed/Medline, CINAHL, Scopus, Cochrane, Web of Science, and Embase) and Google Scholar using search terms under three concepts: CHPs, PHC, and UHC. Of the 3836 records identified, 1407 duplicates were removed, and 2346 were removed based on titles and abstracts. A total of 83 articles were eligible for the full-text review; of them, 18 articles were removed with reasons, and the other 16 were included through hand search. Themes were identified and explained using Sacks and colleagues’ “Beyond the Building Block” framework.ResultsA total of 81 studies were included in the final review. Studies described CHPs as foundations for community health system readiness for PHC services, including decentralization in the health sector, community-controlled governance, resource mobilization, ensuring health commodities (e.g., through community pharmacies), and information evidence. These foundational inputs mediate the actions of CHPs by partnership with community organizations and health workforces (e.g., community health workers). CHPs contributed to improved access to health services by providing health services in public health emergencies, affordable and comprehensive care, and modifying social determinants of health.ConclusionsCHPs are platforms for implementing and delivering PHC services close to communities. They help to modify social determinants of health, promote health and wellbeing, reduce care costs, prevent disease progression, and reduce hospitalisation rates. CHPs are integral parts of community health systems and require investment to improve access to PHC services. Gaps and challenges of CHPs include inadequate funding, limited engagement of the private sector, poor quality of health services, and limited focus on non-communicable diseases (NCDs). Further implementation research is needed to mitigate the burden of NCDs. Health systems efforts focus on increasing resources (e.g., financial and human) required in CHPs to ensure the quality of PHC services provided through CHPs toward better service access, and reaching the unreached and achieve equity and universality of PHC services.

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Exploring the roles and influences of the modern general practice receptionist: a systematic review with narrative synthesis.

Modern general practice is characterised by increased demand and growing multi-disciplinarity, including ring-fenced funding for additional non-clinical roles. However, for practice receptionists training has remained unchanged for decades, yet primary care is under greater pressure than ever with receptionists becoming a growing focal point of abuse and unprecedented numbers leaving the role. To present the evidence of the range of tasks that receptionists continue to perform, describing their impact on primary care delivery and how the role might be better supported. We conducted a systematic review of evidence contained in the major medical databases (Medline/PubMed, CINAHL, ASSIA, Cochrane Library, and EMBASE) up until July 2023, including hand searches of the bibliographies of included studies. We identified 28 studies which we grouped into three themes: Service delivery, confirming the continuing role of receptionists in providing administrative support alongside clinical tasks of prioritising patients for consultations, facilitating repeat prescriptions, and communicating blood test results; Patient attitudes describing how patient's lacked trust in receptionists viewed as unqualified and unnecessarily obstructive; Finally, in considering Receptionist experience, the contrast between their confidence in performing administrative roles and the anxiety induced from the clinically related tasks was described, particularly the mounting pressure from patients to meet their preferences for clinician appointments. Though confident performing administrative tasks, receptionists described the uncertainty and anxiety when providing clinically oriented support or managing patients when their requests for appointments could not be met. More appropriate training or professionalisation might improve staff retainment.

Cost-Effectiveness Analysis of Telehealth and In-Person Primary Care Visits for People Living with Alzheimer’s Disease-Related Disorders in the State of Nevada

To people living with Alzheimer’s Disease-Related Disorders (ADRD), timely and coordinated communication is essential between their informal caregivers and healthcare providers. In provider shortage areas, for example, the state of Nevada, telehealth can be an effective primary care delivery alternative to in-person visits. To evaluate the cost-effectiveness of telehealth visits for people living with ADRD in the state of Nevada, a decision-analytic Markov model was developed from healthcare system perspectives with a 10-year horizon/1-year cycle. To estimate the effects of demographic and geographic parameters on the Markov model, race parameters were divided into non-Hispanic White individuals vs. others and location parameters were divided into urban vs. rural. A 12-item short-version Zarit Burden Interview (ZBI-12) was applied to measure the informal caregiver burdens of non-institutionalized people living with ADRD. The values of mortality rate and healthcare utilization were obtained from healthcare systems’ publicly available payor administrative data and Nevada State Inpatient/Emergency Department datasets. Among urban-residing non-Hispanic White individuals, the Incremental Cost-Effectiveness Ratio (ICER) per modified ZBI-12 indicated a cost saving of USD 9.44 with telehealth visits; among urban-residing racial minorities, the ICER per modified ZBI-12 indicated a cost saving of USD 29.26 with in-person visits; and among rural residents, the ICER per modified ZBI-12 indicated a cost-saving of USD 320.93 with telehealth visits. Distributional differences in the cost-saving effects of telehealth primary care were noted in line with racial and geographic parameters. Workforce and caregiver training is necessary for reducing distributional differences, especially among urban-residing racial monitories living with ADRD in the provider shortage area of the state of Nevada.

The Impact of the COVID-19 Lockdown on Cancer Referrals in Primary Care in the UK: Two Years On

Background: Cancer is common, with most cancer patients presenting initially to a general practitioner. The COVID-19 pandemic led to changes in the delivery of primary care, which could have affected cancer referrals. This observational study looked at two-week cancer referrals (2WRs) made before, during and after the first UK COVID-19 lockdown in 2020, at a GP practice in the Wirral, England. Methods: A search was conducted to find the cancer referrals made between 23rd March 2020 - 1st July 2020, during the first lockdown. Using the same methodology, cancer referral data was collected for the corresponding time periods in 2019 and 2021. The number of 2WRs and positive diagnostic yields were then compared. Results: The number of cancer referrals decreased by 40.4% in 2020, compared to 2019. In 2021, the number of referrals then increased by 225%, compared to 2020. Overall, the number of cancer referrals increased between 2019-2021. The positive diagnostic yield for the 2020 2WRs increased by 251.4%, compared to that of 2019. The calculated yield for the 2021 data then decreased by 10.8% compared to 2020. Overall, the positive diagnostic yield increased between 2019-2021. Conclusion: The numbers and outcomes of cancer referrals at this Wirral GP practice have changed considerably following the first UK COVID-19 lockdown in 2020, and the influence of the pandemic was still affecting cancer referrals in 2021. A greater focus on early cancer detection in primary care could help overcome the ways in which the pandemic has affected primary care delivery.

Navigating the Challenges of Primary Health Care in Selected Local Government Authorities in Tanzania: Bringing Lipsky’s Theory in Its Requisite Panorama

Introduction The robust delivery of primary health care (PHC) service is a complex interplay of key stakeholders, including policymakers, citizens, the government, parliamentarians, academics, and street-level bureaucrats - health staff in this context. While each of these players has a stake in ensuring robust PHC delivery, this paper specifically examines the role of street-level bureaucrats (SLBs) in dealing with service delivery challenges in Local Government Authorities (LGAs) in Tanzania. Although the engagement with these actors gained momentum in the decentralization reforms of the 1990s, their contribution has been slow. The question remains: How can SLBs cope with LGAs’ predicaments to enhance service delivery? Lipsky’s (1980) theory focuses on this contention by proposing that under challenging encounters, SLBs can develop specific patterns of practices to deal with the status quo. Methods Data were collected through interviews with policymakers at Mvomero District and Moshi Municipal Councils. To assess the effectiveness of primary health care services attributes such as authority, accountability, and access were closely examined. A thematic review of the literature was conducted to corroborate the findings from the interviews. Results The findings indicate that SLBs can cope with complex and challenging situations related to PHC delivery by rationing resources, simplifying their work environment, or exiting from turbulent environments. Although the engagement of SLBs gained momentum during the decentralization reforms of the 1990s, their contribution has been slow. The primary factor hindering their effectiveness is the inability to establish a mutually beneficial relationship between the Central Government and LGAs. Conclusion The government's attempts to control SLBs' behaviors, including limiting their intrinsic and extrinsic motivation, undermine their client responsiveness. Empowering SLBs and fostering a more collaborative relationship between the central government and LGAs is essential to enhance PHC delivery.

Effects of COVID-19 on Irish general practice activity from 2019 to 2021: a retrospective analysis of 500,000 consultations using electronic medical record data.

General practice (GP) is crucial to primary care delivery in the Republic of Ireland and is almost fully computerised. General practice teams were the first point of contact for much COVID-19-related care and there were concerns routine healthcare activities could be disrupted due to COVID-19 and related restrictions. The study aimed to assess effects of the pandemic on GP activity through analysis of electronic medical record data from general practice clinics in the Irish Midwest. A retrospective, descriptive study of electronic medical record data relating to patient record updates, appointments and medications prescribed across 10 GP clinics over the period 2019-2021 inclusive. Data relating to 1.18 million record transactions for 32k patients were analysed. Over 500k appointments were examined, and demographic trends presented. Overall appointment and prescribing activity increased over the study period, while a dip was observed immediately after the pandemic's arrival in March 2020. Delivery of non-childhood immunisations increased sixfold as a result of COVID-19, childhood immunisation activity was maintained,while cervical smears decreased in 2020 as the screening programme was halted. A quarter of consultations in 2020 and 2021 were teleconsultations, and these were more commonplace for younger patients. General practice responded robustly to the pandemic by taking on additional activities while maintaining routine services where possible. The shift to teleconsulting was a significant change in workflow. Analysing routinely collected electronic medical record data can provide valuable insights for service planning, and access to these insights would be beneficial for future pandemic responses.

The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools.

While prior studies have explored staffing infrastructure for primary care practices in general, little is known about the range of academic primary care practice models and supports available for academic general internists. To characterize the range of practice arrangements and expectations for attending academic physicians in general internal medicine (GIM) practices at the top 22 medical schools across the USA. Cross-sectional survey administered electronically between October 30, 2022, and December 28, 2022. Clinical leaders in GIM at the top 22 primary care medical schools, as identified by the 2023 US News and World Report Rankings. Clinical load, productivity expectations, cross-coverage, and team-based care models. Twenty-two leaders responded, representing 68% (15/22) of medical schools surveyed. The practices were mostly in urban locations (18/22, 82%) and 86% (19/22) included residents. Practices ranged from 7 to 200 PCPs and from 3 to 112 clinical FTEs. A full-time (1.0 FTE) clinical role for academic attending GIM physicians entailed a median of 9 (IQR 8, 10) weekly half-day clinic sessions, with a median panel size expectation of 1600 (IQR 1450, 1850) patients and a median yearly RVU expectation of 5200 (IQR 4161, 5891) yearly RVUs generated. Staff support was most commonly present for prescription refills and patient portal message checks. It was less commonly available for time sensitive form completion. Occasional clinical coverage for other physicians was an expectation at all practices. In this study, we characterize the organization of and supports available in academic GIM practices affiliated with the top primary care medical schools. Our findings provide comparative information for leaders of academic GIM practices seeking to enhance primary care delivery for their faculty and trainees. They also highlight areas where standardization may be beneficial across academic GIM.

Revolutionizing cancer survivorship: Using human-centered design to build an innovative model for whole-person healing.

355 Background: The cancer care system has struggled for decades to deliver meaningful post-tx survivorship care, relying on patient uptake of clinical guidelines for surveillance, and SCPs for health promotion and managing late effects. On paper, we know how to support survivors. However, there is a lack of “comprehensive guidance on patient-centered practices that specifically address how cancer patients experience their care or how to personalize survivorship so that it meets patients’ unique needs” (Mead et al, 2020). Tofill this gap, we developed an evidence-based, community-delivered model for whole-person healing throughout acute and extended survivorship. Methods: We co-designed a new care model with 24 survivors, shaped by their lived experience & unmet needs. The pilot comprised: A) 2-day in-person retreat to evaluate healing modalities (incl. yoga, journaling, group discussion, nutrition coaching, songwriting); B) a 3-hour human-centered design workshop defining “thriving,” mapping survivorship challenges/gaps & crafting an ideal care map; C) 8-12 weeks of facilitated organic social engagement with their retreat cohort. We conducted the intervention 3x (6/2003-3/2024) with 7-9 participants aged 29-60. Pre-intervention & 4-month post-intervention surveys measured QOL, symptoms & self-efficacy. Participants also did a qualitative survey post-intervention, sharing preferences & activity impact. Results: The model addresses cancer's proximal/distal psychological, emotional, physical & existential impacts. It builds a connected survivor community & drives long-term behavior change with group accountability. The intervention: A) reduced fears of recurrence & preoccupation with functional concerns & indicated positive changes in self-concept; B) improved social connectedness. 86% agreed/strongly agreed they felt seen & understood; 100% strongly agreed that they can implement 1+ new wellness/healing tool in daily life; 80% increase in confidence keeping emotional distress from interfering with life; 40% reduction in perception of cancer/Tx causing negative changes in self-concept; 60% increase in confidence keeping fatigue from interfering with life. Conclusions: A new model of post-treatment survivorship care is needed that aligns with oncology and primary care delivery, builds on the modern wellness movement, and is able to be sustained in daily life. Survivorship can be delivered in the community leveraging in-person/virtual retreats, workshops, apps and social networks. This intervention shows potential to transform survivorship care delivery & radically improve outcomes.

'A void in our community': exploring the complexities of delivering and implementing primary care services for transgender individuals in Northern Ontario.

To understand how the implementation of primary care services for transgender individuals is undertaken and delivered by practitioners in Northern Ontario. Northern Ontario, Canada, has a shortage of primary care health practitioners, and of these, there are a limited number providing transgender primary care. Transgender people in Northern Ontario must also negotiate a lack of allied and specialty services related to transgender health and travel over long distances to access those services that do exist. A convergent mixed methods design was guided by normalization process theory (NPT) to explore transgender primary care delivery and implementation by nurses, nurse practitioners, physicians, social workers, and psychotherapists. A survey measuring implementation processes was elaborated through qualitative interviews with participants. Analysis of key themes emerging using the NPT framework informed understanding of primary care successes, barriers, and gaps in Northern Ontario. Key themes included the need for more education on transgender primary care practice, increased need for training and awareness on transgender resources, identification of unique gaps and barriers to access in Northern Ontario transgender care, and the benefits of embedding and normalizing transgender care in clinical practice to practitioners and transgender patients. These findings are key to understanding and improving access and eliminating healthcare barriers for transgender people in Northern Ontario.

Comprehensive Teleoptometry Exams in Canada: A Proposed Clinical Framework

Purpose: Many high-income countries like Canada are faced with unmet needs regarding the availability of access to eye care, especially in rural, remote, or northern areas. Teleoptometry has the potential to improve access to primary eye care and help prevent, detect, diagnose and treat uncorrected refractive error and sight-threatening eye diseases. Given the rapid adoption of technology for virtual care during the COVID pandemic, the existing teleoptometry guidelines in Canada are limited in scope and may lead to uncertainty for optometrists practicing remote care. The purpose of this paper is to build a scaffold that highlights the similarities and differences between an in-person comprehensive eye examination and one that is delivered through comprehensive teleoptometry in Canada. This proposed clinical framework draws from both the existing published literature and the clinical experience of the authors. This paper discusses issues for teleoptometry including patient consent, efficiency, delegation, training and the patient pathway including referral protocols when indicated. Results: Comprehensive teleoptometry eye exams are very similar to in-person eye exams, but they depend more on the assistance of an in-person technician/optometric assistant. The exams include delegated tests performed by an optometric assistant and tests controlled remotely by the optometrist like refraction. However, other tests that require clinical judgment to execute or interpret should be performed by the optometric assistant under the direct supervision of the remote optometrist using live video. The remote optometristbe able to repeat any test during videoconferencing. Conclusion: Teleoptometry is a tool optometrists can use to reach patients that struggle to access an in-person eye exam. This evidence-informed, draft framework provides a point of reference for discussion by the Federation of Optometric Regulatory Authorities of Canada and the provincial regulatory authorities to protect the public and increase access through the delivery of remote primary eye care in Canada.

Inequalities in Ambulatory Care Sensitive Conditions: An International Comparison of High-Income Countries

ObjectiveTo examine the differences in inequalities in Ambulatory Care Sensitive Conditions (ACSC) hospitalizations relative to socioeconomic status across nine countries, namely Australia, Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). ApproachThe International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) research collaborative developed national data sets with hospitalization and sociodemographic data aggregated to small-area levels and pooled across countries using a common data model. Inequalities were assessed using both the slope index of inequality and the relative index of inequality. ResultsThis study developed a common definition and set of codes for ACSC hospitalizations that proved to be comparable across countries and regions. Consistent socioeconomic gradients were observed in all countries with higher ACSC hospitalization rates for individuals in most disadvantaged areas. The greatest difference in hospitalizations between the highest and lowest income quintiles were observed in New Zealand (1603 per 100,000), Finland (1802 per 100,000) and England (1955 per 100,000). ConclusionsThe high-income countries included in this study displayed many commonalities in inequalities in ACSC hospitalizations. As a proxy measure of primary care access and quality, the observed inequalities may implicate disparities in health care quality and access for the lowest socioeconomic status groups. ImplicationsBarriers to health care access in low socioeconomic groups remain a complex and multifaceted issue. Future research should investigate the underlying contributing factors to the observed ACSC hospitalization equity gradients, including primary care delivery model, remuneration approach, and population structure.

A high-performance framework to integrate primary care and behavioural health

This paper describes a large statewide initiative in Arizona led by the Arizona Medicaid programme to integrate the delivery of primary care and behavioural services. Healthcare in the USA remains fragmented, as reflected in no small measure by the separation of primary care and mental health services, in both structure and delivery. The fact that this historical separation continues to be perpetuated is detrimental to the goals of the Triple Aim. The fragmentation between both clinical service lines is further compounded by the high rate of co-occurring physical and mental illness, shortage of mental health professionals, under-skilling of primary care providers in the management of mental health, and stigma associated with mental illness. Underserved communities, where trust deficits of healthcare systems are commonplace, are especially vulnerable to the untoward effects of fragmented services. In this paper a framework is described to integrate primary care and behavioural health, implemented as a multi-year, multi-stakeholder programme at microsystem level, with policy implications for improving access, outcomes, costs and disparities.

Developing a comprehensive curriculum program for nurse practitioners delivering primary care in the long-term care setting.

In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.

Development, implementation, and evaluation of an advanced primary care pharmacist pilot training program as a strategy to enhance team-based primary care.

Canada's 50,000+ pharmacists play a crucial role in the comprehensive delivery of primary care. Recognizing this, a program in alignment with the Team Primary Care national initiative was developed to enhance their skills and knowledge in collaborative care, aiming to cultivate advanced primary care pharmacist leaders. The curriculum development involved aligning activities with pharmacist roles and competencies, emphasizing interprofessional teamwork. A mixed-methods evaluation revealed positive outcomes: 14/15 pharmacists completed the program, reporting improved readiness for team-based care. All non-pharmacist team members expressed a desire for continued pharmacist collaboration. Overall, satisfaction was high among participants and team members, indicating success in training. The program's comprehensive approach, covering primary care landscape, clinical skills, teaching, change management, and advocacy, empowered pharmacists to integrate team-based care and contribute to positive change in primary care settings. Training more pharmacists with this program is one of the many strategies to further establish and optimize team-based primary care.

Could the minimum intervention oral care framework help improve the quality of oral health delivery and access to NHS primary dental care?

Access to NHS primary dental care services is a perennial issue in the UK. Two aspects must be considered when measuring access to dental care: ‘entry access', which relates to service availability resulting in realised initial or continued access; and ‘effective access', the delivery of effective, equitable and efficient care, which manifests as equitable and optimal outcomes of care. It is proposed that the minimum intervention oral care (MIOC) delivery framework provides a person-focused, prevention-based, susceptibility/needs-related, team-delivered approach to ensuring effective access to primary oral and dental care. A theory of change model could identify the key barriers to overcome the implementation of the MIOC approach, involving all key stakeholders in primary oral and dental care delivery.

Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries.

The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan

AbstractShortage of physicians/doctors in the primary health care system has been evidenced in various countries. Among other things, these countries deployed nurse practitioners (NPs) in the health care delivery system to address this shortage. Countries in America, Europe, and Asia use NPs to address physicians/doctors shortage in the primary health care delivery systems. Various studies have shown that NPs have been deployed in primary health care facilities to curb these shortages.While in Tanzania shortage of physicians/doctors and other health professionals is evidenced in every sector of the health care system, nurses play a crucial role to cover this shortage by providing care and support for individuals and communities. Nurses work in various settings from being a nurse, counselor, laboratory technologist, social worker, educationist, and physician, to name a few. Nurses play a key role in preventing, diagnosing, and attending to common health problems. The question is, “When will the Tanzanian health delivery system recognize the pivotal role of these nurses and upgrade them to NPs?” This study suggests that deployment of NPs in Tanzania's health care systems could be a “game changer.” As a fellow on Critical Care Nursing Course at Fujita Health University Bantane Hospital in Japan, witnessed deployment of NPs in health care delivery and the reaped benefits are enormous; increased access to health care services, reduction in health care costs, reduced hospital stays, and customer satisfaction through client empowerment and comfort. This is an observational study of tasks performed by NPs in Fujita Health University Bantane Hospital and their relevance as a positive innovation to curb physician shortages for effective health care delivery. The duration of the study at Bantane Hospital was 2 months from January 15 to March 16, 2024. One-to-one interviews with NPs on duty were conducted. Also, collected and reviewed information from Tanzanian government Web sites, published government documents, and academic literature. Results show that NPs perform a lot of procedures that physicians/doctors were supposed to do. In the wards, theater, laboratories, and clinics, they play a pivotal role to curb shortage of physicians/doctors in health settings. NPs are an effective addition to medical facilities. They perform various procedures in the absence of the doctors. The findings from this study have important implications for improving health care delivery in Tanzania. NPs could be “game changers” in the health care landscape in Tanzania. Investment on nurses' education, proper training, and policy changes in nurse practice regulations are key for this to succeed.