Primary Health Care Settings Research Articles

Opportunities and challenges of integrating eye care and neglected tropical diseases services in primary health care setting in sierra leone: a mixed method study

Opportunities and challenges of integrating eye care and neglected tropical diseases services in primary health care setting in sierra leone: a mixed method study

Monitoring of Non-communicable Diseases in a Primary Healthcare Setting in India: A Quality Improvement Initiative.

Background The majority of patients with non-communicable diseases (NCDs) seek care in a primary healthcare setting. There is a lack of effectivemonitoring of patients with NCD, whichleads to poor disease control and an increase in morbidity and mortality. We wanted to explore the feasibility of maintaining patient health record and utilising it for disease monitoring in a primary healthcare setting.Therefore, we aimed to increase the availability of patient health records from 0% to 100% using the principles of quality improvement (QI) among patients with hypertension and/or diabetes within six weeks and to use these records for assessingthe disease control status of patients through cohort monitoring approach. Methods This QI initiative was conducted at an urban health centre (UHC) located at Dakshinpuri, New Delhi. We specifically focused on two major NCDs: diabetes and hypertension. We formed a QI team and identified the gaps using fishbone analysis and a process flow diagram.We used the model for improvement and the Plan-Do-Study-Act (PDSA) framework.We conducted repeated rapid PDSA cycles for the designed intervention and monitored the change every week using a run chart. The data from the patient health record were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA) using Google Forms (Google, Inc., Mountain View, CA) and Epicollect5 (Oxford Big Data Institute, Oxford, England).We used the cohort monitoring approach of the India Hypertension Control Initiativeto assess the quarterly control rate for hypertension and diabetes at the UHC. Results The root cause analysis revealed that the lack of a policy for keeping patient records and the lack of perceived need in the past were the primary reasons behind the absence of NCD health records. In brainstorming sessions with the QI team, we designed a paper-based patient health recordsystem involving unique identity (ID) generation, an index register, an NCD record file and an NCD passbook (Dhirghayu card) for each patient. We reorientated the process of patient flow and devised a mechanism for record-keeping at the UHC. This initiative increased the availability of patient health records from 0% to 100% in the initial three weeks. The system of maintaining patient health records was well received by the patients and was better utilised by treating physiciansfor NCD management. After the intervention, we were able to use the data from the NCD file toassess the quarterly control ratesof the patients with hypertension and/or diabetes. Conclusion Our study showed that patients'health records can be generated and maintained in a primary healthcare setting by using the principles of quality improvement. These records can be utilised for the disease monitoring of patients with hypertension and/or diabetes, which can lead to better disease control. The sustainability of this initiative and the performance of the health facility can be assessed in future studies using annual control rates.

Nurses' preparedness for disaster response in rural and urban primary healthcare settings in Tanzania.

Nurses are often on the frontline of disaster management, providing care to patients with emerging physical, mental, and emotional turbulence, and acting as educators for health promotion and disaster prevention in both rural and urban contexts. However, the literature suggests that nurses are inadequately prepared for disaster response. This study examined preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. This qualitative descriptive study involved purposefully selected qualified nurses and nurse administrators working in rural (n=20) and urban (n=11) primary healthcare facilities in Tanzania. Telephone-based interviews were conducted to gather data that were then analyzed thematically. Five themes emerged from the analysis: previous experiences, technical capacity, current strategies, challenges, and overall preparedness. Previous experiences included personally caring for victims, working in disaster response teams, working in administrative roles during disasters, and conducting community sensitization. Most nurses in rural contexts had not received training on disaster response and relied on past experience, knowledge from nursing school, observing peers, and knowledge from the internet and movies. Current strategies for disaster response included response teams (although these were considered 'weak'), ensuring the availability of equipment and supplies, and infrastructure for victim management. Challenges in disaster response included inadequate resources, understaffing, lack of expertise at primary healthcare facilities, nurses tasked with multiple responsibilities, inadequate technical capacity, fears of infection, poor interpersonal relationships, inadequate community knowledge, poor reporting systems, delayed healthcare seeking, long distances to facilities, and poor road infrastructure. These challenges were more pronounced in rural settings. Most nurses felt they were well prepared to respond to disasters, although this appeared to be rooted in a willingness to provide care rather than having adequate knowledge, skills, and resources for disaster response. Suggestions for better preparing nurses for disaster response included training, increasing essential equipment and medical supplies, increasing the nursing workforce, improving reporting systems, disseminating local guidelines, strengthening disaster response teams, and improving the nursing training curricula to cover disaster management. A range of institutional, individual, and community challenges affect nurses' preparedness for disaster response in rural and urban primary healthcare settings. Addressing these challenges requires multiple strategies that extend beyond the capacity building of nurses to strengthen health system disaster preparedness in general, prioritizing rural contexts.

Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil

Hypertension and diabetes mellitus (DM) are highly prevalent in low and middle-income countries (LMICs), and the proportion of patients with uncontrolled diseases is higher than in high-income countries. Innovative strategies are required to surpass barriers of low sources, distance and quality of health care. Our aim is to assess the uptake and effectiveness of the implementation of an integrated multidimensional strategy in the primary care setting, for the management of people with hypertension and diabetes mellitus in Brazil. This scale up implementation study called Control of Hypertension and diAbetes in MINas Gerais (CHArMING) Project has mixed-methods, and comprehends 4 steps: (1) needs assessment, including a standardized structured questionnaire and focus groups with health care practitioners; (2) baseline period, 3 months before the implementation of the intervention; (3) cluster randomized controlled trial (RCT) with a 12-months follow-up period; and (4) a qualitative study after the end of follow-up. The cluster RCT will randomize 35 centers to intervention (n=18) or usual care (n=17). Patients ≥18 years old, with diagnosis of hypertension and/or DM, of 5 Brazilian cities in a resource-constrained area will be enrolled. The intervention consists of a multifaceted strategy, with a multidisciplinary approach, including telehealth tools (decision support systems, short message service, telediagnosis), continued education with an approach to issues related to the care of people with hypertension and diabetes in primary care, including pharmacological and non-pharmacological treatment and behavioral change. The project has actions focused on professionals and patients. This study consists of a multidimensional strategy with multidisciplinary approach using digital health to improve the control of hypertension and/or DM in the primary health care setting. We expect to provide the basis for implementing an innovative management program for hypertension and DM in Brazil, aiming to reduce the present and future burden of these diseases in Brazil and other LMICs. This study was registered in ClinicalTrials.gov. (NCT05660928).

ANAEMIA IN PREGNANCY: THE IMPACT ON MATERNAL AND FETAL HEALTH, INNOVATION, AND MANAGEMENT IN KEDUNGJATI PRIMARY HEALTH CARE

Anaemia is a common condition affecting a significant proportion of pregnant women worldwide, particularly in low- and middle-income countries. Anaemia is associated with adverse outcomes for both the mother and the developing fetus, including increased risk of preterm birth, low birth weight, and maternal mortality. Primary health care settings play a crucial role in the identification, management, and prevention of Anaemia in pregnant women. This review aims to provide an overview of the prevalence and impact of Anaemia on maternal and fetal health, as well as the current approaches to its management in primary health care settings. We conducted a comprehensive search of electronic databases for relevant studies published between 2010 and 2021, including systematic reviews, meta-analyses, and clinical practice guidelines. The results indicate that the prevalence of Anaemia in pregnancy varies widely depending on the population and the diagnostic criteria used, with rates ranging from 20% to 80%. Anaemia is associated with a range of adverse maternal and fetal outcomes, including increased risk of preterm birth, low birth weight, and maternal mortality. The management of Anaemia in primary health care settings involves a multifaceted approach, including iron and folic acid supplementation, dietary and lifestyle modifications, and close monitoring of maternal and fetal health. While the evidence base for the management of Anaemia in primary health care is relatively strong, there is a need for further research on the effectiveness and cost-effectiveness of interventions, as well as strategies to improve the identification and management of Anaemia in pregnant women.

Nurse Practitioner Perspectives of Setting-Specific Opioid Prescribing Guidelines in Ontario: A Qualitative Study

Aim: To investigate the views of Nurse Practitioners (NPs) regarding the development of setting-specific opioid prescribing guidelines. Background: There has been a rise in opioid-related deaths and adverse events in Canada in recent years. Although NPs make up a significant opioid prescriber group, no Canadian setting-specific guidelines exist to help guide their opioid prescribing. Methods: Purposive sampling was used to select NPs practicing in inpatient settings. One-on-one semi-structured interviews were conducted virtually with 14 NPs (n=14) from Ontario. Directed qualitative content analysis was used to interpret interview data. Findings: The majority of NPs interviewed (n=13, 92.8%) believe that setting-specific opioid prescribing guidelines would benefit their practice. Interview responses illustrated that NPs face several challenges associated with inpatient opioid prescribing. To help mitigate these challenges, they often consult a pharmacist and reference prescribing resources such as Lexicomp and UpToDate. Additionally, several NPs in our study formulated their own setting-specific opioid prescribing resources to help guide their prescribing. Furthermore, NPs who had transitioned to acute care from a primary health care setting experienced a lack of confidence with opioid prescribing in a specialty setting. Conclusion: The development of setting-specific NP opioid prescribing guidelines in Canada can improve the prescribing process for NPs by providing them with clear, evidence-based recommendations, thus reducing ambiguity and promoting positive patient outcomes. Future research should explore the possibility of adapting internationally published setting-specific opioid prescribing guidelines for Canadian practice and the unique opioid prescribing challenges NPs experience when transitioning from primary care to acute care settings.

Prescrição de Benzodiazepinas e outros Sedativos na Administração Regional de Saúde de Lisboa e Vale do Tejo de 2013 a 2020: Um Estudo Retrospetivo

Among the Organization for Economic Co-operation and Development members, Portugal has the highest reported consumption of anxiolytics, hypnotics, and sedatives, of which a large proportion are benzodiazepines or related drugs. These are known to cause tolerance and dependence. Other drugs with hypnotic effect, such as antidepressants, antihistamines, antipsychotics, or anticonvulsants have been identified by some reports as alternatives to benzodiazepines for the treatment of insomnia. In this regard, the aim of this study was to characterize the consumption of benzodiazepines, non-benzodiazepine anxiolytic, hypnotic or sedative effect drugs and other drugs with the potential to be used off-label to treat insomnia, and the results concerning benzodiazepine consumption related indicators in the primary health care setting in the Lisbon and Tagus Valley region. From 2013 to 2020, a census, descriptive and retrospective study was conducted. The evolution of the variables total defined daily doses, defined daily doses per 1000 inhabitants per day (DHD) and relevant indicators were characterized. Data were extracted from the SIARS platform used in the Lisbon and Tagus Valley regional Health Administration. There was a decrease in the consumption of benzodiazepines (from 57.44 to 63.11 DHD) and an increase of non-benzodiazepines and of drugs with potential off-label use (from 6.56 to 8.56 DHD and from 14.70 to 25.95 DHD, respectively). Among non-benzodiazepines, zolpidem was the most consumed drug, also showing an increasing trend (from 4.86 to 6.96 DHD). For the group of drugs with off-label use potential, there was an increased consumption of trazodone (from 3.81 to 7.92 DHD), mirtazapine (from 3.52 to 6.48 DHD), pregabalin (from 3.15 to 4.87 DHD), quetiapine (from 2.68 to 4.59 DHD) and gabapentin (from 1.32 to 1.90 DHD), which was only the case (or, at least, more significantly) for the lower dose formulations. The median of results of the Primary Health Care setting indicator "proportion of elderly patients without prescription of sedatives, anxiolytics, and hypnotics", was 81.0 in 2015 and increased to 84.9 in 2020. For the indicator "proportion of patients without prolonged prescription of sedatives, anxiolytics, and hypnotics", the median was 93.6 in 2019 and 94.3 in 2020. There was, overall, a decreasing trend in the dispensing of benzodiazepines in the Lisbon and Tagus Valley Region. Even though this data suggests a change in the therapeutic pattern for insomnia, more robust studies are needed to confirm this observation.

Undiagnosed and ‘overdiagnosed’ COPD using postbronchodilator spirometry in primary healthcare settings: a systematic review and meta-analysis

BackgroundDespite chronic obstructive pulmonary disease (COPD) being a major global cause of mortality and hospitalisation, it is often undiagnosed or inaccurately diagnosed in clinical settings.ObjectiveTo systematically synthesise all peer-reviewed papers...

31. Evaluation of Hypertension Patient's Adherence to Treatment in Primary Healthcare Settings Across Multiple Centers in Indonesia

Background: Hypertension is a significant public health concern as it can lead to cardiovascular and cerebrovascular diseases. Many hypertension patients are unaware of their condition and do not take any medication. Riskesdas 2018 stated that the prevalence of hypertension in ages >18 years old is 34,1%, 8,8% being diagnosed, 13,3% not taking medication, and 32,3% in poor compliance. Multiple factors contribute to poor compliance with long-term antihypertensive therapy. This study examines hypertensive therapy compliance in primary care and its major determinants. Method: We gather the data of patients with hypertension using the Electronic Medical Record in the Primary Healthcare Center (Puskesmas). We also included the National Health Insurance system data to determine when the patient went to Puskesmas from November 2021 to October 2022. The patient's gender and other comorbid conditions become the independent variable. The dependent variable is patient compliance which is associated with the number of patient visits in 1 year. Result: We Gather 44,293 data from patients visiting 5 Puskesmas. These are 1,493 unique patients diagnosed with hypertension. Only 493 male patients from 1,493 patients (33%) went to the Puskesmas for treatment. However, there was no difference in compliance between male and female patients (p = 0.136). Hypertensive patients with comorbid (diabetes) amounted to 225 out of 1,790 patients (13%). The independent t-test showed that patients with comorbidities were more likely to routinely control (p = 0.000). Conclusion: Compliance from hypertensive patients is often neglected. Gender and comorbidities are essential for planning appropriate public interventions to increase patient compliance.

AN OBSERVATIONAL STUDY TO ASSESS THE CLINICAL PROFILE AND OUTCOMES OF DIABETIC FOOT ULCER AT A TERTIARY CARE HOSPITAL IN JAIPUR

Background: Diabetes mellitus (DM) is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades [2, 3]. According to epidemiological studies, the number of patients with DM is estimated to be more than 360 million people by 2030 [4, 5]. DFU is considered as a major source of morbidity and a leading cause of hospitalization in patients with diabetes. In view of this, the present study was undertaken to address the demographics, clinical prole, and outcomes of diabetic foot ulcer at a tertiary care hospital in Jaipur. A hospital based prospective observational study The mea Methods: Observations: n age of the study participants was found to be 56.33 + 12.637. 61.8% of the study participants were found to have pure neuropathic type of ulcer with 24.3% having neuro-ischemic type of ulcer. 13.9% of the study participants had pure ischemic type of ulcer. 37.5% of the study participants underwent wound debridement. 3.5% of the study participants underwent SSG,59% of the study participants underwent amputations. The mean HbA1c of the study participants was found to be 8.951 + 1.6008. The mean duration of stay at hospital of the study participants was found to be 5.73 + 2.025. Mortality of the study population was 3.5%. Majority of the patients underwent multiple toe amputations, there w Conclusion: as a signicant statistical association between the Wagner's grade and the mode of intervention performed, . Adequate glycaemic control, periodic screening for diabetic foot neuropathy, preventive foot care and education programs should be made available, particularly in primary and secondary health care settings to tackle the DFU disease which is a contributor to signicant morbidity among diabetics

Understanding the theoretical underpinnings of preventative early parenting interventions: A theory-based evaluation

Early parenting programmes which promote nurturing care for children aged 0–3 years are popular in community-based primary health care settings. However, little research has explored the causal and theoretical assumptions underpinning these programmes. This paper outlines a programme theory evaluation which was conducted to explore the change principles inherent in a complex early parenting intervention, the parent and infant programme, which aims to support parents and infants aged 0–2 years. A documentary analysis and qualitative interviews ( n = 19) with key stakeholders were undertaken to describe programme components, outline intervention objectives and identify the mechanisms assumed to be important to programme success. The interpretation of the findings was informed by the Consolidated Framework for Implementation Research, within which we explore and describe the theoretical perspectives that underpin the programme and guide its operationalisation and delivery. The importance of attending to the causal mechanisms underlying early parenting interventions is outlined.

Intimate Partner Violence; Are Saudi Physicians in Primary Health Care Setting Ready to Identify, Screening, and Respond?

Intimate partner violence (IPV) is a growing hot topic in Saudi Arabia and primary health care (PHC) physicians play a significant role in preventing it. Our objective was to assess the PHC Physicians' readiness and barriers to identify, screen, and respond to IPV in Saudi Arabia. A cross-sectional study recruited physicians working in PHC centers in Saudi Arabia. Data was collected using a modified online self-administered questionnaire based on the PREMIS "The Physician Readiness to Identify and Manage IPV." The questionnaire consisted of respondent profile, perceived preparedness and knowledge, actual knowledge, practice issues, and opinion regarding barriers. Among 169 PHC physicians, 60.9% had never experienced any formal IPV training. Around one-fifth of participants have a good perceived and actual knowledge, whereas one-third have a good perceived preparedness. Nearly half of the participants (46.7%) do not screen for IPV and two-thirds of them (66.3%) have never identified an IPV case during the previous 6 months. The logistic regression model showed that family physicians were 2.27 times more likely to have a good knowledge than a general practitioner, and participants with IPV training were more likely to have a good level of perceived preparedness, perceived knowledge, and more likely to perform screening of IPV. The low level of PHC physicians' readiness to identify and respond to IPV is worrisome. Findings emphasize the urgent need for an IPV training program, a supportive work environment, and a clear referral system in order to help the practitioner to provide comprehensive services and ensure safety plans for abused women.

Performance of older adults in a digital change detection task: The role of heterogeneous education

The influence of education on traditional paper-and-pen cognitive assessments is widely reported. However, a minimal amount of evidence is available regarding the role of education in digital tasks. This study aimed to compare the performance of older adults with different educational attainment in a digital change detection task, as well as to relate their performance on the digital task and traditional paper-based tests. Participants (n = 180) were recruited in primary health care settings from a countryside city in the state of Sao Paulo-Brazil and were assigned to three different groups according to their educational background. Traditional paper-based neuropsychological instruments (i.e., ACE-R, Digit Span, Bells test) were used in addition to a digital change detection task. There was no difference in reaction time on the change detection task between the groups; however, participants with higher educational levels performed better than illiterates or lower education groups. The digital test was correlated to ACE-R total score as well as to its language domain. Our results suggested that the performance in the digital task was different for older adults with heterogeneous educational attainment. Technology is a promising pathway in cognitive assessment, and education should be considered in the interpretation of the results.

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.

Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria.

Detection and management of female genital schistosomiasis (FGS) within primary healthcare is crucial for achieving schistosomiasis elimination, however, current technical strategies are not feasible in many settings. In Nigeria, there are currently no established standard operating procedures to support front-line health workers. This article presents an evaluation of piloting an FGS care package in two LGAs of Ogun State, Nigeria. We used quantitative and qualitative analysis, including 46 interviews with patients, health workers and the quality improvement team; observations of training, learning sessions and supervision across 23 heath facilities; and records of patients detected and managed. Of 79 women and girls who were screened, 66 were treated and followed up. Health workers assimilated knowledge of FGS and effectively diagnosed and managed patients, demonstrating the feasibility of using symptomatic screening and treatment tools to diagnose and care for women or girls with suspected FGS. Challenges included establishing a referral pathway to tertiary care for patients with complications, insecurity, gender norms that limited uptake and sensitization, the limited capacity of the workforce, conflicting priorities and praziquantel acquisition. Simple tools can be used in primary healthcare settings to detect and manage women and girls with FGS. Contextual challenges must be addressed. Sustainability will require political and financial commitments.

Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program.

Women living in low- and middle-income countries are more exposed to known risk factors for depression occurrence and persistency over time. Our aim was to investigate the course of depression in the first 2 years postpartum among Brazilian women enrolled in a cash transfer program. Longitudinal analysis of baseline (T0; mean 3.7 months postpartum) and first follow-up data (T1; mean 18.6 months postpartum) from a trial to assess the impact of a child development promotion program in 30 municipalities from six Brazilian states. The program does not include any interventions against maternal depression. The Edinburgh Postnatal Depression Scale (EPDS) at cutoff ⩾10 was applied. Women were categorized into four groups based on EPDS at T0 and T1: absence of depression, persistence, discontinuity, or emergence pattern. Adjusted Poisson regressions were run using a multilevel hierarchical model. Two thousand eight hundred sixty-three women were assessed. Prevalence of depression was 26.4% [24.8, 28.1] at T0 and 24.4% [22.8, 26.0] at T1. Persistence, discontinuation, and emergence were found in 14.1% [11.3, 17.6%], 12.8% [11.4, 14.3%], and 10.2% [8.0, 13.0], respectively. In adjusted analyses, the persistence pattern was directly associated with parity and inversely associated with schooling of the woman and of the child's father. Living with husband/partner and support from the child's father and family members during pregnancy were protective against persistence. The discontinuity and the emergence patterns were not associated with any of the exposure variables. Depressive symptoms were highly prevalent during the first 2 years postpartum. About half of the women with depression at T1 were persistent cases that could have been detected earlier. Screening for maternal depression should be an essential component in every encounter of women with health professionals in primary health care settings.

The multidisciplinary team in diagnosing and treatment of patients with diabetes and comorbidities: A scoping review.

Multidisciplinary Teams (MDTs) has been suggested as an intervention to overcome some of the complexities experienced by people with diabetes and comorbidities in terms of diagnosis and treatment. However, evidence concerning MDTs within the diabetes field remains sparse. This review aims to identify and map available evidence on key characteristics of MDTs in the context of diagnosis and treatment in people with diabetes and comorbidities. This review followed the PRISMA-ScR guidelines. Databases PubMed, EMBASE, and CINAHL were systematically searched for studies assessing any type of MDT within the context of diagnosis and treatment in adult people (≥ 18years) with diabetes and comorbidities/complications. Data extraction included details on study characteristics, MDT interventions, digital health solutions, and key findings. Overall, 19 studies were included. Generally, the MDTs were characterized by high heterogeneity. Four overall components characterized the MDTs: Both medical specialists and healthcare professionals (HCPs) of different team sizes were represented; interventions spanned elements of medication, assessment, nutrition, education, self-monitoring, and treatment adjustment; digital health solutions were integrated in 58% of the studies; MDTs were carried out in both primary and secondary healthcare settings with varying frequencies. Generally, the effectiveness of the MDTs was positive across different outcomes. MDTs are characterized by high diversity in their outline yet seem to be effective and cost-effective in the context of diagnosis and treatment of people with diabetes and comorbidities. Future research should investigate the cross-sectorial collaboration to reduce care fragmentation and enhance care coordination.

The Colocation Model in Community Cancer Care: A Description of Patient Clinical and Demographic Attributes and Referral Pathways.

Cancer disparities are well documented among Black, Indigenous, and People of Color, yet little is known about the characteristics of programs that serve these populations. Integrating specialized cancer care services within community settings is important for addressing the needs of historically marginalized populations. Our National Cancer Institute-Designated Cancer Center initiated a clinical outreach program incorporating cancer diagnostic services and patient navigation within a Federally Qualified Health Center (FQHC) to expedite evaluation and resolution of potential cancer diagnoses with the goal of collaboration between oncology specialists and primary care providers in a historically marginalized community in Boston, MA. Sociodemographic and clinical characteristics were analyzed from patients who were referred to the program for cancer-related care between January 2012 and July 2018. The majority of patients self-identified as Black (non-Hispanic) followed by Hispanic (Black and White). Twenty-two percent of patients had a cancer diagnosis. Treatment and surveillance plans were established for those with and without cancer at a median time to diagnostic resolution of 12 and 28 days, respectively. The majority of patients presented with comorbid health conditions. There was a high prevalence of self-reported financial distress among patients seeking care through this program. These findings highlight the wide spectrum of cancer care concerns in historically marginalized communities. This review of the program suggests that integrating cancer evaluation services within community-based primary health care settings offers promise for enhancing the coordination and delivery of cancer diagnostic services among historically marginalized populations and could be a method to address clinical access disparities.

A pangenome approach-based loop-mediated isothermal amplification assay for the specific and early detection of Bordetella pertussis

Despite widespread vaccination, Bordetella pertussis continues to cause pertussis infections worldwide, leaving infants at the highest risk of severe illness and death, while people around them are likely the main sources of infection and rapidly spread the disease. Rapid and less complex molecular testing for the specific and timely diagnosis of pertussis remains a challenge that could help to prevent the disease from worsening and prevent its transmission. We aimed to develop and validate a colorimetric loop-mediated isothermal amplification (LAMP) assay using a new target uvrD_2 informed by the pangenome for the specific and early detection of B. pertussis. Compared to that of multitarget quantitative polymerase chain reaction (multitarget qPCR) using a large clinical DNA specimen (n = 600), the diagnostic sensitivity and specificity of the uvrD_2 LAMP assay were 100.0% and 98.6%, respectively, with a 99.7% degree of agreement between the two assays. The novel colorimetric uvrD_2 LAMP assay is highly sensitive and specific for detecting B. pertussis DNA in nasopharyngeal swabs and showed similar diagnostic accuracy to complex and high-cost multitarget qPCR, but it is faster, simpler, and inexpensive, which makes it very helpful for the reliable and timely diagnosis of pertussis in primary health care and resource-limited settings.

Improving interaction of primary health care facilities and narcological service to provide care to patients with riskу, harmful use or dependency from alcohol or other psychoactive substances

This article provides description of the existing regulatory framework for interaction between medical organizations that provide health to people with risky, hazardous (harmful) use of alcohol or other psychoactive substances in the Russian Federation.Aim. Exploring existing opportunities to improve interaction of primary health care institutions and narcological service to provide care to patients with risky use, harmful use or dependence on psychoactive substances.Materials and methods. The article presents results of implementing the action plan to organize medical prevention in 71 regions of the Russian Federation, based on data provided by chief narcologists of these regions during 2017–2018. The analysis of the existing practice of the interaction of medical institutions for the prevention of the harmful use of psychoactive substances was carried out; were studied the principles of organizing screening and preventive counseling in primary health care; the features of training and education of specialists of medical organizations in the methodology of screening, preventive and motivational counseling were studied in different regions of the Russian Federation.Discussion. During 2017–2018 more than 14.5 million patients were screened in primary health care. Problems alcohol and other psychoactive substances use were identified in more than 300,000 patients (2.4 %). The highest rates of identified substance use disorders’ risks were observed in primary specialized medical care settings (5.1 %); lower rates were observed among those who were undergoing screening in primary health care settings (1.8 %), during preventive health assessment (2.3 %) and during preventive medical check-ups (2.4 %). More than 19,000 health workers have been trained in motivational counseling techniques.Conclusion. The problem of substance abuse and related medical and social consequences remains highly relevant, and therefore requires further implementation of preventive technologies with proven effectiveness.