Primary Health Care Settings Research Articles

Relationship between CD4 count, viral load, and quality of life in HIV-infected patients on HAART attending a primary healthcare setting in South Africa

Relationship between CD4 count, viral load, and quality of life in HIV-infected patients on HAART attending a primary healthcare setting in South Africa

Factors associated with fall risk of community-dwelling older people: A decision tree analysis.

To examine the predictive attributes for accidental falls in community-dwelling older people in Hong Kong using decision tree analysis. We recruited 1151 participants with an average age of 74.8 years by convenience sampling from a primary healthcare setting to carry out the cross-sectional study over 6 months. The whole dataset was divided into two sets, namely training set and test set, which respectively occupied 70% and 30% of the whole dataset. The training dataset was used first; decision tree analysis was used to identify possible stratifying variables that could help to generate separate decision models. The number of fallers was 230 with 20% 1-year prevalence. There were significant differences in gender, use of walking aids, presence of chronic diseases, and co-morbidities including osteoporosis, depression, and previous upper limb fractures, and performance in the Timed Up and Go test and the Functional Reach test among the baselines between the faller and non-faller groups. Three decision tree models for the dependent dichotomous variables (fallers, indoor fallers, and outdoor fallers) were generated, with overall accuracy rates of the models of 77.40%, 89.44% and 85.76%, respectively. Timed Up and Go, Functional Reach, body mass index, high blood pressure, osteoporosis, and number of drugs taken were identified as stratifying variables in the decision tree models for fall screening. The use of decision tree analysis for clinical algorithms for accidental falls in community-dwelling older people creates patterns for decision-making in fall screening, which also paves the way for utility-based decision-making using supervised machine learning in fall risk detection.

Prevalence of Proteinuria among Type 2 Diabetic Patients Attending Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background: Diabetes mellitus has been reported to be the primary cause of end-stage renal disease in some Asian and American countries. However, no such data were available among type 2 diabetic patients in North-Western Nigeria. This study was aimed to assess the prevalence and associated risk factors of proteinuria among type- 2 diabetic patients by measuring the total protein-to-creatinine ratio (TPCR) and to provide some possible recommendations to enhance the level of health care rendered to the patients. Methods: This was a cross-sectional study. Spot urine TPCR was performed on 182 diabetic patients who attended the diabetic clinic at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2018 to December 2018. Other relevant parameters were extracted from the Chemical Pathology Department register, and the patients' case folders. The data were statistically analysed using SPSS version 23.0 (Chicago IL). Results: Among the total of 182 diabetic patients recruited during the study period, 66(36.3%) were males and 116(63.7%) were females. Out of the patients, (82)45.1% had hypertension; and (105)57.7% of the study population were obese. The overall prevalence of pathological proteinuria (TPCR ≥ 150 mg/mmol creatinine) was found in 116 (63.7%) of the study population. Conclusions: The prevalence of proteinuria is high in the study subjects (63.7%). The high prevalence observed might be a result of kidney disease in a primary healthcare setting. However, this study is a hospital-based finding with a small sample size, therefore, a larger study population size is recommended for future studies. Keywords: prevalence, proteinuria, type 2 diab

Individual factors affecting compliance with standard infection prevention precautions on the use of personal protective equipment among community health practitioners in Bayelsa State, Nigeria

Background: Individual factors may have an impact on how well healthcare workers adhere to standards for infection prevention. The aim of the study was to identify individual factors affecting compliance with personal protective equipment (PPE) use among community health practitioners in Bayelsa State, Nigeria.Methods: Three hundred and fifty-four (354) self-structured questionnaires were manually distributed among community health practitioners who worked at government-owned primary health care facilities in Bayelsa State, Nigeria. Item mean analysis with a criterion mean set at 2.0 was used to analyze the quantitative data of the 3-Likert scale and results were presented in tables, item mean, and percentages.Results: Individual factors affecting compliance with standard infection prevention precautions on the use of PPE were difficulty to feel veins while wearing PPE (x=2.7), some level of discomfort while performing skills using the PPE (x=2.0), and lack of knowledge of how to use the PPE (x=2.9). It was also revealed that those who complied with the standard infection prevention precaution do so because they understand that the use of PPE prevents them from being infected (x=2.9).Conclusions: Individual factors that affect compliance with standard infection prevention precautions on the use of PPE among community health practitioners can be modified. It is recommended that community health practitioners should have a positive attitude towards compliance with standard infection prevention precautions, especially in this post-COVID-19 era. The government should conduct continuous in-service training and regular supportive supervision on compliance with standard infection prevention precautions among health workers in the primary health care setting.

Issues, challenges and opportunities in accessing primary health services in tribal-rural setting in India: a decadal view

Even after 75 years of independence, the country's most underprivileged tribal population is still far from getting health benefits. Tribals in India have poor health and present a bleak picture in terms of social development metrics, especially health. From this perspective, this paper is intended to identify the problems and existing challenges faced by tribal communities in accessing health care from primary health care settings. Exploring the observations based on reviewed scholarly articles published between 2012 and 2022 from databases like PubMed and Google Scholar and in addition to several government reports and articles. These articles were selected and subsequently analyzed to extract specific outcomes. By applying the principle of the 'five A' approach, the analysis revealed a significant shortfall in the service delivery of health wellness centers. It was implicit that despite the introduction of affirmative policies by the government, gaps still existed in the healthcare system at grass root level. Major gaps are lack of human resources, staff stereotyping indigenous population, and inadequate infrastructure; and high health costs due to out of pocket expenditure and informal payments were evident. The paper recommended both individual and community-level strategies to overcome the barriers of rural health services. More decentralized planning and cultural competency training are immediate measures for the inclusion of tribal-rural people in healthcare services. Further, we proposed developing a "Mangal Health Team' which will coordinate between Health and wellness centre and villagers.

ASSESSMENT OF NURSES/MIDWIVES INVOLVEMENT IN THE ACHIEVEMENT OF THE SUSTAINABLE DEVELOPMENT GOAL 3.8 IN SOUTH-EAST AND SOUTH-WEST, NIGERIA.

This study assessed the involvement of nurses/midwives in the achievement of the sustainable development goal 3.8 in south-east and south-west, Nigeria. The objective of the study was to investigate the involvement of nurses/midwives in the primary health care setting and how this could help Nigeria in achieving universal health coverage. Also to determine the quality and outcome of nursing care received by the clients/patients in the healthcare facilities.
 The research design employed in the study was a cross-sectional survey. The population of the study consisted of nurses/midwives and patients attending the facilities during the study in eighteen primary healthcare facilities in Anambra and Lagos states. The sample size consisted of 123 nurses and 202 patients attending the facilities during the study period, who were randomly selected. Purposive judgement was used in determining the health facilities. Data for the study were collected from both primary and secondary sources. The primary data were derived from observations and the administration of copies of the questionnaire. Secondary data were sourced from the five-year facility’s records, previous research works, books, professional journals, and relevant websites. Sirota’s Three-Factor Theory framework of Equity/Fairness, Achievement and Camaraderie was used to examine and explain the critical variables in the study. The instruments used for the study were researcher-developed questionnaire items and a standardized hospital assessment of healthcare providers and systems(HCAHPS) tool. The instruments were validated by the supervisor and other relevant experts from nursing, health management, public health and statistics. Descriptive and inferential statistics were used for data analysis for the generated data. Cronbach alpha was used and the reliability coefficient of 0.86 was derived which is indicative of the reliability of the instrument.

VOICE–Validating Outcomes by Including Consumer Experience: A Study Protocol to Develop a Patient Reported Experience Measure for Aboriginal and Torres Strait Islander Peoples Accessing Primary Health Care

Aboriginal and Torres Strait Islander peoples' (hereafter respectfully referred to as Indigenous Australians) experiences of health care are shaped by historical, social and cultural factors, with cultural security critical to effective care provision and engagement between services and community. Positive patient experiences are associated with better health outcomes. Consequently, it is an accreditation requirement that primary health care (PHC) services must formally gather and respond to patient feedback. However, currently available patient feedback tools were not developed with Indigenous Australians, and do not reflect their values and world views. Existing tools do not capture important experiences of care of Indigenous Australians in PHC settings, nor return information that assists services to improve care. Consistent with the principles of Indigenous Data Sovereignty, we will co-design and validate an Indigenous-specific Patient Reported Experience Measure (PREM) that produces data by and for community, suitable for use in quality improvement in comprehensive PHC services. This paper presents the protocol of the study, outlining the rationale, methodologies and associated activities that are being applied in developing the PREM. Briefly, guided by an Aboriginal and Torres Strait Islander Advisory Group, our team of Indigenous and non-Indigenous researchers, service providers and policy makers will use a combination of Indigenous methodologies, participatory, and traditional western techniques for scale development. We will engage PHC service staff and communities in eight selected sites across remote, regional, and metropolitan communities in Australia for iterative cycles of data collection and feedback throughout the research process. Yarning Circles with community members will identify core concepts to develop an "Experience of Care Framework", which will be used to develop items for the PREM. Staff members will be interviewed regarding desirable characteristics and feasibility considerations for the PREM. The PREM will undergo cognitive and psychometric testing.

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

BackgroundThe overuse of antibiotics in primary healthcare settings (PHSs) has caused a serious public health problem in China. The outbreak of the Coronavirus Disease-19 (COVID-19) pandemic brought about dramatic changes in the supply of and demand for medical services in PHSs, possibly resulting in unprecedented changes in antibiotic use.ObjectiveThis study aims to assess the immediate and long-term impacts of the COVID-19 pandemic on the changes in antibiotic consumption in PHSs.MethodThe data on antibiotic consumption were collected from selected township hospitals in Shandong, China from January 2019 to December 2021. Antibiotic consumption was quantified by using the defined daily doses (DDDs) and the WHO Access, Watch, Reserve category. A segmented regression model was established to analyze the immediate and long-term impacts of the COVID-19 pandemic on antibiotic use by using the interrupted time series analysis.ResultsThe overall antibiotic consumption in all PHSs decreased by 32.04% and 16.69% in 2020 and 2021 respectively compared to the corresponding period in 2019. Over the entire study period, the use of penicillins (J01C) and cephalosporins (J01D) accounted for more than 50% of the total antibiotic consumption. The average annual consumption of Watch category antibiotics decreased by 42.02% and 33.47% in 2020 and 2021 respectively compared to that in 2019. According to the interrupted time series analysis, the total antibiotic consumption decreased significantly immediately after the COVID-19 pandemic outbreak (coef. = − 2.712, p = 0.045), but it then increased significantly over a long-term (coef. = 0.205, p = 0.005). Additionally, the consumption of Access category antibiotics increased significantly in PHSs in the long-term (coef. = 0.136, p = 0.018). However, the consumption of Watch category antibiotics declined sharply immediately after the pandemic (coef. = − 1.222, p < 0.001), but then it increased slightly over a long-term (coef. = 0.073, p < 0.001).ConclusionThe extensive use of penicillin and cephalosporins should be of great concern. After the outbreak of COVID-19 pandemic, the total antibiotic consumption decreased generally and the use pattern was improved to some extent in the PHSs in Shandong, China. This provides an opportunity for improving the misuse of antibiotics in PHSs in China.

Efficacy of Bromhexine versus Standard of Care in Reducing Viral Load in Patients with Mild-to-Moderate COVID-19 Disease Attended in Primary Care: A Randomized Open-Label Trial.

A 28-day randomized open-label multicenter study was conducted to assess the efficacy of bromhexine plus standard of care (SOC) (n = 98) vs. SOC alone (n = 93) in 191 outpatients with mild-to-moderate COVID-19 in the primary health care setting. Bromhexine three daily doses of 10 mL (48 mg/day) were administered for seven days. The primary efficacy endpoint was the reduction of viral load estimated as the cycle thresholds (Ct) to detect ORF1ab, N Protein, and S Protein genes by RT-qPCR in saliva samples on day 4 as compared with baseline. Ct values of the three genes increased from baseline throughout days 4 to 14 (p < 0.001) but significant differences between the study groups were not found. Differences in the percentages of patients with low, medium, and high viral loads at 4, 7, and 14 days were not found either. In summary, treatment with bromhexine plus SCO was associated with a viral load reduction of ORF1ab, N Protein, and S Protein genes at day 4, which was not significantly different than similar viral load reductions observed with SOC alone. The present findings do not seem to favor the use of bromhexine as an antiviral in patients with COVID-19.

Facilitators and barriers to professional nurses implementing integrated services in urban primary health care clinics in Kavango East region, Namibia.

The World Health Organization (WHO) has advocated for the implementation of people-centred and integrated health services. Although there is growing evidence of integration's benefits for sexual and reproductive health, human immunodeficiency virus (HIV) and rights, health services face tremendous resource constraints when it comes to integrating these services. The aim of study was to explore and describe the facilitators and barriers to professional nurses implementing the person-centred model of integrated services in urban primary health care clinics in the Kavango East region, Namibia. We interviewed professional nurses from urban primary health care clinics in low-resourced settings in Rundu health district, Kavango East region, Namibia. This study employed a qualitative approach utilising an explorative, descriptive and contextual strategy. Semistructured interviews were used to collect the data. Fifteen participants were selected using a purposive sampling technique. The interviews were audio recorded, transcribed verbatim and coded, before the data were analysed using thematic analysis. The data analysis led to the emergence of the following four themes: understanding integrated services; facilitators for implementing integrated services; barriers to the implementation of integrated services; and improvement measures for implementing integrated services. Findings showed that the implementation of integrated services faces many barriers, which are related to lack of human resources skills, a lack of essential supplies and space constraints. These findings will hopefully create an awareness and understanding of the facilitators and barriers that professional nurses face in the implementation of integrated services for urban primary health care in the Namibian urban context.Contribution:The study's findings can be used to develop strategies and ongoing interventions that focus on addressing the barriers professional nurses face in the implementation of integrated services in both urban and rural primary health care settings.

Planning and setting up of a patient health record system for patients with non-communicable diseases in a primary healthcare setting

India has a high burden of non-communicable diseases (NCDs). For NCD surveillance, there are national and international targets. However, India lacks good quality data for NCD surveillance. Maintenance of the NCD record improves the quality of care and helps a treating physician in making a clinical decision. Most of the patients with NCDs seek care at the primary level and these facilities lack NCD record management. Through this paper, we share our experience of planning and setting up of a paper-based NCD health record system at a primary health care setting. We developed a system to generate and maintain patient health records which consisted of unique ID generation, index register, NCD record file and NCD passbook (Dhirghayu card) for each patient. We reorientated the process and devised a mechanism for record-keeping and data management. We faced several challenges during its implementation and overcame those with the mentioned solutions. Findings from this paper can be used to develop a similar system for patient health records at primary health care facilities, which can be used for NCD surveillance and patient monitoring purposes.

Inclusion of Naturopaths in Northern Ontario Primary Care: A Proposed Solution for The Health Human Resources Shortage

The shortage of primary healthcare practitioners, such as physicians and nurses, in northern Ontario has persisted fordecades despite multiple strategies to address it. Poor health outcomes for people living in northern Ontario must be viewed through an equity lens that takes into account the multiple proximal, intermediate, and distal social determinants of health, including, but not limited to, the impact of colonization and continued colonialism on the health of Indigenous Peoples, challenges in housing, education and employment, as well as lack of food security. The increase in chronic health conditions in northern Ontario and the need for interprofessional healthcare teams that offer patient-centred care are key issues. Whole person care that takes into consideration the integration of body, mind, and spirit is central to Indigenous concepts of health and wellness, as well as being central to the foundations of naturopathic medical philosophy. Inclusion of naturopathic doctors in publicly funded multi-disciplinary primary healthcare settings is proposed as an achievable strategy to fill gaps in health human resources and advance the movement towards holistic care for Indigenous Peoples and others living in northern Ontario.

An ethnographic discourse approach to explore GP-counsellor communication in primary health care settings in Hong Kong.

This study aims to explore the nature of GP-counsellor interaction during discussions of patients' mental health issues in primary care services. An ethnographic discourse analysis of audio-recorded GP-counsellor conversations and the participating counsellor's reflective accounts. Two participating GPs and one counsellor were recruited from a private medical clinic in Hong Kong. The GPs and the counsellor mainly discussed their patients' issues in terms of medication management, the counsellor's case conceptualization, the case management, knowledge transfer and acknowledging the partnership. During case discussions, both the GPs and the counsellor used a range of interactional strategies to clarify a patient's condition and treatment plans for mutual understanding. The GPs and the counsellor co-construct an insider discourse that covers a greater diversity of topics, including both medical and non-medical concerns. The research findings have implications for theory and practice, including the potential of ethnographic discourse analysis in understanding the features of participants' behavior and evaluating the effectiveness of communication in a particular setting, as well as the importance of exploring professionalized discourse during GP-counsellor communication in developing training programs aimed at enhancing staff awareness of effective IPC communication.

Validation of the international classification of functioning, disability, and health (ICF) core sets for musculoskeletal conditions in a primary health care setting from physiotherapists’ perspective using the Delphi method

Purpose To analyze the possibilities of using ICF core sets for musculoskeletal conditions in primary care physiotherapy units of the Health Service of “Castilla y León” (Spain). Methods A three-round Delphi study was conducted by physiotherapists working in a primary care setting. The data obtained were linked to second-level ICF categories and their relevance was assessed by the participants. The most relevant categories were compared with those present in the existing ICF core sets for musculoskeletal conditions. Results Eighty-four physiotherapists participated in the survey. The consensus was reached for 45 ICF categories and 5 personal factors after the survey. Thirty-five of these categories were present in the Comprehensive Core Set for post-acute Musculoskeletal Conditions. In addition, 35 categories present in the core set were not considered relevant from the participants' perspective. Conclusions Physiotherapists mainly considered movement-related categories as relevant. The ICF core set for post-acute musculoskeletal conditions comprises many of these categories and can therefore be taken as a basis for the adoption of ICF in the clinical context. Relevance Primary care physiotherapists should be aware of the advantages of using ICF in their clinical settings. Implications for Rehabilitation This study shows which body functions and structures, activities and participation, environmental factors, and personal characteristics are relevant from primary care physiotherapists’ perspective assessing persons with musculoskeletal conditions. The Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions includes most of the categories identified in this study, but they need to be refined to fully represent the primary care physiotherapists’ perspective. The results of this study support the use of the Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions as a basis for operationalizing ICF in this clinical setting.

Adaptation, implementation, and evaluation of the HEARTS technical package in primary health care settings in Jordan to improve the management of hypertension: a pilot study.

The majority of patients with hypertension in Jordan have uncontrolled blood pressure. This study aimed to adapt and implement the hypertension management protocol (a module in the HEARTS technical package) in health care centers in Jordan and evaluate its effectiveness on hypertension management and control. The hypertension management protocol was adapted and implemented in six health centers followed by training of the healthcare staff on the adapted protocol. Patients above 18 years old who attended health centers during the study period were recruited consecutively. The blood pressure of 852 patients was monitored over 4 months, using an individual patient treatment card. At the baseline visit, the proportion of patients with uncontrolled blood pressure was 71.5%. After 4 months of the implementation of the protocol, the proportion of patients with uncontrolled blood pressure decreased to 29.1%. Of all studied characteristics, age was the only significant predictor of achieving blood pressure control. Patients aged ≤50 had a higher rate of controlled blood pressure readings after 4 months of implementation of the protocol compared to patients older than 60 years (OR = 1.98, 95% CI: 1.07, 3.67; P value = 0.028). In conclusion, the implementation of the HEARTS hypertension management protocol has successfully achieved better control of the blood pressure of the enrolled patients after 4 months of implementation. To achieve better control of hypertension in the general population, integrating evidence-based strategies for hypertension control that are listed in the HEART technical package into routine care is strongly recommended.

Nurses Involvement in the Management of Family Violence Victims in Primary Care Settings in Ondo State, Nigeria: A Qualitative Study

Background: Nurses in primary healthcare settings are strategic for appropriate responses to family violence victims in Nigeria. The study described nurses’ involvement in identifying and managing victims of family violence.&#x0D; Methods: The interpretive descriptive qualitative approach was adopted for the study. Participants were purposively selected and in-depth interviews were conducted among 12 nurses working at primary health care settings with a developed interview guide. The interviews were analyzed via qualitative content analysis.&#x0D; Results: Findings showed that nurses identified victims of physical violence via signs of physical injury. Nurses had difficulty identifying other forms of violence that may not have physical signs and not disclosed by victims. Nurses’ management strategies were wound care for physical injuries sustained, counselling and mediation. Risk assessment, safety planning measures were not instituted as well as effective management and specialized care services for victims.&#x0D; Conclusion: This study showed there were gaps in identifying family violence cases and their management by nurses. Hence, the implication for further education and training of nurses, and advocacy for policy guidelines for effective management of family violence victims.

Perceptions towards integrated care through the narrative of practicing social workers and psychologists in PHC: a cross-case analysis

PurposeIn a collective effort to build a patient-centered and coordinated health care system, social workers and psychologists are being progressively introduced to primary health care (PHC) settings worldwide. The present study aims to explore the current status of integration through the narrative of social workers and psychologists in PHC settings in Kazakhstan.Design/methodology/approachIn this paper purposive snowball sampling was utilized to recruit social workers and psychologists who work, or used to work, in PHC settings since the onset of integration in Nur-Sultan for participation in an in-depth interview. A semistructured interview guide was based on normalization process theory (NPT). Interviews were conducted via video conference, in Russian language, lasted no more than 50 min, and transcribed verbatim. Cross-case analysis of eight cases was performed using NPT constructs.FindingsCross-case analysis included findings from the interviews from five social workers and three psychologists. Four major constructs of implementation process from NPT were reflected in the findings: coherence (believes integration improves patient care, functions within integrated care), cognitive participation (individual changes to role performance, mechanisms of work), collective action (status of support from stakeholders, cooperation within a multidisciplinary team) and reflective monitoring (existing mechanisms for monitoring the integration).Research limitations/implicationsDespite organizational integration, there is a lack of successful clinical integration of social workers and psychologists in PHC settings of Kazakhstan, which is manifested by a lack of understanding of responsibilities and functions of these mental health care specialists. Consensus was reached by all participants that both social workers and psychologists are valuable assets in a multidisciplinary team.Originality/valueThe present study contributes to the current knowledge of integrated PHC service delivery by addressing the status of integrated care in Kazakhstan from interviews with key stakeholders in social work and mental health. Moving forward, improvements are needed to (1) establish the monitoring mechanism to evaluate the status of integration, (2) enhance effective collaboration within multidisciplinary teams in PHC settings and (3) increase awareness among medical workers and community members on mental health issues and the available support offered by social workers and psychologists to promote quality of life in a holistic, integrated manner.

Telephonic Follow-up and the Risk of Death in Ambulatory Patients with COVID-19.

Primary care level close monitoring of mild COVID-19 patients has shown to provide a risk reduction in hospitalization and death. We aimed to compare the risk of all-cause death among COVID-19 ambulatory patients who received and did not receive telephonic follow-up in primary health care settings. A secondary database analysis, 2-group comparative study, was conducted with data from the medical information systems of the Mexican Institute of Social Security. A total of 1,498,808 ambulatory patients aged 20 years old and over and with laboratory confirmed SARS-CoV-2 by PCR or rapid antigen test were analyzed. Of them, 535,898 (35.8%) where followed by telephonic calls. The cases were attended from October 14, 2020, to April 10, 2022. Death incidence was evaluated. To assess the association between death and telephonic follow-up we calculated risk ratio using a multivariate logistic model. Case fatality rate was 1.29% in the patients who received telephonic follow-up and 2.95% in the cases who did not receive phone calls. Medical history of chronic kidney disease, COPD, cardiovascular disease, tobacco consumption and diabetes were associated with increased risk of death. In the multivariate model, telephonic follow-up was associated with lower risk of all-cause death, with an adjusted risk ratio of 0.61 (95% confidence interval from 0.59, 0.64). Our data suggest that telephonic follow-up is associated with a risk of death reduction in adult outpatients with mild COVID-19, in the context of a multimodal strategy in the primary health care settings.

A scoping review of the healthcare provided by nurses to people experiencing domestic violence in primary health care settings.

Domestic and family violence is a significant and growing public health concern in many communities around the world. Nurses are often the first and sometimes only point of contact for people seeking healthcare following DFV incidents and are therefore well placed to identify and support these vulnerable people. The aim of this scoping review is to examine the English language studies of healthcare provided by nurses in primary healthcare settings to people experiencing domestic and family violence. A scoping review of the following databases was undertaken between March-June 2021: CINAHL, Medline, and PubMed. Primary studies were included if written in English, published from 2000 onwards, and focused on the care provided by primary healthcare nurses to people experiencing DFV. A critical appraisal of included studies was conducted using the Mixed Methods Appraisal Tool (MMAT). Results were synthesised narratively. Six studies were included, from the United States (n=2), United Kingdom (n=1), Sweden (n=2), and Brazil (n=1). Five studies were quantitative and one qualitative. A fundamental aspect of the healthcare provided by nurses, reported by all studies, was the screening of DFV. Other healthcare provided includes physical and mental health assessment and referral to other services, including sexual assault clinics, social supports, and law enforcement agencies. Findings suggest the level of DFV screening conducted by nurses is limited. Nurses' knowledge of how to support people experiencing DFV was also reportedly limited. Two studies reported that nurses were unfamiliar with DFV practice guidelines and the existence and availability of support networks for people experiencing DFV. Findings suggest inconsistency in primary healthcare nurses' level of education, skill and knowledge, and detection of people experiencing DFV. As the largest healthcare professional discipline, nurses have frequent contact with people experiencing DFV. There is an urgent need for nurses to be better educationally prepared and more organisationally supported in order to adequately respond and provide healthcare to people experiencing DFV. Given that the number of people experiencing DFV has increased due to the COVID-19 pandemic, it is ever more important for nurses to be well equipped to identify and respond appropriately.

An epilepsy curriculum for primary health care providers: a report from the Education Council of the International League Against Epilepsy

Primary health care providers are directly responsible for the care of people with epilepsy. However, their education about epilepsy might be inadequate or lacking. Our objective was to develop an evidence-based and consensus-driven educational curriculum for the management of epilepsy within the primary healthcare setting. The International League Against Epilepsy (ILAE) Education Council commissioned a task force of international experts, who met virtually at monthly intervals in 2020/2021 to develop the curriculum. The task force adopted and added to five domains from the ILAE Epileptology Curriculum after discussions on context, structure and wording of associated competencies and learning objectives. The consensus-approved curriculum was disseminated to the ILAE leadership and constituency in six different languages. An online survey was used to collate structured feedback which further refined the curriculum. Feedback was obtained from 785 voluntary respondents who were inclusive of epilepsy specialists and primary healthcare providers. Nearly two thirds of the respondents approved the use of the curriculum to advance the competency of primary health care providers in epilepsy. The final educational curriculum comprised six domains, 26 competencies and 85 learning objectives. The six domains were: (1) ability to diagnose epilepsy and its broad subtypes; (2) ability to provide counselling to people with epilepsy over a range of issues; (3) ability to introduce treatment and follow-up to people with epilepsy; (4) competency to appropriately refer people to higher centres of care; (5) ability to manage epilepsy emergencies including status epilepticus; and (6) ability to recognize and provide basic care for psychiatric and somatic comorbidities. The curriculum represents an advance in providing inclusive care for epilepsy within the primary health care setting and ideally should be used to facilitate future primary health care epilepsy education packages.