Primary Cares Research Articles

Exploring the equity of distribution of general medical services funding allocations in Wales: a time-series analysis.

Good access to quality primary care in high-income countries can improve population health. Access to primary care is however often not equal among socioeconomic groups; our analysis sought to explore whether funding, a determinant of service supply, is equitably distributed among GP practices in Wales. We sought to explore the relationship between funding and deprivation among GP practices in Wales, to understand the equity of current funding policies. We obtained funding data for general practices in Wales between 2014 and 2022 and explored the equity of distribution using the percentage of practice patients living in the 20% most deprived small areas in Wales. We generated a linear regression model exploring the relationship between practice funding and deprivation, with an interaction term with time in years. Practice funding rose for all practices between 2014 and 2022. Practice deprivation and time in years were both associated with practice funding, with increases in practice deprivation associated with reduced funding allocations, and time being associated with a small increase in funding over the study period. Over the period of analysis of 2004-2022, for every 10% increase in patients living in the most deprived LSOAs, funding per patient decreases on average by 1%. Primary cares in Wales in more deprived areas receive discernibly less funding per patient than those in less deprived areas. Given the potential and likelihood primary care can affect population health outcomes, this underinvestment may be contributing to existing health inequalities and requires urgent further analysis and action.

Impact of essential newborn care education on knowledge and practice of new-born care among nurses in rural primary health centres in Ebonyi state of Nigeria

Background: This study was designed to determine the level of knowledge and the extent of practice of the components of essential new-born care (ENC), and the effects of a training programme on the knowledge and practice of ENC among nurses in rural primary health cares (PHCs) in Ebonyi state Nigeria. Methods: This study was a one group pre-test and post-test intervention design. The components of ENC considered were: New-born initiation of breastfeeding, thermoregulation, new-born cord care, newborn eye care, initiation of breathing and administration of vitamin K. A neonatal care knowledge and practice assessment (NCKPA) questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (48) available nurses (All female). Results: There was significant improvement in the level of knowledge and extent of practice of the components of ENC following the training programme. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of eye care 20 (41.6%) pre-intervention, and least knowledge of cord care 35 (72.9%) and eye care 45 (93.8%)-post-intervention. Conclusions: Increase in knowledge corresponded with increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, update courses and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rate.

A Clinical-Based Drug Interaction Alert (CIDIA) System for Preventing Drug Interaction and Its Associated Factors at Rural Primary Care Centres

Objectives: Drug-drug interaction (DDI) occurs following the prescription of more than one drug. DDI and its associated factors in Indonesia’s country’s primary care have not been reported.
 Materials and Methods: Through this descriptive cross-sectional study, we analysed the DDI incidence using the Clinical-Based Drug Interaction Alert (CIDIA) alert system. Purposive research was carried out by analysing prescriptions (n=2410) from nine primary health cares.
 Results: CIDIA alert system detected 7.5% DDI incidence in all prescriptions, categorized as mild (63%), moderate (36%) and serious (1%). Significant DDI incidence was observed in female patients (p<0.01), in patients older than 18 years (p<0.01) and in patients receiving three or more drugs (p<0.01). The most frequent incidence of DDI from each category was paracetamol-domperidone; dexamethasone-mefenamic acid and captopril-allopurinol.
 Conclusion: CIDIA alert system has been shown to provide beneficial support in detecting DDI incidence. Careful consideration should be addressed particularly towards female patients, older patients, and patients receiving three or more drugs in preventing DDI incidence.
 Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 667-675

The impact of telemedicine services on primary health care - before and after analysis- Jharkhand digital dispensary model

Background: The service utilization at primary health cares (PHCs) by the rural population is challenging considering the lack of service availability and health care practitioners. Telemedicine and digitization of services have high potential to address the service provision gaps. Government of Jharkhand and Apollo tele health services-initiated PPP project to provide digital healthcare (digital dispensary) services at 100 rural PHCs in the state of Jharkhand. Methods: The research study seeks to explore before and after impact of telemedicine services at the government run PHCs at Jharkhand. This retrospective analysis of health management information system (HMIS) and Jharkhand digital dispensary (JHDD) project data was performed for 19 PHCs out of 100 where JHDD project has been initiated. A pre-post study design was used to understand the impact of JHDD project implementation and uptake of outpatient department (OPD) utilization. The 19 centers were randomly selected using selective sampling, considering the data availability and travelling restrictions. Primary baseline data was analyzed in the excel sheet and secondary data- was entered, verified, and analyzed with statistical package for the social sciences (SPSS) version 25. Results: Patients have to travel up to 75 kms to visit a doctor and avail health services. Medical officer was adequate, but not available for eight hours and every day. JHDD project data have highlighted the prevalence of NCDs in rural areas with significant increase in the diagnosis of diabetes and hypertension. The availability of general physician and specialist doctors virtually, with laboratory tests and medicines were the enabling factors in addressing the NCDs for the rural areas. Conclusions: Telemedicine is strong enabler in addressing NCDs in remotest inaccessible areas. The study has pointed out the importance of available remote workforce, basic infrastructure and technology can strengthen the healthcare system by reaching the unreached.

Maternal and Child Health Handbook Utilization, Quantity and Quality of Antenatal Services, and Maternal Emergency Rates in Padang City in 2022

This study analyzed the relationship between the utilization of the Indonesian Ministry of Health’s Maternal and Child Health Handbook and the quantity and quality of antenatal care to maternal emergency levels. This study applied mixed methods with a consecutive sampling technique and included 108 mothers undergoing maternal emergencies at a central general hospital (quantitative) and eight mothers, seven midwives, and five cadres at primary health cares (qualitative) as informants. The result showed a relationship between the utilization of the Maternal and Child Health Care Handbook (p-value = 0.043), the quantity of antenatal care (p-value<0.001), the quality of antenatal care (p-value = 0.044) and the maternal emergency level. Not all mothers understood the benefits of the Maternal and Child Health Handbook. Most did not read it, and some mothers perceived that it could prevent emergency cases for them. The mothers were satisfied with the quality of the antenatal care services received. Maternal emergency cases are still quite high; hence, it is necessary to increase the use of Maternal and Child Health Handbook and the quantity and quality of antenatal care.

Job Satisfaction Model of Primary Health Care Midwives Based on Indonesian Workforce Research in the Health Sector

Promotive, preventive, curative, and rehabilitative efforts that are comprehensive, integrated, and sustainable are employed to enhance the health state of the global population. Within this context, however, the quality of primary health care depends on job satisfaction, which leads to the happiness of human resources in the health sector. Therefore, this study aimed to analyze and formulate a job satisfaction model among primary health care midwives in Indonesia. This study was an advanced secondary data analysis of a cross-sectional study conducted in 2017 by the National Institute of Health Research and Development, Ministry of Health of the Republic of Indonesia. A total of 87,341 midwives from all 9,669 primary health cares in Indonesia participated in this study. Data were collected by distributing the Minnesota Satisfaction Questionnaire, elaborating on the satisfaction level and relevant contributing factors. The prefilled Likert scale questionnaire was analyzed using logistic regression. The findings suggested a model indicating that motivation, work area (region), history of salary delay, and training received were important for their job satisfaction, whereas the motivation aspect contributed the most. Therefore, the local and central governments must consider these factors in the human resource policymaking process.

WHO-PEN intervention in Iran's health system based on 5As healthy lifestyle counseling model: A randomized-clinical trial.

Skill Training Intervention Based on the Healthy Lifestyle Counselling Module (5As model) in the Ira PEN Program. This study was a randomized controlled trial in Iran. Participants were 184 health workers and 184 clients (92 in each study group). The training program entailed an online training course, educational video, and clip. The behavior related to a healthy lifestyle in clients was also followed-up 2 months later. Data were analyzed using SPSS 22 software. Based on the observations, significant improvement in lifestyle counseling skills among health workers in the intervention group compared to the control group in terms of healthy nutrition (P < 0.001), physical activity (P < 0.001), smoking cessation (P = 0.03), and withdrawal of alcohol consumption (P < 0.001) was observed. Also, lifestyle-related behaviors among clients in terms of healthy nutrition (P < 0.001), physical activity (P < 0.001), and withdrawal smoking (P < 0.001) increased significantly. Furthermore, waist circumference (P < 0.024) and BMI (P < 0.001) among clients were significantly reduced. The training program for health personnel in healthy lifestyle has a more effective role in changing people's behavior and prevention of noncommunicable risk factors. Healthy life style counselling in primary health cares may lead to control risk factors for Noncommunicable disease.

Evaluating population-based geographic access to primary healthcare services in Jeddah second cluster, Saudi Arabia

Objective: The study addresses the wider question of whether accessibility of the existing primary health cares (PHCs) is sufficient to provide services to individuals. Based on this question, the aim of this study was to gen erate quantitative evidence regarding PHC spatial access in Jeddah city, Saudi Arabia. Methods: A cross-sectional study design was used to conduct this descriptive study. Jeddah second cluster-Jed dah city (J2-J) had a total of 18 PHCs with a total population of 1.7 million, which represents 49.4% of the total population of Jeddah city. Results: The Al-Safa 1 and 2 district health centers were located in the areas with the highest population densities, with populations of 209 908 (12.4%) and 187 233 (11.1%) of the l J2-J total population, respectively. On average, individuals living in sparsely populated areas must travel 3.05 to 4.65 km to reach their nearest PHC, while individuals living in highly populated areas must travel an average of 1.13 to 1.85 km to their nearest PHC. In J2-J, the population density varies significantly between districts, with services concentrated in some highly populated areas. While most J2-J residents were located within reasonable distance of their nearest PHC, some PHCs provided services to up to 200,000 people. Conclusion: Despite the current reforms affecting the health care system, particularly those pertaining to the new model of care, the capacity of PHCs is insufficient to satisfy the demands of the population.

Perf-Use-Sport study: Consummation of performance enhancing substances among athletes consulting in primary cares centers of Herault

In our knowledge data about supplementations of recreational athletes are very limited in France. The health of these athletes is mostly under the supervision of their general practitioner. If it was shown that these athletes use substances, their general practitioners will need to find effective ways to protect their health. The main objective of this study is to estimate the prevalence of use of performance enhancing substances among athletes consulting in primary care center. Others goals are to collect information about motivations of user's, person advising consumer's and places to purchase substances. All major athletes consulting in general medical practice between the 24th of August 2020 and the 06th of November 2020 were invited to answer an anonymous questionnaire. A total of 40 randomized physicians of Herault participate in the study. We installed posters and flyers in waiting room to provide information and allow the athlete to submit to online version or paper version of questionnaire. A total of 281 athletes submitted to the questionnaire with 54.5% of male ( n = 153) and 45.5% of female ( n = 128) and an average age of 39.7 years (± 14.9). Over than 96% was recreational athletes ( n = 272) and 59.9% of them report using a least one substance. About 66.9% of consumers report using dietary supplement, 67.5% medications and 13.6% illicit drugs or anabolic agents. Motivations and places to purchase depend on substances. Near of 60% of athletes consulting in primary care center report use performances enhancing substances. It seems important that physicians are aware of this in order to help the athlete to protect his health. À notre connaissance, les données concernant la supplémentation des sportifs amateurs sont très limitées en France. La santé de ces sportifs est majoritairement assurée par le médecin généraliste. S’il était mis en évidence que ces sportifs utilisent des substances alors il serait du devoir de leur médecin de trouver des solutions pour protéger leur santé. L’objectif principal de cette étude est d’estimer la prévalence d’utilisation de substances améliorants les performances chez les sportifs consultants en centres de soins primaires. Les objectifs secondaires seront de collecter des informations concernant les motivations des utilisateurs, leurs sources d’information, de conseils et d’achats. Tous les sportifs adultes consultant en cabinets de médecine générale entre le 24 août 2020 et le 6 novembre 2020 ont été invité à participer à un questionnaire anonyme. Un total de 40 médecins généralistes du département de l’Hérault, tirés au sort, ont participé à cette étude. Des posters et des flyers ont été installés dans leurs salles d’attentes afin de délivrer une information et de permettre au sportif de se soumettre à une version papier ou en ligne du questionnaire. Un total de 281 sportifs ont répondu au questionnaire avec 54,5 % d’homme ( n = 153) et 45,5 % de femme ( n = 128) et un âge moyen de 39,7 ans (± 14,9). Plus de 96 % étaient des sportifs amateurs ( n = 272) et 59,9 % d’entre eux déclarés consommer au moins une substance. Environ 66,9 % des consommateurs déclarer utiliser des compléments alimentaires, 67,5 % des médicaments et 13,6 % des drogues illicites ou des agents anabolisants. Les motivations et lieux d’approvisionnement étaient dépendant du type de substance. Prés de 60 % des sportifs consultant dans les centres de soins primaires déclarent utiliser des substances améliorants les performances. Il semble important que le médecin en ai conscience afin d’aider le sportif à protéger sa santé.

Medication Adherence and Self-Management Practices among Type 2 Diabetes Mellitus Patients in Jeli District, Kelantan, Malaysia

This study was carried out to investigate the level of medication adherence and diabetic knowledge among type 2 diabetes mellitus patients in Jeli District, Kelantan, Malaysia. This cross-sectional study was done from February to July 2019 by giving a questionnaire to 150 type 2 diabetes mellitus patients aged 40-80 years at three primary health cares in Jeli District, Kelantan, Malaysia. The quantitative descriptive method was used in this study. The findings of this study revealed that knowledge was significantly related to poor adherence. When sex, history of diabetes, and education were accounted for, patients with low diabetic knowledge had an odds ratio of 4.53 for poor adherence compared to those with high knowledge (adj 95% CI (1.92-10.69), p-value = 0.001). To achieve the goal of regulating diabetes management in primary health care, a clinical supervision program should be implemented to improve staff competence in diabetes management and to empower patients through self-management.

20 Years of Real-World Data to Estimate the Prevalence of Heart Failure and Its Subtypes in an Unselected Population of Integrated Care Units.

Introduction: Heart failure (HF) is a clinical syndrome caused by structural and functional cardiac abnormalities resulting in the impairment of cardiac function, entailing significant mortality. The prevalence of HF has reached epidemic proportions in the last few decades, mainly in the elderly, but recent evidence suggests that its epidemiology may be changing. Objective: Our objective was to estimate the prevalence of HF and its subtypes, and to characterize HF in a population of integrated care users. Material and Methods: A non-interventional cross-sectional study was performed in a healthcare center that provides primary, secondary and tertiary health cares. Echocardiographic parameters (left ventricle ejection fraction (LVEF) and evidence of structural heart disease) and elevated levels of natriuretic peptides were used to define two HF phenotypes: (i) HF with a reduced ejection fraction (HFrEF, LVEF ≤ 40% and either NT-proBNP ≥ 400 pg/mL (≥600 pg/mL if atrial fibrillation (AF)/flutter) or BNP ≥ 100 pg/mL (≥125 pg/mL if AF/flutter)) and (ii) HF with a non-reduced ejection fraction (HFnrEF), which encompasses both HFpEF (LVEF ≥ 50% and either NT-proBNP ≥ 200 pg/mL (≥600 pg/mL if AF/flutter) or BNP ≥ 100 pg/mL (≥125 pg/mL if AF/flutter) in the presence of at least one structural cardiac abnormality) and HF with a mildly reduced fraction (HFmrEF, LVEF within 40–50% and either NT-proBNP ≥ 200 pg/mL (≥600 pg/mL if AF/flutter) or BNP ≥ 100 pg/mL (≥125 pg/mL if AF/flutter) in the presence of at least one structural cardiac abnormality). The significance threshold was set at p ≤ 0.001. Results: We analyzed 126,636 patients with a mean age of 52.2 (SD = 18.3) years, with 57% (n = 72,290) being female. The prevalence of HF was 2.1% (n = 2700). The HF patients’ mean age was 74.0 (SD = 12.1) years, and 51.6% (n = 1394) were female. Regarding HF subtypes, HFpEF accounted for 65.4% (n = 1765); 16.1% (n = 434) had HFmrEF and 16.3% (n = 439) had HFrEF. The patients with HFrEF were younger (p < 0.001) and had a history of myocardial infarction more frequently (p < 0.001) compared to HFnrEF, with no other significant differences between the HF groups. The HFrEF patients were more frequently prescribed CV medications than HFnrEF patients. Type 2 Diabetes Mellitus (T2D) was present in 44.7% (n = 1207) of the HF patients. CKD was more frequently present in T2D vs. non-T2D HF patients at every stage (p < 0.001), as well as stroke, peripheral artery disease, and microvascular disease (p < 0.001). Conclusions: In this cohort, considering a contemporary definition, the prevalence of HF was 2.1%. HFrEF accounted for 16.3% of the cases, with a similar clinical–epidemiological profile having been previously reported in the literature. Our study revealed a high prevalence of patients with HFpEF (65.4%), raising awareness for the increasing prevalence of this entity in cardiology practice. These results may guide local and national health policies and strategies for HF diagnosis and management.

Interprofessional Collaborative Practice and Health Workers Retention at Remote Primary Health Care: Case Study from Nusantara Sehat Team-based Program

The Nusantara Sehat Team (NST), established in 2015 and consist of multi-professional health workers, implemented to provide comprehensive services at remote primary health cares (PHCs) for two years. This study aimed to explore how the NST leverages the Interprofessional Collaboration (IPC) and its impact on the future career prospects of health workers. Using a qualitative approach, the information was gathered from 48 informants drawn from the current 30 NST recruits and 18 alumni through semi-structured interviews. Of these 48, 20 were clinical practitioners, while the rest were non-clinical health workers. The findings revealed several challenges in promoting collaborative practice, including the community's high demand for curative services, the unclear division of tasks among the NST and local PHC staff, and inadequate health facility support. The curriculum of IPC was yet to be included in the pre-service education and in-service training before NST, allowing the staff to enter the workplace and collaborate, especially in the backward areas. The institutional support through macro and meso policies has yet to enable collaborative-practice ready workers adequately. Other factors such as personal values, family expectations, gender roles, and career sustainability also affected the retention of personnel in the NST.

Georeferencing of Current Dental Service Locations in the Jazan Region, Saudi Arabia

Background: This study focused on the Jazan region, Kingdom of Saudi Arabia. To date, there has not been any documented evidence about geographical distribution of dental health-care services in the region. The study aimed to assess the geographical accessibility of dental health-care services in Jazan. Materials and Methods: Most recent, openly accessible, nonidentifiable data and information were used in this study. The location of health facilities was obtained from the Ministry of Health (MOH) Statistical Yearbook 2020 and interactive map of the MOH, which was converted to longitude and latitude, using Google Maps with 90% of the level building. The study data to be analyzed were imported from the integrated database in Quantum Geographic Information Systems into Microsoft Excel software, where the ratios of health-care facilities to the study population were computed. Results: There were 145 primary health cares (PHCs) and 19 hospitals with a dental component in the Jazan region of 17 governorates with a total of 1,726,739 residents. The overall PHC-, hospital-, and dentist-to-population ratios were 1 PHC to 114,365 residents, 1 hospital to 90,881 residents, and 1 dentist to 9136 residents. Only 14.5% of PHCs and 5.6% of the hospitals served 70% of the population who are living within 20 km from the governorate's center. Conclusion: This study shows that irregular distribution of health services has led to decreased access to services in the region. Further research is needed focusing in mapping MOH, private and other health facilities, and the burden of oral disease in the region.

Analysis of Chronic Disease Direct Cost at Public Primary Health Cares in Indonesia

Objectives: This study aims to analyze the of drug costs for patients with chronic diseases in the capitation system in public primary health cares (Public PHCs).&#x0D; Materials and Methods: This research is a quantitative study with an observational cross-sectional approach at 16 Public PHCs. Data collection used the retrospective method. The total sample was 293 outpatients in 2016.&#x0D; Results: The results showed that 63% of patients are female. The most patients are aged between 56-65 years (37%). The average drug cost for patients receiving more than 3 types of drugs is IDR 7,726. The biggest drug cost is patients with DM type 2 with which the average cost is IDR 7.400. And the metformin treatment is 17 (6%) patients with the cost IDR 4,500,-. Chi-square analysis shows that the quantity of drug items, type of disease and prescriptions there are have significant effect on drug cost (p-value &lt;0.05). However, gender and age group there are no significant effect on drug cost (p-value &gt;0.05). Drug prescriptions are an important component in managing chronic diseases patients. Prescribing costs provide important information in the sustainability of the management of chronic disease programs.&#x0D; Conclusion: This study recommends that the prolanis policy in public PHCs is focused on the elderly age group patients and female group.&#x0D; Bangladesh Journal of Medical Science Vol.20(4) 2021 p.762-767

Descriptive study of behavior in using Personal Protective Equipment (PPE) to prevent Covid-19 for primary health care officers in Padang City

The number of positive patients infected by Coronavirus Disease 2019 (Covid-19) in the city of Padang continues to increase and is highest in West Sumatra Province. Until May 5, 2020, there were 131 positive confirmed cases. Six of them are primary health care officers. The purpose of this study was to measure the description of the use of Personal Protective Equipment (PPE) in the prevention of Covid-19 in primary health care staff in Padang City. This research uses descriptive quantitative method which was carried out in March - June 2020 in Padang City primary health cares. The study population are primary health care officers who deal with patients directly in the city of Padang with a sample of 100 people. Data were collected using a questionnaire and analyzed univariately. The results showed that 55% of staff used incomplete PPE, 57% are old, 54% have low knowledge, 54% have negative attitudes, 46% PPE are not available at the primary health care, and 45% lacked leadership support. The results also noted that 58% of officers began using PPE when announcing the first positive case in Padang City. For further research can conduct bivariate analysis and qualitative research for in-depth analysis.

Improving Patient-Centered Communication about Sudden Unexpected Death in Epilepsy through Computerized Clinical Decision Support.

Sudden unexpected death in epilepsy (SUDEP) is a rare but fatal risk that patients, parents, and professional societies clearly recommend discussing with patients and families. However, this conversation does not routinely happen. This pilot study aimed to demonstrate whether computerized decision support could increase patient communication about SUDEP. A prospective before-and-after study of the effect of computerized decision support on delivery of SUDEP counseling. The intervention was a screening, alerting, education, and follow-up SUDEP module for an existing computerized decision support system (the Child Health Improvement through Computer Automation [CHICA]) in five urban pediatric primary care clinics. Families of children with epilepsy were contacted by telephone before and after implementation to assess if the clinician discussed SUDEP at their respective encounters. The CHICA-SUDEP module screened 7,154 children age 0 to 21 years for seizures over 7 months; 108 (1.5%) reported epilepsy. We interviewed 101 families after primary care encounters (75 before and 26 after implementation) over 9 months. After starting CHICA-SUDEP, the number of caregivers who reported discussing SUDEP with their child's clinician more than doubled from 21% (16/75) to 46% (12/26; p = 0.03), and when the parent recalled who brought up the topic, 80% of the time it was the clinician. The differences between timing and sampling methodologies of before and after intervention cohorts could have led to potential sampling and recall bias. Clinician-family discussions about SUDEP significantly increased in pediatric primary care clinics after introducing a systematic, computerized screening and decision support module. These tools demonstrate potential for increasing patient-centered education about SUDEP, as well as incorporating other guideline-recommended algorithms into primary and subspecialty cares. clinicaltrials.gov, NCT03502759.

Development and Usability Testing of a Consultation System for Diabetic Retinopathy Screening

This study aims to develop a novel web-based decision support system for diabetic retinopathy screening and classification of eye fundus images for medical officers. The research delivers diabetic retinopathy information with a web-based environment according to the needs of the users. The proposed research also intends to evaluate the developed system usability to the target users. The complex characteristics of diabetic retinopathy signs contribute to the difficulty in detecting diabetic retinopathy. Therefore, professional and skilled retinal screeners are required to produce accurate diabetic retinopathy detection and diagnosis. The proposed system assists the communication and consultation among the medical experts in the hospital and the primary health cares located at the health clinics. The agile software development model is the methodology used for the development of this research project. The project collaborates with the Department of Ophthalmology, Hospital Melaka, Malaysia for the medical content expertise and testing. Representative medical officers from Hospital Melaka and all the public health clinics in Melaka were involved in the preliminary study and system testing. This research study consists of a web development producing an interactive web-based application of diabetic retinopathy consultation which comprises image processing and editing features as a core of the system. It is envisaged that this research project will contribute to the management of diabetic retinopathy screening among medical officers.

Time trend, prevalence and factors affecting place of delivery in rural area: a comparative study among two sub centers in field practice area of tertiary care center, Aurangabad, Maharashtra

Background: In the developing world, even today, perhaps delivery is the commonest event where life and death stand side by side for both, the expectant mother and her forthcoming newborn. India being second most populous country in the world, women and pre-school children constitute about one third of total population; any neglect or delay in care can adversely affect the wanted outcome. The aim of the study was to assess factors affecting institutional and home delivery in rural areas under field practice area of tertiary care center in Aurangabad city. The objectives of the study were as follows: to estimate the prevalence of home and hospital delivery in rural area and to study and analyze the factors affecting place of delivery i.e. home or hospitalMethods: Present study was undertaken in the two sub centers under one of the primary health cares in field practice area under tertiary care hospital in Aurangabad city. A total of 659 respondent women were interviewed to collect information regarding first and last delivery.Results: Total 58.27% women were delivered in private hospitals and only 18.66% delivered in Government institutions while prevalence of Home delivery was 23.06%.Conclusions: Early antenatal care (ANC) registration from the first pregnancy of the women with recommended visits should be encouraged since ANC registration has greater influence in selection of place of delivery.

Dampak Kebijakan Pengadaan Obat Pada Puskesmas di Jakarta Era Jaminan Kesehatan Nasional

Obat merupakan input penting dalam pelayanan kesehatan. Bila obat tidak tersedia, dapat berpengaruh negatif terhadap hasil terapi pasien. Tujuan penelitian observasional ini adalah untuk mengetahui proses pengadaan obat puskesmas di Jakarta, yang seluruhnya berstatus Badan Layanan Umum Daerah, guna memetakan permasalahan dan upaya penyelesaiannya. Data primer diperoleh melalui wawancara mendalam dan focus group discussion dengan Apoteker dan Pejabat Pembuat Komitmen dari 20 puskesmas yang mewakili 5 kotamadya, ditambah 1 puskesmas Kepulauan Seribu, menggunakan 20 jenis obat indikator yang 4 di antaranya adalah obat antihipertensi. Hasil penelitian yang dilakukan pada Januari sampai Maret 2019 ini menunjukkan bahwa dari 21 puskesmas yang melakukan pengadaan e-Purchasing, 11 puskesmas berhasil; 3 puskesmas gagal namun menindaklanjuti melalui pengadaan langsung; dan 10 puskesmas lainnya yang gagal tanpa menindaklanjuti, sehingga terjadi kekosongan obat antihipertensi. Puskesmas yang memenuhi kebutuhan obat ditemukan memiliki apoteker penanggung jawab pengadaan obat. Pada puskesmas yang terjadi kekosongan obat, apoteker yang ada tidak diberi peran dalam pengadaan obat, kondisi tersebut berdampak pada rerata proporsi rujukan pasien hipertensi yang mencapai 12%, atau 4 kali lipat dari puskesmas yang memenuhi kebutuhan obat, yaitu 3%. Dapat disimpulkan bahwa pelaksanaan pengadaan obat JKN di puskesmas di Jakarta masih mengalami hambatan, yang memerlukan dukungan peraturan pengadaan BLUD dan peran apoteker dalam pengadaan obat.

The Effectiveness of the Environmental Health Services in the Primary Health Care Against the Prevention of Pulmonary Tuberculosis in the Regency of Banyuwangi

Introduction: One of the promotive and preventive efforts in the prevention of pulmonary tuberculosis (TB) disease in primary health care is a health services environment that includes counseling, inspection and intervention of environmental health. The purpose of this study is to evaluate the effectiveness of the Environmental health services in the primary health care against the prevention of Pulmonary TB disease in Regency of Banyuwangi. Method: This research was observational descriptive design of study cross-ssectional. The study population was the primary health care in districy of Banyuwangi and a large sample of 6 primary health care. The determination of the study sample by using purposive sampling based on criteria of results Assessment of Performance of primary health care (PKP) services and programs environmental health in primary health cares and numbers Case Notification Rate (CNR) at the top of the East Java Province. Processing and analysis of data using a scoring system based on the scale of the theoretically grouped in the category of good, enough, less. The data is then interpreted descriptively. Result and Discussion: The Program of health service in the prevention of the disease is said to be effective when the probability of &gt;50.00%. The results showed the probability of the effectiveness of the environmental health services in the Primary Health Care of Klatak of 77.00%. The Primary Health Care of Mojopanggung, Sobo, and Kabat respectively 78.80%, Primary Health Care of Gitik by 64.20% and the Primary Health Care of Songgon 49.50%. Human resources at the Primary Health Care of Songgon not competent. The Primary Health Care of Gitik and Songgon not planning activities. The achievement of the output in all the primary health care less, it is because of the lack of commitment of the implementers and the coordination of cross-program not running. Conclusion: There are 5 primary health cares service programs environmental health in the prevention of Pulmonary TB effective that the Primary Health Care of Klatak, Mojopangung, Sobo, Kabat and Gitik while at the Primary Health Care of Songgon is not effective. The effectiveness of services and programs environmental health in TB patients is influenced by policies, human resources, infrastructure, planning and coordination across the program.