Access To Primary Health Care Research Articles

Exploring the path to optimal diabetes care by unravelling the contextual factors affecting access, utilisation, and quality of primary health care in West Africa: A scoping review protocol.

The prevalence of diabetes in West Africa is increasing, posing a major public health threat. An estimated 24 million Africans have diabetes, with rates in West Africa around 2-6% and projected to rise 129% by 2045 according to the WHO. Over 90% of cases are Type 2 diabetes (IDF, World Bank). As diabetes is ambulatory care sensitive, good primary care is crucial to reduce complications and mortality. However, research on factors influencing diabetes primary care access, utilisation and quality in West Africa remains limited despite growing disease burden. While research has emphasised diabetes prevalence and risk factors in West Africa, there remains limited evidence on contextual influences on primary care. This scoping review aims to address these evidence gaps. Using the established methodology by Arksey and O'Malley, this scoping review will undergo six stages. The review will adopt the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines to ensure methodological rigour. We will search four electronic databases and search through grey literature sources to thoroughly explore the topic. The identified articles will undergo thorough screening. We will collect data using a standardised data extraction form that covers study characteristics, population demographics, and study methods. The study will identify key themes and sub-themes related to primary healthcare access, utilisation, and quality. We will then analyse and summarise the data using a narrative synthesis approach. The findings and conclusive report will be finished and sent to a peer-reviewed publication within six months. This review protocol aims to systematically examine and assess the factors that impact the access, utilisation, and standard of primary healthcare services for diabetes in West Africa.

The effects of mobile primary health teams: Evidence from the Médico del Barrio strategy in Ecuador

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N = 55,666), 2012–13 (N = 92,500) and 2018–19 (N = 168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program’s implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA

BackgroundIndigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements.MethodsWe systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10–24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety.ResultsA total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors – providers’ competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents.ConclusionThis review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.

Promotion of Influenza Vaccination in the Emergency Department

BackgroundInfluenza vaccine uptake is low among underserved populations whose primary health care access occurs in emergency departments. We sought to determine whether implementation of two interventions would increase 30-day influenza vaccine uptake in unvaccinated patients in the emergency department.MethodsThis three-group, prospective, cluster-randomized controlled trial compared two interventions with a control group in noncritically ill, adult patients in the emergency department who were not vaccinated for influenza in the current vaccine season. The unit of randomization was individual calendar days. Participants received either Intervention M (an influenza vaccine messaging platform consisting of a video, one-page flyer, and scripted message, followed by a vaccine acceptance question and provider notification if participants indicated vaccine acceptance), Intervention Q (no messaging but the vaccine acceptance question and provider notification), or control (usual care/no intervention). The primary outcome was receipt of an influenza vaccine at 30 days ascertained by electronic health record review and telephone follow-up, comparing the Intervention M group with the control group. Secondary outcomes included comparisons of 30-day vaccine uptake in Intervention Q versus control and Intervention M versus Intervention Q.ResultsBetween October 2022 and February 2023, a total of 767 trial participants were enrolled at six emergency departments in five U.S. cities. Median age was 46 years; 353 (46%) participants were female, 274 (36%) were African American, and 158 (21%) were Latinx; 126 (16%) lacked health insurance, and 244 (32%) lacked primary care. The Intervention M, Intervention Q, and control groups had 30-day vaccine uptakes of 41%, 32%, and 15%, respectively (P<0.0001 for Intervention M vs. control). Comparing Intervention M versus Intervention Q, the adjusted difference in 30-day vaccine uptake was 8.7 percentage points (95% confidence interval, −0.1 to 17.6 percentage points).ConclusionsImplementation of influenza vaccine messaging platforms (video clips, printed materials, and verbal scripts) improved 30-day vaccine uptake among unvaccinated patients in the emergency department. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT05836818.)

"Closed books": restrictions to primary healthcare access in Aotearoa New Zealand-reporting results from a survey across general practices.

In Aotearoa New Zealand, primary care is organised by enrolling patients with a primary care provider. However, the benefits of this arrangement are frustrated when providers "close their books" due to insufficient capacity for new patients. We investigated the extent, evolution and impact of this situation on health access and equity in access to primary healthcare. We distributed a survey for general practice personnel in 2022, yielding 227 valid responses. We examined responses across respondents' practice characteristics, including practice size, rural-urban setting, average co-payments, region and ethnic composition of the catchment population. Most general practices are selectively enrolling their patients. In 2022, only 28% of respondents freely enrolled new people. Since 2019, most respondents (79%) had "closed books" or limited enrolments at some point. The situation worsened between 2019 and 2022, compromising equal opportunity and access in healthcare. Restricted enrolment poses a widespread barrier to health access and equity, and it worsened since the beginning of the COVID-19 pandemic. Addressing closed books and limited enrolments in general practice could significantly improve health services' access and equity. The study aims to inform ongoing health reforms.

Bridging gaps: improving the access of primary health care in rural Ukraine through mobile health units

Rural healthcare is an integral part of the Ukrainian healthcare system. However, access to healthcare for the rural population is uneven due to poor development of medical infrastructure and staffing. The problem of access to medical care in rural areas has been exacerbated by the full-scale war.The objective: to study and analyze the current state of accessibility of primary health care in rural areas in Ukraine, followed by a discussion of promising areas for the introduction of mobile health units as a tool for implementing the “Medical Guarantees” program in hard-to-reach regions of Ukraine.Materials and methods. The study included data from official statistical reports, regulatory documents and scientific sources. The methodology includes bibliosemantic, medical and statistical methods and the method of structural logical analysis.Results. It has been established that the low level of access to primary health care for the rural population of Ukraine has been significantly exacerbated by the devastating impact of the war on medical and transport infrastructure, especially in the frontline and recently de-occupied rural areas, and by migration processes. The situation is complicated by the fact that most patients in rural areas are elderly people who are physically unable to use public transportation, even if it is available. The analysis of international practice has shown that mobile health units can be introduced into the public healthcare system as a temporary measure to meet the urgent needs of the Ukrainian population, especially in rural areas. Integration of mobile health units into the state program “Medical Guarantees” can effectively address the urgent health care needs to increase access to health care for the rural population of Ukraine. State regulation of the division of these units will eliminate problems such as duplication and uneven service delivery and will create a transparent system of remuneration for the staff included in these units.Conclusions. The results of the study suggest that the practice of mobile medical units should be introduced as a tool for implementing the “Medical Guarantees” program for regions/locations of Ukraine with low access to medical infrastructure, namely remote rural areas and areas that have been devastated by the war. Mobile medical units will ensure the stability of access to primary health care services and contribute to improving the health of the population.

Impact of primary care coverage on hospital admissions for conditions sensitive to primary care in the municipality of Rio Verde – GO

The indicator Hospitalizations for Causes Sensitive to Primary Care (ICSAP) has been used as an indicator of access and quality of primary health care, and its high rates have been correlated with deficiencies in service coverage or an inadequate resolution capacity of primary care for certain basic health problems, The study was carried out with the objective of characterizing the rates of hospital admissions for causes sensitive to primary care in the city of Rio Verde – GO, as well as describing its historical series and verifying the impact of Primary Care coverage, in period from 2008 to 2018. Ecological time series study, whose data were collected from the Hospital Admissions System of the Unified Health System, based on the Brazilian List of Admissions for Conditions Sensitive to Primary Care. For data analysis, the research was divided into two axes: clinical-epidemiological and demographic aspects. The causes of hospitalizations for conditions sensitive to primary care were based on the list from the Ministry of Health. It was concluded that hospitalizations for conditions sensitive to primary care showed a reduction, while the coverage of primary care and the health strategy teams of the family, an increase was observed throughout the period analyzed. The three main groups with the highest percentage of hospitalizations for conditions sensitive to primary care were infectious gastroenteritis, followed by heart failure and lung diseases.

‘When I tried to explain, they shouted back at me!’: exploring how community pharmacists navigate tensions implementing antimicrobial stewardship in Vietnam

ABSTRACT Antimicrobial resistance is a major global and national health challenge, accelerated by ‘irrational’ antibiotic use. In response, Vietnam has been implementing a public health plan of antimicrobial stewardship since 2013 to reduce antibiotic sales in community pharmacies, although it has had limited effect. Given that private pharmacies are increasingly the entry point to access healthcare, reflective of the inhibited accessibility of primary healthcare, understanding how the positioning of community pharmacists shapes the delivery of antimicrobial stewardship plans warrant further investigation. This qualitative analysis draws on data from 24 in-depth interviews with licensed community pharmacists in Vietnam. Interviewees described being constrained in rationing the sale of antibiotics by tensions within their professional role, in which the delivery of antimicrobial stewardship within their public health commitments rubs up against commercial and social obligations to their livelihoods and communities respectively. The concept of ‘resistance’ provides insight into what obstructs the integration of national antimicrobial stewardship guidance and policy, hindering the transformation of local practices concerning antibiotic sales at the community level. Findings reveal opportunities to recast community pharmacists as ‘productive anchors’ who can facilitate the appropriate use of antibiotics and strengthen links to primary care within the local context. Structural changes are needed, however, so that people do not use antibiotics as a proxy for health care. Improving the accessibility of primary healthcare would also curtail the reliance on community pharmacists’ to dispense antibiotics as a local mechanism of financial protection and social care within community.

Barriers and facilitators to digital primary health care access in immigrant and refugee populations: a scoping review

Barriers and facilitators to digital primary health care access in immigrant and refugee populations: a scoping review

Actual questions of ensuring accessibility of primary health care for the adult population (review)

Actual questions of ensuring accessibility of primary health care for the adult population (review)

Use of electronic health records and primary health care accessibility according to data from the third cycle of the PMAQ-AB.

The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.

First contact access and coordination in Primary Health Care: evaluation by nurses

First contact access and coordination in Primary Health Care: evaluation by nurses

Unmet need for healthcare in the Russian Federation: subnational retrospective modelling analysis (2014–2018)

IntroductionUnmet need for healthcare is a proxy indicator used to assess the performance of healthcare systems throughout the world. While the Russian Federation is committed to improving healthcare for its...

Assessment of Awareness and Knowledge of Oral Potentially Malignant Disorders and Oral Cancer among Accredited Social Health Activist Workers from Randomly Selected Blocks of Thrissur District, Kerala, India: A Cross Sectional Study

Introduction: Oral and oropharyngeal cancers are prevalent in the head-and-neck region, with global rates decreasing. However, in India, they are rising due to a lack of knowledge about risk factors and symptoms. The Indian government launched the National Health Mission to provide accessible, affordable, and reliable primary health care. Accredited social health activist (ASHA) workers can link health services to rural people. This study aimed to evaluate the awareness level among these workers about potentially malignant oral disorders and oral cancer (OC). Materials and Methods: A predesigned semi-structured questionnaire-based descriptive cross-sectional study was conducted among 150 voluntary ASHA workers from randomly selected blocks of Thrissur district, Kerala, to collect the data. Results: Our study showed that the majority of ASHA workers (82.3%) were aware of the role of tobacco in OC. A substantial portion of workers (88.4%) expressed that early detection of OC is possible at its initial stage. Less than 10% (7.5%) of all the ASHA workers were educated by dentists, whereas almost three-quarters (75.5%) of ASHAs preferred primary health center health practitioners as primary representatives for early OC detection, despite their being poorly trained in the early diagnosis and detection of OC. Conclusion: India has made progress in controlling malignancies but still lags in reducing OC mortality rates. Spreading knowledge of contributory agents and early detection methods through ASHA workers could reduce the incidence and mortality of OC. Including more dentists in the public health system and training ASHA workers on early OC detection can play a major role in reducing its incidence.

Patient-reported primary health care experiences in Canada: The challenges faced by Nepalese immigrant men

BackgroundDespite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care. MethodsWe undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada. Data collection and analysisWe conducted six focus groups in total with 34 participants (each group comprising 5–7 participants) in their preferred language, Nepalese, or English. Demographic information was collected prior to each focus group. Transcriptions of the discussions were prepared, and thematic analysis was employed in the qualitative data set. ResultsParticipants reported experiencing barriers at two stages: before accessing PHC services and after accessing PHC services. The barriers before accessing PHC were long wait time for an appointment with physicians, limited knowledge of own health- and services-related issues, limited service availability hours, cultural differences in health practices, and transportation and work-related challenges. The barriers after accessing PHC were long wait time in the clinic to meet with the physicians at the time of appointment, communication challenges and misunderstandings, high healthcare costs associated with dental and vision care and prescribed medicines, and inappropriate behaviours and practices of doctors and service providers. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC. ConclusionsThis study identifies barriers to accessing PHC in Canada from a group of immigrant men's perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well.

FREQUENCY OF DEPRESSION IN PATIENTS OF CHRONIC HEPATITIS C BEFORE STARTING TREATMENT

Introduction: Pre-existing psychiatric illnesses, such as mood and psychotic disorders, are 3–4 times more common and frequently undetected in HCV patients. This could be brought on by a diminished desire to use or access mental and primary health care services, actual or imagined stigma against HCV patients, or denial of their psychiatric symptoms. Comorbid depression can impact the outcome because it is linked to decreased HCV therapy adherence. Objectives: To quantify the prevalence of depression among Hepatitis C patients not receiving treatment. Study Design: This was a cross-sectional study. Setting: Medical Department, Faisalabad Medical University and affiliated Allied Hospital, Faisalabad. Study duration: 30th December 2021 to 29th June 2022. Materials &amp; Methods: A total of 310 patients having Hepatitis C infection, with an age range of 20 years to 60 years, were included, while the patients suffering from an additional underlying chronic medical disease like CKD, COPD and diabetes, which can cause depression, were excluded. Demographic data, including age, gender, residence (rural or urban), education of patient (Primary, middle or higher education), marital status (single, married or separated), income of patient and duration of Hepatitis C infection were recorded. The researcher interviewed the selected patients by using Beck Depression Inventory. Results: The study's age ranged from 20 to 60 years, with a mean age of 41.75 + 8.62. Most 163 patients (52.58%) were in the 20–40 age range. 166 (53.55%) of the 310 patients were men, and 144 (46.45%) were women, for a male-to-female ratio of 1.2:1. In our study, the frequency of depression in patients with Hepatitis C infection not receiving any treatment was found in 187 (60.32%) patients. Conclusion: The conclusion of the study is that the frequency of depression in patients suffering from Hepatitis C infection not receiving any treatment is very high.

Primary Care Physicians in Nova Scotia: Are They Where They Need To Be?

Purpose: Accessible primary health care (PHC) is a key area of interest for policy and research as accessible PHC is associated with better health outcomes and lower health system costs. A critical dimension of accessible PHC is an adequate supply of family physicians (FPs) or general practitioners (GPs). Our study sought to analyze the geographic distribution of FP/GPs practicing in Nova Scotia (NS) and to provide an in-depth analysis of the distribution of FP/GPs in relation to population PHC needs. Methods: Using data from the College of Physicians &amp; Surgeons of Nova Scotia’s registry and 2019 annual license renewal survey, we provide a descriptive analysis of physician distribution, demographics and practice structure characteristics across the four Nova Scotia Health management zones (Central, Eastern, Northern, Western) for the population of FP/GPs practicing in NS in 2019. Additionally, we provided a descriptive analysis of PHC demand indicators and population demographics derived from the Canadian Institute for Health Information, the Canadian Community Health Survey, and the Canadian Census. These population PHC need indicators include hospitalization rates for ambulatory care sensitive conditions (ACSC), perceived health, the Canadian Index of Multiple Deprivation (CIMD), and the percentage of the population aged 65 and over across Nova Scotia Health management zones. Results: FP/GPs practising outside the Central zone are less numerous, older, and more likely to be male and international medical graduates. FP/GPs practicing outside the Central zone are more likely to have solo practices, practice in rural areas and not provide care through technology. Additionally, there is a greater potential demand for PHC outside of the Central zone, indicated by lower physician-to-100,000 population ratios, higher rates of hospitalizations for ACSC, a larger percentage of individuals living in rural areas, aged 65 and over, rating their health as fair or poor, and in the most deprived quintile of the situational vulnerability and economic dependency dimensions of the CIMD. Conclusions: These findings indicate a geographic maldistribution of physicians across NS and potential gaps in access to FP/GPs compared to population health needs across Nova Scotia Health management zones. The findings have implications for targeted physician resources planning and policy.

How to improve the capacity of general practitioners? – a Flemish approach

“Barely any region left with freely accessible primary health care in Flanders.” This is one of the many newspaper headlines that was recently published to emphasize the fact that more and more general practitioners refuse to take in new patients, because they run out of capacity to provide patients with proper health care. Where does it go wrong? &#x0D; Accessibilty to general practitioners is a hot topic for the Flemish policymakers. An aging population and an increase of mental health problems asks a lot from the general practitioners, as well as the shift of tasks from hospitals towards primary health care and the growing attention for prevention. However, is there a real shortage in general practitioners? Looking abroad learns that the number of general practitioners might not be the major cause of the capacity problem, but that the true bottleneck might lie in the way of organizing primary health care capacity and accessibility. Embedded in a landscape of health care where general practitioners mostly work on a self-employed base, and the fragmented governmental structure in Belgium as an extra obstacle makes this a major challenge for the near future.&#x0D; A dialogue between policy makers from all Belgian governments was opened to create a common approach: each government will take actions within their own authorities. The Flemish government worked out a plan to counter this massive challenge in primary health care through different initiatives, in cooperation with representatives of the general practitioners on the field, local authorities and umbrella organizations.&#x0D; Flanders commits itself by installing three major fundaments which can create change in the way general practitioners are organized: a first step is to create an accurate and up-to-date database of the current available general practitioners health care services compared with the local care need; in parallel the funding of general practitioners will be expanded in a way which stimulates interdisciplinary collaboration and optimizes health care capacity; on top of that the Flemish government is experimenting with new forms of primary care practices in which integrated care is the keystone and which are supported by local authorities and in close connection with welfare services. &#x0D; These projects described above are in full development. On the working field more and more general practitioners are willing to put their shoulders under these initiatives to create solid solutions for the future. &#x0D; The international audience of this lecture might recognize similar issues they encounter in their own countries and will be able to see similarities and differences compared to the Flemish context. By drawing these parallels one can have a broader view on the approach of improving health care capacity and accessibility. &#x0D; These Flemish projects will be brought together with the initiatives from the other Belgian governments at a roundtable discussion to align all the initiatives on primary health care capacity and create a future proof primary health care capacity in Belgium.

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage.

The Government of Ethiopia (GoE) has made significant progress in expanding access to primary health care (PHC) over the past 15 years. However, achieving national PHC targets for universal health coverage will require a significant increase in PHC financing. The purpose of this study was to generate cost evidence and provide recommendations to improve PHC efficiency. We used the open access Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool to estimate actual and normative recurrent PHC costs in nine Ethiopian regions. The findings on actual costs were based on primary data collected in 2018/19 from a sample of 20 health posts, 25 health centers, and eight primary hospitals. Three different extrapolation methods were used to estimate actual costs in the nine sampled regions. Normative costs were calculated based on standard treatment protocols (STPs), the population in need of the PHC services included in the Essential Health Services Package (EHSP) as per the targets outlined in the Health Sector Transformation Plan II (HSTP II), and the associated costs. PHC resource gaps were estimated by comparing actual cost estimates to normative costs. On average, the total cost of PHC in the sampled facilities was US$ 11,532 (range: US$ 934-40,746) in health posts, US$ 254,340 (range: US$ 68,860-832,647) in health centers, and US$ 634,354 (range: US$ 505,208-970,720) in primary hospitals. The average actual PHC cost per capita in the nine sampled regions was US$ 4.7, US$ 15.0, or US$ 20.2 depending on the estimation method used. When compared to the normative cost of US$ 38.5 per capita, all these estimates of actual PHC expenditures were significantly lower, indicating a shortfall in the funding required to deliver an expanded package of high-quality services to a larger population in line with GoE targets. The study findings underscore the need for increased mobilization of PHC resources and identify opportunities to improve the efficiency of PHC services to meet the GoE's PHC targets. The data from this study can be a critical input for ongoing PHC financing reforms undertaken by the GoE including transitioning woreda-level planning from input-based to program-based budgeting, revising community-based health insurance (CBHI) packages, reviewing exempted services, and implementing strategic purchasing approaches such as capitation and performance-based financing.

Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic.

Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic. We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis. Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability. This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.