Primary Health Care Centers Research Articles

Identification of factors causing stunting in Lamper Tengah primary healthcare centre, Semarang City

Background: Stunting is a form of growth failure due to the accumulation of nutritional deficiencies characterised by height-for-age below the applicable standard. The prevalence of stunting in Indonesia in 2021 is 24.4%. In Semarang, the prevalence of stunting fluctuates. 2015, it was 14.4% and increased to 21% in 2017. Until 2021, the stunting rate in Semarang is 21.3%. The Semarang government has made various efforts, but the stunting rate has remained unchanged. Objective: This study aims to discover more about the factors that cause stunting in Semarang. Method: This research is qualitative research with a phenomenological approach. The data obtained in this study was from observation and interviews with mothers who have stunted children. Result: A total of 15 informants were selected using purposive sampling techniques. The analysis method used is a descriptive method with inductive analysis. Conclusion: The result showed maternal factors were inadequate nutrition intake, genetic factors, stress during pregnancy, and poverty. In comparison, the factors in children are low birth weight, repeated infections, children's difficulty eating, and micronutrient deficiency. The environmental factors are the home environment polluted with cigarette smoke and unhealthy home conditions, poor sanitation, and limited access to clean water, leading to repeated infections.

Serbian Version of the eHealth Literacy Questionnaire (eHLQ): Translation, Cultural Adaptation, and Validation Study Among Primary Health Care Users.

As digital health services are increasingly developing and becoming more interactive in Serbia, a comprehensive instrument for measuring eHealth literacy (EHL) is needed. This study aimed to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ); to evaluate EHL in the population of primary health care (PHC) users in Serbia; and to explore factors associated with their EHL. The validation study was conducted in 8 PHC centers in the territory of the Mačva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. The Translation Integrity Procedure was followed to adapt the questionnaire to the Serbian language. The psychometric properties of the Serbian version of the eHLQ were analyzed through the examination of factorial structure, internal consistency, and test-retest reliability. Descriptive statistics were calculated to determine participant characteristics. Differences between groups were tested by the 2-tailed Students t test and ANOVA. Univariable and multivariable linear regression analyses were used to determine factors related to EHL. A total of 475 PHC users were enrolled. The mean age was 51.0 (SD 17.3; range 19-94) years, and most participants were female (328/475, 69.1%). Confirmatory factor analysis validated the 7-factor structure of the questionnaire. Values for incremental fit index (0.96) and comparative fit index (0.95) were above the cutoff of ≥0.95. The root mean square error of approximation value of 0.05 was below the suggested value of ≤0.06. Cronbach α of the entire scale was 0.95, indicating excellent scale reliability, with Cronbach α ranging from 0.81 to 0.90 for domains. The intraclass correlation coefficient ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest EHL mean scores were obtained for the understanding of health concepts and language (mean 2.86, SD 0.32) and feel safe and in control (mean 2.89, SD 0.33) domains. Statistically significant differences (all P<.05) for all 7 eHLQ scores were observed for age, education, perceived material status, perceived health status, searching for health information on the internet, and occupation (except domain 4). In multivariable regression models, searching for health information on the internet and being aged younger than 65 years were associated with higher values of all domain scores except the domain feel safe and in control for variable age. This study demonstrates that the Serbian version of the eHLQ can be a useful tool in the measurement of EHL and in the planning of digital health interventions at the population and individual level due to its strong psychometric properties in the Serbian context.

Family Caregivers’ Experiences during the COVID-19 Pandemic: Qualitative Study

Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers’ context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: “Caregivers during lockdown—providing care in a time of adversity” and “Caregiving toward normality”. The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person’s health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.

Primary healthcare professionals’ attitudes toward patients with current or previous drug use

Objective People with current or previous drug use (PCPDU) often lack long-term healthcare contacts in primary healthcare (PHC). While international research has shown negative attitudes toward PCPDU in healthcare, PHC professionals’ attitudes toward PCPDU have not been assessed in Sweden. The aim of this study was to investigate PHC professionals’ attitudes to PCPDU, and to compare attitudes toward people who actively use illicit drugs with those toward patients in opioid assisted treatment (OAT). Design In this survey study, respondents were asked for background data, and their attitudes toward patients using illicit drugs, OAT patients and patients with depression were assessed by using an adapted version of the Medical Condition Regard Scale (MCRS). Setting and subjects Nurses and physicians at primary healthcare centers (PHCCs) in Skåne, Sweden. Main outcome measures Mean MCRS scores, dichotomized responses to MCRS items, and associations between MCRS score and background covariates (age, sex, profession and duration of professional experience). Results Eighty-nine PHC professionals from 13 PHCCs responded (approximately 39% of relevant workforce). The median MCRS score was 44 for patients with illicit drug use and patients in OAT, and 51 for patients with depression. Drug use and OAT displayed similar minimum, maximum and interquartile range values as well, while scores regarding depression displayed a higher minimum value and smaller spread. No significant associations were found between background covariates and MCRS scores for either drug use or OAT. Conclusions The results indicate widespread negative attitudes to PCPDU, with implications for health equity in the clinic. Further studies are needed to see if the results reflect attitudes in Swedish PHC in general. Key Points People with current or previous drug use (PCPDU) often lack necessary primary healthcare (PHC) and are commonly subject to prejudice. Swedish PHC professionals held more negative attitudes toward PCPDU than toward patients with depression. Attitudes toward patients with active drug use and patients in opioid assisted treatment (OAT) were almost identical. Study findings have potential implications for the health of PCPDU as well as health equity in the clinic. Widespread negative attitudes to PCPDU in our sample indicate the need of larger-scale studies of attitudes toward PCPDU in Swedish PHC.

Using spirometry for screening and diagnosis of chronic respiratory diseases in primary health care: findings from a community health project in rural India

Background Chronic respiratory diseases (CRDs) such as Chronic obstructive pulmonary disease (COPD), Asthma and post-tuberculosis lung disease (PTLD) are a growing public health concern in India. Early diagnosis and management of CRDs require a good quality spirometry test, a technician to conduct spirometry and a chest physician to interpret the results. In India, these are not available at the primary care level. This study reports the feasibility of a large-scale CRD diagnosis and management program in primary care using a unique point-of-care spirometry solution, Briota PFT in a Box™. # Methods A community-based cross-sectional study was conducted among 15,602 adults in Dindori Taluka (subdivision), Nashik, Maharashtra state. This study was part of a holistic CRD diagnosis and management program SAVE™ (Spirometry Assisted Virtually Early). Make In India point of care solution Briota PFT in a Box™ was used. A House‐to‐house community-based assessment checklist (CBAC) survey, 4-parameter spirometry test, 15-parameter pre and post-bronchodilator spirometry test and a software-assisted medical examination by the medical officer at primary care were conducted. Software was used to generate CRD diagnosis and lung health score (LHS™). The diagnosis was verified by the chest physician. Confirmed diagnosed patients were provided treatment and offered a patient support program. Interviews were conducted with the patients, nurses, doctors and public health officials for understanding feasibility and documenting learning from program SAVE™. # Results Out of 15,602 adults surveyed, total 4,937 (31.6%) were identified as “CRD high risk”. 1231 participants based on medical examination, spirometry tests and software analysis were identified as CRD candidates by medical officers at primary care. 1154 participants out of 15,602 (7.4%) were confirmed diagnosed as CRD patients post independent evaluation by chest physicians. At the time of follow-up, 537 patients (75% of 712 patients enrolled in patient support program) reported improvement in symptoms and high satisfaction with the program. District health officer, Medical officers, nurses, Accredited Social Health Activist (ASHA) from the primary health care centers confirmed ease of use and feasibility of using Briota PFT in a Box™ in program SAVE™. Outcome and learning from program SAVE™ was documented and submitted to Ministry of Health and Family Welfare Government of India. # Conclusions CRD diagnosis and management in large scale settings in primary healthcare level using a point of care spirometry solution Briota PFT in a Box™ is highly feasible.

Model Development of Telemedicine for Hypertension Patients in a Rural Primary Healthcare Center in Thailand: A Qualitative Study

Background: Hypertension services were disrupted by the COVID-19 pandemic. Telemedicine was heavily used to overcome this disruption. The aims of this study were to describe a typical hypertension service and recommendations for telemedicine development for hypertension patients in a rural, Sub-District-level, primary healthcare center.Methods: A qualitative case study was utilized. In-depth interviews were conducted with healthcare staff at a rural primary healthcare center in April 2023. The interview process was continued until data saturation had been achieved. Data from the interviews were assessed via the triangulation method. Analytic induction was used to analyze the data.Conclusion: The total number of participants was 10 persons (3 male and 7 female). The median age was 42 years old (min. 32, max. 58). The qualitative results revealed that participants believed that telemedicine provided adequate hypertension services. The patients’ data was sent from the primary healthcare center to the secondary hospital (Provincial level) via the internet system. Communications between the patients and doctors at the provincial hospital were executed via video calls. All services were performed and completed at the primary healthcare center. The use of telemedicine by Sub-District healthcare hospitals could mitigate the limitations of traditional care, such as the lack of physicians, delays in treatment, and limited medical equipment. The engagement of stakeholders was the key factor in the success and sustainability of the program.

Pattern of Hemoglobinopathies among Patients Attending PHC in Riyadh, Saudi Arabia

Background: Hemoglobinopathies pose a significant public health burden globally, with varying prevalence rates across different references. Understanding the pattern of hemoglobinopathies among patients attending primary healthcare centers (PHCs) is essential for guiding effective prevention and management strategies. Study Aim: To determine the pattern of hemoglobinopathies among patients attending PHCs in Riyadh, Saudi Arabia. Methodology: A cross-sectional study design was employed, involving 320 participants attending PSMMC PHCs in Riyadh. Demographic data and HGB types were collected, and Chi-square tests were conducted to test associations between demographic variables and HGB types. Results: The majority of participants were aged between 18 to 30 years (40.6%), with a nearly equal distribution of females (52.8%) and males (47.2%). All participants were of Saudi nationality. The most prevalent HGB genotype was S/S (63.1%), followed by A/S (36.6%). Significant associations were found between age groups and HGB types (χ^2 = 28.233, p &lt; 0.001), with the S/S genotype more prevalent among younger participants. Gender did not show a significant association with HGB types. Conclusion: This study provides insights into the prevalence and patterns of hemoglobinopathies among patients attending PHCs in Riyadh, Saudi Arabia. The findings underscore the need for targeted screening and intervention programs tailored to specific age groups to effectively address hemoglobinopathies within the population.

Physicians’ intentions to use digital tools – a comparative survey, before and after the COVID-19 pandemic, in Southern Sweden

Objectives To describe changes in Swedish primary care physicians’ use of, attitudes and intentions toward digital tools in patient care between 2019 and 2022. Design A survey using a validated questionnaire measuring physician’s intentions to use digital tools based on the theory of planned behavior. Setting Sample of primary health care centers in southern Sweden. Subjects Primary care physicians. Main outcome measures Self-reported use and intentions to use, digital tools including digital consultations by text or video, chronic disease monitoring and artificial intelligence (AI) and the associations between attitudes, subjective norms, perceived behavioral control and behavioral intentions to use digital tools, in 2019 compared to 2022. Results In both 2019 (n = 198) and 2022 (n = 93), physicians reported high intentions to use digital tools. Self-reported use of video was slightly higher in 2022 (p = .03). No other changes were seen in the self-reported use or behavioral intentions to use digital tools. Conclusion The slow adoption of patient-related digital tools in Swedish primary health care does not seem to be explained by a low intention to use them among physicians. Future research on implementation of digital tools should include a focus on contextual factors such as organizational, technical and cultural barriers.

Description Of The Usage Of Antiretroviral Medicine With Atc/Ddd Method In The Primary Health Care Centers Of Kediri 2021

AIDS (Acquired Immune Deficiency Syndrome) is a collection of symptoms and infections caused by damage to the human immune system, HIV (Human Immunodeficiency Virus ), a virus that can weaken human immunity. PLWHA patients must undergo antiretroviral virus (ARV) drug therapy, one of the drug use analysis classification systems is using the ATC/DDD system which is a means of researching drug use in an effort to improve the quality of drug use, one of these components is the presentation and comparison of drug consumption levels. international. The aim of this research is to determine the use of antiretroviral drug consumption in primary health care center in the Kediri City area for the 2021 period using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method. The design of this research is quantitative descriptive, namely describing a particular event systematically and accurately and the treatment of this research is the process of collecting data and evaluating the use of antiretroviral drugs as well as verifying Primary health care center data by interviewing primary health care center pharmacists in the Kediri city area in 2021. Consumption of antiretroviral drugs (ARVs). ) is highest in the Campurejo primary health care center, namely Lamivudine (3TC) as much as 31.71%, Balowerti in primary health care center with Zidovudine (AZT) as much as 29.02% and Pesantren 1 primary health care center with the drug Nevirapine (NVP) as much as 32.62%, while the use of ARV drugs is low. At the Campurejo primary health care center, it was 0.0002% of the drug Dolutegravir (DTG), and at the Balowerti primary health care center, it was 0.0012% of the drug Dolutegravir (DTG), then at Pesantren 1 primary health care center , it was 0.0015% of the drug Dolutegravir (DTG). The incidence of HIV is still high in Indonesia, especially in the city of Kediri.

Impact of Covid-19 Pandemic upon Iraqi women’s Commitment to Family Planning at Primary Health Care Centers in Baghdad City

Objectives: To evaluate the impact of COVID-19 upon Iraqi women's commitment to family planning before and during COVID-19 pandemic Methods: A descriptive design, correlational approach was conducted from November /2021 to July / 2022. The setting of the study including two primary health care centers in Baghdad City. A non-probability 'purposive sample' consists of (200) women at reproductive age (16-49) years old. Descriptive and correlational statistics were used for data analysis. Results: The results of the study shows that regarding commitment to use of family planning methods among women before and during COVID19 pandemic; the “Use family planning methods” among (94.5%) before-COVID19 and (83%) during COVID19. there is high significant relationship between commitment to use of family planning before-COVID19 and during COVID19 at p-value= .001 respectively. Conclusion: The pandemic has affected women’s commitment to family planning methods, as well as its impact on the type of method that used. Despite the pandemic family planning is very important to women’s reproductive health so, it is necessary to improve family planning information, services, and access.

Assessment of factors related to caregivers and children on the IMCI program outcomes in Baghdad City in 2021

Background: The implementation of the Integrated Management of Childhood Illness (IMCI) program has led to enhancement in outcomes for many treatable childhood diseases. This study aims to assess how implementing IMCI affects child mortality and morbidity in Iraq. Methods: A cross-sectional study spanning from January to December 2021 was carried out at primary healthcare centers (PHCCs) with IMCI units in Baghdad, Iraq. Using a lottery sampling method, 40 PHCCs were randomly chosen from a total of 235 centers across both sides of the city. A universal sampling technique was adopted to select all children attending these PHCCs regularly. With a p-value below 5%, multiple logistic regression analyses were performed to identify the significant independent predictors at a 95% confidence interval. Results: The majority of caregivers were mothers (97.8%), aged 20 to 30 years (75.8%), and housewives (59.2%). Sixty percent of children (6 to 35 months) had normal anthropometric measurements. Bottle feeding was common (44.2%), and most children had a normal neonatal history (82.9%). In bivariate analysis, the severity of illness, severe cases of diarrhea, and acute respiratory infection (ARI) showed significant associations with worsened or not improved outcomes (χ2 = 18.900, p &lt; 0.001; χ2 = 6.265, p= 0.016; and χ2 = 7.549, p= 0.003, respectively). However, multiple logistic regression analysis indicated that mild and moderate illness severity (OR = 10.634, 95% CI: 6.985 to 16.192, p &lt; 0.001), strict breastfeeding (OR = 3.307, 95% CI: 1.703 to 6.421, p &lt; 0.001), and completing treatment at home (OR = 6.190, 95% CI: 4.115 to 9.311, p &lt; 0.001) significantly improved outcomes through IMCI services. Conclusion: Severe illness, especially in diarrhea and ARI, correlates with poorer outcomes. Conversely, exclusive breastfeeding, prompt medical attention within a day of illness onset, and completing home treatment are associated with improved outcomes.

Transport accessibility and efficiency of PHC location in Kanyakumari district, Tamil Nadu

Transportation is an essential feature of modern economics. In general terms, as an economy grows and develops, it becomes more dependent on its transport sector. The efficient location of any PHC center mainly depends on the network pattern. The study area, Kanniyakumari, is the southernmost district of Tamil Nadu. Kanyakumari District lies between 77°15’ and 77°36’ of eastern longitude and 8°03’ and 8°35’ of northern longitude. The study area has 83 nodes and 120 edges in the transport network system. The main objectives of the paper are to analyze the variation in the degree of connectivity, accessibility, and nodal efficiency of the network pattern and to assess the relationship between road network structure and the location of the PHC center. (Primary Health Care). The present study depends on secondary data. The secondary sources were collected from various transport offices and institutions. Cartography mapping and buffer analysis are used by GIS software. The quantitative research approaches in network analysis were measures to determine the spatial structure, associate number, route development, nodal efficiency, and accessibility of a given PHC location. The Shimbels shortest path matrix was used to identify the health centrality of a node in the network, and its minimum accessibility was found for each PHC center. The detour index was computed based on knowing the route for existing network systems. The present study aims to understand the characteristics of the road transport network in relation to the structural location of the PHC of connectivity, accessibility, and route efficiency in Kanniyakumari district.

Awareness of Gestational Diabetes Mellitus Maternal and Neonatal Outcomes Among Women Attending Primary Healthcare Centers in Qassim, Saudi Arabia

Awareness of Gestational Diabetes Mellitus Maternal and Neonatal Outcomes Among Women Attending Primary Healthcare Centers in Qassim, Saudi Arabia

Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study.

Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.

Patient Satisfaction with Private Community Pharmacies versus Pharmacies in Primary Health Care Centers in Saudi Arabia

IntroductionSaudi Arabia has begun reforming its government-run health care system to increase efficiency and reduce costs. One effort is the adoption of an electronic prescribing system (Wasfaty) and outsourcing pharmaceutical services from government-run clinics to community pharmacies (CP). This study aims to compare satisfaction with pharmaceutical services offered in the two systems. Materials and methodsThis cross-sectional observational study used existing survey data collected from patients (≥15 years of age) visiting government primary health care centers from January 2022 to June 2022. Satisfaction with three pharmaceutical services (availability of medications, pharmacist’s explanation of the prescription, and waiting time to get medications) were the main outcomes. ResultsThe study comprised 91,317 participants, 74.06 % of them were CP/Wasfaty users. CP/Wasfaty patients had lower odds of satisfaction with the three pharmaceutical services: availability of medications (OR = 0.49, 95 % CI = 0.47–0.51), pharmacists’ explanation of prescription (OR = 0.55, 95 % CI = 0.53–0.58), and waiting time to get medications (OR = 0.81, 95 % CI = 0.75–0.88). Additional findings showed variations in satisfaction levels based on demographic factors and clinic types. ConclusionsThe significant differences observed in satisfaction levels based on demographic characteristics and type of clinics visited emphasize the importance of tailoring pharmaceutical services to meet the specific needs and expectations of different patient populations.

Health Beliefs and Practices Among Subaltern Women: An Ethnographic Account From Rural Telangana, India

Apart from biological factors, social determinants play a major role in shaping health beliefs and paving the way for various behaviours. Subaltern women, being the lowest strata of the caste hierarchy, have additional barriers to accessing modern healthcare and may be more likely to experience poor health outcomes due to a combination of social, economic and cultural factors. Structural violence represents a dynamic process that impedes an individual’s social, economic and biological potential, affecting both socially excluded, economically disadvantaged and historically marginalized subaltern communities. Social justice significantly influences individuals’ life prospects and health outcomes, with health disparities stemming from social disadvantage and inequality. Addressing disparities in health, the Health Gap underscores the importance of acknowledging the role of social determinants of health. Health equity entails enhancing the well-being of marginalized social groups and tackling the broader social determinants of health. The current qualitative study was conducted in three villages in the Nalgonda district of Telangana, India. In addition to focus group discussions and one-on-one interviews, the ethnography method was employed to capture subaltern women’s health beliefs and practices regarding food habits, puberty, menstruation, sexuality and sexual life, childbearing and childbirth, breastfeeding and the role of primary healthcare centres in promoting healthcare. Subaltern women experience double discrimination as members of a lower caste and a weaker gender, and access to healthcare, like other fundamental human rights, is a recurring issue. Many of them are impoverished and unable to afford contemporary medical care, forcing them to rely on the more cost-effective traditional model of healthcare. Despite being forbidden from accomplishing many things owing to a range of societal and age-old customary sanctions, modernization and state-owned institutional mechanisms are bringing about a good shift towards better health.

Developing a multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty

Abstract Introduction Reducing overprescribing in primary care through targeted structured medication reviews (SMRs) is a national priority. Shared decision-making and a multidisciplinary team (MDT) approach to SMR are recommended for successful deprescribing (stop/reduce inappropriate medications) among older people, specifically those with frailty. Aim To develop a multidisciplinary medication review and deprescribing intervention in primary care for older people with frailty. Methods The intervention development involved two stages and was informed by the Medical Research Council framework for complex intervention. Stage one involved intervention planning and included: 1) a realist review of 28 articles that identified 35 context-mechanism-outcome (CMO) configurations for successful MDT medication review and deprescribing in primary care[1] and 2) a qualitative study with 26 primary care healthcare professionals (HCPs) including GPs, pharmacists, and advanced clinical practitioners, and 13 older people with polypharmacy and their informal carers recruited from two general practices within Wessex. Using the person-based approach, drawing on the COM-B model for behaviour change, and a normalisation process theory lens, the findings of these two studies informed the development of intervention’s guiding principles. Stage two involved intervention development based on six co-design online workshops with key stakeholders (n=25), including primary care HCPs recruited from across the South region, patient and carer representatives, and the research management team. The intervention guiding principles were presented in these workshops and possible intervention content, format and delivery were proposed, discussed and refined through an iterative process. Workshop data were analysed drawing on a rapid analysis method and a final version of the intervention was agreed. Results The final version of the complex intervention consisted of five main components based on findings from stages one and two: 1) Proactive identification of patients with frailty and polypharmacy for targeted SMR using the electronic frailty index embedded in primary care health systems and the UK national polypharmacy prescribing comparators, 2) HCPs preparation to conduct SMR through targeted education on deprescribing and identifying and prioritising high-risk medications for deprescribing using evidence-based deprescribing tool(s), 3) Preparing and educating patients and carers about the purpose of SMR and reasons for potentially stopping or changing medications (patient leaflet sent prior to SMR), 4) Conducting a person-centred SMR that includes in-person, phone or virtual appointments tailored to patient and carer needs and preferences, involving other MDT members based on their expertise, documenting and sharing any agreed changes with patients and other staff members, and 5) Tailored follow-up plans that allow continuity of care and management and include highlighting specific signs and symptoms for patients and carers to monitor following medication changes, and arranging further contact through text, phone or in-person follow-up appointment. Conclusion The use of multiple research methods has led to the development of a complex MDT medication review and deprescribing intervention for older people with frailty and drawing on behaviour and implementation theories could potentially maximise the intervention’s feasibility, acceptability and successful implementation. A mixed-method study in primary care is currently underway to test the feasibility and acceptability of intervention implementation, in preparation for a full trial.

A rare case of urinary tract infection by Burkholderia cepacia

Burkholderia cepacia is a motile, aerobic, non-fermentative, gram-negative bacillus and has been widely documented as a lung pathogen in patients with cystic fibrosis and chronic granulomatous disease. It is documented as an important emerging cause of multi-drug resistant nosocomial infections, and an important cause of morbidity and mortality. A 64-year-old male patient visited the Nikea Primary Healthcare Center, Piraeus, Greece, referred by the family doctor (GP), for follow-up due a history of prostate cancer (patient on immunosuppression) and recurrent UTIs with subsequent admission to the hospital. Patient history revealed diabetes mellitus type 2, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, history of recurrent UTIs, with 4 hospitalizations in a tertiary hospital during the last 2 years, prostatic hypertrophy, 2 episodes of prostatitis before the diagnosis of prostate cancer Gleason score 6, at the end of 2019, with subsequent total prostatectomy, and radiotherapy. Patient history also revealed dysuria, frequent urination, pain and burning sensation during urination and erectile dysfunction. Urinalysis showed intense pyuria, abundance of micro-organisms and abundance of red blood cells. The urine culture grew monomicrobial Burkholderia cepacia 105 CFU/ml. The bacterium was identified by the RapID™ REMEL ONE identification system (Thermo Fisher Scientific). Antimicrobial susceptibility testing revealed susceptibility to antibiotics such as, Ceftazidime, Ciprofloxacin, Norfloxacin, Levofloxacin and Imipenem.The patient received treatment with Levofloxacin. Burkholderia cepacia infections outside the respiratory system are rare. Moreover, recurrent UTIs with B. cepacia is a rare finding, which highlights the importance of our study. UTIs with B. cepacia have been associated with bladder irrigation or use of contaminated hospital objects and liquids. B. cepacia is one of the most antimicrobial-resistant organisms and treatment options are limited. The patient was treated with Levofloxacin (3rd generation fluoroquinolone — Tavanic) 500 mg daily per os for 2 weeks, due to his history.

Integrated Health and Social Home Care Services in Catalonia: Professionals' Perception of its Implementation, Barriers, and Facilitators.

This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS. Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment. A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS. Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments.

Covid-19 vaccination acceptance among visitors of Erbil primary health care centers

Background: Vaccination is probably the most effective approach to prevent and control COVID-19. Studies assessing acceptance towards vaccination showed huge regional variations. Objective: To find out the rate of acceptance of Covid 19 vaccine and its associated factors as well as to explore out both the most frequent reasons behind acceptance or refusal of this vaccine and the most received and preferred type. Patients and Methods: In this cross-sectional study, a convenience sample of 1000 visitors to primary health care centers (PHCCs) in Erbil/Iraq, aged 18 years and older, were collected from December 2021 to December 2022. A structured questionnaire was used for data collection through a direct interview. Results: The study showed that 43.9% of the participants accepted the vaccine. The main reason behind refusal (53.8%) was not trusting its development, while the main reasons for receiving were to protect themselves (44.2%), majority of those vaccinated (76.5%) received Pfizer, which was the most preferred type (67.4%), 10.3% of them were not completing the recommended dose and the most common reasons behind this were neglect and shortage of time (31%), and afraid from side effects (31%). A significant association found between vaccination practice with gender, education, occupation, family income and socioeconomic status. Vaccinated persons were less likely to be infected with COVID19 (20.7%) than nonvaccinated ones (62.7%). Conclusion: Less than half of the participants were accepted the vaccine and the acceptance rate significantly associated with male gender, education, occupation, family income, and socioeconomic status. Keywords: COVID-19 vaccination acceptance, vaccine, primary health care centers .