Primary Health Care Doctors Research Articles

Public perceptions of the Hippocratic Oath in the U.K. 2023

This paper explores public perceptions of the Hippocratic Oath (Physician’s Oath) in the U.K. Results of a questionnaire administered online to 106 adults indicated that the majority were of the opinion that their primary and secondary health care doctors had taken the Oath (88% and 86% respectively). A majority thought that nurses, paramedics, psychotherapists and graduate scientists and researchers should also take some form of professional oath. Elements of the Oath which were deemed most important included that it is a sworn oath, that doctors should not harm patients, act in the best interests of patients, abide by the principles of autonomy and informed consent and maintain patient confidentiality. A significant proportion - about 20% - of the UK public felt that doctors had forgotten their Hippocratic Oath during COVID-19 lockdowns and associated vaccination programme, suggesting that recent history may have damaged the public faith in the medical profession.

The effect of team-model on healthcare usage and treatment levels among people with type 2 diabetes

Abstract Background In North Karelia Finland, a team-based service model was implemented in some municipalities’ primary healthcare (PHC) centers during 2020. In this team-model, a healthcare customer contacts a nurse who initiates the service process immediately. Nurses can also consult or direct customers to other healthcare professionals and arrange physical appointments if needed. The aims of the model are improved customer and personnel experience and satisfaction, and improved quality and effectiveness of care. We assess the effect of this team-model on treatment levels, measurement activity, and health care usage among patients with type 2 diabetes (T2D). Methods Patients with T2D were identified using the ICD-10 code E11 from the regional electronic health records. The data include all patients diagnosed by 2016 who were alive and residing in North Karelia in 2023 (N = 6312). Diabetes-related contacts with nurses or doctors in outpatient PHC and specialized healthcare (SHC) were considered, along with measurement activity and levels of glycated hemoglobin (HbA1c) and low-density lipoproteins (LDL) between the years 2017 and 2022. Annual differences between areas were analyzed using logistic and linear mixed models. Results In 2017, patients’ mean age was 66 and age range 20-93. The proportion of men was 55% and 45% resided in team-model areas in 2023. The team-model increased T2D-related outpatient PHC remote contact with nurses for a couple of years. But eventually they decreased to a lower level than before. Additionally, the team-model reduced the number of other contacts. An increased difference between areas in measurement activity on HbA1c and LDL levels was also observed. But the difference between areas in proportion of those who achieved treatment targets stayed unchanged. Conclusions In the long-term, the team-model reduced the number of T2D-related contacts and increased the measurement activity of HbA1c and LDL, but it had no effect on treatment levels. Key messages • Team-based service models might potentially reduce service use in the long term. • More research and evidence are needed on the effectiveness and cost-effectiveness of team-based service models.

Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial

BackgroundHIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. MethodsWe conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). ResultsThe intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. LimitationsThe highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. ConclusionThe trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registrationClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).

The importance of physiotherapy in women with osteoporosis: an observational study

Osteoporosis is the most prevalent metabolic bone disease, characterized by a gradual decrease in bone mineral density. The aim of this study was to highlight the importance of physiotherapy in women with osteoporosis in the district of Elbasan, Albania. Data from 90 patients (newly diagnosed and previously diagnosed) during the period 2022-2023 were included in the study. The study population was classified into two groups: patients who received only pharmacological treatment and patients who, in addition to medications, underwent physiotherapy sessions and regular physical activity. The data were obtained from medical records and interviews conducted with patients referred to the rheumatologist at the Polyclinic of Specialties, Regional Hospital “Xhaferr Kongoli” Elbasan, as well as from family doctors in primary health care. The statistical program SPSS (Statistical Package for Social Sciences), version 23, was used to analyze the study data. The questionnaire variables were interpreted using a five-point Likert scale. Correlative statistical relationships were evaluated using Pearson Correlation coefficient and the level of reliability (significance). Functional relationships between variables were presented through the mathematical equations of logistic regression. The population group that engaged in regular physical activity and physiotherapy in addition to pharmacological treatment showed a higher degree of functional improvement in their daily activities. The incorporation of physiotherapy procedures for patients with osteoporosis and the restructuring of medical protocols for the prevention and treatment of this disease are considered successful steps in reducing the human and socio-economic costs and the serious impact of fractures on functional abilities.

Effectiveness of a training program in improving knowledge and skills about selected common neurological disorders among primary healthcare doctors: The Karnataka Brain Health Initiative (KaBHI) in India.

Neurological disorders are the leading causes of death and disability globally. In low-middle-income countries such as India, there is a wide treatment gap for neurological disorders. To address this gap, an initiative known as the Karnataka Brain Health Initiative (KaBHI) was developed in collaboration with the public health system of the state of Karnataka in India. A structured hybrid training program was conducted for 120 medical doctors working in the Primary Health Centers (PHCs) in the public health system in three districts of Karnataka. Pre- and post-training evaluation was conducted to assess physicians' knowledge and skills for evaluating patients with common neurological conditions. Of 120 PHC doctors, 111 (92%) scored below the passing score of 50 points out of 100 before the training program. After the training, all trainees scored above this cut-off. The study found a significant improvement in knowledge and skills after the training (before training: 40.48 ± 7.92, after training: 66.28 ± 8.98 (P < 0.001) mean difference = 25.81), and was comparable among the PHC doctors in all three districts. Our study shows the feasibility of training primary care doctors in the public health system to manage selected common neurological disorders. The training program can potentially help to reduce the treatment gap for neurological disorders in India.

Working practices and integration of primary health care doctors in remote rural areas in Brazil: a qualitative study

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.

Family medicine viewed through the public lens: A national cross-sectional study in Lebanon.

Family medicine (FM) is a medical specialty that provides continuing, comprehensive health care for the individual and the family. This study aimed to describe Lebanese citizens' knowledge, attitudes, and practices toward FM as a specialty. This is a national cross-sectional phone-based survey targeting the knowledge of the public about FM and its scope of practice. Questions were asked whether participants had primary health care doctors and their specialties. A total of 373 participants were included, with a response rate of 85.2%. Two-thirds were aware of the specialty of FM, while only 16.6% of the participants had previously visited a family physician. Most participants (69.7%) had a doctor they regularly consulted. One-third of participants had a general practitioner as their regular doctor. More than 80% of the participants agreed that FM physicians treat all family members with common and chronic diseases. Around 60% to 75% of participants knew that family physicians provide medical care to children, treat patients with psychiatric impairments, and perform minor surgeries. There was a significant gap in the participants' knowledge of FM physicians' role in managing obstetric or gynecologic patients. Despite public awareness of FM, limited understanding and system challenges hinder its utilization in Lebanon. Educational campaigns, government-supported FM practices, and collaborations with public health initiatives are crucial to bridging the knowledge gap and establishing FM as the cornerstone of primary care. This knowledge gap challenges the specialty's identity and necessitates promoting FM as the cornerstone of primary care, potentially requiring a system-wide endorsement.

About the textbook “Outpatient Therapy” edited by professors O.Yu. Kuznetsova and E.V. Frolova

The textbook “Outpatient Therapy,” prepared by a team of authors under the guidance of professors O.Yu. Kuznetsova and E.V. Frolova, allows you to implement a competent approach to training the future primary health care doctors. The textbook complies with the Federal State Educational Standard of Higher Education. The book is written at a high scientific and methodological level, it is distinguished by a holistic approach to the coverage of the training material and the focus on the formation of both universal and general professional, and specialized professional competencies in the future doctor. The textbook is intended for students of medical faculties and can be used as the main educational literature in the discipline “Outpatient Therapy”.

Enhancing adherence to clinical practice guidelines for hypertension management: Evaluation of the effectiveness of a Hypertension Management Tool Kit (HMTK) among primary healthcare doctors. (ImprovBP-HMTK)

IntroductionAdherence to guidelines in managing hypertension among primary healthcare doctors remains suboptimal. ObjectiveWe assessed the effectiveness of a Hypertension Management Tool Kit (HMTK) in improving guideline adherence. MethodsMedical records of 392 patients attending 2 primary care clinics in the Klang district with 3 or more anti-hypertensive medications were audited. Paired T-test and repeated measure ANOVA were used to evaluate the effectiveness of the HMTK intervention with the evaluation of interaction within-subject effects, between subject effect and time. ResultsThe mean MOGC score of doctors with <5 years of service was 79.765 (95 % CL 78.351,81.178) and with >5 years of service; 81.238 (95 % CI 80.621,81.855). Statistically significant (p-value <0.001) results were shown based on the time effect and mean MOGC score with HMTK; pre-intervention 72.426 (95%CI 71.045, 73.808) and post-intervention 88.576 (95 % CI 87.922, 89.230). The mean MOGC score post-intervention based on the time effect and years of service for both groups were statistically significant (p-value <0.001) and increment was shown in <5 years of service; 69.252 (14.915) to 87.149 (6.484) while >5 years of service; 73.485 (14.281) to 89.613 (5.149). Statistically significant was shown by years of service in time-group interaction effect pre- and post-intervention (p-value <0.001); pre-intervention for <5 years of service; 71.892 (95%CI 69.339,74.446) and >5 of service; 72.960 (95 % CI 71.895,74.075). Post-intervention in <5 years of service; 87.692 (95%CI 86.427,88.846) while >5 years of service; 89.516 (95%CI 88.987,90.044). ConclusionThe HMTK is an effective tool to improve the management of hypertension among doctors.

TYPE 2 DIABETES MELLITUS MANAGEMENT KNOWLEDGE AMONG PHC PHYSICIANS IN BURAIDAH CITY, 2020

Introduction: Type 2 diabetes mellitus (T2DM) is highly prevalent in Saudi Arabia. primary health care (PHC) doctors provide most of T2DM medical care Objectives: To estimate PHC physicians and family medicine residents level of T2DM management knowledge as per Saudi national reference of clinical guidelines for care of diabetic patients. Methods: We conducted a cross-sectional study using a structured questionnaire. Beside general participant characteristics, we prepared 17 questions on four aspects of T2DM management. These were diagnosis, non-pharmacological and oral hypoglycemic agent, insulin and follow up. Each aspect was given a score of 4-6 points and the total score was 20 points. Result: Out of 258 physicians, 178 were actually available at the time of the survey and 106 completed the study questionnaire. The overall response rate was 41.1%. The mean age of participants was 34.1 years and around two thirds of them were males. In-training family medicine residents formed the largest segment, 45 (42.5%). Mean duration of practice was 7.8 years. The reported daily workload showed that more than one-third of physicians (36.5%) manage ≥ 20 patients per day and almost all of them manage T2DM. Out of the total 20 points, only one quarter of participants had scored more than 15 points, while another quarter could not achieve more than 40%. Only physician qualification had impacted physician performance. Conclusion: PHC doctors knowledge about T2DM management is sub-optimal. Properly selected educational activities targeted diabetes management are needed.

Experiences of Malaysian primary healthcare providers with vaccine hesitancy: A qualitative study.

Vaccine hesitancy was declared as one of the ten threats to global public health by the World Health Organization in 2019. It undermines the effort towards eradication of vaccine-preventable diseases. Healthcare providers, who are directly involved in vaccination services and vaccine advocacies, are important in combating vaccine hesitancy. Studies have shown that vaccine refusers have various reasons for refusal including distrust towards healthcare providers. Hence, it is important to understand healthcare providers' perspectives. This study aimed to explore primary healthcare providers (PHCPs)' experiences in dealing with vaccine hesitancy. This qualitative study was conducted among public PHCPs across six states in Malaysia. Purposive and snowball sampling methods were used. Fifteen primary healthcare doctors and nurses underwent in-depth interviews. Recruitment was stopped when data saturation was achieved. Data were thematically analysed. Four themes emerged: 1) views towards vaccination and vaccine hesitancy, 2) disparity in strategies and resources used among PHCPs, 3) fixed-minded vaccine deniers and religious incompatibility: the two towering hurdles and 4) negative impact after encounters with vaccine hesitancy. Malaysian PHCPs encounter negative experiences with vaccine hesitancy, impacting them negatively. These experiences are attributed to the challenges and lack of standardised resources for reference. These findings suggest the development of a more flexible policy, a training module inclusive of all professional roles and a standardised repository of resources for managing vaccine hesitancy.

The association of family doctor contract service and patient trust in doctor: evidence from twenty-five village clinics of three counties in rural China

BackgroundChina is implementing the family doctor (FD) system to reform the primary healthcare (PHC). The family doctor contract service (FDCS) policy plays a crucial role in this system implementation, aiming to transform the doctor-patient relationship and enhance PHC quality. This study aims to investigate the impact of FDCS on the doctor-patient relationship in PHCs using field research methodology.MethodThe field research methodology was employed to address the research questions. Quantitative methods were utilized for data collection and analysis. A structure questionnaire was used to collect data based on the research questions. Our investigation encompassed twenty-five village clinics across three counties in China. A total of 574 subjects helped us to finish this investigation in the study. The collected data was analyzed using statistical analysis including ordinary least squares (OLS) model and propensity scores matching model (PSM) to estimate the relationship.ResultThe findings from ordinary least squares (OLS) regression revealed that FDCS had a positive influence on patient trust in doctors within PHCs, with patients who participated the FDCS exhibiting higher levels of trust compared to those who did not participate. Propensity score matching (PSM) analysis further confirmed these results by accounting for selection bias.ConclusionsThe implementation of family doctor contract service has brought about significant transformation in the doctor-patient relationship within rural Chinese PHCs. In essence, it has revolutionized the service model of doctor in PHC, playing a pivotal role in improving primary health quality and enhance the service capability of doctors in PHC. This transformative process has been crucial for carrying out hierarchical diagnosis and treatment policy, which aims to adjust the medical service structure and optimizing the health service system. Therefore, it is imperative for government authorities and health administration departments to ensure continuous support for this essential service through appropriate formulation.

The Behavior of Primary Healthcare Doctors Toward Antibiotic Prescriptions for Upper Respiratory Tract Infections.

Unnecessary prescription of antibiotics for patients with upper respiratory tract infections (URTIs) carries the potential risk to the development of bacterial resistance. This study aimed to investigate the behavior of primary healthcare (PHC) physicians toward an antibiotic prescription for URTI, Al-Madinah City, Saudi Arabia in 2021. A cross-sectional study was conducted at PHC centers in Al-Madinah City, Saudi Arabia. The study invited all physicians in the randomly selected 28 PHC centers to participate in the study. A master sheet adopted from a researcher done in the Asir region of Saudi Arabia about the pattern of prescription for URTIwas used and included data about socio-demographic characteristics and data about presenting symptoms and signs of URTIs, the clinical diagnosis, type of medication prescribed, and duration of treatment also, included data about the factors that press physicians to prescribe antibiotics and their response. The questionnairewas filled out and returned back by 140 physicians. The collected data were analyzed and tabulated using appropriate statistical tests. The mean age of the studied physicians was 34.4 ± 7.6 years (25-59 years). General practitioners and specialists were 66.4% and 33.6%, respectively. The prevalence of antibiotic prescriptions was 44.3%. The most prescribed antibiotics were amoxicillin (58.6%)and Augmentin(28.6%). Congested tonsils (87.1%), ear discharge (84.2%), and cervical lymphadenopathy (89.3%) were the most clinical factors that affected physicians' decisions to prescribe antibiotics for URTI. The non-clinical factors affecting physicians' decisions include patient request (52.8%) and press (28.5%), with no statistically significant difference detected between general practitioners and specialists. The study findings indicate the need to develop intervention programs targeting physicians as well as the general population to decrease inappropriate antibiotic prescriptions in primary care centers.

Assessing Physician Confidence in Counseling Patients on COVID-19 Disease and Vaccination: A Survey of Physicians' Perspectives in the Kingdom of Saudi Arabia.

The COVID-19 vaccine has been available and well acceptable among the Saudi population since its introduction in 2020; however, concerns still remain regarding the confidence of doctors in giving such vaccines. How confident are physicians in the Kingdom of Saudi Arabia about giving counseling and advice for patients regarding COVID-19 disease and COVID-19 vaccines? To determine how confident Saudi Arabian doctors are in their ability to advise patients on the COVID-19 illness and COVID-19 vaccines. To assist the health authorities in the Kingdom of Saudi Arabia in developing and implementing programs to improve doctors' skills and knowledge in giving advice to patients about the COVID-19vaccine. The research employed an online cross-sectional study methodology to gather insights from doctors employed at hospitals, healthcare centers, and clinics across the Kingdom of Saudi Arabia. The inclusion criteria encompassed doctors actively engaged in healthcare settings, while the exclusion criteria were applied to those who had never encountered COVID-19 patients and those who declined participation in the study. It was found that doctors were confident that there's a potential for adverse effects that are not yet seen in vaccine trials. Further results showed that primary health care doctors are more confident about the common side effects associated with the approved vaccines. Most doctors were confident about thevaccine,yet theyalso knowthat there are some hidden side effects that are not yet discovered. Sincepatients trusted doctors as the main source of information about the vaccine, the studyprovided evidence to emphasize the ruleof doctors as areliablesource ofinformation.

Using formative research to inform a mental health intervention for adolescents living in Indian slums: the ARTEMIS study

BackgroundAdolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents’ Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints.MethodsIn the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed.ResultsThe anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO’s mhGAP algorithm, built into the digital health application.ConclusionThe formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups.Trial RegistrationThe trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022.

Understanding child development and care integrality: Primary Health Care doctors and nurses' view.

To identify perceptions of primary care health professionals regarding the conceptual aspects of child development and propose strategies to address difficulties. This descriptive-analytical study was conducted in a small municipality in the countryside of the State of São Paulo, Brazil. The primary health care in this region is comprised of Family Health Units and Basic Health Units. The sample included 52 participants, consisting of doctors and primary care nurses. A questionnaire with open and closed questions was utilized, covering knowledge and practices related to child development. For this study, the first question of the questionnaire, which asked for a descriptive response about participants' understanding of child development, was employed. The responses were transcribed, and content analysis using the thematic approach was conducted. Among the participants, 54% were nurses, and the average duration of working with the pediatric population was ten years. 80% reported never having undergone training in child development. The analysis of the responses revealed heterogeneity in the professionals' understanding of the conceptual dimension of child development. Additionally, there was an insufficient grasp of the theoretical and practical aspects and a scarcity of resources to support comprehensive care for children. A predominant biomedical model focusing on disease and biological aspects of child health was evident in defining the understanding of the subject. The findings underscore the necessity of implementing health education initiatives and service projects in primary care settings. It is crucial to strengthen a comprehensive perspective of child health within the biopsychosocial model of the health-disease process.

Pharmacokinetic monitoring of chronic treatment with digoxin from Primary Health Care

ObjetiveTo assess the pharmacokinetic monitoring of SDC performed from primary healthcare (PH) in patients with chronic treatment. MethodsCross-sectional retrospective study of patients with chronic treatment with digoxin belonging to the department of a General University Hospital.Data were analized: age, sex, diagnosis, number of serum digoxin concentration determinations, date and origin of the request for monitoring, analytical result and pharmacokinetic assessment are collected. Results624 patients are undergoing chronic treatment with digoxin, 68% women, mean age 78.4 (39-98) years. 308 (49.4%) patients haven’t analytical determination of SDC (Group 1), 183 (29.3%) patients have a SDC occasionally performed with a request from specialist care (Group 2) and 133 (21,3%) patients have CSD performed with a request from primary healthcare doctors, with an average of 2.42 monitoring per patient and year (Group 3). These are those patients who have pharmacokinetic monitoring of chronic treatment with digoxin.Of the group 2.25 (13.6%) patientes were hospital admission from emergency department for presenting digitalis intoxication with CSD>2 ng/ml, and 39 (21.3%) patients for low dosing with CSD<0.5 ng/ml. Group 3.4 (3%) patients presented digitalis intoxication and 5 (3.8%) for insufficient dosing. ConclusionsA small proportion of patients undergoing chronic treatment with digoxin are under pharmacokinetic monitoring and a reduction in complications derived from inappropriate CSD compared to those not under pharmacokinetic follow-up is observed.

Mental health related stigma, service provision and utilization in Northern India: situational analysis

Stigma, discrimination, poor help seeking, dearth of mental health professionals, inadequate services and facilities all adversely impact the mental health treatment gap. Service utilization by the community is influenced by cultural beliefs and literacy levels. We conducted a situational analysis in light of the little information available on mental health related stigma, service provision and utilization in Haryana, a state in Northern India. This involved: (a) qualitative key informant interviews; (b) health facility records review; and (c) policy document review to understand the local context of Faridabad district in Northern India. Ethical approvals for the study were taken before the study commenced. Phone call in-depth interviews were carried out with a purposive sample of 13 participants (Mean = 38.07 years) during the COVID-19 pandemic, which included 4 community health workers, 4 people with mental illness, 5 service providers (primary health care doctors and mental health specialists). Data for health facility review was collected from local primary health and specialist facilities while key policy documents were critically analysed for service provision and stigma alleviation activities. Thematic analysis was used to analyse patterns within the interview data. We found poor awareness and knowledge about mental illnesses, belief in faith and traditional healers, scarcity of resources (medicines, trained professionals and mental health inpatient and outpatient clinics), poor access to appropriate mental health facilities, and high costs for seeking mental health care. There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.

Study of the problems of ageism and assessment of attitudes towards age in the medical environment

BACKGROUND: Ageism pervades all areas of life, including the areas of medical and social care. Gerontological ageism has a significant negative impact on indicators of physical, mental health, functional status and well-being of older people. In the conditions of an aging society, the study of the scale and characteristics of this problem in various spheres of life is very relevant.&#x0D; AIM: To assess the prevalence of stereotypes of attitudes towards older age among primary health care physicians, senior students of a medical university and directly elderly people.&#x0D; MATERIALS AND METHODS: In the period from 2018 to 2022, 538 people aged 20 to 75 were interviewed in 3 subgroups: 1) senior students of a medical university of medical specialties, 2) young and middle-aged primary health care doctors, 3) elderly people.&#x0D; RESULTS: It was revealed that the opinions about the problems in this age period in the elderly and the beliefs of doctors and medical students often do not coincide.&#x0D; CONCLUSIONS: When training medical personnel, it is necessary to form the correct attitude to age and skills of communicative competence with different age groups of patients.

Development of the information quality scale for health information supply chain type 2 diabetes mellitus management using exploratory factor analysis.

Research on the quality scale of the healthcare supply chain is still limited. This study aimed to assess the information quality of the supply chain model with a focus on construct validity. Studies related to information quality measurement generally focus on measuring the dimensions of the completeness of medical records and consumer perspectives. We intended to assess the scale based on doctors needed as care coordinators on type 2 diabetes mellitus or the Non-Insulin-Dependent-Diabetes-Mellitus (NIDDM) program in primary healthcare. Sixty-four primary healthcare doctors with an age range of 24-51 years were involved in this research. The scale obtained was formed from the assessment of the point of view of a panel of experts through the content validity index (CVI). The exploratory factor analysis (EFA) method was used to explore the scale of information quality in the information supply chain model for the NIDDM chronic disease management program. The data analysis results indicated three main factors that affected the quality of the information supply chain model of NIDDM, namely accessibility, safety, and efficiency of information related to NIDDM. The results of the validity and reliability of the data showed that the scale used in this research was valid and reliable with a Cronbach alpha coefficient of 0.861. The scale developed in this research could be used to explore the quality of the information supply chain of NIDDM management in primary healthcare. Each item on the scale could explain the variables according to their respective groups.