Primary Health Care Hospitals Research Articles

In Search of Best Practices for Improving the Operational Efficiency of the Primary Healthcare Hospitals in Thailand through Benchmarking

Background: Thailand's public health policy emphasizes equitable access to healthcare services, leading to a rapid increase in primary healthcare demands. Enhancing efficiency has become a crucial solution to address this challenge, especially amidst the constraints of limited resources. Aims: To measure the operational efficiency of sub-district or tambon health-promoting hospitals (THPHs) in the Eastern Economic Corridor (EEC) by applying the mathematical technique of Data Envelopment Analysis (DEA) and to identify best practices from efficient THPHs that can be applied to improve the operational efficiency of other THPHs. Methods: First, the operational efficiency of 104 THPHs in Chachoengsao, a province in EEC, was measured using the DEA method. Second, 13 efficient THPHs were selected as benchmarks for operational best practices. In-depth interviews were conducted with five individuals from each selected THPH, including the director and four key stakeholders. The interview data were analyzed and synthesized using directed content analysis to formulate a list of best practices. Finally, the identified best practices were evaluated using the Delphi technique to produce a final list of best practices to improve the operational efficiency of THPHs. Results: 76 best practices were initially generated from the content analysis of the benchmark interviews. However, after the Delphi experts' evaluation, 66 best practices met the required criteria (Mdn > 3.50 and IQR < 1.50) and were ultimately accepted as potential general strategies for improving the efficiency of THPHs. Of these, 35 best practices were related to input management, and 31 were related to output management.

Determination of 3-hydroxyanthranilic acid in the sweat of healthy older adults

3-Hydroxyanthranillic acid (3HAA) is one of the key metabolites from the tryptophan (TRP) metabolism pathway and is associated with aging, age-associated diseases, and healthy lifespan extension. This study aims to detect 3HAA in the sweat of healthy older adults using simple, high-performance liquid chromatography (HPLC) method. Chromatographic separation using 20 mmol/L sodium acetate, 3 mmol/L zinc acetate, and 7% (v/v) acetonitrile as mobile phase is possible to simultaneous detect 3HAA, KYN, and TRP with UV and fluorescence detection, respectively, under 6 min. This method demonstrated excellent linearity with coefficient of determination (r2) greater than 0.998 for all analytes. The linear range were 0.05–6 µg/mL for TRP, 0.1–6 µg/mL for KYN and 0.2–6 µg/mL for 3HAA. Percentage recoveries from spiked in human sweat ranged from 90 ± 7–101 ± 3 for TRP, 86 ± 1–92 ± 3 for KYN, and 96 ± 1–103 ± 4 for 3HAA. The precision (%RSD) of repeatability and reproducibility is less than 3% and 6%, respectively. This method was used in a cross-sectional study with 81 participants aged 50–79 years, selected randomly from a local primary healthcare hospital’s sampling frame. A detectable amount of 3HAA was observed in all sweat samples, marking the first report of 3HAA presence in human sweat. Additionally, the results revealed that the 3HAA sweat levels increased with age analyzed in three different age groups ranging from 50–59, 60–69, and 70–79. These findings enhance our understanding of sweat profiles and their correlation with aging, potentially further improving early diagnosis, disease monitoring, and development of customized treatment programs for older adults.

The Impact of Physical Activity on Depression, Anxiety, and Stress during Pregnancy in Saudi Arabia: A Cross-Sectional Study.

Background and Objective: This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal-Wallis rank sum tests, with significance levels set at p < 0.05. Results: The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels (p < 0.001). Conclusions: This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.

Factors Associated with the Development of Chronic Kidney Disease in Patients with Arterial Hypertension.

Chronic kidney disease affects a large part of the population with hypertension, diabetes mellitus as well as those over 50 years of age. Research reported that male sex and other comorbidities such as obesity and anemia are more frequent in Chronic kidney disease, as well as uncontrolled diabetes mellitus or hypertension. To determine the risk factors associated with the development of chronic kidney disease in adults with arterial hypertension. Retrospective cohort study of 455 patients with hypertension treated in a primary health care hospital. Medical records and laboratory information were reviewed for the diagnosis of chronic kidney disease and its staging. Patients aged 40 years and older, of both sexes and evaluated between the years 2015 -2017 were included. Logistic regression analysis allowed the identification of risk factors associated with the development of chronic kidney disease. 63.7% were female and 36.3% male. The average age for 2015 was 69.79 ± 9.03, more than half of participants had diabetes mellitus and controlled hypertension and the predominant nephroprotection was with Losartan (53%) that year. Male sex (OR 1.68, CI 1.03-2,76), age: 60 years or older (OR 6.38, CI 2.65-15,37) and anemia (OR 1.71, CI 1.03-2,85), were risk factors for the development of chronic kidney disease (p < 0.05), whereas nephroprotection (OR 0.39, CI 0.18-0,88) and controlled diabetes mellitus (OR: 0.18, CI 0.07-0,47) were shown to be protective factors (p < 0.05). The prevalence of chronic kidney disease between 2015 and 2017 was 19% and 45%, respectively, with predominance of category G2. The comparison group is the same cohort analyzed in each year under study. Male sex, age over 60 years, and anemia are risk factors for chronic kidney disease. Nephroprotection, controlled diabetes mellitus, and patient follow-up are factors that prevent its development.

Pursuing the efficient operation of the primary healthcare hospitals in Thailand through efficiency assessment using the data envelopment analysis method.

This study aimed to assess the operational efficiency of Sub-District or Tambon Health Promoting Hospitals (THPHs) in Thailand's Eastern Economic Corridor (EEC) and to propose management guidelines for future improvements. The current state of Thailand's public health demonstrates that government policy has prioritized equal access to public health services in all areas. This increases the need for primary public health services, yet resources are limited and cannot be increased to meet the growing demand. The only effective way to address this issue is to develop the efficiency of public health operations. The sample consisted of 104 THPHs in Chachoengsao, a province in Thailand's EEC. Data for five input and seven output variables were collected between September 18 and November 15, 2023. An online survey was conducted to gather the required data for fiscal year 2022. Data envelopment analysis was used to measure the efficiency of THPHs. The average efficiency index of the 104 THPHs was 0.9066, with about 60% having an efficiency index of 1.00. When classified by size, it was found that the efficiency levels of the THPHs grew with size, considering that the average efficiency index of the small, medium, and large THPHs was 0.8642, 0.9140, and 0.9417, respectively. The proportion of efficient THPHs also increased with size, at 58.14%, 60.00%, and 66.67%, respectively. Regarding efficiency improvement targets, small THPHs had the highest output targets (28.40%), followed by medium THPHs (15.31%) and large THPHs (9.91%). For the inefficient THPHs, some management guidelines were made to improve their future performances.

Experience in a primary care inpatient hospital (Comárcal) with the use of CSF results for the diferential diagnosis of Alzheimer’s disease

AbstractBackgroundTo analyze the usefulness of the use of Alzheimer’s disease (AD) biomarkers in cerebrospinal fluid (CSF) since its incorporation into clinical practice, in a first‐line care hospital setting.MethodWe review clinical history, neuroimaging and neuropsychology, and results of B‐amyloid 42, B‐amyloid 42/40 ratio, total tau and p‐tau in CSF in patients who consulted for cognitive impairment. Prior to biomarker determination, they were assigned a degree of suspicion based on history, neuroimaging and neuropsychology. Afterwards, they were reclassified into probable AD/ dementia not AD/no evidence of AD or neurodegeneration according to the ATN system. Finally, the usefulness was assessed according to whether a high degree of diagnostic certainty was achieved in each case.Result39 patients gave ICF and were analyzed; mean age 69.5 years; cases with typical and atypical clinical course. After determination of biomarkers, they were classified according to whether they presented A+/A‐, T+/T‐ and N+/N‐; findings were correlated with previous clinical and paraclinical data and compared with them, and stratified according to the degree of diagnostic certainty provided. A high degree of diagnostic certainty was achieved in 34/39 patients.Conclusiondetermination of CSF biomarkers is a useful, affordable and decisive tool in the differential diagnosis of patients with Alzheimer’s disease, which makes it a diagnostic resource to be used preferably even in primary health care hospitals.

Predicting nurses' safety compliance behaviour in a developing economy, using the theory of planned behaviour: A configurational approach.

The study's main objective was to use a fuzzy set qualitative comparative analysis to identify the configuration of recipes that predict nurses' safety compliance behaviour. A cross-sectional design. A survey was used where questionnaires were collected from 285 nurses across four primary healthcare hospitals within the Ashanti Region, Ghana. The data collection happened between June 1 to August 2, 2022. A fuzzy set qualitative comparative analysis was used to identify the recipes of psychological factors that determine nurses' safety compliance behaviour. Results from the study suggest that the necessary configurations that explained nurses' safety compliance behaviour came from the presence of subjective norm, attitude, perceived behavioural control, perceived organizational support and negation of intention. The result highlights the need for safety protocols to be conscious of the interplay between nurses' assessment of self, social clues and perception of management care and support since such psychological factors must be considered concurrently to achieve the optimal safety compliance behaviour among nurses. A health and safety protocol that fails to recognize the importance of psychological antecedents on subordinates' safety compliance behaviour could limit the safety policy's usefulness in bringing the appropriate behavioural change in nurses. To date, no study has combined the antecedents of theory planned behaviour with perceived organizational support and cue to action to assess how they collectively predict nurses' safety compliance behaviour. Findings from the study suggest that nurses in primary health facilities inform their safety compliance behaviour by assessing self-capabilities, social signals from superiors and colleagues and perception of management support. Hospital administrators and nursing managers in sub-Saharan Africa may rely on these psychological forces to persuade nurses to develop positive safety compliance behaviour at the health facility. No Patient or Public Contribution.

Analysis of the costs incurred by patients with Chagas disease: The experience in endemic municipalities in Colombia

BackgroundOut-of-pocket expenditure (OOP) are key costs (medical and non-medical) that many individuals incur to receive health services. They have been identified as a key access barrier for vulnerable populations, in particular for populations affected by neglected diseases with a chronic progression, such as Chagas disease. It is important to understand the costs of accessing healthcare services that are borne by patients with T. cruzi infection. MethodologyWe prepared a structured survey for patients with T. cruzi infection/Chagas disease who were all treated by the healthcare system in endemic municipalities in Colombia. The results were analyzed according to three categories: 1. The socioeconomic profiling of the patients; 2. The costs of accommodation, food and transportation, in addition to the time spent commuting; and 3. the income losses (money that was not earned due to absence from work) related to treatment at the local primary care hospital or at the high-complexity reference hospital. Main findingsNinety-one patients answered the survey voluntarily. The data revealed that, when treated at the specialized reference hospital, patients spent 5.5 times more on food and accommodation, transportation costs were five times higher, and the loss of earnings was three times higher than when they were treated at the local primary care hospital. Moreover, the amount of time spent on transportation was 4 times higher at the reference hospital. ConclusionsProviding comprehensive healthcare services for Chagas management at local primary healthcare hospitals would allow the most vulnerable patients to save on expenses related to medical and non-medical costs, in turn leading to higher adhesion to treatment thus benefiting the health system as a whole. These findings are in alignment with the WHO's World Health Assembly 2010 Resolution on the importance of treating Chagas at local primary care hospitals, thereby saving patients time and money, allowing for timely care, and promoting access to healthcare.

Molecular Detection of the Effect of Malaria Infection on Nutritional Status in Paediatrics Attending Primary Health Care Hospitals (PHC) Around Sokoto Metropolitan, Sokoto, Nigeria

Molecular diagnosis is now considered to be the most efficient and reliable method for detection of malaria parasites; hence the present research was designed to access the effect of malaria infection on the nutritional status of the pediatrics attending PHC in Sokoto, 400 children were recruited randomly, nutritional status was determined using mid-upper armed circumference (MUAC) tape, blood samples was collected then subjected to Nested Polymerase Chain Reaction (nPCR) test. Out of 400 samples analyzed, 199/400 (49.75%) were acutely malnourished, 117/400 (44.25%) were normal and 84/400 (21.00%) were severely malnourished. Although 237 (59.25%,) were found positive for Plasmodium falciparum, those that are severely malnourished had the highest infection rate [78/84 (92.86%)] followed by those that are normal [124/199 (62.31%)] than those that were acutely malnourished [35/84 (41.67%)], a significant association was reported for those that are severely malnourished based on parent’s occupation (P=0.001), place of living (P=0.000), and sleeping under nets (P=0.012), there was also significant relationship in those that are normally based on gender (P=0.001), and sleeping under nets (P=0.021) only while those that were normal showed significant relationship based on sleeping under nets (P=0.001) and parents occupation (P=0.000). The high prevalence of malaria in the study demonstrates high sensitivity and specificity of molecular diagnosis. There is a need to embark on massive community campaigns and adoption of mosquito control measures in the study area.

Patients’ and family caregivers’ experiences and perceptions about factors hampering or facilitating patient empowerment for self-management of hypertension and diabetes in Cameroon

BackgroundNoncommunicable diseases like hypertension and diabetes require long-term management, and are financially draining for patients and their families bearing the treatment costs, especially in settings where the inadequacy or non-existence of the health insurance system prevails. Patient empowerment-focused interventions have been shown to improve adherence to therapeutic regimens and decrease unnecessary health care utilization and costs. This study aims to examine enabling and impeding factors to the development of patient empowerment in a resource-limited setting like Cameroon.MethodsWe used qualitative methods entailing three levels of investigation and involving a public primary healthcare hospital in Yaoundé, Cameroon. Data were collected through 40 semi-structural interviews with patients having hypertension or diabetes and their family caregivers, one focus group discussion with six patients, 29 observations of consultations of patients by specialist physicians, seven observations of care received by inpatients from generalist physicians, and nine documents on the management of hypertension or diabetes. A novel approach combining thematic and lexicometric analyses was used to identify similarities and differences in barriers and facilitators associated with patient empowerment at different levels of the healthcare delivery system in Cameroon.ResultsBarriers generally outnumbered facilitators. There were particularities as well as commonalities in reported facilitators and barriers linked to patient empowerment from different experiences and perspectives of outpatients, inpatients and their family caregivers, given the healthcare services and organization of health personal and resources that deliver healthcare services to meet the health needs of patients with hypertension or diabetes in Cameroon. While specific factors identified by patients were directly related to the self-management of their disease at the individual level, family caregivers were mainly focused on factors present at organizational and central levels, which are indirectly related to the management of the diseases and beyond the control of patients and families.ConclusionsThe preponderance of individual-level factors linked to patient empowerment more than those at the central and hospital/organizational levels calls for due attention to them in the multilevel design and implementation of patient empowerment interventions in resource-limited settings like Cameroon. Accounting for patient’s and families’ perspectives and opinions may be key to improving healthcare delivery.

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely; Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.

Assessment of Safety Status and Response Capacity of Selected Primary Health Care Hospitals in Bangladesh

Assessment of Safety Status and Response Capacity of Selected Primary Health Care Hospitals in Bangladesh

Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China.

PurposeOveruse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients.MethodsMedical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use.ResultsA total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics.ConclusionOveruse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.

Evaluation of Outcome of Subjects with Shoulder Pain- A Retrospective Analysis

Background: Shoulder pain is usually not related with favorable outcome in approximately 40-50% of all cases presenting to the primary health care hospital. Different prognostic factors have been regarded in few of the 16 studies like sex, type of injury, psychological factors, stresses, anatomical factors and impairment of strength. The aim of the present study was to evaluate the predictors of subject outcome with shoulder pain. Subjects and Methods: The present retrospective analysis was performed in the orthopedic department for a duration of 2 years. Anterior or posterior drawer tests were used to indicate the shoulder instability. Severe loss of motion was regarded when the patient had loss of more than 50% of the normal physiological motion range. Different treatment modalities were evaluated based on whether the patient needed that type of treatment or not. All the data thus obatined was arranged in a tabulated form and analyzed using SPSS software. Probability value of less than 0.05 was regarded as significant. Results: The mean change in quickdash score after treatment was 16.76+/-9.21. The mean number of total visits was 12.43+/-5.28 and the mean visits per week was 2.25+/-0.62. There was a significant change in the quickdash score amongst the subjects. The number of visits to the doctor also showed significant effect. The presence of comorbidities also showed a significant difference amongst the subjects. Conclusion: The best predictors found in the study were the quickdash score and the incidence of visits to the health care services.

Geriatric club attached to a primary care hospital as an effort to physically, socially, and mentally engage elderly: A case study from Kerala, India.

Introduction:Ageing leads to physiological, social and mental changes. The case study shares experiences about the development and evolution of a ‘geriatric club’ attached to a primary health centre in Kerala, India and the early outcomes noticed among the members of the geriatric club.Process:This club, established three years before, has become an ongoing self-sustainable organisation helping senior citizens to socialise with their peers. Meeting on a regular day every week at the health centre, with programs varying from discussions on health issues to entertainments like music, dance, festival celebration and film shows, the club has become part of all elderly patients in and around the health centre.Outcome:Outcome of the club was looked qualitatively and quantitatively through Focus Group Discussions and before and after comparison of Mini Mental Status Examination Scores and Geriatric Depression Scale scores of elderly club members. FGDs concluded that members were benefitted through participation in the club and the club activities helped them to get engaged physically, mentally and socially. Mean GDS scores of the participants decreased from baseline [5.43, SE 0.76] to after six months [5.20, SE 0.74] (P 0.006). Mean MMSE scores showed improvement from baseline [22.26, SE 0.69] to after six months [24.80, SE 0.81] (P 0.001).Conclusion:Geriatric social clubs attached to primary health care hospitals with suitable contextual adaptations can engage elderly patients physically, mentally and socially. It is hypothesised that such activities can have positive impact on depression and cognitive improvement.

Prevalence and associations of microalbuminuria in proteinuria-negative patients with type 2 diabetes in two regional hospitals in Cameroon: a cross-sectional study

BackgroundMicroalbuminuria (MA) is the earliest clinical evidence of diabetic nephropathy, but most patients in sub-Saharan Africa (SSA) only have access to much cheaper dipstick proteinuria as a means to screen for diabetic nephropathy. The aim of this study was to determine the prevalence and associations of MA among proteinuria-negative type 2 diabetic patients in a SSA setting.MethodsIn this cross-sectional study, patients with type 2 diabetes screened negative for dipstick proteinuria in a primary healthcare hospital were assessed. Detection of microalbuminuria was carried out in two steps: qualitative detection using special microalbumin urine strip, and quantitative laboratory measurement and calculation of urinary albumin-to-creatinine ratio (UACR). Microalbuminuria was defined as UACR of 30–300 mg/g.ResultsA total of 162 type 2 diabetic patients were included. Using quantitative assessment, the prevalence of microalbuminuria was 14.2% (95% CI 8.8–19.6) whereas 26.5% (95% CI 19.8–34.0) had microalbuminuria with urine strip. The mean systolic blood pressure (p = 0.032), diastolic blood pressure (p = 0.032) and serum creatinine concentration (p < 0.001) were higher in people with microalbuminuria as compared to those with normoalbuminuria, whereas the mean body mass index (p = 0.046) and mean eGFR (p < 0.001) were lower in the albuminuria group. In multiple linear regression, eGFR (p = 0.001) and serum creatinine concentration (p = 0.003) were independently associated with increased UACR.ConclusionsOne in every seven proteinuria-negative type 2 diabetic patients has microalbuminuria in primary care setting in Cameroon; microalbuminuria is associated with higher systolic and diastolic blood pressure, and declining kidney function. Our results emphasize the urgent need to increase the accessibility to microalbuminuria testing to ensure that all diabetic patients with negative dipstick proteinuria can benefit.

A model of congenital heart disease screening through the healthcare services

Congenital heart disease (CHD) causes high morbidity and mortality. Early diagnosis facilitates optimal therapy and prevention of complications. In undeveloped and developing countries, the availability of pediatricians is very limited to perform a physical examination of and treat every child. Therefore, healthcare workers and nurses who work in primary healthcare hospitals have an important role in communities. A model of CHD screening was established for healthcare workers and nurses to provide them with skills in physical examination and in recognizing the signs related to cardiovascular diseases, with the aim of rapid detection through the routine healthcare services. The model comprises participation in a training course, screening in elementary schools and re-evaluation of children suspected of having CHD by pediatric cardiologists. A total of 23,633 children in 179 elementary schools were screened by healthcare workers and nurses. Of 312 children suspected of having CHD, 83 had innocent murmurs and 38 had CHD. The positive predictive values for CHD and cardiac murmur detection were 13.29% and 49.59%, respectively. The utilization of an effective model provides an opportunity to acquire the skills needed to increase the potential of detecting CHD. Acquiring these skills not only increases the chances of detection in school children, but also in infants and toddlers with CHD during routine practice in primary healthcare hospitals.

Abstract WP399: Effectiveness of Acute Stroke Team in a Regional Primary Health Care Hospital

Introduction: Stroke is the second leading cause of death in Australia. In 2012, the total financial costs of stroke in Australia were estimated to be $5 billion. Costs are estimated to be higher for regional or rural hospitals, especially those without acute stroke services. Studies have shown significant benefit of an acute stroke team in improving thrombolysis rates, reducing door-to-CT, door-to-needle and in- hospital mortality. But this model is largely adapted by metropolitan tertiary health care hospitals. The benefit of implementing acute stroke service in a primary care hospital is not known. Aim: We undertook an internal audit to evaluate the effectiveness of acute stroke team in improving thrombolysis rates, door-to-CT, door-to-needle, length of stay (LOS) and mortality in a regional primary health care hospital. Methods: Data from 6 months pre and post commencement of acute stroke team and stroke unit was collected retrospectively. A literature review was undertaken with search terms “stroke”, “acute stroke team”, “stroke unit” and “mortality”. Results: We identified 152 and 160 patients pre and post commencement of services. Of 312 all strokes, 152 and 160 patients were admitted pre and post stroke unit respectively. There was a 3 fold increase in the number of stroke calls and thrombolysis rates increased from 7.6% to 12.9%. A reduction of 44mins and 20mins was seen in door-to-CT and door-to-needle times respectively. The mean LOS reduced 50% from 8 to 4 days while in-hospital mortality dropped from 12.5% to 6.25%. Failure rate of admission swallow screen assessment improved 10-fold from 51% to 5%, although assessment data was missing in 33 pre-stroke unit patients. Cost-benefit analysis showed a $600 saving per patient. Conclusions: Our study highlights the advantage of an acute stroke team in improving thrombolysis rates, door-to-CT and door-to-needle times, and swallow screen assessment. It reduces LOS and in-hospital mortality and results in an annual saving of $96,000. We plan to expand our service after hours and perform a larger prospective study to confirm our findings with the long-term aim of providing service to a wider catchment area.

ASSESSMENT OF PRIMARY HEALTH CENTER SERVICES AND CLIENT’S SATISFACTION

Patients' satisfaction is a valuable tool to assess the quality service of primary health care hospital. The study aimed at assessing the satisfaction level of patients among health care services provided by various primary health centers. Cross-sectional study was conducted in the study. The primary data was collected from the respondents of ten primary health centers out of seventy four primary health center located in Erode district. The ten primary health centers were chosen randomly. Field survey method was employed to collect first hand information. For this purpose, a well structured questionnaire was used as a tool for collecting the pertinent data from the 300 sample respondents. The respondents were selected by using simple random sampling method from the select primary health centers. The result indicated that the facility'24 hours medical care service' is found to be the most satisfactory item among the various services and facilities offered by the primary health centers made by the respondents with the highest mean rating of 4.46. The study concluded that the policy makers should take necessary steps to solve the problems of patients with providing more satisfaction and to retain them with primary health center.

Surgical treatment of chronic osteomyelitis in children admitted from developing countries

The surgical management of chronic osteomyelitis in children is still challenging in developing countries. This study analysed the extent of the disease and the therapeutic regime. This was a retrospective study in two primary health care hospitals from January 2009 to December 2013, 27 children (20 males and 7 females, mean age 7 years) admitted from developing countries who were treated for chronic osteomyelitis. Localization, duration of the disease, extent of the osseous involvement, spectrum of germs, number of previous and required surgical procedures and duration of hospital stay are reported. A total of 16 cases had haematogenous and 11 cases post-traumatic aetiology. The mean duration of the disease was 18 months. On average, three (range, 1-12) previous surgical procedures were performed. The affected bones were: Tibia in 11, femur in 8, forearm in 6 cases, spine and humerus each in 1 case. Staphylococcus aureus was the responsible germ in 75%. On average, four (range, 2-8) surgical procedures were required. Osseous stabilizations were necessary in 17, plastic soft tissue reconstructions in 8 cases. In three cases with metaphyseal/diaphyseal defect, bone transfers had to be performed (2 × fibula-pro-tibia, 1 × rib for radius). The mean hospital stay took 8 (range, 4-20) weeks. Three local recurrences occurred within 3 months, all could be cured surgically. The surgical treatment of chronic osteomyelitis in children requires a radical osseous debridement. The knowledge of different plastic-surgical procedures is necessary to reconstruct osseous and/or soft tissue defects.