Primary Health Care Organizations Research Articles

Locum doctor working and quality and safety: a qualitative study in English primary and secondary care

BackgroundThe use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the...

Key elements to support primary healthcare nurses to thrive at work: A mixed-methods sequential explanatory study.

Develop evidence-based recommendations for managers to support primary healthcare nurses to thrive at work. A mixed-methods sequential explanatory design. National data were collected in 2020 via an e-survey based on a meta-analysis of antecedents of thriving from 213 primary healthcare nurses across New Zealand. Structural equation modelling analysis identified the key factors supporting primary healthcare nurses to thrive. This informed a second open-ended e-survey in 2022 of 19 nurses from one primary healthcare organization. The thematic analysis provided recommendations for improving management strategies to support thriving primary healthcare nurses. The vitality component of thriving significantly reduced burnout and intention to leave organization and profession. In contrast, the learning component of thriving had a significant positive effect on burnout. The key factors that support thriving at work are empowering leadership and perceived organizational supports (decreases burnout and intention to leave organization and profession through enhanced vitality). Recommendations for improving thriving were made in eight key areas: communication, effective management, professional development, scope of practice, autonomy, effective orientation, reward and work-life balance. Vitality is important in reducing burnout and turnover intentions. While learning was identified as increasing burnout, professional development and training for managers were identified as essential. Hence, the vitality dimension of the thriving at work construct should be studied at the dimension level, but more research is needed into the impact of learning on thriving over time. Primary healthcare nurses have identified that empowering leadership and perceived organizational support are critical factors in supporting them to thrive, and they provide specific recommendations for managers to improve these factors in the clinical setting. This study collected data from Registered Nurses only. A plethora of existing research focuses on resilience in nurses rather than thriving at work. Enabling employees to thrive at work contributes to improved well-being and sustainable organizational performance. Empowering leadership and perceived organizational support are the key factors that support primary healthcare nurses to thrive at work. The vitality dimension of the thriving at work construct should be studied at the dimension level, and further research is needed into the impact of learning on thriving over time. Primary healthcare nurses recommend that managers focus on improving communication, management efficiency, professional development, scope of practice, autonomy, orientation, reward and work-life balance.

Readiness of medical graduates to self-guided work in primary health care organizations

Aim. To study the opinion of senior medical students about their readiness for self-guided practice in primary health care organizations.Material and methods. In 2023, a continuous cross- sectional social study was conducted among 5th and 6th year students of the Northern State Medical University (Arkhangelsk), of which 137 were from pediatric faculty (5th year — 70, 6th year — 65), 266 — general medicine faculty (5th year — 140, 6th year — 126).Results. An insufficient level of readiness of medical graduates for self-guided practice in primary health care facilities was revealed. Only 19,0%, after passing the primary accreditation, aim to immediately work as a local pediatrician and a local general practitioner, while 44,2% are not ready to begin independent practical activity. The main work direction of a local physician is considered to be prevention by 67,2% and 28,6% of senior pediatric and general medicine students, respectively. More than 75% of graduates are ready to work independently in a medical information system, but 15,1% of respondents are not sure that they will be able to independently make an electronic sick note, while 41% — a referral for disability examination, and about a third of graduates — fill out a statistical electronic form.Conclusion. The study results confirm the need to strengthen the practice in the training of medical students and introduce a mentoring system in primary health care facilities.

“VR is the future”: perspectives of healthcare professionals on virtual reality as a diagnostic tool for dementia status in primary care

BackgroundHealthcare professionals (HPs) hold critical perspectives on the barriers and facilitating factors for the implementation of virtual reality (VR) dementia diagnosis tools in the clinical setting. This study aims to explore HP perspectives regarding the clinical implementation of dementia diagnosis tools using VR platforms.MethodsAn exploratory qualitative interview study was carried out between July and September 2022. In-depth semi-structured interviews were conducted with HPs (n = 7) with clinical expertise in dementia diagnoses drawn from medicine, nursing and allied health practices. A hermeneutic phenomenological approach was used to frame the interview data across the dementia diagnosis pathway and application of new technology.ResultsHPs were on average 36.29 years old (SD = 11.56) with 11.85 years of experience (SD = 12.80, range:4–42). Analyses identified three main themes related to the contemporary methods of dementia diagnosis, dementia diagnosis and the medical landscape and HP perspectives on the usefulness and barriers of VR implementation. VR was considered an innovative prospect, with improved ecological validity compared to commonplace, current cognitive assessments. Concerns of time commitments, monetary costs and the validity of the new technology were identified as key barriers to implementation. Overall, implementation of a new diagnostic tool was considered a complex process.ConclusionsOur insight into general practice and nursing clinics can be supported to embed and integrate virtual reality platforms in primary care settings. Primary healthcare organizations require more funding and time related resources to produce a context in which VR tools could be implemented in a beneficial manner.

Organization of primary health care as a factor in the effective development of rural areas

Organization of primary health care as a factor in the effective development of rural areas

Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System's guidelines.

This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.

Эффективность организации работы лечебно-профилактических учреждений в период пандемии COVID-19: Взгляд пациента

The COVID-19 pandemic has presented primary health care organizations with a number of new challenges, including system readiness in terms of infection control, infection prevention, active case finding, and provision of care to patients.The purpose of the study: determination of factors affecting the effectiveness of the primary health care organization based on the results of a sociological survey of respondents to these clinics.Methods. We conducted a one-time prospective cross-sectional study. The study involved 2501 outpatients of polyclinics from 17 regions of the republic at the city and district levels, 2101 relatives of patients of polyclinics, as well as 2133 visitors. The survey was conducted in two stages: during the COVID-19 pandemic in 2022, and in 2023, in the period after quarantine due to the disease.Results. Patients of the clinic trust specialists in 91.2% of cases, regularly visiting them during the period of the disease, during preventive examinations, and dynamic monitoring, but they are not satisfied with long queues for medical appointments (81.7%, (r≤0.001)) and the correctness of patient management (55.2%, (r≤0.001)). In addition, patients believe that a patient's care with one doctor for a long time (more than 5 years) is an indicator of his ability and willingness to work in COVID (r≤0.001) conditions.Conclusions. Summarizing the results of the regression analysis, we were able to predict that proper patient management and counseling of the patient's relatives will reduce the number of visits to several offices by the patient. For patients, it is important to conduct preventive talks and events, as well as the professionalism of the medical staff.

Жедел медициналық жәрдем қызметін цифрландыру туралы

Information technologies are becoming an integral part of the medical industry in Kazakhstan, playing an increasingly important role every year in improving the quality and accessibility of healthcare. The introduction of digital solutions makes it possible to significantly optimize the processes of medical care, improving diagnosis, treatment and monitoring of patients' condition. Digitalization has affected not only hospitals and primary health care organizations, but also the emergency medical service. To date, the figures help to analyze the main indicators of emergency medical care, such is the indicator of the efficiency of the ambulance team's arrival, the indicator of successful resuscitation, the analyzed cases help to update the reasons for non-compliance, which today improve the work of emergency medical care. In this manuscript, we wanted to report the results of the review and analysis of the main techniques used to digitalize the emergency medical service. The development of a system of indicators in an integrated medical information system contributes to a deeper analysis of the activities of the ambulance service and allows you to identify both positive and negative trends in its work. This makes it possible to make informed decisions to improve processes and improve the quality of services provided, which ultimately has a beneficial effect on the health and well-being of the region's population. The introduction of a navigation system for tracking the movement of teams made it possible to exclude unauthorized arrivals, misuse of vehicles, as well as unreasonably long stay on call. As a result, it was possible to significantly improve the efficiency of the arrival of the brigades. The provision of organizational and methodological assistance to employees of call service departments of the 4th category of urgency, as well as constant monitoring of their work with the identification and timely correction of deficiencies, allowed to increase the proportion of timely serviced calls.

Comparative Analysis of Primary Health Care Organization Models: Global Experience and the Republic of Kazakhstan

At present, the Republic of Kazakhstan is facing an increase in chronic diseases and an aging population, which presents new challenges to the healthcare system. A comparative analysis of primary health care organization models based on global experience and the experience of the Republic of Kazakhstan can contribute to the improvement of the primary health care system, increasing its accessibility and quality, and improving the health of the country's population. The purpose of this study is to evaluate and compare the primary health care systems of leading countries to improve the understanding and effectiveness of population health care at the global level.In recent years, significant achievements have been observed in global health, such as an increase in life expectancy, a decrease in child mortality, and increased access to drugs and vaccines. However, XXI century healthcare systems require innovative approaches and significant investments to overcome challenges such as aging populations and the growth of chronic diseases. In this context, primary health care becomes a key component of sustainable health system development, playing an important role in the prevention, diagnosis, and treatment of common diseases. The importance of a comparative analysis of primary health care organization models in different countries lies in identifying unique features, achievements, and barriers of each. Through analysis and research, effective strategies can be developed to improve population health and increase accessibility and quality of medical care, providing a basis for the development of effective public health strategies.

Partnership “Integrated Broad Intake” (IBI)

Three primary health care organizations are working together to ensure that the barrier is lowered for vulnerable groups to make effective use of all kinds of rights, both financial and social. This partnership “Integrated Social Care” wants to combat non take up and wants to increase the accessibility of social services by working proactively and by outreach.&#x0D; To set up such partnership depends on the local context. A careful analysis and knowledge of the field, involvement of all relevant actors and the target group itself, are essential to make it work. Client participation is a crucial aspect.&#x0D; Every citizen can turn to a partner of this partnership for all questions related to health, work, care, finances and social problems. Nevertheless, this partnership focuses on the most vulnerable citizens who do not (yet) receive the social rights they are entitled to.&#x0D; Colleagues from different ranks of the public social welfare center (OCMW), the social work center (CAW) and the social work department of the health insurance funds (DMW) work together on solutions, along with other local partners and service users.&#x0D; The partnership ""Integrated Social Care"" is not an organizational model, but it is a way of offering solutions to vulnerable citizens with complex welfare questions that you cannot find within your own organization alone. This partnership provides neutral information on local social help and service options. They investigate and realize social rights, clarify questions and refer to appropriate local social help and services in a neutral way. A client no longer has to go to different services. Social workers from this different organizations find each other so that the necessary expertise is shared. They work by client centered focus and in a proactive and outreaching way to detect people who were previously under the radar.&#x0D; This network is strengthened with local partners, such as poverty associations, community work and family doctors. The local government has the final responsibility.&#x0D; The process guidance provided by the Flemish government to realize this partnership in practice is through the principles of Service Design. In fact, Service Design is both an attitude (customer orientation), a methodology (co-creation with users and employees) and a set of tools (a collection of techniques to develop aid and social services). So, it is not only talking about it, but it's about working in practice with and for the target group.&#x0D; &#x0D; &#x0D; Several scientific studies have given us insights to improve the local implementation of this partnership. And we are still learning. The 59 different partnerships ""Integrated Social Care"" are also inspired by each other by using an online platform and by participating guided moments where they exchange good practices.&#x0D; The objective is a rollout across Flanders in 2022-2023 and a structural embedding of the working principles of “Integrated Social Care” in 2025.&#x0D;

Family medicine in rural area- perspectives and development opportunities.

Access to health care should be universal and equal regardless of health needs, socio- economic status and place of residence. Empirical research confirms, however, that there are differences in access to health care between urban and rural areas. 40% of Poles currently live in rural areas. Until 2050, 27% of them will be of post-productive age, compared to 19% in 2020. What’s important, access to health care in rural areas of Poland is diverse. In some provinces the availability of services is optimal, in others access is severely restricted. The main challenges for the health care system in rural areas are staff shortages, lack of coordination between primary care, outpatient specialized care and hospitals, greater distance from large hospitals, difficult access to specialist and preventive services, and lower effectiveness of emergency care. &#x0D; Practical solutions that can help organization of care in primary healthcare in rural areas have been identified. &#x0D; 1.Horizontal and vertical collaboration between healthcare professionals (HCPs).&#x0D; Collaboration between HCPs should happen both at level of medical professionals within primary healthcare (PHC) and in collaboration with outpatient specialist care. Delegation of some of doctors’ responsibilities to other professions (nurses, midwifes, care coordinators) will allow for more effective use of recourses. Investing in correct skill-mix for PHC teams is also crucial. &#x0D; 2.Financial motivators for HCPs working in rural areas&#x0D; Additional financial motivation does not exist in Poland, but it’s implementation is crucial to motivate staff to work outside the larger centers, thus improving care for patients in rural areas. The reward for working in remote and sparsely populated areas should apply to all members of the PHC team – doctors, nurses, midwives, coordinators. An adjustment of the capital increase rate on the basis of three conditions, which add up depending on the circumstances, Degurba index, population density and distance from the Medical University, could be a good solution for the Polish system.&#x0D; 3.Effective use of modern technologies&#x0D; Overcoming technical barriers and effectively implementing telemedicine services can dramatically improve the organization of care, particularly in rural areas facing shortages of staff. Many telemedicine solutions are already successfully introduced in Poland, such as e-prescriptions, e-referrals, phone consultation, electronic doctor’s note. Those should be supplemented by online patient case conferences, access to patients’ electronic health records (EHRs) and sharing of an individual patient plan. &#x0D; Considering main challenges of rural areas, modern technologies based on self-care and remote monitoring of patients' health are likely to greatly improve quality of care received by patients. &#x0D; Study analyzed practical solutions which could improve the organization of primary healthcare in rural areas. Effective and efficient care for the population must be consistent with the concept of care coordination.

Exploring Factors Shaping Primary Health Care Readiness to Respond to Family Violence: Findings from a Rapid Evidence Assessment

Abstract Purpose Family violence (FV) is defined as any situation where an individual employs abusive behaviour to control and/or harm a former or current spouse, non-marital partner, or a member of their family. The health consequences of FV are vast, including a wide range of physical and mental health conditions for individuals experiencing violence or survivors, perpetrators, and their children. Primary health care (PHC) is recognized as a setting uniquely positioned to identify the risk and protective factors for FV, being an entry point into the health care system and a first, or only, point of contact for families with professionals who can facilitate access to specialist care and support. Methods A rapid evidence assessment of empirical studies on FV interventions in PHC was conducted to examine outcomes of effective FV interventions that promote identification, assessment, and care delivery within diverse PHC settings, factors shaping PHC provider and system readiness, and key intervention components that are important for sustaining PHC responses to FV. After completing data extraction, quality appraisal, and a hand search, a total of 49 articles were included in data synthesis and analysis. Results Several FV interventions that include multiple components such as, screening and identification of FV, training of PHC providers, advocacy, and referrals to supports, have been rigorously tested and evaluated in diverse PHC settings in rural and urban areas including primary care/family medicine practice clinics and community PHC centers. These interventions have demonstrated to be effective in identifying and responding to violence primarily experienced by women. There is a dearth of FV interventions or programs from empirical studies focused on men, children, and perpetrators. Additionally, provider and system readiness measurement tools and models have been implemented and evaluated in PHC specifically to assess physician or the health care team’s readiness to manage FV in terms of knowledge and awareness of FV. The findings highlight that there is no clear or standardized definition of provider or system “readiness” in the literature related to FV responses in PHC. Further, the findings revealed four key intervention components to facilitate PHC provider and organization readiness to address FV: (1) multidisciplinary teamwork and collaboration, (2) improving provider knowledge on the social and cultural determinants impacting FV, and (3) embedding system-level supports within PHC. Conclusions FV is a serious public health concern and PHC providers have a vital role in early detection of FV and the poor health outcomes associated with violence A focus on comprehensive or multi-component FV interventions are more likely to change provider behavior, and would allow for safe, confident, and professional identification and assessment of FV within PHC.

Показатели и направления оптимизации первичной медико-санитарной помощи в Южном федеральном округе.

The study of indicators and directions for optimizing primary health care in the regions of the Russian Federation allows us to assess the effectiveness of the functioning of the first and basic level of contact of patients with the health care system. The purpose of the work is to study indicators and directions for optimizing primary health care in the Southern Federal District. Materials and methods: A theoretical analysis of literature, statistical information and documents related to indicators and optimization of primary health care in the Southern Federal District was performed. For a comparative assessment of the dynamics of indicators, the growth (%) was calculated. Results. The supply of local therapists in the Southern Federal District is lower than the national average. It was revealed that the Republic of Kalmykia, Astrakhan region and Rostov region have a negative increase in the provision of local therapists for 2016 and 2021: –6.1; –20.9 and –22.2% respectively. In terms of the number of local pediatricians, a negative increase (9.0%) is observed only for the Rostov region. An analysis of directions for optimizing primary health care showed that in the regions of the Southern Federal District programs are being implemented to improve the infrastructural organization and equipment of primary health care, as well as to eliminate the personnel shortage of medical personnel. However, the reports indicate only indicators of the number of doctors per 10 thousand population without highlighting primary health care workers. Conclusion. The key problem of the Southern Federal District is the shortage of doctors in the field of primary health care. The dynamics of the health care situation in the Southern Federal District have not been sufficiently studied. It is necessary to continue: improving the material and technical equipment of the industry, including in hard-to-reach areas, carrying out preparatory work with students in medical institutions, improving working conditions and offering attractive labor financing for workers and organizing social assistance.

The enrolment gap and the COVID-19 pandemic: an exploration of routinely collected primary care enrolment data from 2016 to 2023 in Aotearoa New Zealand.

Introduction For many countries, primary health care (PHC) serves as the gateway for individuals to access healthcare services. It has been shown to not only improve health but also health equity. To maximise this benefit, a substantial proportion of the population needs to be connected with PHC. The aim here was to assess the degree and evolution of enrolment in light of the coronavirus disease 2019 (COVID-19) pandemic in Aotearoa New Zealand. Methods We examined data on the enrolment of people in PHC organisations between 2016 and 2023. This analysis included breakdowns by sex, age groups, ethnicity, and socioeconomic deprivation levels. Poisson regression models were used to explore whether enrolment changed because of the COVID-19 pandemic. Results In 2016, Māori, young people and the most deprived had lower enrolment rates relative to their peers. Although young people's enrolment rate increased over time, especially during the COVID-19 pandemic, the Māori enrolment rate declined, as did the rate for Pacific people, and those who were the most deprived. The groups who had increases in enrolment rates were those with the lowest levels of socioeconomic deprivation and those in the 'Other' ethnic category, predominantly made up of European New Zealanders. Conclusion Enrolment statistics reveal disparities across sociodemographic lines. The COVID-19 pandemic was associated with changed patterns of enrolment that appear to have consequences for population health.

Evaluating local primary health care actions to address health inequities: analysis of Australia’s Primary Health Networks

BackgroundMeso-level, regional primary health care organisations such as Australia’s Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs’ activities.MethodsAnalysis of all 31 PHNs’ public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions.ResultsPHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs’ equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process.ConclusionsPHNs’ equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the ‘upstream’ factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.

Availability and quality of primary health care in the compulsory health insurance system in Kazakhstan

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;To evaluate patient satisfaction with primary healthcare services and determine effectiveness indicators within Kazakhstan&amp;#039;s compulsory health insurance system.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;An analytical observational study with cross-examination was conducted in Kazakhstan&amp;#039;s primary healthcare (PHC) organizations. Patient satisfaction was assessed through a 35-item closed-question questionnaire. An analysis of stimulating component result indicators for per capital standard financing in PHC organizations based on their achieved outcomes was performed.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Among surveyed patients, 54.0% (1.80&amp;amp;plusmn;1.108) expressed complete satisfaction with medical care, while 59.4%&amp;lt;br /&amp;gt;(1.82&amp;amp;plusmn;1.269) perceived laboratory tests as readily accessible. Notably, males exhibited higher satisfaction levels with medical care and the availability of laboratory tests compared to females. The city polyclinics № 3 and № 14 in Almaty, Kazakhstan, achieved significant performance indicators, resulting in a 1.1-fold increase in the incentive component of per capital funding.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Within the framework of compulsory health insurance, primary healthcare organizations in Kazakhstan offer affordable and effective medical care, as attested by surveyed patients and the final result indicators of the polyclinics.&amp;lt;/p&amp;gt;

Managing uncertainty - leaders’ perspectives on health system resilience during COVID-19 in Finland

Abstract Background The role of leadership in resilience is commonly acknowledged but empirical studies in the context of healthcare are less frequent. One key to public health preparedness is to understand how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks. Finland offers an opportunity to investigate resilience in a public sector setting where the health system is decentralized and local health systems, including primary healthcare, are responsible for most public health actions. In this study we examined how leaders responsible for local health systems interpreted changes in their operational environment in Finland during the first year of COVID-19, and to how these views reflect aspects of resilience in healthcare. Methods We identified 14 leaders in four regions in Finland from a larger data set of 53 interviews. Leaders had responsibilities for local health and social care during the COVID-19 pandemic. Semi-structured interviews were conducted in March-June 2021. The audio recorded data were transcribed and analysed with abductive thematic analysis using Atlas.TI. Results From the data we identified three core issues of leadership in building primary healthcare resilience. Firstly, living with constant uncertainty was seen as an integral part of leadership not only during crises but also at normal times. Secondly, health systems’ adaptability was considered important. This was maintained through decisions on workforce, information, and collaboration. Thirdly, the leaders responsible for local health systems emphasized holistic approach to crisis governance and service needs of the public. Conclusions Leaders in local health systems have to consider uncertainties and various entwined aspects of resilience during public health crises. This should be emphasised in decision-making and policy recommendations. Qualitative research designs are needed to obtain a broad understanding of the entity. Key messages • Holistic approach and adaptability were key factors of local health system resilience in Finland. • Resilience should be studied more in the context of local health systems and primary healthcare where complexities are processed continuously.

Sustainability of organisational models implementation in primary care: the CIRCE-JA approach

Abstract Fostering healthcare is the aim of EU4Health 2021-2027 agenda. To promote it the EU commission has launched calls for projects, in particular, a call for best practices (BPs) in primary healthcare (PHC). The Joint Action (JA) CIRCE-JA that was funded aims to transfer and implement PHC BPs among Member States, raising their capacity in implementing innovative care models and addressing health system transformation. To be fully effective and maintained over time a BP should be sustainable; part of the efforts of CIRCE-JA are dedicated to study and assure sustainability of the project. Sustainability is a key issue to make an intervention, although already proved of good quality, useful for the population through time. To identify factors of a sustainable implementation, a search of the literature has been done to outline a questionnaire that will be validated through DELPHI methodology and submitted to organisations already managing the BPs and the affiliated entities that will introduce the BPs in their organisations. CIRCE JA will lead to the implementation of 6 PHC BPs in 44 implementation sites located in 14 European countries. This variability calls for a solid transferring methodology to sustain the implementation. The theme of sustainability is not new and the literature search is going to provide enough material for the implementation of the questionnaire. The questionnaire will be compiled by BPs owners which have created the organisational model and the implementing sites; this will be done in order to understand the problems faced and assay the perceived issues. PHC is a priority for EU bodies. Sharing experiences and organisational models on PHC and the diffusion of BPs can be useful to improve quality and access of healthcare, also promoting the so-called European Health Union. Furthermore, a proper study of the sustainability of the interventions leads to a better and longer implementation, not causing a waste of effort, money and time. Key messages • To effectively transfer and implement an organisational model, a solid study on sustainability should be conducted. • An efficient PHC organisation and provision is crucial to improve quality and access to healthcare.

Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol.

This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.

“The measures taken by the government overburdened the daily practice” – insights of the PRICOV-19 study on German general practitioners in times of COVID-19

BackgroundThe international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures?MethodsThis study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models.ResultsThe response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures.ConclusionGPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.