Primary Health Care Personnel Research Articles

Retinoblastoma in Developing Country

Background: Retinoblastoma is the most common intraocular malignancy of childhood occurring in children below five years of age. Its worldwide incidence is one in 10,000 live births. Mortality rate in developed world is 5%, in developing countries is 50% while it can reach 99% if not treated. The etiology of high mortality in developing world is multifactorial like late presentation due to lack of knowledge or poor health care facility, limited knowledge about the severity of the disease among health care workers, fewer centers for its treatment and lack of modern day treatment facilities in the hospitals. Aim: To describe the profile of retinoblastoma presentation and management in a tertiary care hospital in a developing country. Methods: A retrospective data analysis of all diagnosed retinoblastoma patients who received treatment at a tertiary care hospital since last 12 years. Results: Mortality and morbidity due to retinoblastoma has improved in last 12 years due to earlier presentation when we can still save life as well as globe in many patients. Destructive procedures like exenteration and enucleation can be avoided by going for conservative treatment like chemotherapy if they present early. Conclusion: Early presentation and proper diagnosis of retinoblastoma significantly improves the outcome of its management. Awareness campaigns among parents as well as primary health care personnel is crucial for early detection of disease so that life and globe saving measures can be done to improve mortality and morbidity.

Efectividad de programas formativos orientados al consumo de alcohol en atención primaria: revisión sistemática

ObjectiveTo evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems. DesignA systematic review of randomised controlled trials. Data sourcesTrip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017. Study selectionThe final sample was n=3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included. Data extractionThe main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required. ResultsThree Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention. ConclusionThe development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques.

Applying the consolidated framework for implementation research to identify barriers affecting implementation of an online frailty tool into primary health care: a qualitative study

BackgroundFrailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls. Frailty can be better managed with early screening and intervention, ideally conducted in primary health care (PHC) settings. This study used the Consolidated Framework for Implementation Research (CFIR) as an evaluation framework during the second stage piloting of a novel web-based tool called the Frailty Portal, developed to aid in the screening, identification, and care planning of frail patients in community PHC.MethodsThis qualitative study conducted semi-structured key informant interviews with a purposive sample of PHC providers (family physicians, nurse practitioners) and key PHC stakeholders who were administrators, decision makers and staff. The CFIR was used to guide data collection and analysis. Framework Analysis was used to determine the relevance of the CFIR constructs to implementing the Frailty Portal.ResultsA total of 17 interviews were conducted. The CFIR-inspired interview questions helped clarify critical aspects of implementation that need to be addressed at multiple levels if the Frailty Portal is to be successfully implemented in PHC. Finding were organized into three themes 1) PHC Practice Context, 2) Intervention attributes affecting implementation, and 3) Targeting providers with frail patients. At the intervention level the Frailty Portal was viewed positively, despite the multi-level challenges to implementing it in PHC practice settings. Provider participants perceived high opportunity costs to using the Frailty Portal due to changes they needed to make to their practice routines. However, those who had older patients, took the time to learn how to use the Frailty Portal, and created processes for sharing tasks with other PHC personnel become proficient at using the Frailty Portal.ConclusionsStructuring our evaluation around the CFIR was instrumental in identifying multi-level factors that will affect large-scale adoption of the Frailty Portal in PHC practices. Incorporating CFIR constructs into evaluation instruments can flag factors likely to impede future implementation and impact the effectiveness of innovative practices. Future research is encouraged to identify how best to facilitate changes in PHC practices to address frailty and to use implementation frameworks that honor the complexity of implementing innovations in PHC.

"Project Dhoop" and primary healthcare personnel as its ambassador.

"Project Dhoop" and primary healthcare personnel as its ambassador.

Prioritizing rural and community mental health in India: Now, more than Ever Before

Community mental health care in India started in the 1970s. It was long felt that integrating mental health with primary care by training and supporting primary health care personnel to deliver basic mental health care was the best way to provide care for those in need of mental health services in the developing countries. This has been recently echoed by an international consortium as well. The national mental health program, and later the district mental health program, has been right and ambitious steps in this direction. However, effective coverage for severe mental disorders and epilepsy continues to be very low. While there are vast variations across regions of the country, the highest treatment gaps are in rural areas because of inequities in the distribution of mental health resources and variable implementation of mental health program across states. We now know what to do, but we have to begin doing it effectively. It is indeed high time that we prioritize rural and community mental health in India.

Developing and validating a perinatal depression screening tool in Kenya blending Western criteria with local idioms: A mixed methods study

BackgroundRoutine screening for perinatal depression is not common in most primary health care settings. The U.S. Preventive Services Task Force only recently updated their recommendation on depression screening to specifically recommend screening during the pre- and postpartum periods. While practitioners in high-income countries can respond to this new recommendation by implementing one of several existing depression screening tools developed in Western contexts, such as the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire-9 (PHQ-9), these tools lack strong evidence of cross-cultural equivalence, validity for case finding, and precision in measuring response to treatment in developing countries. Thus, there is a critical need to develop and validate new screening tools for perinatal depression that can be used by lay health workers, primary health care personnel, and patients. MethodsWorking in rural Kenya, we used free listing, card sorting, and item analysis methods to develop a locally-relevant screening tool that blended Western psychiatric concepts with local idioms of distress. We conducted a validation study with a random sample of 193 pregnant women and new mothers to test the diagnostic accuracy of this scale along with the EPDS and PHQ-9. ResultsThe sensitivity/specificity of the EPDS and PHQ-9 was estimated to be 0.70/0.72 and 0.70/0.73, respectively. This compared to sensitivity/specificity of 0.90/0.90 for a new 9-item locally-developed tool called the Perinatal Depression Screening (PDEPS). Across these three tools, internal consistency reliability ranged from 0.77 to 0.81 and test-retest reliability ranged from 0.57 to 0.67. The prevalence of depression ranges from 5.2% to 6.2% depending on the clinical reference standard. ConclusionThe EPDS and PHQ-9 are valid and reliable screening tools for perinatal depression in rural Western Kenya, the PDEPS may be a more useful alternative. At less than 10%, the prevalence of depression in this region appears to be lower than other published estimates for African and other low-income countries.

Delayed diagnosis of transanal prolapse of an ileo-colic intussusception in a 10-month-old infant in rural Cameroon: a case report

BackgroundTransanal protrusion of intussusception is a complication of intussusception which involves the exteriorization of the apex of the intussusceptum through the anus. However, it is rarely reported and its confusion with rectal prolapse often leads to a diagnostic delay.Case presentationA 10-month-old female with no significant past history from a rural area in the Extreme North region of Cameroon was referred from a local health centre to our emergency deparment for an irreducible mass. It was reported that the child had spent 5 days at home on over-the-counter medication, then 3 days at a health centre where she was being treated for a respiratory tract infection and a rectal prolapse. On arrival at our hospital, she was conscious and moderately dehydrated. Cardiopulmonary examination revealed generalized coarse crackles over both lung fields. Her abdomen was tender, with a left upper quadrant mass, absent bowel sounds and a dark anal mass. In view of these, diagnoses of bronchopneumonia, intestinal obstruction and a probable rectal prolapse were made. An exploratory laparotomy was carried out after resuscitation with per-operative findings of a prolapsed ileo- colic intussusception and a necrosed intussusceptum. The necrosed portion was resected and an end-to-end ileo-transverse anastomosis was carried out. The immediate post- operative period was uneventful, but the patient died 3 days after the surgery, from an overwhelming sepsis.ConclusionsTransanal protrusion of intussusception requires timely surgical intervention to prevent mortality. The similarity in presentation to rectal prolapse coupled with inadequate knowledge on the condition by primary healthcare personnel causes a delay in the diagnosis and an increased mortality. A high index of suspicion is essential for an early diagnosis and an improved referral system for timely and definitive treatment.

Cases of acute pesticide poisoning in Colonia Puerto Pirapó, Itapúa, Paraguay, February, 2014

In Paraguay, pesticides are the causative agent in 13.7% of poisonings, especially organophosphorus compounds. Such poisoning produces the inhibition of acetylcholinesterase generating three possible clinical conditions: acute poisoning, intermediate syndrome or late neurotoxicity. We present 15 cases of acute poisoning, ten women and five men from a rural community between 5 and 67 years of age, whose symptoms began after using water contaminated by pesticides from the community network. The most common symptoms were nausea and vomiting, followed by abdominal pain, headache, fever, itching, red eyes and sweating. Five patients underwent blood tests for blood count, renal and liver function and serum cholinesterase, with results within the reference values; just one patient had high liver enzymes.In two samples from the community water supply network the active compound detected was profenophos. It is essential to train primary health care personnel to identify cases of acute pesticide poisoning in a timely manner to provide appropriate treatment, especially in rural areas. Additionally, it is necessary that responsible institutions monitor compliance with environmental regulations in these areas to avoid such incidents.

Describing the gingival involvement in a sample of 182 Italian predominantly oral mucous membrane pemphigoid patients: A retrospective series.

BackgroundThe oral cavity has been frequently described as the only site of involvement or as the first manifestation of mucous membrane pemphigoid (MMP), being the gingival tissues often involved, but usually this has been effusively detailed in limited case series. This is a retrospective evaluation of the gingival involvement in 182 Italian patients with oral MMP.Material and MethodsThe diagnosis of MMP was established by both clinical morphology and direct immunofluorescence finding. Patient information (age, gender, risk factors and medical status) and parameters of manifestation (lesions’ distribution, site and type) were detailed.ResultsThe mean age was 62 years for women (n=137) and 67 years for men (n=45). Patients had several sites of oral involvement; the gingiva was the most common one, affecting 151 patients (82.96%; 119 f - 32 m). Female subjects had more possibilities to develop gingival lesions than male patients (P = 0.005). Sixty-five patients (35.7%; 58 f - 7 m) had pure gingival involvement. Patients with lower gingival involvement statistically had more complaints (P = 0.006).ConclusionsThis report is one of the largest about predominantly oral MMP cases, detailing the very frequent gingival involvement; this could be crucial not only for oral medicine specialists but also for primary dental healthcare personnel and for periodontists. Key words:Mucous membrane pemphigoid, gingival status, clinical features.

Training Primary Health Professionals in Breast Cancer Prevention: Evidence and Experience from Mexico

To analyze the key successful factors of a national educational strategy for early breast cancer detection developed in Mexico for primary health care personnel from 2008 to 2014, an educational strategy to train physicians, nurses, health promoters, and medical students from local ministries of health with a competency-based approach was developed and implemented using diverse educational modalities, face-to-face, blended, and a massive open online course (MOOC). Formative and summative evaluations were used during the implementation of the course. A total of 19,563 health professionals were trained from 2008 to 2014. The graduation rate, an average of all educational modalities, was 91 %, much higher than those previously reported in the literature. The factors that might have influenced this success were (1) the training strategy, which was designed according to the characteristics and specific needs of the target groups; (2) the political will and commitment of the country’s health authorities; (3) the technological and educational models used; and (4) the punctual follow-up of participants. This study shows that carefully designed educational interventions can improve service professionals’ competencies and that regardless of the modality, face-to-face, blended learning, or MOOC, high graduation rates can be achieved. Further evaluation is required to demonstrate that the competencies remained in all target groups after 6 months of the intervention and that the women served by the trained personnel were provided accurate information and timely diagnoses of breast cancer.

Neurological Manifestations in Leprosy: A Study in Tribal Community of Hill Tracts

Background: Leprosy is a chronic granulomatous infectious disease having major burden on humans over thousands of years. If untreated, it results in permanent damage to various systems and organs. So we designed this study to evaluate the neurological complications in early stage in adult leprosy patients.Objective: The aim of this study was to find out the pattern of neurological manifestations among adult leprosy patients.Materials and Methods: This cross-sectional hospital-based study on 85 adult tribal leprosy patients was conducted in a district level health care facility from January to December 2014 using simple, direct, standardized questionnaire including history and neurological examinations.Results: The commonest age group affected was 18–30 years (62.4%). Male group was predominant (68.2%). Majority cases (66%) had multibacillary leprosy. At first visit 72.7% cases with neurological findings could not be diagnosed correctly by primary health care personnel. More than six months were required for correct diagnosis in 61.2% cases. Numbness was the commonest (74.5%) neurological symptom. In upper limb, motor findings were predominant with wasting in 50.9% cases. In lower limb, sensory findings were predominant with stock pattern sensory impairment being the commonest (56.4%). Ulnar nerve was the commonest peripheral nerve to enlarge with tenderness. Facial nerve was the commonest cranial nerve involved. All cases with multiple cranial nerves involvement were of multibacillary type. Due to physical disability 92.7% cases lost their jobs.Conclusion: In this study neurological involvement was found associated with severe disability.J Enam Med Col 2016; 6(1): 10-14

Colorectal cancer in the young, many questions, few answers.

At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the West is showing a rising incidence of this cancer in young individuals. Central to this has been the 75% increase in rectal cancer incidence in the last four decades. Furthermore, predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030 - a statistic that calls for collective global thought and action. While predominance of colorectal cancer (CRC) is likely to be in that part of the large bowel distal to the splenic flexure, which makes flexible sigmoidoscopic examination an ideal screening tool, the cost and benefit of mass screening in young people remain unknown. In countries where the incidence of young CRC is as high as 35% to 50%, the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only. Improvement in our understanding of genetic pathways in the aetiology of CRC, chiefly of the MSI, CIN and CIMP pathway, supports the notion that up to 30% of CRC is genetic, and may reflect a familial trait or environmentally induced changes. However, a number of other germline and somatic mutations, some of which remain unidentified, may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young. Clinically, a proportion of young persons with CRC die early after curative surgery, presumably from aggressive tumour biology, compared with the majority in whom survival after operation will remain unchanged for five years or greater. The challenge in the future will be to determine, by genetic fingerprinting or otherwise, those at risk of developing CRC and the determinants of survival in those who develop CRC. Ultimately, prevention and early detection, just like for those over 50 years with CRC, will determine the outcome of CRC in young persons. At present, aside from those with an established familial tendency, there is no consensus on screening young persons who may be at risk. However, increasing awareness of this cancer in the young and the established benefit of prevention in older persons, must be a message that should be communicated with medical students, primary health care personnel and first contact doctors. The latter constitutes a formidable challenge.

Hepatitis B infection and vaccination: Knowledge, Attitude and Practices among primary health care personnel in Lucknow

Background: Hepatitis B is a major global health problem and one of the most serious type of viral hepatitis, but it can be prevented with strategies like safe and effective vaccination, increasing awareness and by adhering to universal precautions. Objective: The present study aimed to assess the knowledge attitude and practice concerning Hepatitis B infection among the health care personnel in selected Primary Health Care Centres in Lucknow. Materials and methods: Cross-Sectional study was conducted among health care personnel working at the Primary Health Centres in Lucknow. A total of 89 health care personnel comprising of medical officers, staff nurses, laboratory technicians, pharmacists including class IV workers present on the day of data collection were included in the study and interviewed using pretested questionnaire. Descriptive summary using frequencies, proportions and percentages were used to present study results. Result: Majority (93.4%) of the medical officers were aware about type of hepatitis, while knowledge regarding same was comparatively low among staff nurses, paramedical staff and class IV workers (20.0%, 21.8% and 4.5% respectively). Knowledge about symptoms of hepatitis B was found minimal (9.1%) among class IV workers and paramedical staff (18.7%) as compared to doctors (80.0%) and staff nurse (35.0%). Only 13.6% of class IV worker had concern to report each and every case of needle stick injury. Practice to strictly follow of universal precautions and biomedical waste management guidelines was found to be least (9.1% and 18.1% respectively) among class IV workers. Conclusion: The study revealed sub-optimal KAP in concern to several aspects of Hepatitis B infection among primary healthcare personnel. Therefore insights a need to increase the knowledge level as well ideal behaviour in practice through quality training and proper orientation programmes for health care personnel to prevent the spread of hepatitis B infection.

Focus on the Top Ten Diagnoses Could Reduce Pediatric Dermatology Referrals.

There is a sense that many patients seen at referral centers could be managed at a primary health care level. The objective of the current study was to examine the range of diagnoses among consultations at the Red Cross Children's Hospital in Cape Town, South Africa, to help develop a strategy for targeted education of primary health care personnel. This was a retrospective review of data for children seen at a pediatric dermatology clinic from 2005 to 2010, recorded according to International Classification of Diseases coding and compared with published data from similar clinical settings. There were 13,253 clinic visits, with 4,789 patients seen (median age 4.8 yrs, range 2 days to 18.6 yrs). The top 10 diagnoses accounted for 88.5% of consultations (59.5% atopic eczema [AE], 7.1% seborrheic dermatitis [SD], 4.2% superficial mycoses, 3.1% molluscum contagiosum, 2.8% vitiligo, 2.7% viral warts, 2.4% prurigo or scabies, 2.3% psoriasis, 2.3% hemangioma, 2.1% impetigo). Disease prevalence was somewhat different during the first year of life (AE 43.7%, SD 18.6%, hemangiomas 13.4%). Inflammatory dermatoses (76.6%) were more prevalent than infections and infestations (14.5%). The disease spectrum was similar to that in developed countries, although AE prevalence was higher in this study (followed by London 36%, Greece 35%, and Hong Kong 33%) than in 19 published studies. The top 10 diagnoses accounted for more than 70% of diagnoses in 12 studies. The retrospective nature and setting at a specialist clinic increased bias and limited generalizability. Focused education on the optimal care of common diseases, especially AE, could reduce referrals, improve access, and allow specialists at tertiary centers more time to manage complex and uncommon dermatoses.

Estudio actitudes sobre vacunación antigripal en profesionales sanitarios de atención primaria de Cataluña

ObjectiveHealth personnel are at risk of acquiring influenza infection and of nosocomial influenza transmission. The objective of this study was to assess the relationship between the knowledge and attitudes of primary care health personnel in Catalonia as regards influenza vaccine and the factors related to the uptake of this vaccine. DesignA cross-sectional study using a web survey. SettingPrimary care health personnel of the Catalan Health Institute. ParticipantsA total of 1212 primary health care personnel were included in the survey. Those who had medical reasons for being or not being vaccinated were excluded. ResultsA total of 423 replies were valid, with a 46.6% overall vaccination coverage. Vaccination rate was higher among 45 to 54 year-olds, paediatricians, those vaccinated in preceding seasons, and those living with chronic patients. There was an association between having received the vaccine and considering vaccination the best preventive action, advocating vaccination to at risk population, concern about acquiring influenza, and considering health personnel vaccination important. ConclusionsActions taken to increase vaccination rate among health personnel should aim at correcting lack of knowledge and misconceptions about influenza vaccination of health personnel.

Knowledge about childhood bronchial asthma among primary health care personnel in eastern Saudi Arabia

Background: Bronchial asthma (BA) is a chronic non-communicable disease affecting children and adults. Despite the availability of written guidelines for diagnosis and management, yet still knowledge and application were inadequate. The aim of this study was to assess asthma knowledge of primary health care centers (PHCCs) personnel in Dammam city, eastern Saudi Arabia. Materials and Methods: This was a cross-sectional study conducted in 22 PHCCs. The sample consisted of 194 personnel (50 physicians and 144 nurses). Data was collected through a self-administered questionnaire which contained 58 questions. Knowledge score about asthma was coded as good and poor. Descriptive statistics, paired t-test and logistic regression were used for statistical analysis. Results: The majority of PHCCs personnel (96.9%) had no postgraduate studies and 78.4% of them didn't receive any training about BA. More than half (55.2%) of the PHCCs personnel showed good total knowledge score about BA. Also, 81.8% of the physicians and 52.7% of the nurses had good total knowledge level regarding the total aspects of BA in children. Physicians had statistically higher mean knowledge score than nurses regarding all components and total knowledge scores. Knowledge about role of exercise and prognosis was inadequate. Being a physician, female, younger, less years of work in PHCCs were statistically significant and associated with good knowledge level. Conclusions: There are still some deficiencies in knowledge about different aspects related to bronchial asthma. It is recommended that both physicians and nurses receive training about national asthma guidelines through continuing medical education.

Perceptions of rural primary healthcare personnel about expansion of early communication intervention

BackgroundEarly communication intervention services rendered by speech-language therapists and audiologists to families of infants and young children with feeding difficulties, hearing loss or emerging communication disorders should be implemented throughout South Africa. Early intervention can ameliorate risks, enhance development and may prevent further delays. Based on research initiated during a community-service year experience in a rural subdistrict, an incremental process of establishing accessible early communication intervention services was deemed feasible. Such a process cannot be successful if the collaboration of primary healthcare personnel and managers is not ensured.ObjectivesThe aim of the article was to describe the perceptions of primary healthcare personnel with regard to expansion of early communication intervention services to infants at risk of developmental delay.MethodA qualitative descriptive survey design was followed. Semi-structured interviews were conducted with 20 primary healthcare nurses and sisters and eight primary healthcare programme managers in Ditsobotla subdistrict in the North West province of South Africa.ResultsThe participants indicated that by improving team work, developing training programmes and evaluating identification methods and resources, the step-by-step rollout of early communication intervention functions on four organisational levels may be a realistic goal for sustainable services in the resource-limited district.ConclusionThe positive perceptions and contributions by participants promise a rich human-resource basis for transdisciplinary collaboration between speech-language therapists, audiologists and primary healthcare personnel in order to reduce the burden of early communication disorders in a rural district.

Community mental health care in South Asia

Community mental health care in South Asia

Compreender o trabalho na Atenção Primária à Saúde para desenvolver ações em Saúde do Trabalhador: o caso de um município de médio porte

INTRODUÇÃO: a integralidade da atenção em Saúde do Trabalhador (ST) exige a expansão das ações para a Atenção Primária em Saúde (APS). Nesse sentido, compreender o trabalho na APS e suas possibilidades torna-se necessário para subsidiar os planos e as ações em ST com vistas à integralidade. OBJETIVO: apresentar a percepção de trabalhadores da APS, de município de médio porte do estado de São Paulo, quanto ao desenvolvimento das ações de ST em suas unidades de saúde. METODOLOGIA: foi utilizado questionário autoaplicável com 20 perguntas desenvolvido pela pesquisadora. Utilizou-se análise descritiva das perguntas fechadas e de conteúdo das perguntas abertas. RESULTADOS: 45% do total de profissionais respondeu, abrangendo todas as unidades de saúde do município e todas as categorias que compõem as equipes de APS. As respostas sugerem que os profissionais levam em consideração o trabalho dos usuários nos seus atendimentos e que algumas ações do campo da ST são desenvolvidas nas unidades de saúde. Os respondentes também apontam que suas dificuldades para a realização dessas ações se relacionam muito mais a aspectos da organização e gestão do sistema do que a especificidades da área de ST. CONCLUSÃO: O estudo aponta que a condição de trabalho do trabalhador da saúde é uma importante questão para a implementação de ações de Saúde do Trabalhador na APS.

The views of health-care personnel about video consultation prior to implementation in primary health care in rural areas

The aim of this study was to describe the views of health-care personnel about video consultation (VC) prior to implementation in primary health care in rural areas. For people living in rural areas, it is often a long distance to specialist care, and VC could be an opportunity for increased access to care. Therefore, this study was to investigate what views primary health-care personnel had on VC as a working method in the distance between primary and specialist care. The development of technology in society and the introduction of technology in health care mean that the working methods must be adapted to a new approach. It is therefore important that in the initial phase of the introduction of new working methods to capture the personnel views regarding this. Focus group (FG) discussions with health-care personnel from five primary health-care centres in northern Sweden. The transcribed FG discussions were analysed with qualitative content analysis. The analysis revealed four main categories: a patient-centred VC; the importance of evaluating costs and resources; new technology in daily work; technology gives new possibilities in future health care.