Primary Health Care Providers Research Articles

Impact of Chinese visceral adiposity index on all-cause mortality risk in community-dwelling older adults: a prospective cohort study

BackgroundsWhether excess visceral fat tissue increases the risk of death in older individuals remains controversial.AimsTo investigate the association between the Chinese Visceral Adiposity Index (CVAI) and all-cause mortality risk in older Chinese individuals.MethodsThis cohort study utilized data of individuals aged ≥ 65 years in 2014 to 2018 wave from the Chinese Longitudinal Healthy Longevity Survey database. Older individuals in the 2014 wave were included and followed up in 2018. CVAI was calculated based on age, body size, and blood lipid parameters, with higher values indicating increased visceral fat. Survival status was determined from official death certificates, local primary healthcare providers, or the family members of participants. Kaplan-Meier survival curve and log-rank test were employed to analyze cumulative mortality risk through CVAI tertiles (tertile 1: CVAI index < 97.34; tertile 2: 97.43 ≤ CVAI index < 132.21; and tertile 3: CVAI index ≥ 132.21). A Cox proportional hazards regression model was used to assess the relationship between the CVAI groups and all-cause mortality risk. Additionally, a sensitivity analysis was performed by excluding participants who died within the first year of follow-up. A subgroup analysis was performed based on age and sex, and a restricted cubic spline plot was created to analyze the dose-response relationship between CVAI and mortality risk.ResultsA total of 1414 individuals were included, and the mean age of the participants was 84.6 (standard deviation: 10.9) years, of which 46.4% were women and 32.8% were died during a median follow-up time of 36.4 months. In the multivariable adjusted Cox regression model, we observed a significantly lower risk of mortality in the CVAI tertile 2 and 3 groups than in the tertile 1 group. The hazard ratios (HR) of the tertile 2 and 3 groups were 0.68 (95% CI, approximately 0.52–0.89) and 0.63 (95% CI, approximately 0.48–0.82), respectively. Subgroup analysis revealed that the protective effect of higher CVAI levels on mortality was more pronounced in participants aged 65–79 years and in women.ConclusionOur study established a linear relationship between CVAI and mortality risk among community-dwelling older adults, with higher CVAI levels associated with a lower risk of all-cause mortality. These findings highlight the potential importance of visceral adiposity in predicting mortality risk in community-dwelling older adults.

Psychological problems and related factors among primary healthcare staff in major cities in China during the COVID-19 pandemic

This study aimed to explore psychological problems and related factors among frontline primary healthcare workers who belongs to community health service centers and directly provides medical security services to community residents during the COVID-19 in Shanghai. We used a cross-sectional data analysis design to investigate the anxiety and depression levels of 929 frontline healthcare staff (primary healthcare providers, nurses, village doctors, and public health workers) during the Shanghai epidemic.The prevalence of depression among frontline primary healthcare workers was 39.7% (369 cases) and that of anxiety was 30%(279 cases). There was a significant correlation between the depression symptoms and anxiety symptoms. And factors associated with depression were being female, advanced education, expecting psychological interventions, expecting vacations as a reward, and expecting financial rewards. Factors strongly associated with anxiety were being female, expecting psychological interventions, and expecting vacations as a reward. Psychological problems among frontline primary healthcare workers merit more attention during the COVID-19 outbreak, especially those who are vulnerable (e.g., females and those with an advanced education).

Migration and mental health care in South Africa: the question of language in context

Access to mental healthcare for migrants is a global problem, with many challenges and barriers, including the issue of language discordance. Most research on this topic comes from well-resourced countries...

Corrigendum: Perceptions of primary healthcare providers for screening and management of mental health disorders in India: a qualitative study

Corrigendum: Perceptions of primary healthcare providers for screening and management of mental health disorders in India: a qualitative study

Access to Care and Health-Related Quality of Life in Multiple Sclerosis.

Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL). In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL. We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed. Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.

Barriers and Facilitators to the Inclusion of Naturopaths in Interprofessional Health Care Teams: A Scoping Review.

Objective: The growing population of individuals with chronic pain presents a challenge to a globally overburdened health care workforce. Naturopaths are trained as primary health care providers who manage patients with chronic pain and, yet, are often overlooked in health care teams. This scoping review aims to identify barriers and facilitators affecting naturopathic inclusion into interprofessional health care teams managing patients with chronic pain. Methods: This study protocol was registered a priori through Open Science (https://doi.org/10.17605/OSF.IO/2G3JT). A search was conducted using databases AMED, CINAHL, MEDLINE, SCOPUS, Web of Science, APA PsycInfo, and Health Business Elite. Search limits included English language from 2012 to 2023. Included publications were from academic and gray literature. Search terms used included the following: "Naturopath*" OR "Integrative medicine" AND "Health care system*" OR "Health system*" OR "Models of health care" OR "Professional autonomy" OR "Professional regulation" OR "Professional govern*" OR "Interprofessional practice (IPP)" OR "Multidisciplinary communication." The scoping review utilized Covidence software and was analyzed using thematic analysis. Themes were identified following Arksey and O'Malley's (2005) framework to inform a narrative approach. Results: Five themes emerged that relate to the inclusion of naturopaths in health care teams as follows: (1) perceptions of naturopathy, (2) practice standards, (3) legitimacy, (4) resources, and (5) shifting power dynamics and cooperation. Conclusions: Barriers for naturopathic inclusion into health care teams are influenced by perceptions of naturopathy, naturopathic education standards, regulations, research, and patient equity and access. Facilitators for inclusion include the growing shift toward person-centered care, greater interprofessional education, and shared assets, including colocation.

Choice of primary healthcare providers among population in urban areas of low- and middle-income countries—a protocol for systematic review of literature

IntroductionStrengthening and reforming the urban primary healthcare (PHC) system is essential to efficiently deliver need-based healthcare services to the rapidly increasing urban poor population. Such reforms of PHC system need to emphasize the opinion of patients in co-designing services in order that delivery of services can be accessed effectively by the urban population in a timely and low-cost way. Hence, it is important to identify the preference of urban population while choosing healthcare providers. The aim of this proposed protocol is to summarize a planned systematic review of existing evidence on the attributes considered for choosing PHC providers in urban settings of low- and middle-income countries (LMICs), as classified by the World Bank.Methods and analysesAn inclusive literature search will be conducted in electronic databases including Pubmed/MEDLINE, Embase, Global Health, Cochrane Library, Web of Science, and Scopus. Databases will be searched from the earliest date of entry until March 30, 2024. Database search will be supplemented by manual search of citations, reference lists, and grey literature sources. Following the pre-set inclusion and exclusion criterion, two researchers will independently screen all the retrieved studies in Covidence. Any discrepancies will be resolved through a discussion between two researchers, and if disagreements persist, a third reviewer will be consulted. The methodological quality of included studies will be appraised using checklist for Conjoint Analysis studies and the Mixed Methods Appraisal Tool (MMAT). An Excel-based data extraction table will be developed, piloted, and refined during the review process. Preference attributes will be identified and analyzed according to their types. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines.DiscussionThe identification of attributes, their influence on preference, and heterogeneity with socioeconomic characteristics of the population will help the policymakers and researchers to design targeted PHC interventions. Such evidence will be also useful to design choice experiment studies to quantify the preferred attributes of PHC providers in urban context of LMICs.Systematic review registrationPROSPERO CRD42023409720.

Culturally Tailored Lifestyle Intervention Improves Glycemic Control in a Newly Diagnosed Untreated Type 2 Diabetic Patient: A Case Report

Type 2 diabetes makes up about 90% of all diabetes cases and affects roughly 10% of adults worldwide, with a higher rate among non-Hispanic Black individuals than non-Hispanic White individuals. This case study presents a 45-year-old Black African female newly diagnosed with type 2 diabetes and referred from her primary healthcare provider with a fasting blood sugar (FBS) reading of 176.4 mg/dl, glycated hemoglobin (HbA1c) of 7.8%, weight of 91.5 kg, waist circumference of 97.8 cm, BMI of 35.1 kg/m2, waist-to-height ratio (WHtR) of 0.61, and positive family history. The patient had a three-month culturally tailored lifestyle intervention consisting of structured physical activity and healthy local Ghanaian whole foods, plant-based meals, and social intervention. This led to remission with a FBS of 88.2mg/dl, HbA1c of 5.5%, weight of 82 kg, BMI of 31.4 kg/m2, waist circumference 91.4 cm, and a WHtR of 0.57. Blood pressure measurements were normal throughout the three months. A culturally adapted lifestyle intervention was used to achieve remission of type 2 diabetes in the patient. This underscores the role of lifestyle intervention as a cost-effective means of managing type 2 diabetes with remission necessitating the need for its incorporation into routine care for diabetes in primary care clinics.

“They say it may cause cancer:” A Qualitative Exploration of Filipinos' Contraceptive Misconceptions and Primary Healthcare Interventions

Background and Objective. Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them. Methods. A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized. Results. Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month. Conclusion. Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.

Screening and referral programs for diabetes and cardiovascular disease: Can community pharmacists bridge the care gap?

Background and ObjectivesHeart disease and diabetes are leading causes of death in the U.S., with timely screening, referrals, and education being critical for effective treatment. The Community-based Valued-driven Care Initiative (CVCI) aimed to develop, implement, and evaluate the feasibility of delivering patient-centered care interventions for high priority disease states in community pharmacies. This article focuses specifically on two of the selected interventions, both of which were screening and referral (S&R) programs for the prevention and treatment of cardiovascular disease (CVD) and diabetes (DM) respectively. This exploratory evaluation was designed as an effectiveness-implementation hybrid Type II study. Its objectives were to assess both implementation and preliminary program effectiveness using mixed data. MethodsFifteen community pharmacies opted to implement one of the two programs over a 12-month period. Implementation feasibility involved examining program adoption rates by sites and patients; acceptability, appropriateness, feasibility, and intent to sustain use survey scores; and pharmacists' interviews. Program effectiveness was based on patient referral rates, physician follow-up communication rates, and perceived outcomes, collected via patient logs, surveys, and interviews. ResultsTwo of the 15 sites discontinued participation, yielding an 87 % adoption rate. Patient adoption varied based on contact and screening rates, due to differences in patient recruitment, staffing, and workflow. Pharmacist acceptability, compatibility, and feasibility remained high throughout implementation; however, only three pharmacy sites planned on continuing offering the programs. All at-risk patients were appropriately referred based on screening results, with 65 % having their screening results communicated to their primary healthcare providers. The programs were perceived as beneficial, increasing pharmacists' knowledge and motivation, enhancing relationships with patients, and producing an impact on patients'' health. DiscussionResults highlight the implementation feasibility and preliminary outcomes of delivering DM and CVD S&R programs in community pharmacies. However, despite these positive results, most pharmacies did not intend to continue the programs, underscoring the continued need for sustainable clinical services models in non-traditional settings. Success with broader implementation will require a paradigm shift in support of community pharmacists as clinical care extenders.

Culture, community, and cancer: understandings of breast cancer from a non-lived experience among women living in Soweto

BackgroundIndividual perceptions, socio-cultural beliefs and health system factors are key determinants of people’s health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: “how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?”, we qualitatively explored, individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting.MethodsUsing a deductive approach and allowing new themes to emerge inductively, we investigated phenomenologically, breast cancer perceptions among 34 women from Soweto, Johannesburg (aged 35–74 years) in 6 Focus Group Discussions. We then conducted 20 follow-up semi-structured in-depth interviews to explore novel themes and suggestions for increasing breast cancer screening.ResultsFindings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. Women only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake.ConclusionsHealth literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among women from Soweto. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working collaboratively. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilize breast cancer screening services.

Non-Pharmacological Spine Pain Management in Clinical Practice Guidelines: A Systematic Review Using AGREE II and AGREE-REX Tools

OBJECTIVE: To summarize the content and critically appraise the quality and applicability of recent clinical practice guidelines (CPGs) for non-pharmacological, non-surgical management of spine pain. DESIGN: Systematic review of CPGs. LITERATURE SEARCH: Six databases and seven guideline clearinghouses. STUDY SELECTION CRITERIA: Included de novo CPGs for non-pharmacological, non-surgical management of spine pain designed for any primary healthcare providers, published in English, Arabic, French, or traditional Chinese within the past 12 years. DATA SYNTHESIS: Five reviewers independently appraised the guidelines using AGREE II and AGREE REX. Inter-rater agreements were calculated for each domain and the total score of these tools using the intraclass correlation coefficient (ICC [2,1]) with absolute agreement. RESULTS: We included 30 CPGs, primarily (90%) developed in Western countries, which contained 404 recommendations. High-quality CPGs consistently recommended exercise therapy and multimodal care, encompassing a combination of exercises, mobilization/manipulation, education, alternative medicine, and cognitive-behavioral treatments. Generally, CPGs did not recommend assistive (e.g., coresets and orthosis) devices or electro/thermotherapies (e.g., therapeutic ultrasound, and transcutaneous electrical nerve stimulation). Approximately half of the CPGs demonstrated good methodological quality according to AGREE II, while the rest were of poor quality. On the AGREE-REX assessment, one-third of the recommendations were of excellent quality. CONCLUSION: Although recent guidelines frequently recommended exercise therapy and multimodal care for the management of spine pain, their recommendations often overlooked demographics and comorbidities. Despite methodological improvements, most CPGs lacked simple clinical applicability and considerations of knowledge users’ values.

A digital dashboard for reporting mental, neurological and substance use disorders in Nairobi, Kenya: Implementing an open source data technology for improving data capture.

The availability of quality and timely data for routine monitoring of mental, neurological and substance use (MNS) disorders is a challenge, particularly in Africa. We assessed the feasibility of using an open-source data science technology (R Shiny) to improve health data reporting in Nairobi City County, Kenya. Based on a previously used manual tool, in June 2022, we developed a digital online data capture and reporting tool using the open-source Kobo toolbox. Primary mental health care providers (nurses and physicians) working in primary healthcare facilities in Nairobi were trained to use the tool to report cases of MNS disorders diagnosed in their facilities in real-time. The digital tool covered MNS disorders listed in the World Health Organization's (WHO) Mental Health Gap Action Program Intervention Guide (mhGAP-IG). In the digital system, data were disaggregated as new or repeat visits. We linked the data to a live dynamic reproducible dashboard created using R Shiny, summarising the data in tables and figures. Between January and August 2023, 9064 cases of MNS disorders (4454 newly diagnosed, 4591 revisits and 19 referrals) were reported using the digital system compared to 5321 using the manual system in a similar period in 2022. Reporting in the digital system was real-time compared to the manual system, where reports were aggregated and submitted monthly. The system improved data quality by providing timely and complete reports. Open-source applications to report health data is feasible and acceptable to primary health care providers. The technology improved real-time data capture, reporting, and monitoring, providing invaluable information on the burden of MNS disorders and which services can be planned and used for advocacy. The fast and efficient system can be scaled up and integrated with national and sub-national health information systems to reduce manual data reporting and decrease the likelihood of errors and inconsistencies.

Navigating the Diagnostic and Management Challenges of Suspected Cardiac Amyloidosis in Resource-Limited Settings: Ethiopia Experience.

This report discusses the diagnostic and therapeutic complexities encountered in resource-limited environments when assessing patients suspected of cardiac amyloidosis (CA). The study describes a case involving a patient who initially presented with heart failure symptoms and eventually received a CA diagnosis after 13 months and four primary physician visits, primarily based on discrepancies observed between electrocardiographic and echocardiographic findings, alongside elevated cardiac troponin levels. The case underscores the limited awareness of CA among primary healthcare providers in Ethiopia, contributing to a higher likelihood of misdiagnosis and inappropriate treatment approaches. Additionally, the report discusses the specific challenges associated with diagnosing and managing CA patients. It advocates for essential resources such as heightened clinical suspicion, proficiency in recognizing the characteristic electrocardiogram (ECG) and echocardiographic indicators of CA, and prompt referral to cardiologists.

Effectiveness of specialist involvement in case discussion conferences with primary healthcare providers on the management of type 2 diabetes patients: a study protocol for a cluster randomized controlled trial

BackgroundIn supporting primary healthcare in delivering high-quality care for individuals with type 2 diabetes mellitus (T2DM), previous research emphasized strategies to facilitate communication and collaboration between primary healthcare providers and hospitals. This study aims to evaluate the effectiveness of case discussion conferences between specialists from hospitals and primary healthcare providers in China on the optimization of diabetes management and the improvement of patient health outcomes.MethodsThis study will be a parallel cluster randomized controlled trial in which primary healthcare institutions in Shouguang city and Shangsi County will be randomly allocated to the intervention and control groups. The intervention will involve regular case discussion conferences where attendants will meet to discuss complex cases with patients diagnosed with type 2 diabetes mellitus, exchange experiences, and seek and provide expert advice. Family doctor teams from primary healthcare institutions and specialists from secondary or tertiary hospitals will engage in these conferences. Data will be collected at baseline and at the 6- and 12-month follow-ups. The primary clinical outcome measures will focus on the changes in the HbA1c and FBG levels of patients under management. The secondary outcomes will include other physiological indicators, such as blood pressure, BMI, and cholesterol. The evaluation will extend to changes in the capabilities and behaviors of primary healthcare providers. Furthermore, the feasibility and adherence of this intervention will be thoroughly assessed.DiscussionThis study is designed to generate robust evidence on the effectiveness of case discussion conferences, an interprofessional collaboration strategy, in enhancing diabetes care delivery in primary healthcare, with the ultimate goal of improving patient health outcomes.Trial registrationChinese Clinical Trial Registry ChiCTR2300078829. Registered on December 19, 2023. https://www.chictr.org.cn/showproj.html?proj=210293

HPV vaccination in Croatia (2016-2023): Increased vaccine uptake and declining sex disparities

Abstract Background The Human papillomavirus (HPV) is a known cause of cervical cancer, and is associated with the development of vaginal, vulvar, anal, penile, and head and neck cancer. The availability of the HPV vaccine has enabled generations of young people to be protected from HPV-related cancers. In 2016, a national immunization program targeting 14-year-old girls and boys has been initiated in Croatia. To date, systematic data on HPV vaccination coverage (VC) in Croatia is lacking. This study aims to determine HPV VC, examine trends in HPV vaccination in Croatia from 2016 to 2023 in the context of the national vaccination program, and assess differences between sexes. Methods The study is designed as a retrospective analysis covering the data from 2016 to 2023, collected from primary healthcare providers. HPV VC within 2000-2008 birth cohorts (BC) are analyzed for all vaccinated with at least one dose and assessed by sex. The trend in HPV vaccination is shown using joinpoint regression. The chi-square for trend is used to compare the vaccination coverage of females (FVC) and males (MVC). The rate ratio between FVC and MVC is calculated. Results HPV VR increased significantly among observed BCs from 6,44 % in 2000 BC to 44,22 % in 2008 BC (FVC rose from 10,67 % to 52,78 %, and males MVC from 2,47 % to 36,05 %). Joinpoint analysis revealed a statistically significant increase in all birth cohorts, while the steeper increase is seen in 2000-2006 BCs (APC = 35,47, P &amp;lt; 0,05) than in 2006-2008 BCs (APC = 13,93, P &amp;lt; 0,05). FVC is significantly higher than MVC in all birth cohorts (Extended Mantel-Haenszel chi-square for linear trend = 809.23, P &amp;lt; 0,001). The highest FVC/MVC rate ratio was observed in the initial 2000 BC (4,31), and the lowest in the last 2008 BC (1,46). Conclusions In Croatia, HPV VC continuously increases among observed BCs. The positive trend is present in both sexes, and the rate ratio between female and male cohorts is decreasing. Key messages • The study presents a systematical overview of HPV vaccination coverage in Croatia from the beginning of the national immunization program, which is crucial for monitoring progress. • In the following years, if the revealed trends persist or advance, Croatia could be closer to reaching Europe’s Beating Cancer Plan concerning eliminating HPV-related diseases.

Strengthening the quality of primary healthcare services and interdisciplinary collaboration

Abstract Background Political organisations stress the need for preventive strategies to reduce the amount of avoidable hospital admissions, i.e. admissions that could have been avoided given timely and adequate care in the primary healthcare setting. Interdisciplinary collaboration has been suggested as a means to prevent hospitalizations, but effective implementation remains a challenge. Thus, there is a need for evidence-based strategies to prevent avoidable admissions and support interdisciplinary collaboration. The aim was to develop an evidence-based framework for preventive and coordinated interventions strengthening the quality of primary healthcare services and supporting interdisciplinary collaboration. Methods The project consists of three sub-studies: 1) a mixed methods systematic review following the JBI methodology; 2) a focus group study with primary healthcare providers in the Central Denmark Region, including general practitioners, physiotherapists, occupational therapists, home care providers, registered nurses and nurse specialists; and 3) a study using participatory design, where a framework for coordinated interventions were developed based on the results from study 1 and 2, supported by all stakeholders. Results Findings suggest that some hospitalizations can be prevented by intervening on mental factors, e.g., through trustful relations, and social factors, e.g., living situation. Also, a strong collaboration between healthcare providers from different disciplines and healthcare services is needed to improve the care pathway and prevent hospitalization. The collaboration may be strengthened if the health providers share a common language regarding the citizens’ health status. Conclusions Stakeholders at all levels should be informed about the relevance of considering mental, social and physical factors to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration. Key messages • By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some admissions. • Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration.

A canine onchocercosis report from the portuguese west region in 2024: implications for Public Health

Abstract Issue/problem Onchocerca lupi parasitosis, known as onchocercosis, affects dogs, sporadically cats and humans, posing a public health concern due to possible vectors in the environment. This neglected tropical disease(NTD), has no known human cases outside endemic areas. However, recent reports in non-endemic areas raise concerns about future implications. Climate change has increased the potential risk of disease vectors establishing themselves in previously unaffected areas. Description of the problem A case of canine onchocercosis in the West Region of Portugal, made the pet owner look for medical counselling. Primary health care providers contacted the Public Health Unit(PHU) for guidance and actions. There had been no previous reports in this region. In this case report, we explore the potential public health implications, through a one-health approach. Results History of the disease was collected, and travel history of the dog revealed that he had lived in the Algarve during 11 years with only a one-and-a-half-month travel to Italy in this period. Literature review revealed reports of previous cases of oncochercosis in the Iberian Peninsula. Collaboration between the PHU, research institutes, and veterinary authorities led to the assumption of probable transmission in the Algarve. Lessons Increased vector surveillance is needed, especially in areas associated with animal onchocercosis. Proactive measures reduce transmission risks, protecting both humans and animals. Tracking animal cases is vital for understanding regional environmental factors. PHU’s must conduct thorough risk evaluations and maintain assertive risk communication strategies to address public and pet owner concerns effectively. Adopting a One Health approach improves the understanding of the disease dynamics and enables targeted interventions. Key messages • NTD’s transmitted by vectors pose a potential future challenge. This report underscores the need for a One Health approach, with collaborative multidisciplinary efforts to address these challenges. • Furthermore, systematic interaction and reporting between human, animal, and environmental health authorities are crucial to ensure comprehensive surveillance and mitigation strategies.

Behavioral incentives on pay-for-performance schemes in primary health care: a scoping review

Abstract Background Incentivizing healthcare professionals through pay-for-performance (P4P) schemes has become an essential strategy to enhance healthcare quality and efficiency. In Portugal, a P4P framework was put in place in Primary Health Care (PHC). Understanding how these incentives influence healthcare delivery is crucial for optimizing P4P effectiveness. Objectives This scoping review aims to compare the impacts of intrinsic and extrinsic incentives of P4P schemes within PHC teams. Methods We are conducting a comprehensive scoping review following the PRISMA-ScR guidelines. The databases PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO are being searched to identify experimental and quasi-experimental studies. Eligible studies focused on PHC providers organized in teams, examining the role of intrinsic and extrinsic incentives under both public and private healthcare settings. Results Preliminary findings include a Dutch study demonstrating significant improvements in adherence to prescribing guidelines through electronic health records based P4P indicator. In Ethiopia, performance-based non-financial incentives led to enhanced data quality and evidence utilization among health workers. Conversely, a study from Burkina Faso highlighted mixed results in antenatal care quality improvement despite incentive implementation. In Scotland, studies on the removal of financial incentives indicated potential declines in certain quality care metrics, suggesting the complexities involved in the direct and indirect effects of incentive withdrawal. Conclusions The preliminary evidence indicates that both intrinsic and extrinsic incentives can significantly impact the effectiveness of P4P schemes, though the nature and magnitude of these impacts vary considerably. The findings underscore the necessity of a nuanced approach to designing and implementing incentive mechanisms in PHC to foster sustainable improvements in healthcare quality. Key messages • Intrinsic and extrinsic incentives significantly influence P4P scheme effectiveness in PHC. • Designing P4P incentives requires nuanced consideration of varying impacts on healthcare quality.

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.