Quality Of Primary Health Care Research Articles

Analysing the preferences for family doctor contract services in rural China: a study using a discrete choice experiment

BackgroundPreliminary evaluations have found that family doctor contract services (FDCSs) have significantly controlled medical expenses, better managed chronic diseases, and increased patient satisfaction and service compliance. In 2016, China proposed the establishment of a family doctor system to carry out contract services, but studies have found the uptake and utilization of these services to be limited. This study aimed to investigate rural residents’ preferences for FDCSs from the perspective of the Chinese public.MethodsA discrete choice experiment (DCE) was performed to elicit the preferences for FDCSs among rural residents in China. Attributes and levels were established based on a literature review and qualitative methods. Five attributes, i.e., cost, medicine availability, the reimbursement rate, family doctor competence, and family doctor attitude, were evaluated using a mixed logit model.ResultsA total of 609 residents were included in the main DCE analysis. The respondents valued the high competence (coefficient 2.44, [SE 0.13]) and the good attitude (coefficient 1.42, [SE 0.09]) of family doctors the most. Cost was negatively valued (coefficient − 0.01, [SE 0.01]), as expected. Preference heterogeneity analysis was conducted after adjusting the interaction terms, and we found that rural residents with higher educational attainment prefer a good attitude more than their counterparts with lower educational attainment. The estimated willingness to pay (WTP) for “high” relative to “low” competence was 441.13 RMB/year, and the WTP for a provider with a “good” attitude relative to a “poor” attitude was 255.77 RMB/year.ConclusionThe present study suggests that strengthening and improving the quality of primary health care, including the competence and attitudes of family doctors, should be prioritized to increase the uptake of FDCSs. The contract service package, including the annual cost, the insurance reimbursement rate and individualized services, should be redesigned to be congruent with residents having different health statuses and their stated preferences.

Patient enablement after a consultation with a general practitioner-Explaining variation between countries, practices and patients.

BackgroundPatient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking.ObjectiveTo explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement.DesignWe constructed multi‐level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated.Setting and ParticipantsA total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data.ResultsIn the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient‐level and only a few practice‐level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health‐care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported.Discussion and ConclusionsThere are large differences in patient enablement between GPs and countries. Patient characteristics and patients’ perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient‐reported measures as an indicator of health‐care system performance, researchers should be aware of the influence of cultural elements.

Challenges to Quality Primary Health Care in Saudi Arabia and Potential Improvements Implemented by Other Systems: Systematic Review

INTRODUCTION: As primary healthcare centres play an important role in implementing Saudi Arabia’s health strategy, this paper offers a review of publications on the quality of the country’s primary health care. With the aim of deciding on solutions for improvement, it provides an overview of healthcare quality in this context and indicates barriers to quality. 
 
 METHOD: Using two databases, ProQuest and Scopus, data extracted from published articles were systematically analysed for determining the care quality in Saudi primary health centres and obstacles to achieving higher quality.
 
 RESULTS: Twenty-six articles met the criteria for inclusion in this review. The components of healthcare quality were examined in terms of the access to and effectiveness of interpersonal and clinical care. Good access and effective care were identified in such areas as maternal health care and the control of epidemic diseases, whereas poor access and effectiveness of care were shown for chronic disease management programmes, referral patterns (in terms of referral letters and feedback reports), health education and interpersonal care (in terms of language barriers). Several factors were identified as barriers to high-quality care. These included problems with evidence-based practice implementation, professional development, the use of referrals to secondary care and organisational culture. Successful improvements have been implemented by other systems, such as mobile medical units, electronic referrals, online translation tools and mobile devices and their applications; these can be implemented in Saudi Arabia for improving the quality of the primary healthcare system in this country.
 
 CONCLUSION: The quality of primary health care in Saudi Arabia varies among the different services. To improve quality, management programmes and organisational culture must be promoted in primary health care. Professional development strategies are also needed for improving the skills and knowledge of healthcare professionals. Potential improvements can be implemented to improve the quality of the primary health system.

Quality Management System: Quality of Education, Science and Clinical Practice in Primary Care, Legislative and Regulatory Framework (Distance Learning Lecture)

The article presents modern data on the development of primary health care (PHC) and approaches to managing its quality, conceptі of quality, model of quality by A. Donabedian and WHO, the quality of structure, process and result of PHC, approaches to monitoring and improving quality. The regulatory framework and the results of reforming the PHC inUkraineare given, its impact on the quality of the PHC.The aim: is to provide basic concepts of quality of medical care and to explain the changes of quality of medical care in the process of reforming the healthcare system inUkraine.Materials and methods. A systematic review of the literature and legal documents, own experience and observations.Results. According to the WHO definition, primary health care is a providing treatment and prevention services at the local community level, usually by family doctors, patronage nurses, staff at local outpatient facilities, or other medical personnel. In the Astana Declaration of 2018, all countries of the world pledged to direct efforts and public investments to improve the quality of education, science and clinical practice of primary health care in order to ensure that all patients have access to the highest possible level of health. The creation of quality management systems for medical care is one of the priority areas of health care reform and determines both current and strategic prospects for the activities of any medical organization. According to the concept of A. Donabedian and WHO, quality is a multidimensional concept that consists of many components – safety, effectiveness, timeliness/optimality, efficiency/economy, fairness/equality, patient-orientation. In addition, quality is divided into three main components – the quality of the structure, process and result. The quality of the structure is the organizational aspects of the PHC – human and material and technical resources, legal support. The quality of the process is actually medical care itself, the implementation of diagnostic procedures in accordance with protocols and standards. The quality of the result – these are indicators that indicate what happens to the patient in the process of providing PHC. Monitoring the quality of PHC is carried out using indicators that can be developed and approved at the state or local levels. Quality improvement is described by the Deming Plan-Do-Check-Act cycle. When describing these concepts, legal documents on reforming the PHC inUkraine, international directives and a description of the impact of their implementation on the quality of the PHC inUkraine are indicated.Conclusion. Taking into account the reformation of the Ukrainian healthcare system, the recommendations of the world community and the transition to market relations, general practitioners – family doctors need to learn an additional skill in managing the quality of medical care.

PROGRAMA NACIONAL DE MELHORIA DO ACESSO E DA QUALIDADE DA ATENÇÃO BÁSICA: VISÃO DE ENFERMEIROS

Objetivo: compreender os reflexos da implementação do Programa Nacional de Melhoria doAcesso e da Qualidade da Atenção Básica no processo de trabalho de equipes da Estratégia Saúdeda Família, a partir da visão de enfermeiros.Método: pesquisa qualitativa, descritiva e exploratória, desenvolvida com nove enfermeiros nointerior do Rio Grande do Sul. As entrevistas foram realizadas entre janeiro e abril de 2017 esubmetidas à análise temática.Resultados: os padrões de qualidade requeridos pelo Programa contribuem para a superação daslacunas da organização e assistência dos serviços de saúde. A pactuação de metas e indicadoresincitam a mobilização dos atores envolvidos, intermediando ações, manejos e recursos, suprindoas necessidades das equipes.Conclusão: a implementação do Programa nas equipes trouxe melhorias no acesso e na qualidadeno contexto estrutural, equipamentos e insumos, refletindo diretamente no processo de trabalhodas equipes.

Patient evaluations of asthma counselling quality in primary health care \u2014 a cross-sectional survey

BackgroundHealthcare staff have a key role in counselling patients. This study describes asthma patients’ evaluations of primary care counselling quality.MethodsThe research applied a cross-sectional study design, with data collected from adult asthma patients (n = 73). Data were analysed by descriptive statistics.ResultsMost of participating patients were women (73%) and over 60 years old (67%). The patients were generally satisfied with the counselling. Subjection to an asthma test (p = 0.009) and smoking (p = 0.019) were found to significantly positively affect patient perceptions of counselling quality. The patients also felt that support services should be covered more (74%). Patients with comprehensive education (p = 0.039) and smokers (p = 0.015) were more likely to be satisfied with the counselling than other patients. Counselling was client-oriented (53%) and most patients reported experiencing positive interactions (92%). Most patients agreed that counselling benefitted adherence to self-care (75%) and health promotion (67%). Moreover, almost all of the patients were satisfied with the staff members’ knowledge and skills (97%). Subjection to an asthma test (p = 0.043), age (p = 0.030), smoking (p = 0.014), and duration of illness (p = 0.002) influenced satisfaction with counselling resources.ConclusionThe results indicate that counselling benefits asthma patients. Performing an asthma test, as well as considering smoking habits and educational level, can improve patient perceptions of counselling.

Universal coverage challenges: Determinants of enrolment in family-based social health insurance

ABSTRACT Background: With the aim of achieving universal coverage, the Family-based health insurance was introduced for informal sector workers and their families in Vietnam in 2015. Objective: The objective of the study is to identify the factors influencing enrolment in Family-based health insurance. Methods: Data were collected from a cross-sectional in-house survey in Soc Son district from April to June 2016. A total of 469 household heads were interviewed with information on 2,071 residents. A logistic regression model was used to estimate the probability of uptake in Family-based health insurance in relation to socio-economic factors. Results: The results indicate a low coverage of Family-based health insurance schemes (16.6%) compared with relatively high rates of willingness to join (71.9%). The significant influential factors were: knowledge of health insurance; historical use of health services; and place of residence. Conclusion: To increase the Family-based health insurance enrolment it is necessary of strengthening communication and education about health insurance scheme at the local level and improvement of the quality of primary health care.

Reasons for encounter in primary health care in Brazil.

Primary health care (PHC) delivery in Brazil has improved in the last decades. However, it remains unknown whether the Family Health Strategy teams are meeting the health needs of the population. To describe the reasons for encounter (RFEs) in PHC in Brazil and to examine variations in RFEs according to sex, age and geographic region. This descriptive study is part of a national cross-sectional study conducted in 2016. The sample was stratified by the number of PHC physicians per geographic region. Physicians who had been working for at least 1 year in the same PHC unit were included. For every participating physician, 12 patients aged ≥18 years who had attended at least two encounters were included. Patients were asked about their RFEs, which were classified according to the International Classification of Primary Care. In 6160 encounters, a total of 8046 RFEs were coded. Seven reasons accounted for 50% of all RFEs. There was a high frequency of codes related to test results, medication renewal and preventive medicine. RFEs did not vary significantly by sex or geographic region, but they did by age group (P < 0.001). The rates of prescriptions, requests for investigations and referrals to specialized care were 71.1%, 42.8%, and 21.3%, respectively. This novel study opened the 'black box' of RFEs in PHC in Brazil. These findings can contribute to redefining the scope of PHC services and reorienting work practices in order to improve the quality of PHC in Brazil.

The Health Access Initiative: A Training and Technical Assistance Program to Improve Health Care for Sexual and Gender Minority Youth

PurposeThis article describes the Health Access Initiative (HAI), an intervention to improve the general and sexual health care experiences of sexual and gender minority youth (SGMY) by providing training and technical assistance to providers and staff. The training consisted of an online and in-person training, followed by site-specific technical assistance. We present the findings of a pilot evaluation of the program with 10 diverse clinics in Michigan. MethodsThis program was developed using community-based participatory research principles. Based on a framework of cultural humility, program activities are guided by the Situated Information–Motivation–Behavioral Skills Model. The mixed method program evaluation used training feedback surveys assessing program feasibility, acceptability, and effectiveness; pre/post surveys assessing knowledge, attitudes, and practices toward SGMY; and in-depth interviews with site liaisons assessing technical assistance and structural change. ResultsThe HAI is a highly feasible and acceptable intervention for providers and staff at a variety of health care sites serving adolescents and emerging adults. The results from 10 clinics that participated in the HAI indicate strong intervention efficacy, with significant and meaningful improvements seen in the knowledge of, attitudes toward, and practices with SGMY reported by providers and staff at 6-month follow-up compared with baseline, as well as in qualitative interviews with site liaisons. ConclusionsThe HAI is a promising intervention to improve the quality of primary and sexual health care provided to SGMY. Expanded implementation with continued evaluation is recommended. The HAI may also be adapted to address specific health needs of SGMY beyond sexual health.

Progress of equalizing basic public health services in Southwest China--- health education delivery in primary healthcare sectors

BackgroundEqualizing basic public health services (BPHS) for all has been one goal of the health system reform in China since 2009. At the end of the 12th five-year plan, we conducted a series of surveys to understand BPHS implementation in Southwest China, and firstly reported implementation of health education (HE) and explore the barriers to HE delivery.MethodsMixed research methods were used to investigate achievement in and barriers to HE in Southwest China. SPSS 22.0 was used for data analysis.ResultsNine hundred and eighty-nine residents were surveyed by questionnaire. 16 health care workers (HCWs) and 16 directors from 16 PHC sectors were included in the in-depth interviews. Less than 50% of residents who knew or utilized some item of HE. Age, residence, region (Chongqing or Guizhou), marital status, education, occupation, type and quality of primary health care (PHC) sectors to deliver BPHS, self-reported health and status of chronic diseases were associated with knowledge or utilization of HE. Distance to PHC sectors was associated with the knowledge of HE, gender and health insurance were associated with utilization of HE. Age, marital status, occupation region and self-reported health were associated with satisfaction regarding HE. Barriers to HE delivery included defects in HE design, weak capacity in PHC sectors to provide HE, residents’ poor cooperation, lack of multi-sector cooperation, poor equipment and weak health system.ConclusionsSouthwest China delivered HE in all PHC sectors. However, our study underlined many barriers to equalization of HE. To address those barriers and achieve HE quality improvement, comprehensive measures to improve capacity of PHC sectors, enhance multi-sector cooperation and strengthen health information systems are all urgent needs.

The Role of Organizational Factors and Human Resources in the Provision of Dental Prosthesis in Primary Dental Care in Brazil.

This study aimed to investigate factors associated with dental prosthesis procedures by oral health teams (OHTs) in the Brazilian primary health care in 2013–2014, who participated in the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB). This is an analytical cross-sectional study using a questionnaire with dichotomous questions applied in 18,114 OHTs. The dependent variable studied was making any type of prosthesis (removable or fixed). Independent variables involved issues related to human resources and health service management. Data were submitted to simple and multiple binary logistic regression with odds ratio calculation, 95% confidence intervals, and p-values. Most OHTs (57%) do not perform any dental prosthesis. The teams that are more likely to perform dental prostheses have human resources-related characteristics, such as professionals admitted through public examinations (OR 1.25, 95% CI 1.14–1.36) and those involved in permanent education (OR 1.13, 95% CI 1.02–1.26). Moreover, OHTs with a more organized work process and that receive more significant support from municipal management are more likely to perform dental prostheses (p < 0.05). The oral health teams which tended to provide the most dental prostheses to benefit patients were; hired as civil servants, had a municipal career plan, involved all members of the oral health team, and trained undergraduate dental students from outreach programs. Better organizational support and improved work incentives may be needed to get the majority of oral health teams to start providing dental prostheses to their patients.

LEGAL PRINCIPLES OF RURAL MEDICINE DEVELOPMENT IN THE CONTEXT OF MEDICAL REFORM IN UKRAINE

Legal support for the constitutional right of citizens to health care and medical care is an important condition for the realization of the principle of recognition the individual on the highest social value. The state guarantees everyone the right to protection of health, medical care and medical insurance; creates the conditions for effective and affordable medical care for all citizens. At the same time, the low level of provision of modern medical equipment, machinery and medicines makes it virtually impossible to provide timely and high-quality medical services in rural areas. The quality of primary health care in rural areas is in terrible condition and the people who live there, and this is more than 30 % of the total population of Ukraine, were very looking forward to changes in this area. After all, most of the old buildings and medical equipment are in poor condition. Medical institutions do not have a complete set of equipment, medical supplies and equipment necessary for primary care. The state of the legal regulation of providing medical care to the rural population of Ukraine objectively needs to be improved. Despite the adoption of numerous normative legal acts, the issues of providing health facilities located in rural areas with the necessary modern equipment and technology remained unresolved until recently. The goal of the article is to investigate the current problems of the legal support for providing medical care in the rural settlements. Particular attention is paid to the reform of the network of the rural health facilities and the problems of staffing. According to the results of the study it is established that from January 1, 2018, the implementation of the rural health reform began in Ukraine. This was due to the need to improve the availability of medical services for the population living in rural areas, to increase the efficiency and effectiveness of the use of funds allocated for the development of health care in the village, to bring the network of healthcare institutions in rural areas and their material and technical support into line with the needs of the population. Rural medicine reform is the lengthy process that requires not only careful adherence to legislation, but also a preliminary assessment of the real state of medicine in the remotest corners of Ukraine in order to prepare a platform for change. It is determined that the implementation of medical reform in cities is perceived better, and therefore much faster is happening, what not to say about the countryside. The prompt and timely solution of the problems of reforming rural medicine is possible with the assistance of the state authorities and local self-government, domestic businesses, foreign investors and financial donors, without which it is extremely difficult to cope with decentralization.

Analysis of satisfaction with the accessibility and quality of primary health care for patients with pathology of lower limb arteries

Aim. To study the opinion of the population about satisfaction with the accessibility and quality of primary health care for diseases of the arteries of the lower extremities in institutions of the Sverdlovsk region, as well as to identify problems in the organization of its provision.&#x0D; Methods. From January to June 2019, an anonymous survey of 384 patients with diseases of the arteries of the lower extremities who applied for a consultative appointment with a cardiovascular surgeon at the clinic of the Sverdlovsk Regional Clinical Hospital No. 1 was carried out. A representative sample was determined by formulae, in which, out of the general population the number of registered cases of arterial disease of the lower limbs in the Sverdlovsk region, was acceptable. The survey involved 301 (78.4%) men and 83 (21.6%) women.&#x0D; Results. More than 90% of respondents were over 50 years old. More than 35% of respondents expected a referral for a consultation with a specialist later than 1 month away. The accessibility and timeliness of obtaining specialized medical care were influenced by the geographical remoteness from the regional center. The presence of queues in outpatient clinics at the place of residence, the difficulty in obtaining a coupon for an appointment with a doctor, the inaccessibility of free research, as well as the inconvenient work schedule of specialist doctors were the main reasons for not obtaining medical care. When examined in the clinic at the place of residence, more than half of the respondents used their own money. Just over a third of patients (35.2%) thought that the level of medical care has improved over the past decade, 19.5% thought that it had become worse, 16.4% that it had not changed, and 28.9% found it difficult to answer. About half of the respondents (48.8%) were satisfied with the result of the medical care provided, 11.2% were not satisfied, and 40% of the patients found it difficult to answer.&#x0D; Conclusion. The shortcomings identified in the organization of outpatient care in medical institutions of the Sverdlovsk region indicate the need to improve primary health care for patients with lower limb arterial disease. Such improvements will achieve the goals and objectives of the National Healthcare project through the development of telemedicine technologies and the development of organizational and functional patient routing models, standard operating procedures for examining more patients with cardiovascular pathology by primary care physicians, and their active introduction into public health practice.

Structure for the work and composition of Family Health Support Unit teams: national survey - Program for Improving Primary Health Care Access and Quality (PMAQ), 2013.

to describe the structure of Family Health Support Unit (FHSU) teams with regard to physical space, training received, continuing education and professionals that support Primary Health Care (PHC) teams in Brazil, in 2013. this is a descriptive study using data from the external evaluation stage of the Program for Improving Primary Health Care Access and Quality (PMAQ). the 1,773 FHSU teams mainly used shared clinics at primary health care centers (85.7%); 63.4% of professionals were offered specific training when they started work at their FHSU, while 67.4% were offered continuing education; the teams received support mainly from physiotherapists (87.4%) and Physical Education professionals (87,0%). the structure available for FHSU teams is in accordance with the guidelines; some FHSU professionals have not received any specific training for the job.

No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali: an interrupted time series analysis.

Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the implementation and subsequent withdrawal of the PBF pilot programme in the Koulikoro region of Mali on a range of relevant maternal and child health indicators targeted by the programme. We relied on a control interrupted time series design to examine the trend in maternal and child health service utilization rates prior to the PBF intervention, during its implementation and after its withdrawal in 26 intervention health centres. The results for these 26 intervention centres were compared with those for 95 control health centres, with an observation window that covered 27 quarters. Using a mixed-effects negative binomial model combined with a linear spline regression model and covariates adjustment, we found that neither the introduction nor the withdrawal of the pilot PBF programme bore a significant impact in the trend of maternal and child health service use indicators in the Koulikoro region of Mali. The absence of significant effects in the health facilities could be explained by the context, by the weaknesses in the intervention design and by the causal hypothesis and implementation. Further inquiry is required in order to provide policymakers and practitioners with vital information about the lack of effects detected by our quantitative analysis.

Maternal Near Miss Obstetric Events In A Tertiary Care Hospital

Background: Maternal death in pregnancy may not reflect the scale of acute morbidities associated with pregnancy and childbirth. Studying cases of women who survived a severe complication in pregnancy, childbirth on the post partum period (Maternal near miss) is increasingly being recognized as potentially more useful then studying maternal mortality in terms of assessing healthcare needs. To determine the causes of maternal near miss. Maternal Near Miss incidence ratio. Maternal near miss to mortality ratio and mortality index.&#x0D; Materials and methods : A prospective cross sectional study was performed from January 2015- December 2015 at a tertiary care hospital in Chattogram. All women admitted to study facilities with pregnancy related complications or for birth. An adopted version of the WHO Maternal Near Miss Screening Tools was used to identify Maternal Near Miss cases. Incidence of maternal near miss, Maternal Near Miss to maternal mortality ratio and causes of and factors associated with Maternal Near Miss.&#x0D; Results : There were 3089 deliveries, 90 near miss cases during the study period. The maternal near miss incidence ratio was 31.4/1000 live births, maternal near miss to mortality ratio was 5:1 and mortality index was 16.7%. Eclampsia (35.6%) was the leading causes of near miss, followed by haemorrhage (23.3%) and ruptured uterus (11.1%).&#x0D; Conclusion : The Near Miss rate was high. Contributing factors were lack of resources, low quality of primary health care and delays in care. All Near Miss should be accepted as opportunities to improve the quality of maternity care. Health sector should address delays in conducting intervention, referral barriers and fully equipped intensive care units must be created in all facilities.&#x0D; JCMCTA 2019 ; 30 (2) : 32-35

Quality and availability of information in primary healthcare: the patient perspective

Objective: To explore lived experiences of patients communicating with and receiving information from primary health care.Design: Qualitative study analysing transcribed interviews by descriptive content analysis.Setting: Recruitment and interviews took place in southern Sweden in three primary care centres where privacy and undisturbed interview environments was ensured.Subjects: 17 primary care patient informants, 9 men and 8 women aged 31 – 84 years with varying educational levels from primary school to post graduates.Main outcome measures: Thematic categories and subcategories reporting the lived experience of the patients.Results: The analysis yielded three categories and identified as a main theme a feeling of unpredictability based on the emotional aspects of feeling lost and vulnerable when trying to access primary care. The category” Need for easy access” illustrated emotional aspects of importance to patients when contacting primary health care.” Need for individual adaptation” described the need to individually adapt health related information.” Information exchange” comprised experiences of information evaluation and understanding new information.Conclusions: Patients generally trusted the information received, but experienced a lack of communication, which evoked feelings of unpredictability and abandonment. Experiences of limited access to primary health care and the need for varying degrees of adaptation on the part of the individual were factors of concern for how patients experienced the care.Key PointsSmooth communication and understandable information are fundamental for quality primary health care. This qualitative interview study identified the following key points from analysing the views of 17 patients:• Patients indicated a feeling of unpredictability due to lack of access to and communication with health professionals.• Patients sometimes reported an inability to understand information conveyed by health professionals.• Being able to form relationships with health professionals was crucial for patients’ trust and understanding.

The impact of primary healthcare and the reduction of primary health care-sensitive hospital admissions

This study aimed to analyze the association between quality of primary healthcare (PHC) in Brazilian municipalities (counties) and the number of hospitalizations due to primary healthcare-sensitive conditions. This was an ecological study with analysis of nationwide secondary data. The quality of the number of hospitalizations due to primary healthcare-sensitive conditions was based on assessment of the National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). The analysis used a hierarchical explanatory model, with the number of the number of hospitalizations due to primary healthcare-sensitive conditions hospitalizations in the year 2014 as the dependent variable and sociodemographic and health system data as the independent variables. The measure of association between the number of hospitalizations and quality of PHC was calculated with negative binomial regression with robust variance and the total population as offset, with significance set at 20% in the univariate analysis and 5% in the multivariate analysis. The mean number of hospitalizations due to primary healthcare-sensitive conditions admissions during the target period was 359.97 hospitalizations per municipality. The quality of PHC showed a negative association with the number of hospitalizations due to primary healthcare-sensitive conditions admissions. Municipalities with lower quality of PHC (quartile 1) showed 21.2% more number of hospitalizations due to primary healthcare-sensitive conditions admissions than municipalities with higher quality (95%CI: 1.09-1.34). The results showed that quality of PHC in Brazil reduced hospitalizations due to primary healthcare-sensitive conditions, even in contexts of social vulnerability.

The quality of primary care services, vocational training and the More Doctors Program in a health region of southwest Goiás.

Primary health care must assume the centrality of care so that health systems address and solve the health needs of the population. To evaluate the quality of primary health care from the perspective of health professionals, including those associated with the Mais Médicos Brasil Program, verifying associations between quality of services and professional qualification. A cross-sectional study where interviews with health professionals were carried out. The quality of care was measured by means of interviews about the experience of doctors and nurses with the services, using the Primary Care Assessment Tool (PCATool-Brasil). The presence and the extension of the primary health care attributes of the Southwest II region of Goiás state, constituted by 10 municipalities, were investigated. The lowest APS Overall Score was for the first contact access attribute (3.71). The bivariate analysis showed statistical difference between the variables profession and the essential, derived and general scores. Doctors of the More Doctors Program had higher average scores (7,68 essential; 9,11 derivative; 8,04 general) when compared to other medical professionals and nurses. The findings highlight the importance of permanent evaluation of health services, especially primary care, due to its importance and centrality to the organization of other levels of care. Only from this monitoring is possible a better management orientation for strategic and resolutive investments.

Care coordination and longitudinality in primary health care in the Brazilian Amazon.

to evaluate the attributes of primary health care, care coordination and longitudinality, from the perception of the professional and patients in the state of Amazonas, Brazil. quantitative evaluative study, in which was used an external evaluation instrument with 469 professionals and 1,888 patients from 367 primary health care facilities that adhered to the Program for Improving Access and Quality of primary health care (Portuguese acronym: PMAQ) standardized by the Ministry of Health. Data were grouped by multivariate cluster analysis in order to find a classification of primary health care from the perspective of professionals and patients. the attributes of coordination and longitudinality are still expressed in a weak and undeveloped way in the Brazilian Amazon scenario. it is necessary to recognize the organizational barriers and what could promote conditions for the performance of health care teams in the perspective of a continuous, integral and coordinated care.