Primary Health Care Services Research Articles

Organizational health literacy responsiveness in community pharmacies in Serbia

Abstract Background The Faculty of Pharmacy at the University of Belgrade conducted a pilot study at community pharmacies in Serbia in 2023 in the framework of the M-POHL organizational health literacy (OHL) project. Community pharmacies in Serbia are considered relevant settings where people’s health can be promoted within the organization. Methods The validated and culturally adopted Serbian version of the International Self-Assessment Tool for Organizational Health Literacy in Primary Health Care Services (OHL-PHC) was used. We recruited employees from 3 pharmacy chains with pharmacists from different units. A preparatory workshop was organized to explain the procedure and the concept of OHL. First, the self-assessment was performed in a small group of 5 persons individually, and then the results were discussed in a joint assessment. The self-assessment was based on the degree of fulfillment of 4 categories offered for each indicator: not fulfilled (0-25%), predominantly not fulfilled (26-50%), predominantly fulfilled (51-75%), and completely fulfilled (76-100%). The same scale was applied for the indicators, sub-standards and standards and the final score was the mean of the individual scores (min. 0, max. 4). Results The overall score of the OHL on the sample level was 1.93±0.86, with the highest score for providing of easy access to primary care service and facilitating navigation (2.3±0.5). The least fulfilled standards were related to promotion of digital health literacy and promoting health literacy with the same score values of 1.7±1.0. Out of 69 indicators 1 had been self-assessed as not fulfilled and 15 reached low consensus (SD ≤ 1), and needed to be discussed further. Conclusions Improvements in OHL in the piloted institutions are necessary for successful healthcare and health promotion and could be tailed in further usage of the OHL-PHC on a broader scope. More pilot studies are needed in other healthcare settings at primary level in Serbia.

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.

Indicators of primary health care workforce equity for attaining health equity

Abstract Background Healthcare workforce crises are often the result of inequities faced by healthcare workers. This study aims to discuss the primary policy questions related to health equity regarding the primary healthcare (PHC) workforce indicators. Methods Following the purposive review of published literature on HWF equity in PHC services, we applied an intersectional analysis of the compendiums of HWF indicators (e.g., supply, flows, skill mix, working conditions, promotion, training, funding, governance, etc.) to strategically link them to PHC policy issues for health equity and categorized qualitatively under each policy pillar against HWF crises. Results The proposed indicators address the measurement of multiple dimensions of health workforce equity. These include financial and non-financial incentives to monitor worker attrition reduction, gender pay gap, fairness in employment arrangements, remuneration, and working conditions. By monitoring the minimum wage for financially vulnerable health workforce groups, we can identify the need for potential increases to support well-being, reduce turnover, and increase productivity. Equally important is monitoring equity in health workforce education, planning, and management, which is crucial for achieving population health equity. By implementing indicators of health workforce diversity to address rural and underrepresented communities, primary healthcare managers can effectively plan the reduction of their unmet needs and minimize avoidable referrals. Conclusions To ensure equitable access to primary healthcare, we must measure workforce equity and its impact on population health. Monitoring the indicators of equitable health workforce policies and evaluating the improvement in retention and recruitment processes can more effectively address workforce crises. Key messages • Health workforce crises often stem from healthcare workforce inequities. • Health workforce equitable policies require a clear set of indicators.

Assessing primary healthcare quality through avoidable hospitalizations: a systematic review

Abstract Background Avoidable hospitalization (AH) for ambulatory care sensitive conditions (ACSC) has been widely used as a measure of the performance of primary health care. However, the lack of a standardized definition of these conditions and the absence of conclusive evidence regarding their efficacy across diverse healthcare settings remain significant challenges. This review aims to systematically identify and synthesize the utilization of AH for ACSCs as a metric for evaluating the quality of primary healthcare (PHC) and factors influencing such quality. Methods We conducted a systematic search for peer-reviewed studies on 3 electronic databases. Studies that used AH for ACSCs to investigate the quality of PHC were included. The following characteristics were extracted: study design, ACSCs definition, AH rates, intervention if applicable, PHC and or patients’ characteristics associated to AH rates, such as accessibility, continuity of care, demographics, socio-economic status, and comorbidities. Results 73 relevant articles were identified, published between 1994 and 2023 and mostly in USA. Preliminary findings based on 56 articles indicate that the majority (48.2%) employed the list of ACSCs from the AHRQ (i.e. the prevention quality indicators) (48.2%). Meanwhile, 12 studies (17.9%) used lists developed or modified by the authors, and another 7 (12.5%) adopted lists previously utilized in other research. Studies conducted in Brazil, Canada and USA employed lists issued by relevant national institutions. Conclusions Although preliminary, these findings highlight two main trends. Firstly, in countries where health authorities have established a standardized set of ACSCs, a notable uniformity is observed. Conversely, in the absence of such standards, variability in defining these conditions is likely to increase. This variation could hinder the comparability across different Primary Health Care (PHC) service organizations and affect the analysis of care quality. Key messages • Most studies used established indicators for the measuring of primary healthcare quality. • Diverse ACSC definitions across countries impair the generalizability of healthcare quality analysis.

Policies and programs on children’s health promotion in the EU in the context of the JA Health4EUKids

Abstract Background Overweight and obesity prevalence are a global public health challenge. The prevalence is rapidly increasing, with significant health risks such as cardiovascular disease, type 2 diabetes, and cancer. Objectives To describe the state of the art of policies and programs (PPs) on children’s health promotion and responsive parenthood (children 0-12 years) in the EU, and to identify their gaps. Methods A cross-sectional study was carried out through an online survey, as part of the Health4EUKids Joint Action (JA) (HADEA n.101082462), between October and December 2023, targeting all EU member states (MSs) involved. Results The survey collected information about 74 PPs from 11 EU MSs of the JA. The PPs are primarily focused on healthcare (62.1%), education (24.1%), and social sectors (10.3%), with a focus on children aged 6-11 years. The settings for PPs include primary schools, communities, secondary schools, and healthcare services. The PPs are characterized by different degrees of innovation, controversy, equity, transferability, and sustainability, although the structural or systemic impact and public visibility appear to be lower among other characteristics. The formulation and design of PPs include problem analysis (73%), based on national or local data and on stakeholder consultation. As for implementation, most PPs are implemented upon release, but recommended action and allocated human resources are not fully adequate. Regular monitoring and evaluation (47.3%) are based on defined outcomes, standards, and indicators (63.5%). The results are disseminated to decision-makers and stakeholders (37.8%), through media, and to the general population (32.4%). Conclusions Most PPs are variable and context-dependent. It is necessary to align the policies with the implementation, in all its aspects, and to strengthen monitoring, evaluation, and communication with the relevant stakeholders, which currently appear to be the most lacking aspects. Key messages • Most European policies and programs are context-dependent, mainly in healthcare. Yet, a cross-sectoral trend involving health, education, and social sectors emerges. • The study stresses the need for better alignment between policy formulation and implementation to enhance the effectiveness of EU children’s health programs.

Ready to act? Factors associated with nurses’ desire to work in Primary Health Care in Italy

Abstract Background The rapid increase in demand for primary healthcare (PHC) services after the pandemic requires reconsidering nursing staff planning and availability. The objectives of the study were to i) identify knowledge, attitudes, practices and work expectations of future nurses in primary care; ii) estimate the prevalence of nursing students who desire to be employed in PHC and Family and Community Health Nursing (FCHN) services after graduation. Methods A cross-sectional study is being conducted on a sample of nursing students enrolled in universities in the Lazio Region. A structured instrument was built based on the literature and national regulations and validated (Cronbach’s alpha=0.81). Results In this first phase, 163 nursing students were enrolled. The majority of the sample was female (N = 125, 76.7%), with a mean age of 22 (SD ± 5) years and were enrolled in the last year of degree program (N = 85, 52.1%). A total of 49 students (30%) reported adequate knowledge of PHC service reorganization policies and nursing practice in this setting. While 74% (N = 122) of the sample intended to undertake a PHC curricular internship during their degree program, only seven students (4%) participated in one. 52 individuals (30%) expressed their intention to be employed in PHCs after graduation, and 29 (17.8%) indicated their desire to work as FCHN practitioners. The main factors contributing to the undesirability of employment in PHC reported by students were: i) preferring the hospital settings (N = 53, 48%); ii) not having adequate skills to be employed in the PHC (N = 21, 19%); and iii) believing that the PHC does not offer attractive services for nursing practice (N = 14, 13%). Conclusions A multivariable analysis will be conducted to identify predictors of nursing students’ desire to work in PHCs after graduation. Preliminary results of the study showed that only one-third of nursing students indicated a desire to work in PHCs. Key messages • Only one-third of nursing students express a desire to work in PHC and in Family and Community Health Nursing (FCHN) services post-graduation. • Collaboration between the PHC workforce, academics, stakeholders, and policymakers is needed to create tailored initiatives that increase the attractiveness of PHC.

Healthcare access for people with disabilities: a scoping review of COVID-19 policies in Europe

Abstract Introduction The COVID-19 pandemic raised healthcare inequalities, affecting the most vulnerable groups. There is limited evidence of whether the COVID-19 measures and the health system’s preparedness for outbreaks among European countries were sufficient to cover the health access needs of PWDs. Aim To provide a structured overview of the COVID-19 measures and policies addressing access to primary and specialist health services for PWDs during the COVID-19 pandemic in the European Members States (MS) and the United Kingdom (UK), using ten dimensions of healthcare access by Levesque et al. (2013) and the PoliMap taxonomy. Methods This study followed the PRISMA guidelines for Scoping Reviews. A search strategy was employed on PubMed, Embase, Scopus, and Web of Science databases from January 2020 to January 2023. Studies published in peer-reviewed journals in English, Portuguese, and Spanish were included, informing a COVID-19 measure or policy and assessing or providing a rationale with access to primary or special healthcare services. Results The final search strategy yielded 2.076 results, 188 studies were reviewed for full-text analysis, and 74 were included in the final analysis. One hundred twenty-one policies or measures addressing primary or specialist care access were identified. Only thirteen target PWDs, focussing on intellectual or mental disability and addressing mental healthcare services. Results revealed that COVID-19 measures for PWDs were oriented to increase health system response capacity and reduce virus transmission, describing a predominantly negative effect on healthcare access for PWDs. Conclusions The needs of PWDs in access to primary and specialist care were not fully covered by the policies and measures placed during the COVID-19 pandemic among the MS and the UK. One-size approaches focussing on the attendance of COVID-19 infection with stigmatizing measures overlook the specific health necessities of this population. Key messages • Adopting disabled-inclusive measures in the daily healthcare provision and engaging PWDs in the policy cycle is paramount to preparing for the next outbreak and public health crises. • Additional research focusing on primary and specialized healthcare access during outbreaks for PWDs, especially with sensory and physical disabilities, is crucial to furthering health equity.

Towards integration of care in Portugal: Expansion of a new management model for the NHS

Abstract Introduction In 1999, the first Local Health Unit (LHU) was created in the Northern region of Portugal to improve management, share resources and integrate care. The LHU integrated a National Health Service (NHS) hospital and primary healthcare (PHC) services located within the same geographic area and became responsible for public health activities and the provision of care. Over the next few years, 7 LHUs were created, the last one in 2012. In 2024, the government expanded this model to the entire territory, creating 39 LHUs. This research analyses the objectives, characteristics and expected outcomes of the scale-up of LHUs. Methods This study utilised a mixed methods approach based on the 6 Ps - Problem, People (policy stakeholders), Process (policy development), Price tag (Resource allocation), Paper (policies, laws, regulations), Programmes (policy implementation); and the political, social and economic setting of the Policy Circle Framework. Findings A 2015 assessment revealed that LHUs did not differ from non-LHUs in terms of access, waiting times, clinical excellency, patient safety or patient centeredness. The degree of integration of care in LHUs seemed lower compared with non-LHUs. However, there was no systematic evaluation of the creation of the first LHU. Despite this, the government announced the intention to expand LHUs to the entire national territory, which culminated with the creation of 39 LHUs in 2024 to deliver integrated care, with an emphasis on the proximity and continuity of health services and promotion. Conclusions Despite the existing knowledge gap on the impacts of LHUs in health outcomes and management efficiency, LHUs can provide opportunities to advance integrated and patient-centred care and develop strategies for managing scarce resources, including the health workforce. Nevertheless, the integration of hospitals and PHC can threaten the centrality of primary health care both in terms of delivery of care and resource allocation.

Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia

Abstract Background Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population. Methods We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI). Results Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups. Conclusions Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services. Key messages • Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality. • It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.

An observational study in Roma women in Greece: measuring health factors in an understudied group

Abstract Background The Roma have always been one of the most vulnerable and at the same time understudied minority groups in Europe, living under difficult conditions and experiencing discrimination. The aim of the present work was to summarize the health and lifestyle profile of Roma women living in various regions of Greece. Methods A multi-center, observational study was implemented in April-June 2022, in the context of a national program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach”. Roma women, living in 5 areas of Greece, and health professionals working with Roma groups were considered as eligible to participate. A two-step, methodological approach was followed: a. qualitative study with Focus Groups and b. questionnaire-based survey. Results In total, n = 41 participants in FGs, and n = 99 responders in survey were recorded. 40% of participants were smokers (>10-15 cigarettes/day). Main quitting reasons, were “to set a good example and cost’. Increased consumption of ultra-processed foods and beverages, low plant-based foods intake, frequent breakfast omission and eating-out were reported by the vast majority of participants. Only 15% of responders had undergone typical, gynecological, screening tests while 1 in 5 responders used contraception. Regarding vaccinations, even if about 8 in 10 women seemed to comply with the obligatory vaccines for their children, a high vaccination reluctancy in 70% of the study sample was recorded in case of vaccination in adulthood. Conclusions This study stands one of the very few that underscore the vulnerability of Roma women in terms of poor health literacy, unhealthy lifestyle behaviours and low motivation to typical preventive measures. Improving access to primary health care services and tailored, culturally sensitive training is crucial. Key messages • Social inclusion of the increasing population of Roma women is crucial. • Health promotion, taking into consideration Roma women’s special needs, shall be a decisive factor of this process.

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.

Using electronic health records in assessing the prevalence of hypertension in Kyrgyzstan

Abstract Background Non-communicable diseases are an increasing challenge in Kyrgyzstan as well as in other parts of Central Asia. However, there is very little epidemiological data on disease burden in the country. The development of electronic health records in primary health care provides an opportunity to assess the disease incidence and prevalence among patient population. Methods All patients with hypertension (HT) diagnoses (ICD-10 I10-I15) were identified from electronic health records used in primary health care in Kyrgyzstan from years 2021, 2022 and 2023 from all 7 regions and Bishkek and Osh cities (n = 132621-152743). Each year, all patients diagnosed with HT during that year or in previous years were included, while those who had passed away were excluded. The incidence and prevalence of patients was calculated using as denominator both the patients who had visited the services as well as registered patients. Results The prevalence of patients with hypertension calculated using patients with service use as denominator varied by region between 10.2% to 14.0% and was pretty stable during the observed period. The prevalence was the lowest in Chui region and the highest in Bishkek city. When the prevalence was calculated using the registered patient population the prevalence was only between 1.5% to 3.1%. Conclusions The observed prevalences were notably lower compared with data from WHO Steps surveys, which have reported a hypertension prevalence more than 40% among individuals aged 25 to 64. It is known that only approximately 25% of the population in Kyrgyzstan utilize primary healthcare services, with maternity care comprising the largest portion. This factor, coupled with cases that go undiagnosed, could potentially account for the observed low prevalence in electronic patient data. However, the electronic patient records provide useful information on diagnostics and disease burden in the country that can be used in developing the services. Key messages • Electronic health records have developed quickly in Kyrgyzstan and enable extraction of patient data from primary health care. • The low use of primary health care services complicates the use of register data in assessing the disease prevalences.

6.D. Skills building seminar: Family Vulnerability Scale: Why and how to use at Primary Health Care to promote health equity?

Abstract Family vulnerability encompasses multiple perspectives that are interconnected with the health needs of each family member. Families experiencing vulnerability face heightened risks of poor health outcomes. Nonetheless, these vulnerabilities are further compounded by systemic inequalities within healthcare systems, where biological or clinical factors are exclusively considered to organize and/or prioritize access, especially given the scarcity of valid instruments to measure family vulnerability. Primary Health Care (PHC) plays a pivotal role in addressing health inequalities, especially considering its bond with community. From this context, the Family Vulnerability Scale for Brazil (EVFAM-BR, in Portuguese) was developed and validated, been composed of 14 items about four dimensions (income, healthcare, family and violence) (2019-2023). By reducing the gap between science and practice, the implementation process of EVFAM-BR was started at the same year the scale was validated (2023). First, it occurred at 14 PHC services in São Paulo (Southeast Region, Brazil) and second, since 2024 has been implemented at Boa Vista (North Region, Brazil). Also, between 2024 and 2026, the implementation of EVFAM-BR is expected to take place in other Brazilian states participating in the third phase of the PlanificaSUS project, which is developed aiming to support State health departments to implement the Health Care Planning method to organize and integrate PHC and specialized outpatient care based on population health care needs. At this stage, capacity building is needed to align the concept of family vulnerability and to train PHC managers and health professionals on how to apply and use results from EVFAM-BR. This training has already been performed for around 1,000 health professionals from two different regions of Brazil, including managers, Community Health Workers, nurses, and physicians. The present workshop proposal aims to disseminate the EVFAM-BR and to offer the EVFAM-BR experience. It proposes knowledge transferring throughout participants engagement at three activities. Activity 1) “Family Vulnerability: From concept to a scale validity and application”: it is designed to engage participants to discuss about the family vulnerability concept and applicability at PHC, and to discuss on how EVFAM-BR implementation process has been occurring at Brazil and how can be tailored to other contexts. Activity 2) “Role Play: Practicing EVFAM-BR”: Two cases will be used for role play dynamics that will take place in trios, in which one will represent the community health worker, another will be the patient and the third will be the observer. Activity 3) That ones that assumed observer role will share their experiences of using EVFAM-BR. Finally, a discussion will be facilitated based on the participants’ impressions and a review of the main points covered throughout the workshop. Key messages • Family vulnerability stratification (through EVFAM-BR) is essential to plan services achieving equity and qualified population-based care management and to qualify patient approach and care. • Family Vulnerability Scale (EVFAM-BR) training represents efforts to reduce the gap between research and practice and contributes to address social determinants of health on healthcare.

Organizational health literacy in hospitals and primary health care - developing innovative tools

Abstract Background Organizational health literacy (OHL), particularly in health systems, is vital for supporting public health. Self-assessment tools (SAT), critical for quality assessment/improvement and for empowering relevant stakeholders, could support hospitals and primary healthcare services to promote their role in health literacy responsiveness, and support organizations in identifying strengths and areas of improvement. Methods The SAT for OHL in hospitals (OHL-Hos) and in primary healthcare (OHL-PHC) were developed via a participatory process, based on the “Vienna Concept of a Health Literate Healthcare Organization”. Piloting of the tools in European countries shed light on the tools’ depth and the need for revision. The development of short versions followed a Delphi process with experts from ten to thirteen European countries, respectively, from December 2023 - April 2024. Healthcare service diversity within and between countries was taken into consideration as well as cultural/language adaptation. Shortening OHL-Hos followed four steps: 1) prioritization of the most relevant indicators, 2) considering additional resources, 3) consensus process, 4) refinement of the tool and wording. Results The SATs for both healthcare settings are now established. The SAT for OHL-Hos includes a matrix model of eight standards, 21 sub-standards and 75 indicators. The SAT for OHL-PHC includes seven standards, 19 sub-standards and 69 indicators, covering OHL in organizational structures and processes for staff, patients and the community served with specific focus on navigation, communication, and participation. Both SATs are accompanied by a guide to direct organizations through in the self-assessment process. Conclusions The process of identifying OHL needs and opportunities in the health system, facilitated by participatory methods for tool development, led to innovative SATs for OHL which are currently ready for piloting and implementation in European countries.

Perspectives of care providers on obstacles to healthcare access for people with disabilities in Ethiopia: a qualitative investigation

BackgroundDespite having similar healthcare needs to non-disabled individuals, people with disabilities in Ethiopia face significant challenges accessing healthcare services due to existing barriers. This study aimed to explore these barriers from the perspectives of care providers in primary healthcare facilities.MethodsQualitative research was conducted with care providers in Dire Dawa to identify barriers to healthcare access for people with disabilities. Thematic analysis was used to categorize data into themes.ResultsEight healthcare providers from four service departments participated in eight in-depth interviews and two focus groups. Six themes emerged: physical barriers, financial difficulties, non-accommodating diagnostic facilities, care providers’ attitudes and capacity, communication barriers, and lack of access to health information. Non-confidential and non-dignified care was also identified as a barrier.ConclusionThe study highlights important barriers that prevent people with disabilities from accessing primary healthcare services. Addressing these barriers is crucial for achieving disability-inclusive healthcare services. This research can serve as a starting point for further work in this area to promote equitable healthcare for people with disabilities.

Strategies for primary healthcare in Ukraine: An integrated response to gender-based violence

Abstract Issue/problem Survivors of gender-based violence (GBV) and conflict-related sexual violence (CRSV) in Ukraine face significant challenges in accessing appropriate healthcare services. Despite governmental commitment, acknowledgment and regulatory frameworks, including the ratification of the Istanbul Convention, gaps persist in integrating comprehensive GBV/CRSV services into primary healthcare (PHC) settings, exacerbated by the ongoing conflict with Russia. Description of the problem An analysis of healthcare providers’ knowledge has revealed deficiencies in effectively supporting GBV/CRSV survivors. Barriers include workload pressures, lack of inter-sectoral cooperation and case-management protocols, and insufficient training opportunities on survivor support. In collaboration with the World Health Organization, the global Clinical Management of Rape (CMR) guidelines was adapted for Ukrainian context. Among findings from CMR trainings attended by 443 PHC providers in 2022-2023 (213 participants in 2022 and 230 participants in 2023), the results underscore gaps in PHC workers’ basic knowledge and readiness to effectively support survivors during the war. Results Data from WHO training sessions underscored significant gaps in knowledge among healthcare professionals regarding legal protocols, available resources, and best practices in PHC service delivery. Identified barriers emphasized the urgent need for targeted interventions to enhance PHC workers’ capacity in GBV/CRSV response. Lessons Recommendations focus on systemic enhancements including revising regulatory frameworks, developing standardized protocols, and institutionalizing and providing comprehensive training programs. Innovative approaches like online courses, mentoring programs, and integrated service models are crucial for addressing multifaceted challenges. Key messages • A holistic GBV/CRSV response is an essential component in PHC. • This intersectoral survivor-centered approach provides safe spaces that can be adapted to other contexts in Europe.

Prevalence, reasons, and attitude towards abortion among Iranian married women of reproductive age in Qazvin province

Background and aimsAbortion influences the composition and size of population. Estimating the overall and type-specific abortion rates, the reasons to choose the abortion can be helpful in designing and implementing preventive intervention. Therefore, the present study was designed to determine the: (i) prevalence of abortion, (ii) attitude of married women of reproductive age towards abortion, and (iii) reasons for choosing abortion by married women of reproductive age in Qazvin province.MethodsA cross-sectional study was conducted between February and April 2023, and comprised married women of reproductive age (N = 1571) referred to urban and rural comprehensive health centers in five cities of Qazvin province. Utilizing multi-stage proportional sampling process, data for the survey (including demographic and fertility information, reasons for choosing abortion, and attitudes toward abortion) were collected online.ResultsThe lifetime prevalence of abortion was 18.6% (among the total sample). The past-year prevalence was 22.3% (among those who reported having had an abortion). Of those reporting having had an abortion, 73.6% reported it was their first one, and 65.1% reported it was non-spontaneous . Women’s reasons for choosing abortion fell into one of three main clusters: (i) couple’s behavior, health and relationship problems, (ii) fertility-related stressful experiences, and (iii) family economic situations. The main reported reason to choose abortion was a couple’s behavior (e.g., drug use), health (e.g., physical disease, psychological problems), and relationship problems (e.g., sexual infidelity, divorce) explaining 27% of the variance. Also, pro-abortion attitude was the most important attitude towards non-spontaneous abortion explaining 26.33% of variance. The variables that increased the likelihood of non-spontaneous abortion included choosing a reason for abortion vs. having no reason (OR = 1.77, p = 0.05), having poor vs. good mental health (OR = 1.74, p = 0.03), having a pro-abortion attitude (OR = 1.09, p = 0.09), and having ≥ 3 children vs. having no children (OR = 0.53, p = 0.06).ConclusionWomen in high-risk groups for non-spontaneous abortion (i.e., those aged over 35 years, those married for more than five years, those with an infertility history, those with a lower number of children, those living in rural areas, and those having poor mental health status) should be assessed by primary healthcare services during preconception and have early prenatal counseling to help in decisions regarding abortion.

Utilizing laser therapy to manage oral potentially malignant disorders in older adults at the primary care level.

Oral lesions are a significant concern among older adults because they can progress to oral cancer if not diagnosed and treated promptly and effectively. Transportation to the hospital is a major barrier to oral healthcare for many older adults. The purpose of this editorial is to address the challenges of managing oral potentially malignant disorders in the older population, highlighting the barriers they face in accessing healthcare services, the potential use of laser therapy for management, and the direction of research in this area. Due to the limited access of the older to healthcare services, primary healthcare facilities within communities serve as their primary providers. Laser therapy is recommended for the management of oral potentially malignant disorders due to its favorable outcomes. This approach has been tested in several primary healthcare centers in Thailand. In our project, laser therapy was used to treat oral potentially malignant disorders in primary and secondary healthcare services. This includes photodynamic therapy for older patients with extensive lesions, as well as individuals with oral leukoplakia and erythroplakia who have declined curative surgery. It has also been used in cases of recalcitrant lichen planus to steroid or photobiomodulation therapy. This approach has been well accepted by both oral healthcare providers and patients. To expand access to these treatment options in such settings, it is critical to empower healthcare professionals, particularly dentists and dental nurses, to integrate laser techniques into geriatric care and oral cancer screening. Establishing a network foundation for orofacial laserology would also enhance the potential of such settings.

Work ability data management in multisectoral services for people with disabilities: a cross-sectional study

Successful collaboration between professionals working in multisectoral services for people with disabilities requires access to data on the client’s work ability. This study examines work ability data needs, availability, and acquisition in social and health care services and employment services and explores possible differences between these service sectors. A cross-sectional survey was carried out using a self-developed questionnaire based on Choo’s information management process model, the Work Ability House model and previous research on work ability data. The questionnaire was targeted at physicians, nurses, physiotherapists, psychologists, and experts who support the work ability of people with disabilities and who work in primary health care, specialised health care, social services or employment services. The findings indicate that data on clients’ self-perceived health status is more frequently available than data on self-perceived work ability. This variability in data availability exists across professional sectors, highlighting the need for enhanced data management practices related to work ability assessment and support among professionals in social and health care services and employment services. The study underscores the importance of increasing professionals’ willingness to discuss work ability issues with working-age clients, particularly in primary health care and social services. These findings are pertinent in terms of enhancing multisectoral collaboration among professionals who need to comprehensively assess and support the work ability and employment of people with disabilities. Also, the study provides a diverse list of individual pieces of data related to work ability.

A qualitative exploration of Gestalt therapy and systemic pedagogy paediatric primary healthcare consultations in Agramunt (Spain).

Gestalt therapy (GT) and systemic pedagogy (SP) are useful tools to approach emotional difficulties and mental health problems among children and adolescents. The main objective of this study was to explore the perceptions on GT and SP techniques in paediatric mental health-related consultations in a primary healthcare (PHC) centre in Catalonia in 2018-2019, among families, healthcare, and education professionals. Qualitative study, combining semi-structured interviews with families (N = 42) and professionals (N = 15), conducted after a series paediatric PHC consultations including GT and SP techniques. Interviews lasted between 15 and 90min and were conducted at the PHC centre where GT/SP consultations took place, and at professionals' workplaces. Socio-demographics, reasons for consultation, and quantitative ratings on the perceived effectiveness of GT/SP consultations were also collected to combine these data with the qualitative interviews. Qualitative data were analyzed descriptively using thematic analysis. Quantitative data were analyzed by calculating frequencies (percentages) for categorical variables, and means, medians, and ranges for continuous variables. Narratives from families and healthcare professionals indicate that GT/SP consultations might have been effective in improving children and adolescents' symptomatology and emotional health. Improved well-being within the family context was another main finding, based on families' perceptions and experiences. Besides, GT/SP were considered acceptable for approaching emotional and mental health in PHC services, although barriers for implementation were identified. This study presents data on the potential usefulness of GT/SP to design and implement services that promote emotional and mental health among children and adolescents in PHC. Also, for the development of health policies and future research in this area.