Primary Health Care Settings Research Articles

Nutritional guidance needs and influence factors for gastric cancer survivors in primary healthcare setting: a cross-sectional survey

Nutritional guidance needs and influence factors for gastric cancer survivors in primary healthcare setting: a cross-sectional survey

REASSURED evaluation of the Bioline HCV point-of-care testing for diagnosing hepatitis C virus infection in primary healthcare settings of Ghana: a study protocol

IntroductionHepatitis C virus (HCV) infection is a silent epidemic that needs a comprehensive and contextualised approach to manage. Access to readily available, affordable and acceptable HCV point-of-care (POC) in vitro...

Primary healthcare as a strategy for eliminating hepatitis C: the METRIC toolkit.

This paper presents the development of the METRIC toolkit, aimed at enhancing primary healthcare interventions in the context of hepatitis C control, thus contributing to the World Health Organization's global strategy to achieve the elimination of the disease by 2030. At the global level, most people living with hepatitis C are unaware of their condition. As such, the eradication of hepatitis C necessitates comprehensive strategies within primary healthcare settings, as it provides an opportunity to reach the general population, facilitates the identification of potential patients who may be unfamiliar with hepatitis C, and guides them toward adequate care. Herein, we propose the METRIC toolkit as a means to optimize the efficiency and efficacy of healthcare services dedicated to hepatitis C control. The development of the METRIC toolkit was guided by a thorough review of pertinent literature, focusing on primary healthcare interventions in hepatitis C control. Key components were identified, encompassing systematic problem identification, solution formulation, outcome evaluation, and feedback integration. The METRIC toolkit represents a valuable resource for strengthening primary healthcare interventions in hepatitis C control. By fostering a culture of continuous improvement and data-driven decision-making, this framework holds promise in advancing the global agenda towards hepatitis C elimination. However, its successful application requires careful consideration of contextual factors and ongoing adaptation to local needs and circumstances.

Improving Collaborative Management of Multiple Mental and Physical Health Conditions: A Qualitative Inquiry into Designing Technology-Enabled Services for Eliciting Patients' Values

People with multiple chronic conditions (MCC) face challenges planning health care collaboratively with primary care clinicians, particularly when their priorities conflict. These challenges intensify with symptoms of anxiety or depression. Elicitation of patients' values is promoted as a means to aligning patient and clinician priorities in primary care, and as a component of psychotherapy for anxiety and depression. But, these approaches remain siloed. We conducted a qualitative interview study to understand patients' preferences for Technology Enabled Services (TESs) to coordinate values elicitation across primary and mental health care settings. Many participants preferred face-to-face elicitation by a mental health clinician; some preferred elicitation via telehealth and some preferred self-directed elicitation. Participants' preferences were influenced by: 1) how they perceived the rationale and benefits of values elicitation; 2) how they perceived the training and credibility of people facilitating elicitation; and 3) how they perceived their own capacity to engage in values elicitation. Participants also shared numerous concerns about values elicitation that warrant critical examination of TESs to support it.

Primary care physicians' attitudes, practices, and perceived barriers toward depression screening in older people in the Kingdom of Bahrain

PurposeThis study aimed to explore attitudes, practices, and perceived barriers of primary care physicians (PCPs) toward depression screening in older people.MethodsThis cross-sectional study enrolled PCPs from randomly selected representative primary care centers in Bahrain. A self-administered piloted semi-structured questionnaire was used for data collection.ResultsWe enrolled 248 PCPs in the study (82.3% females, and the mean age = 40 ± 8.7 years). More than half of the participants (54.4%) had a positive attitude toward depression screening in older people. However, only 10.9% of the participants reported systematically screening for this condition without using specific tools for screening in 45.5%. The most reported barriers toward this service are short consultation time (95%), the presence of multiple co-morbidities in this age group (90%), and the absence of guidelines or appropriate training in around 30%. Positive attitudes were significantly higher among older PCPs (p = 0.039), family physician consultants (p = 0.008), those with more than 10 years of work experience (p = 0.024), and those who participated in related educational activities (p = 0.007). Under-screening practice is associated with perceived short consultation time (p = 0.002), insufficient continuous medical education (CME) activities attendance in older people's mental health (p = 0.048) as well as having a general physician's title (p = 0.049). Only the PCPs' job title, Adjusted Odds Ratio (OR) = 3.513, 95 C.I [1.225-10.074] and attendance of CME activities, OR = 1.278, 95 C.I [1.098 – 3.192] remained significant when controlled for age and experience.ConclusionMore training on older people's mental health and provision of screening and management guidelines are priorities to promote older people's mental health in primary care settings.

Nutrition and diet in children with orofacial clefts in Africa: a scoping review

Background and aimThe burden of orofacial clefts (OFCs) has declined globally except in sub-Saharan Africa, with a great disease burden in North Africa. Children with OFCs have a high risk of malnutrition, and African countries have some of the highest malnutrition rates. This scoping review assessed the status of research on OFCs and nutrition and feeding among children living in African countries.MethodsWe followed the Joanna Briggs Institute guidelines for conducting scoping reviews. We searched eleven databases for articles on malnutrition and feeding among children with OFCs living in African countries. No restriction was done by type of study or publication date. Books, book chapters, and reviews were excluded. Only publications in English language were included. We extracted information about the publication year, study design, setting, location, participants’ age, data collection methods, international collaboration, and funding. We classified articles into studies assessing (1) the impact of nutritional deficiencies during pregnancy on OFCs, (2) the impact of OFCs on malnutrition, (3) feeding problems in children with OFCs, and (4) the impact of nutritional status on OFCs repair outcomes. We calculated frequencies and used bar charts and a map.ResultsOut of 208 search results, 36 were duplicates, and 25 eventually fit the inclusion criteria, with 52% retrieved from Google Scholar. About 80% of the studies were from four countries: Nigeria, South Africa, Ghana, and Uganda; 72% were hospital-based and 52% were cross-sectional. The most frequent data collection method was clinical examination and questionnaires. Most studies focused on feeding problems in children with OFCs (44%) and the impact of OFCs on malnutrition (32%). International collaboration was observed in six studies, with one study showing South-South collaboration. Only two studies were funded.ConclusionsThere is a predominance of under-funded descriptive research not indexed by international databases. Minimal research has been directed to population-level OFC preventive programs in primary healthcare settings and assessing interventions supporting children with OFCs. A research agenda is needed to prioritize research needs and secure funds to support South-South collaboration to address the nutrition and feeding-related problems associated with OFCs.

How First Nations peoples living in the Torres Strait and Northern Peninsula Area describe and discuss social and emotional well-being.

This study was the first phase of a broader project designed to develop a new tool to screen social and emotional well-being (SEWB). Its objective was to identify words used by First Nations people living in the Torres Strait (Zenadth Kes) and Northern Peninsula Area (NPA) to describe and discuss SEWB. We pay our respects to Elders past and present. We acknowledge the First Nations peoples who took part in this project as holders of their cultural knowledge now and forevermore. This study took place in community and primary health care settings located on islands of the Torres Strait and NPA of Australia. Twelve yarns with 35 community members and health professionals were led by Torres Strait Islander members of the project team between August and December 2022. This study employed a descriptive qualitative design. Yarning, an Australian First Nations relational method, was used to share stories about SEWB. All but one yarn was audio recorded and subsequently professionally transcribed. Inductive thematic analysis was used to analyse the yarns. Worry, sad and stress were the words most often used by participants to describe feelings of low SEWB. Signs of low SEWB included behaviour change, particularly significantly reduced community engagement. Worry is not a word that is used in Australian mainstream tools that screen for psychological distress. Findings of this study indicate that a question that asks about worries should be included when screening for low SEWB in Australian First Nations peoples living in the Torres Strait and NPA.

What about us?: a call to include oral health professions within interprofessional education for collaborative practice

ABSTRACT Interprofessional collaboration (IPC) among the health professions is recognised as a vital component of efficient health systems and comprehensive healthcare teams. Interprofessional education for collaborative practice (IPECP) is foundational for health professional students to gain an understanding of professional roles, responsibilities, and the value of other professions to patient care. Oral health professionals are highly skilled and knowledgeable experts who recognise the oral-systemic health link. However, they have been largely excluded from, and underutilised within primary healthcare settings and interprofessional teams. Given that oral health is a key indicator of overall health and wellbeing, there is a need mobilise oral health professionals within primary healthcare practice. Yet, advancements for IPECP in oral health education face significant barriers which impede the integration of the oral health professions within interprofessional teams. Collaborative approaches across health programmes to devise intentional, authentic, and transformative strategies for IPECP are needed to bridge gaps in patient care and to dismantle problematic perceptions of ‘oral health’ as distinct from overall health and wellbeing in contemporary healthcare practice.

Epidemiology of skin diseases among children attending the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State: a retrospective observational study

Background: Numerous studies have examined skin disease trends in Nigeria, revealing a shift towards increased allergic dermatoses. This research assessed the patient landscape at a clinic and satellite site in Obukpa, Nigeria. Methods: A retrospective study of patients seen in the skin clinic of the university of Nigeria teaching hospital (UNTH), Ituku Ozalla, and the rural outpost in Obukpa between November 2009 and 2018 was carried out. A total of 1851 patients' data were analyzed. Diagnosis was based on clinical findings. Results: There were more females (n=1007 [54.4%]) than males (n=844 [45.6%]). Most of the patients were of school age (6-12 years), and the most typical skin disease category was infectious disorders (32.5%), another categories/miscellaneous group (27.7%). Nearly all patients that presented to the rural outpost in Obukpa resided in the surrounding area of Nsukka (93.4%). Conclusions: Comparing the study findings with an earlier one from the same center, there is no change in pattern, with infectious disorders being the most common skin disease category. However, these are largely preventable and emphasize the need for public enlightenment campaigns and policies to discourage the over-the-counter purchase of prescription-strength corticosteroid creams and antibiotics by parents and caregivers, a prevalent practice before seeking medical attention for their children. In addition, there is an urgent need to strengthen dermatologic training in primary health care settings, especially among pediatricians in Nigeria, to improve access to care.

Provision of Digital Primary Health Care Services: Overview of Reviews.

Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence. This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC. This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included. A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients' health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients' clinical conditions and behavior changes. Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients' clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings.

Population Health Management effectiveness in the primary healthcare setting: a systematic review

Abstract Background Population Health Management (PHM) has shown promise as a tool in the improvement of health at scale. It works by; harnessing health-related datasets, allowing for population segmentation and risk stratification, and targeting interventions to yield positive health impact. Prior reviews on PHM, have sought to define PHM and assess feasibility. To date, there have been no systematic reviews that assess the effectiveness of PHM in achieving some or all of the quintuple aims of PHM (WHO 2023). The aim of this study is to determine the value and impact of a PHM approach in managing ambulatory care sensitive conditions (ACSCs) in the primary healthcare setting. Methods This systematic review is underpinned by a Population-Intervention-Comparator-Outcome (PICO) framework. The PROSPERO-registered study commenced in February 2024 for papers published since January 2000. Pubmed, Cinahl and Web of Science databases were used. Titles and abstracts of studies were reviewed using agreed eligibility criteria to select studies for inclusion and risk of bias assessment. Data abstraction and synthesis determined the effectiveness of PHM against agreed outcome measures. Results The search yielded 427 articles of which 19 were included. Studies addressed diabetes, hypertension, atrial fibrillation, asthma and comorbid conditions. Nearly all studies were based in the U.S.A. Almost 50% of studies showed a significant improvement in health outcomes following PHM. Study features that corresponded with positive health outcomes included; the use of population management tools, the employment of disease/population health managers and the mobilisation of medication reviews/education. Conclusions The challenges facing communities and health services require an alternative innovative approach to health such as a PHM approach. The results of this study will inform a larger body of work which seeks to establish a PHM approach to the delivery of services in the Mid-West region of Ireland. Key messages • Population health management (PHM) could be a viable mechanism for health services to serve increasing need and multi-morbid populations. • This is the first systematic review of PHM against the quintuple aims of PHM, specifically in the management of ambulatory care sensitive conditions in primary healthcare.

Primary prevention of type 2 diabetes in the EU: A systematic review of interventional studies

Abstract Background The GBD 2019 study revealed that type 2 diabetes caused over 109.000 deaths and accounted for 5.3 million Disability Adjusted Life Years in the EU, with an estimated annual cost of EUR 300 billion in 2014. Interventions for primary prevention are pivotal in preventing diabetes, providing a structured approach to implementing lifestyle modifications or community-based programs. The objective of this study was to demonstrate the effectiveness of primary prevention interventions to prevent or delay the onset of type 2 diabetes in the EU member states. Methods A systematic review on six databases was conducted for relevant interventional studies carried out in the EU-28. The main outcome of the studies was determined by changes in the incidence of type 2 diabetes. Results The search yielded 18.885 records, of which 18 met the eligibility criteria. The following studies reported significant incidence reduction in the intervention groups: The Finnish Diabetes Prevention Study by individualised lifestyle intervention (HR: 0.614, 95%CI: 0.478-0.789), the Spanish CORDIOPREV Study through increased plant protein intake (HR: 0.64, 95%CI: 0.43-0.96), the Spanish PreDE trial by promoting healthy diet and physical exercise (RR: 0.68, 95%CI: 0.47-0.99), the Norfolk Diabetes Prevention Study with intensive diet-exercise counselling (OR: 0.57, 95%CI: 0.38-0.87), the Spanish PREDIMED and PREDIMED-Reus trials by mediterranean diet supplemented with extra virgin olive oil or mixed nuts (HR: 0.60, 95%CI: 0.43-0.85; HR: 0.49, 95%CI: 0.25-0.97; HR: 0.48, 95%CI: 0.24-0.96), and the Dutch SLIM Study with advices on diet and physical activity (RR: 0.53, 95%CI: 0.29-0.97). Conclusions Significantly decreasing the incidence of diabetes is feasible within primary healthcare settings through intensive lifestyle interventions targeting individuals at high risk. Therefore, it would be beneficial to incorporate these findings into the European guidelines for preventing type 2 diabetes. Key messages • Primary care plays an important role in the prevention of type 2 diabetes. • Well-defined primary lifestyle interventions are capable of slowing the progression from prediabetes to diabetes.

Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study

Abstract Background Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF. Purpose To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center. Methods This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results 43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting. Conclusion It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.

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.

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.

Development of a systematic referral model to primary care health interventions for patients with atrial fibrillation. a delphi study

Abstract Background The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) recommend integrated care in AF, combining medical treatment with lifestyle modifications and psychosocial management in a multi-disciplinary set-up. Research show that patients with AF can benefit from lifestyle interventions and psychosocial management, like patient education. According to World Health Organization recommendations, these health interventions are moving from hospitals to primary healthcare settings. Therefore, patients with AF should be systematically referred to these interventions. Yet, an evidence-based referral model that can support this transition is lacking. Purpose The purpose is to develop a systematic referral model for primary care health interventions for patients with AF. Methods We used the Delphi-technique with three rounds of questionnaires (figure 1). International and national clinical experts in AF across disciplines and health sectors were invited to participate. In the first round, the expert panel evaluated items that could be part of a referral model on relevance, improvability and self-reporting. In the second round, the expert panel evaluated each item as either an inclusion or exclusion criteria, important knowledge to have, or not relevant. In the third round, the expert panel evaluated the items according to data source and outcome status. A final model was drawn based on items reaching consensus. The study was reported according to the guidance on conducting and reporting Delphi studies (CREDES). Results In total, 69 of 139 invited experts accepted to participate (50%). These were mostly academics or clinicians (90%), stemming from primary sector (16%), secondary sector (35%) and research (32%). Most were medical doctors (36%) and nurses (35%). However physiotherapist, psychologists, dieticians, and other disciplines along with six patients with AF were also represented. The expert panel (60% females) had a mean age of 50 years, and 65% were from Denmark. For the final referral model (figure 2), AF symptom burden and impaired health-related quality of life, anxiety and poor medicine compliance combined with a risk factor profile were the main inclusion criteria. Furthermore, it was important to know about the patients’ mental well-being, self-management abilities and comorbidities. Conclusion Consensus was reached for a generic referral model, which can be further adjusted in the appropriate clinical context. The model includes inclusion criteria which closely correlate with guidelines for AF management focusing on reducing the patients’ symptom and risk factor burden. The referral model is expected to increase the number of patients with AF referred to primary care health interventions, which could lead to better quality of life, fewer hospital admissions and lowered health care costs in AF.

A qualitative study on rehabilitation services at primary health care: insights from primary health care stakeholders in low-resource contexts

BackgroundThe chasm between rehabilitation needs and available rehabilitation services is widening. In most low-resource contexts, there are inadequate rehabilitation professionals at primary health care (PHC), leaving nonrehabilitation primary care providers’ (PCPs) and district rehabilitation professionals and managers to address patients’ rehabilitation needs. This study explored rehabilitation and non-rehabilitation PCPs’ and managers’ perspectives on the situation of rehabilitation service provision in PHC settings and the challenges experienced in providing rehabilitation care.MethodsIn this descriptive, exploratory qualitative study, individual semi-structured interviews and focus group discussions were conducted with purposefully sampled PCPs in Manicaland, Zimbabwe and Eastern Cape, South Africa. The transcripts were analysed thematically using Atlas.ti. version 22.2®.ResultsThirty-six PCPs (29 nonrehabilitation and 7 rehabilitation) and one district manager participated in the study. The current PHC rehabilitation services in the two low-resource contexts were described as inadequate, if not nonexistent. District rehabilitation professionals attempted to fill the gap through outreach and home visits, but resource limitations, particularly in Zimbabwe, often hampered this strategy. The nonrehabilitation PCPs took on task-shifting roles in the identification, referral, and education of patients with rehabilitation needs in the absence of rehabilitation professionals at PHC. Challenges encountered in providing rehabilitation care at PHC included unsupportive leadership, human resource shortages, lack of comprehensive PHC rehabilitation guidelines, no or delayed rehabilitation referral, lack of clear communication strategies, and users’ low demand for PHC rehabilitation.ConclusionTailored approaches, including context-specific rehabilitation guidance for existing task-shifting models, increased investment in rehabilitation and increased rehabilitation awareness, are needed to establish basic rehabilitation services in the described contexts because they are mostly absent. Importantly, the PHC systems in which rehabilitation is to be nested need to be strengthened.

Missed Opportunities for Intervening Early in Preschoolers with Developmental Concern: Perspectives From Head Start Parents, Teachers, and Healthcare Providers.

The purpose of this study was to discover the care meanings of facilitators and barriers to detection and intervention for developmental delay among Head Start preschool-aged children, as viewed by parents, teachers, and primary care providers. We used a qualitative focus group design and broad cultural lens to understand similarities and differences in family and professional care, as Head Start programs educate preschoolers living in poverty who are disproportionately from ethno-racial minoritized groups. We sought the perspectives of 15 Head Start parents equally representing Black, Latino(a), and White parents, 17 teachers, and 11 healthcare providers to discover facilitators and barriers to adherence with professional recommendations. We found that silos in professional communications, parent distrust, knowledge deficits, and stigma were barriers to obtaining developmental recommendations. Participants also identified missed opportunities to facilitate interagency coordination, parental advocacy of a child's developmental needs, and professional alliances to take collaborative actions for early identification and treatment. Furthermore, a subculture of poverty adversely influenced adherence to developmental recommendations, and ethno-racial biases affected Black and Latino(a) families' follow-through. Our findings highlight how the lack of coordination between sectors resulted in the dismissal of parental concerns or denial of services by 1 system or the other, thus, at the very least reducing the child's chances for earlier intervention and treatment. We also identified potential benefits to children when the barriers of poverty and ethnoracial bias are addressed by professionals with coordinated actions, and new systems are developed for sharing developmental screening results and partnering to coordinate care across the preschool and primary healthcare settings.

Exploring Physicians' Perceptions of Digital Health's Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study.

Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised "social and personal," "technical and material," and "organization and policy" factors. The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship.

Factors Influencing Self-Wound Care Adoption in Singaporean Communities: A Cross-Sectional Survey.

Managing wounds often requires frequent clinic visits, posing a burden on both patients and the healthcare system. Shared wound care, which encourages patients to manage dressings at home, has emerged as a potential solution. This study investigates factors influencing self-wound care adoption in Singapore. A cross-sectional survey involving 328 participants from six primary healthcare centers was conducted. The survey examined demographics, wound characteristics, and perceptions towards shared wound care using a locally validated questionnaire. Parametric tests and logistic regression were used to analyze the data. Unlike older participants, younger adults valued time saved through self-care and found clinic visits inconvenient. Participants in the younger age group, those in fixed-schedule employment, and students were more likely to opt for the self-wound care program and adopt self-wound care. Strong social support (p=0.034) and wound location on the head, neck, or face were the most significant factors (p=0.023) favoring self-care. Interestingly, participants with no formal education were significantly more likely to embrace self-wound care (p=0.006 to 0.012). Using individual attributes to select participants for self-wound care adoption may be more effective than relying on educational level. Strong social networks and encouragement from family and community can play a crucial role in promoting self-care practices. However, the generalizability of the findings may be limited, as the study was conducted solely within a Singaporean primary healthcare setting. All the same, while wound care practices may vary across countries, the foundational concepts of wound care are universal in the world. Insights about self-wound care can therefore be valuable and informative on a global scale, not just within Singapore.