Primary Health Nurses Research Articles

A grounded theory exploration of the enablers and barriers of public healthcare access for people with comorbid serious mental and chronic physical illnesses in Jamaica.

Chronic physical illnesses (CPI) are highly prevalent among people with serious mental illnesses (PWSMI) yet people in this population experience significant challenges accessing healthcare. This study utilised a constructivist grounded theory approach to collect and analyse data related to the enablers and barriers to public healthcare access for PWSMI & CPI. Data were collected through semi-structured interviews conducted with fifty-seven participants comprising PWSMI &CPI and their caregivers, health policymakers, primary care physicians, psychiatrists, and mental health nurses. Enablers and barriers to healthcare access were represented using a socio-ecological model consisting of five levels: wider society, health system, clinician, family and community, and individual. Jamaica's free public healthcare system was the most pronounced enabler of healthcare access, while poverty, stigma, and discrimination were the most pronounced barriers. Factors such as social support, time, clinician beliefs, attitudes and training, and individual characteristics were identified as consisting of dimensions that were both enablers and barriers to healthcare access. These findings indicated that factors that influenced healthcare access for PWSMI & CPI were aligned with the social determinants of health. Improved healthcare access for PWSMI & CPI necessitates strategies that incorporate a multi-sectoral approach to address social and environmental factors influencing healthcare access across all levels of the socio-ecological model.

A qualitative exploration of the health system responses to the screening and management of comorbid mental illness and chronic physical illness in Jamaica

Background People with comorbid mental illness (MI) and chronic physical illness (CPI) face a range of health and quality of life challenges. The appropriate screening and management of comorbid MI and CPI are crucial to improving outcomes for this population. Despite this, there is a dearth of research exploring the health system response to the screening and management of patients with these comorbidities in public primary care settings, in several jurisdictions including Jamaica. This study explored and described the attitudes, perspectives, experiences, and practices of policymakers, primary care physicians, psychiatrists, and mental health nurses regarding screening and management of comorbid MI and CPI. Method Twenty-nine participants representing policymakers, primary care physicians, psychiatrists, and mental health nurses took part in semi-structured interviews. Data was collected over the period April to November 2020 and subject to thematic analysis. Results Three overarching themes emerged from the data related to: 1) Policies and Protocols; 2) Clinical Practice; and 3) Personnel. The interplay of these themes illustrated fragmentation and gaps between national policies and guidelines and clinical practice. The findings also identified factors related to personnel, including barriers that limit clinicians’ abilities to adequately screen and manage this patient population. Conclusion There is a need for the continued development and revision of policies and protocols that support integrated care for patients with comorbid MI and CPI in primary care settings in Jamaica. Additionally, programs and strategies to improve clinicans knowledge, skills and access to resources are necessary to help them offer improved quality of care around screening and management for this patient population.

Standing alone on the frontline. The meaning of being a nurse in the archipelago-A phenomenological hermeneutical study.

The aim of this study was to illuminate the meaning of being a nurse in the archipelago. A phenomenological hermeneutical design was applied, as there is a need to understand the lifeworld and the meaning of being a nurse in the archipelago. Approval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate. Individual interviews were conducted with 11 nurses (Registered Nurses or primary health nurses). The interviews were transcribed, and the text was analysed by means of phenomenological hermeneutical method. The analyses ended in one main theme: Standing alone on the frontline, and three themes: 1. Combating sea, weather and the clock with the sub-themes: Fighting to give care to patients despite harsh conditions and Fighting against time; 2. Standing firm but wavering with the sub-themes: Embracing the unexpected and Calling out for support; and 3. Being a lifeline throughout the entire lifespan with the sub-themes: Having responsibility for the islanders and Having an intertwined private and work life. The interviews may be considered few, but the textual data were rich and assessed suitable for the analysis. The text may be interpreted differently, but we deemed our interpretation as more probable than others. Being a nurse in the archipelago means standing alone on the frontline. Nurses, other health professionals and managers need knowledge and insight about working alone and the moral responsibilities thereof. There is a need to support the nurses in their lonely work. Traditional means of consultations and support could preferably be supplemented by modern digital technology.

Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries.

Most women living in low- and middle-income countries (LMICs) present with advanced-stage breast cancer. Limitations of poor serviceable health systems, restricted access to treatment facilities, and lack of breast cancer screening programmes all likely contribute to the late presentation of women with breast cancer living in these countries. Women are diagnosed with advanced disease and frequently do not complete their care due to a number of factors, including financial reasons as health expenditure is largely out of pocket resulting in financial toxicity; health system failures, such as missing services or health worker lack of awareness on common signs and symptoms of cancer; and sociocultural barriers, such as stigma and use of alternative therapies. Clinical breast examination (CBE) is an inexpensive early detection technique for breast cancer in women with palpable breast masses. Training health workers from LMICs to conduct CBE has the potential to improve the quality of the technique and the ability of health workers to detect breast cancers early. To assess whether training in CBE affects the ability of health workers in LMICs to detect early breast cancer. We searched the Cochrane Breast Cancer Specialised Registry, CENTRAL, MEDLINE, Embase, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and ClinicalTrials.gov up to 17 July 2021. We included randomised controlled trials (RCTs) (including individual and cluster-RCTs), quasi-experimental studies and controlled before-and-after studies if they fulfilled the eligibility criteria. Two review authors independently screened studies for inclusion, and extracted data, assessed risk of bias, and assessed the certainty of the evidence using the GRADE approach. We performed statistical analysis using Review Manager software and presented the main findings of the review in a summary of findings table. We included four RCTs that screened a total population of 947,190 women for breast cancer, out of which 593 breast cancers were diagnosed. All included studies were cluster-RCTs; two were conducted in India, one in the Philippines, and one in Rwanda. Health workers trained to perform CBE in the included studies were primary health workers, nurses, midwives, and community health workers. Three of the four included studies reported on the primary outcome (breast cancer stage at the time of presentation). Amongst secondary outcomes, included studies reported CBE coverage, follow-up, accuracy of health worker-performed CBE, and breast cancer mortality. None of the included studies reported knowledge attitude practice (KAP) outcomes and cost-effectiveness. Three studies reported diagnosis of breast cancer at early stage (at stage 0+I+II), suggesting that training health workers in CBE may increase the number of women detected with breast cancer at an early stage compared to the non-training group (45% detected versus 31% detected; risk ratio (RR) 1.44, 95% confidence interval (CI) 1.01 to 2.06; three studies; 593 participants; I2 = 0%; low-certainty evidence). Three studies reported diagnosis at late stage (III+IV) suggesting that training health workers in CBE may slightly reduce the number of women detected with breast cancer at late stage compared to the non-training group (13% detected versus 42%, RR 0.58, 95% CI 0.36 to 0.94; three studies; 593 participants; I2 = 52%; low-certainty evidence). Regarding secondary outcomes, two studies reported breast cancer mortality, implying that the evidence is uncertain for the impact on breast cancer mortality (RR 0.88, 95% CI 0.24 to 3.26; two studies; 355 participants; I2 = 68%; very low-certainty evidence). Due to the study heterogeneity, we could not conduct meta-analysis for accuracy of health worker-performed CBE, CBE coverage, and completion of follow-up, and therefore reported narratively using the 'Synthesis without meta-analysis' (SWiM) guideline. Sensitivity of health worker-performed CBE was reported to be 53.2% and 51.7%; while specificity was reported to be 100% and 94.3% respectively in two included studies (very low-certainty evidence). One trial reported CBE coverage with a mean adherence of 67.07% for the first four screening rounds (low-certainty evidence). One trial reported follow-up suggesting that compliance rates for diagnostic confirmation following a positive CBE were 68.29%, 71.20%, 78.84% and 79.98% during the respective first four rounds of screening in the intervention group compared to 90.88%, 82.96%, 79.56% and 80.39% during the respective four rounds of screening in the control group. Our review findings suggest some benefit of training health workers from LMICs in CBE on early detection of breast cancer. However, the evidence regarding mortality, accuracy of health worker-performed CBE, and completion of follow up is uncertain and requires further evaluation.

PS-P08-2: FACTORS RELATED TO PARTICIPATION IN HEALTH CHECKUPS AMONG MIDDLE-AGED JAPANESE COMMUNITY RESIDENTS IN THE PRECONTEMPLATION STAGE

Objective: In Japan, all medical insurers are obliged to conduct annual specific health checkups. These checkups are part of the National Health Service system and target all insured people aged 40–74 years and aim to facilitate prevention and early detection of atherosclerosis-related diseases such as hypertension, diabetes, and dyslipidemia. However, the participation rate in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). Additionally, previous studies suggested that those in the precontemplation stage were at higher risk for non-participation in health checkups. Therefore, this study explored the factors related to participation in specific health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage. Design and Method: This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal NHI aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After selecting those without missing data (n = 11,180) and those in the precontemplation stage, the analysis included 2,892 participants. Participants were classified into a participation group and a non-participation group. Those who selected “I underwent a specific health checkup in the past year” were classified as the participation group. The study protocol was approved by the Institutional Review Boards. Informed consent was obtained from all participants who were included in this study. Results: In this study, 994 (34.4%) participants were classified in the participation group, and 1,898 (65.6%) were classified in the non-participation group. Multivariable logistic regression analysis revealed factors related to participation in health checkups among those in the precontemplation stage. The factor with the highest odds ratio (OR) for participation in specific health checkups was recommendations from primary care physicians to participate in specific health checkups [multivariable-adjusted OR 3.19, 95% CI 2.45–4.15, presence of recommendations vs. absence of recommendations], followed by recommendations from public health nurses [multivariable-adjusted OR 2.07, 95% CI 1.26–3.41, presence of recommendations vs. absence of recommendations], and self-reported economic status [multivariable-adjusted OR 1.82, 95% CI 1.48–2.24, good vs. poor]. Conclusions: In particular, recommendations from primary care physicians and public health nurses might be important factors related to participation in health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage.

The effects of antiretroviral stockout on primary health care nurses in the Ethekwini and Ilembe districts, KwaZulu-Natal

Background: Nurses face challenges of antiretroviral therapy (ART) stock out when rolling out, leading to drug resistance, poor compliance and decreased viral suppression. Poor viral suppression leads to higher morbidity and mortality rates, hence a need to strengthen supply chain principles in order to achieve equal distribution of resources amongst clinics. Nurses also need to have relevant guidelines available to prevent treatment failure. The study aimed to describe the effects of ART stockouts on primary health nurses rolling out ART in clinics in KwaZulu Natal. Methods: The study followed a qualitative approach, using a descriptive design. Two primary healthcare clinics in Ilembe and Ethekwini districts were selected for the study. The population comprised of 8 purposively selected participants. In-depth interviews and focus groups were conducted to describe the experiences of primary health care nurses rolling out antiretroviral therapy regarding stockout and how it was managed. Data collection and analysis followed Yates, Partridge and Bruce steps. Ethics and trustworthiness were maintained. Results: The singular theme of inconsistent availability of treatment emerged, as well as sub-themes of means used to manage treatment stockout and supply change management issues. Conclusions: An adequate supply of ART through an efficient supply chain management strategy, ongoing training in primary health care and nurse-initiated management of antiretroviral therapy and the availability of treatment guidelines should be enforced.

Chronic Management during Pandemic COVID-19 from the Perspective Primary Health Care Practitioners

This study aims to determine how chronic care management for the covid-19 pandemic is managed from the point of view of public health by health practitioners. The method of this research is to use a literature review using the Proquest, Pubmed, Science Direct, and Ebsco databases. The results showed that 718 articles and seven met the criteria for inclusion in the author's review. In conclusion, chronic care management during the Covid-19 pandemic from the perspective of primary health practitioners is very influential in how people with chronic diseases can survive and be helped by improving the quality of their care.
 
 Keywords: COVID-19, Primary Health Services and Nurses, Management, Chronic Care

Nurse visit utilization and blood pressure control: A multi-cohort study in New Zealand.

This study aimed to retrospectively examine the contribution of nurses to population health outcomes with reference to nurse visits and blood pressure measurement in primary health settings. A retrospective study was conducted using New Zealand Health Survey (NZHS) from 2012 to 2017. Adult population who are 18 years old and over living in New Zealand. Age, gender, and ethnicity, the service utilization of primary health care nurse visit and blood pressure measurement were extracted from the NZHS (2012-2017) to compare with the service utilization of primary health care nurses by different demographic groups. Females who have treated hypertension shows higher utilization of nurse visit than males. From 2015 to 2017, the participants in this cohort have visited a primary health care nurse at least more than once within a year. With blood pressure control, the overall pooled results show the impact of visiting primary health nurses on systolic and diastolic blood pressure control. Our study at a national scale, demonstrated the impact of nurse's contribution to population health outcomes among people living with hypertension in New Zealand. Nurses are key to improving population health outcomes and to achieve universal health coverage.

Early detection of childhood overweight and related complications in a Danish population-based cohort aged 2–8 years

BackgroundOverweight in early childhood often tracks into adolescence and adulthood and early childhood is a critical period for developing sustained overweight. This study aims to investigate the early detection of childhood overweight (including obesity) and related cardiometabolic complications in a Danish population-based cohort of children aged 2.5–8 years in collaboration with primary care municipal dental clinics and public health nurses. MethodsIn this prospective population-based cohort study, 335 pre-school children (age 2.5 and 5 years) were recruited from municipal dental clinics, and 657 school children (age 6–8 years) by public health nurses. A subgroup of 392 children (40%) participated in additional hospital-based examinations including blood pressure measurement and a blood sample. Children were re-examined approximately one year later. ResultsThe prevalence of overweight was 13.73% in pre-school children and 13.69% in school children at baseline. In the pre-school children, differences in cardiometabolic risk markers between children with and without overweight were minor, whereas in school children with overweight, cardiometabolic derangements were manifest including significantly higher levels of fasting glucose, insulin, homoeostasis model of assessment for insulin resistance, triglycerides, and alanine aminotransferase and lower levels of high-density lipoprotein cholesterol. During follow-up the prevalence of overweight did not change in pre-school children but increased to 17.0% in school children. ConclusionsExisting contacts with the primary health care sector, including dental care, can successfully be used for detection of overweight. This study suggests that early detection should be initiated at pre-school ages since overweight-related complications are already established by school ages.

Nurse empowerment needs in diabetes self-management

Nurses play pivotal roles in facilitating diabetes self-management. The objective of this study was to describe the empowerment needs among nurses in primary health centres to facilitate diabetes self-management among peoples with type 2 diabetes mellitus. This was a descriptive study with a cross-sectional approach. Fifty-one primary health nurses from nine primary health centres in Bantul Yogyakarta were selected using a cluster sampling technique. The data were collected using the Nurse Empowerment Needs Questionnaire. The data were analysed using descriptive statistics. The average age of the nurses was 38.6 years with 12.9 years of services, mostly women, and graduated from three years of nursing education (88.2% and 92.2% respectively). Out of 51 nurses, only 13 nurses (25.2%) participated in diabetes management training especially diabetic wound care training (10 nurses). Most of the nurses had a moderate level of knowledge (80.4%), motivation (92.2%), self-efficacy (56.9%), communication (58.8%), skills (86.3%), and work satisfaction (58.8%) in facilitating diabetes self-management. Nurses in primary health centres need to be empowered to improve their performance in facilitating diabetes self-management. It is important to have certified diabetes educators in each primary health centre in Indonesia.

Evaluation of metabolic monitoring practices for mental health consumers in the Southern District Health Board Region of New Zealand.

WHAT IS KNOWN ON THIS SUBJECT?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally. Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes. No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care. Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring. Guidelines may have a role to play in improved monitoring but need service-level support in order to be effective. ABSTRACT: Introduction People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method An audit of clinical records in primary care (n=46) and secondary care (n=47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n=24). Data were analysed using descriptive statistics. Results Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness.

An alternative term to make comprehensive sexuality education more acceptable in childhood

Background: Ignorance, misconceptions and fear hinder the implementation of young children’s age-appropriate sexuality education (SE) globally. Methods to promote the SE of young children are needed. Aim: We aimed to evaluate why parents and professionals resist the concept of childhood SE and to test whether a child-centred term could reduce this resistance. Setting: We conducted nationwide studies in Finland plus focused studies in three groups. Methods: In open online situation analysis and needs assessment studies among early childhood education professionals ( n = 507) and parents ( n = 614) of 1–6-year-olds, negative, adulthood-associated connotations for the term ‘sexuality education’ were detected. We then evaluated whether a less sex-connected term than SE would be feasible to promote SE of young children. We combined ‘body’ and ‘emotion’, after our earlier study on children’s most common sexuality-related expressions, to form the new Finnish term Kehotunnekasvatus [body–emotion education] and tested it among professionals of sexual health ( n = 17) and early education ( n = 63) and primary health nurses ( n = 29). Results: Acceptance of the new term was excellent in all three groups; the new term was reported as ‘ more positive, more neutral, downplaying thoughts of sex’. Most respondents deemed it appropriate, necessary and usable in their work. Furthermore, the majority of those working daily with the parents of young children preferred the new term to ‘sexuality education’. Conclusion: After testing the functionality of a new Finnish term among Finnish professionals, the authors suggest considering replacing the term ‘sexuality education’ with a more child-centred and less sex-connected synonym when referring to SE for young children.

Healthcare challenges of incarcerated women in Australia: An integrative review

Background: Despite the rise in numbers of incarceration women, disparities between health care services and access exist. The health needs of incarcerated women is complex and influenced by multiple social determinants of health.Purpose: Explore the healthcare issues of incarcerated women within Australian Prisons.Methods: Integrative review of the literature.Results: Incarcerated women represent a small proportion of the prison population within Australia, however, health outcomes are significantly impacted. Socioeconomic status, abuse (physical, emotional, sexual), previous incarceration, generational factors are some of the factors impeding the health of incarcerated women. Mental health, chronic disease conditions, maternal and child factors are significant health concerns of this vulnerable population. There is a disparity in health access and programs to improve their health outcomes. This paper explores the challenges impacting the health of incarcerated women.Conclusions: Significant disparities exist in the access of health services available to incarcerated women. There needs to be more focus upon improving access to health services and health support programs to meet the complex health needs of incarcerated in Australia. Furthermore, there is a need for more primary health nurses to prevent and address the healthcare issues of this population.

Suicide assessment and treatment in pediatric primary care settings.

TopicThis article will briefly review screening for depression and suicidal ideation in primary care and school‐based clinics, with a focus on in‐depth screening for imminent suicide risk, developing a safety plan, and incorporating handoffs to urgent and emergency mental health care personnel. The article will cover current definitions of levels of suicidal risk and clinic‐based protocols for a team approach to adolescents in crisis.PurposeTo provide primary care and behavioral health nurses with evidence‐based suicide risk screening and assessment tools and best practices for using them in patient‐centered encounters with adolescents with suicidal thinking or behavior.Sources UsedJournal articles, books, and reports.ConclusionPast studies have shown that many individuals who died by suicide had seen a primary care provider in 30 days before their deaths. Nurses in primary care settings should develop clinic‐based protocols for screening all adolescents for suicide risk, developing safety plans, and providing suicidal youth and families with monitoring, appropriate referrals, follow‐up, and support.

Comparing Two Early Child Development Assessment Tools in Rural Limpopo, South Africa

BackgroundProviding increased cognitive stimulation or learning opportunities to young children significantly increases cognitive and social-emotional competence later in life. This study aims to determine the acceptability of a pediatric assessment tool to track early child development (ECD) in a rural health district in Limpopo, South Africa.MethodsA total of 11 primary health nurses from the region in two focus groups were selected to learn and compare two ECD assessment tools: the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and Ages and Stages Questionnaire (ASQ). Data were analyzed using versus coding to compare between the two focus groups and between ASQ and CAT/CLAMS.ResultsThe major categories that emerged from the discussion were current practice, usability, resource management, cultural adaptation, patient and parent factors, and new knowledge.ConclusionsThis study illustrates the challenges related to adapting and implementing ECD assessment in an environment where ECD is largely unknown by local residents, and differs from the environment in which the tool was initially developed. Further work is needed to develop new tools or alter existing tools that can be adapted to diverse settings and cultures.

A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation.

BackgroundAdvance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources.ObjectiveThe purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk.MethodsThe CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes.Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes.Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey.Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey.ResultsContext: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content.Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback.Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29).Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations.ConclusionsThe CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study.

Improving Cardiovascular Care in Rural Victoria: Primary Health Nurses a Vital Link in the Chain

Improving Cardiovascular Care in Rural Victoria: Primary Health Nurses a Vital Link in the Chain

Hälsovägledning med Somaliska föräldrar inom Svensk Barnhälsovård. En kvalitativ studie

Background: Difficulties in intercultural encounters and communication in health care is well known. Swedish primary child health nurses' have daily encounter with Somali parents for health counsel ...

Antidepressant Medication Management Among Older Patients Receiving Home Health Care.

Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients aged 65 years or older who received HHC in 2006-2007 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (versus discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10- to 20-percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.

INEQUALITIES IN THE DISTRIBUTION OF PRIMARY HEALTH CARE PHYSICIANS AND NURSES IN ALBANIA

CONTEXT: BACKGROUND: The aim of this study was to assess the possible inequalities in the distribution of primary health care (PHC) physicians and nurses in Albania, a transitional country in Southeast Europe. METHODS: Based on the available information from the Albanian Health Insurance Fund, we examined the distribution of PHC physicians in each of the 36 districts of Albania for the period 2000-2011, whereas for the nurses for the period 2007-2011. The inequalities in the distribution of PHC physicians and nurses were assessed by plotting the Lorenz curves. RESULTS: There was evidence of an increasing trend in the inequality of distribution of both PHC physicians and nurses in Albania. The increasing trend was more obvious in the distribution of physicians than in the distribution of nurses. Conclusion: Policymakers in the health care sector should be aware of the need for reallocation strategies for PHC physicians and nurses in Albania as an effective means for reducing inequalities of the health care workforce. Keywords: family physicians, inequalities, Lorenz curves, nurses, primary health care.