Primary Health Settings Research Articles

Psychosocial Factors Related to Repeat Mammography Screening Over 5 Years in African American Women

The purpose of this study was to investigate health beliefs associated with repeat mammography screening in African American women 51 years or older over a 5-year period. Long-term repeat mammography screening is inconsistent in African American women; therefore, this study measured demographic, knowledge, and health belief predictors of repeat screening. The theoretical framework for this study was the health belief model. Baseline data from a larger randomized controlled trial were analyzed using descriptive statistics and logistic regression. The sample consisted of 602 African American women with no breast cancer history and at least 1 reported screening mammogram in the past 5 years. They were recruited from 3 primary care health settings. Having been screened 4 to 5 times in the past 5 years was associated with more knowledge about screening guidelines and fewer perceived barriers to screening. Results point to the importance of collaborating with African American communities to promote life-long mammography screening by increasing access to culturally appropriate information on screening guidelines and ameliorating barriers to screening within the context of the African American experience.

Body Dissatisfaction as a Motivator for Weight Loss: Should Assessment of Body Dissatisfaction be Considered in Primary Health Settings for Women Planning to Lose Weight?

The objective of this study was to assess whether body dissatisfaction predicted weight loss in terms of an inverted U relationship. It was predicted that women with high and low body dissatisfaction were less likely to lose weight than women with moderate levels of body dissatisfaction. The study also sought to determine if the number of weight loss attempts, success at past weight loss and self-concept predicted percentage of weight loss in women at six months; and to test whether weight loss led to decreased body dissatisfaction and increased self-concept. Women attempting to lose weight (n = 209) were asked to complete a set of questionnaires at two time points. Results show that women with moderate scores on body dissatisfaction lost more weight than women with higher or lower scores, although this association disappeared when Body Mass Index (BMI) was controlled for in the analyses. Low BMI, success of previous weight loss and low personal self-concept predicted weight loss six months later. Women who lost weight reported lower body dissatisfaction and improved self-concept. It was concluded that, assessing for body dissatisfaction, BMI and weight loss history in the context of primary health settings, may aid in identifying women able to motivate themselves to successfully lose weight in a self-directed manner.

Broadening Mental Health Services to Disadvantaged Communities in South Africa: Reflections on Establishing a Community Based Internship

The need to provide mental health services in disadvantaged communities remains a priority in South Africa. This paper illustrates how in consultation and partnership with the peri-urban community of Jamestown, a counselling psychology internship was established to provide a range of mental health services at a primary health clinic. We describe how the internship also became an important catalyst for other community interventions. We also illustrate how values of community psychology informed the establishment and foci of the internship. Tensions encountered in reconciling community needs and professional training requirements discussed include the lack of resources at the primary health care level, the bio-medical bias of the primary health setting, and addressing the needs articulated by the community for more direct interventions.

What's Needed to Increase Research Capacity in Rural Primary Health Care?

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians' research involvement. The results showed that popular delivery modes for research training and support were courses and "one-to- one" advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian consultations on research needs in primary health conducted with a diverse range of clinicians at the clinician level. It will direct future research capacity building efforts towards maximising face-to-face discipline specific options and minimising technology use.

Research in primary dental care. Part 1: Setting the scene.

There is a growing trend for research to be conducted in primary health settings, to the benefit of patients and healthcare workers. This article provides an introduction and overview of a series which aims to facilitate research in general dental practice and to encourage general dental practitioners and other members of the dental team to become involved in these studies. The benefits of undertaking research are outlined, as well as barriers to becoming involved in such research. It is argued that many of these barriers can be overcome by encouraging dental practitioners to collaborate with established researchers in a variety of settings.

Using motivational interviewing techniques to talk with clients about their alcohol use

Dramatic changes over the past 3 decades have significantly affected the way clinical services for alcohol problems are conceptualized and provided. An important trend is toward delivering services outside of specialized alcohol programs. Expansion of services to primary health care and mental health settings is likely to reach greater numbers of individuals than can be reached in specialized alcohol treatment programs. An important aspect of the change has been the introduction of motivational interviewing (MI) techniques. Although motivation was once viewed as a trait to explain both poor outcomes as well as why people drop out of treatment, today motivation is conceptualized as a state that can be influenced by therapists. MI is a nonconfrontational way of talking and interacting with clients that involves delivering messages in a manner that avoids eliciting resistance (e.g., not using labels such as “alcoholic”). MI has been shown to increase compliance, reduce resistance, decrease dropouts, and result in better treatment outcomes with all types of alcohol abusers, from those who are mildly dependent to those who are severely dependent on alcohol. This article also provides a table of major MI do's and don'ts and examples of what to say and what not to say to clients.

Post-traumatic stress: Clinical implications

Disaster Manage Response 2003;1:14-8.

Social Work in Primary Care

ABSTRACT A neighborhood primary health care program serving a socially and economically oppressed community, and a graduate school of social work have collaborated to create a social work student field work unit in a primary health care setting, to demonstrate emerging and innovative social work roles in an ever-increasing managed care environment. Patients with high levels of psychosocial stress make large demands on the primary care system and consume considerable laboratory and diagnostic treatment resources. Development of social services in primary care settings is a relatively new concept, however it has been clearly demonstrated that primary care physicians need the skills of social workers to handle the psychosocial and environmental aspects of illness. The principal goal was to demonstrate social work practice in a primary care health setting, utilizing practice research approaches. Validation of effectiveness was noted, as depression, anxiety, adjustment reactions (to name a few) were decreased, resulting in fewer physician visits, less somatization and improved compliance with medical and diet/nutrition regimens. The case examples and single subject data presented provide qualitative evidence, in the context of a natural experiment, for the profession to pursue this model further in both program development and research.

Lessons from the past – learning for the future: Social work in primary health care

There has been an upsurge in interest in social work in primary health care, arising initially from the implementation of community care and – more recently – from the introduction of Primary Care Groups. Although there were numerous examples of social work attachments to primary health care through the 1960s and 1970s, and a substantial literature on the subject, there is a danger that the learning from earlier research fails adequately to inform current policy and practice. Social workers have the potential to perform “diagnostic”, “liaison” and “therapeutic” functions within primary health settings and all of these are valued highly by health services staff. Given the development of Primary Care Groups, this article argues that social workers need to demonstrate greater clarity about their roles in order to function effectively in the new multi-disciplinary climate that is developing

Application of the ambulatory care groups in the primary care of a European national health care system: does it work?

Ambulatory Care Groups (ACGs), a US case-mix system that uses the patient as the unit of analysis, is particularly appropriate for health care systems in which physicians serve a defined list of patients. To determine the extent to which the categorization of patients according to ACGs would account for the utilization of primary care services in a national health care system within the European Union. Of all subjects continuously assigned to 9 physicians from public primary health care centers in Bizkaia, Basque Country (Spain) over a 12-month period, those visited at least once (n = 9,093) were included. According to the subject's age, sex, and ICD-9-CM diagnoses assigned during a year of patient-provider encounters, patients were classified by means of the ACGs system. Multiple linear regression analyses indicated that age and sex did not explain more than 7.1% of the variance in annual visits made by adults and 25.7% by children to primary care physicians. However, the r2 adjusted to the ACGs model was 50% and 48%, respectively, and even higher, that is 58% and 64% for another component of the system, the Ambulatory Diagnostic Groups (ADGs). Those results support the inadequacy of using the patient's age and sex alone to estimate physicians' workload in the primary health setting and the need to consider morbidity categories. The ACGs case-mix system is a useful tool for incorporating patients' morbidity in the explanation of the use of primary health care services in a European national health system.

Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors

This study aimed to assess the prevalence and incidence of postpartum depression (PPD) and to identify risk factors in a community cohort of Israeli-born, as well as new and veteran immigrant women. A random sample of 288 registrants at a community clinic was assessed for depressive symptoms at 26 weeks' pregnancy using the Beck Depression Inventory (BDI) and at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Information regarding risk factors was gathered through interviews and medical record abstracting. The prevalence of PPD was 22.6%. Two-thirds of the women had scored ‘depressed’ during pregnancy, and one-third (6.9%) were new incident cases. Immigrant status was the only significant demographic predictor of PPD identified by either univariate or multivariate analysis, with Russian new immigrants having over twice the risk for PPD as Israeli-born subjects. The rate of PPD in this Israeli cohort was comparable to that found in other countries. The finding that immigrant status was the most potent demographic predictor may support the role of stressful life events in the etiology of PPD. The use of the EPDS for PPD screening was found acceptable and feasible in the primary health setting.

Teaching baby massage to new parents.

In this paper the author reviews six years of running an on-going baby massage group in a health clinic and makes observations, based on experience, on the importance of offering these classes in health centres where they are accessible to all parents with young babies. As baby massage classes are becoming increasingly popular, private individuals are offering classes and, in some cases, there is doubt as to the qualifications of the instructors, their understanding, and their ability to give sufficient support to young mothers at a vulnerable stage in their lives. The quality of training given by the International Association of Infant Massage Instructors based in the USA is appraised and some thoughts are given as to the way ahead in making more baby massage classes available to all parents within the Primary Preventive Health setting.

Improving diabetes care in the primary health setting. The Indian Health Service experience.

To identify key systems issues from the Indian Health Service (IHS) experience that must be addressed to improve metabolic control among patients with non-insulin-dependent diabetes mellitus (NIDDM) who were followed in primary care settings. Records of diabetic patients seen in IHS facilities in specific geographic regions from 1987 to 1994. A representative sample of charts from each facility was reviewed yearly to measure key variables. The sampling frame was the number of diabetic patients currently active on the registry and the sample size calculated to measure a 10% change in selected practices at each facility. Regional diabetes coordinators reviewed charts or trained local providers to sample and extract data in a standard format. Regional data were examined to show trends in the performance of immunizations and foot examinations and in other variables such as hypertension and metabolic control. The percentage of diabetic patients who received a single dose of pneumococcal vaccine improved from 24% in 1987 to 1988 to 57% in 1994 (P < 0.01 for trend) among diabetic patients in Minnesota, Wisconsin, and Michigan. Rates of yearly comprehensive foot examination increased from 36% to 58% (P < 0.01 for trend) over the same period. In Montana and Wyoming, the percentage of diabetic patients with uncontrolled hypertension (defined as the mean of three systolic blood pressure measurements of > or = 140 mm Hg or diastolic pressure measurements > or = 90 mm Hg, or both, during the previous year) decreased from 36% in 1992 to 25% in 1993 after the regional diabetes coordinator emphasized hypertension control. In 1994, when less emphasis was placed on hypertension, 33% of the diabetic patients had uncontrolled hypertension. Estimates of metabolic control from records of diabetic patients in Washington, Oregon, and Idaho in 1994 showed that 29% of patients had excellent metabolic control (a hemoglobin A1c [HbA1c] level < or = 7.5% or mean blood glucose level < or = 9.2 mmol/L) within the past year; only 9% experienced poor control (a HbA1c level > 12% or mean blood glucose level > 18.9 mmol/L). The IHS experience shows that standard, ongoing monitoring of key variables allows facilities to improve diabetes care. Simple, reliable methods of defining metabolic control combined with a feedback system in the primary care setting are needed to improve metabolic control in patients with NIDDM.

Best Practice and Allied Health

In this paper, issues are discussed relating to the provision of quality allied health advice, and the focus of the allied health program in primary health care and community health settings in the Peninsula and Torres Strait Region of Queensland, since Regionalisation in 1991. It was apparent to allied health professionals working in community health, that the change process presented an opportunity to influence not only the Regional Health Authority, but also to act as a united voice for the professions and to be advocates for best practice models of care for the community. Why do allied health professionals need to be utilised in an advisory role in community based health settings? What are the impacts on policy, planning, and on the services provided by community health care workers? How can allied health advisers enhance the quality of outcomes of best practice for the consumers of community health programs? Allied health advisers are important for the whole health sector by ensuring that effective and appropriate allied health services are delivered, that there are increases in allied health resources, that there are improvements in health outcomes for clients, that primary health care models of care are implemented, and, finally, that best practice is implemented by the allied health professional.

Quitting smoking: estimation by meta‐analysis of the rate of unaided smoking cessation

The rates (after 12 months' follow-up) of unassisted smoking cessation reported in the literature have varied from 13.8 per cent to 8.5 per cent. A meta-analysis was conducted of the abstinence rates observed in 14 samples of smokers who presented at primary health settings and received either no intervention aimed at smoking or usual care (which involved no deliberate intervention for smoking cessation). The estimated rate of stopping smoking without intervention, over an average 10-month period, was 7.33 per cent. This rate is consistent with others reported in the literature when motivation to quit is taken into account. The estimate provides a baseline to judge the effects of smoking-cessation interventions.

Treatment, care, and rehabilitation of the chronic mentally ill in Poland.

In Poland primary health settings provide about 71 percent of mental health services, particularly to patients with less serious illnesses, while psychiatry provides specialized mental health care for the chronic mentally ill, the mentally retarded, and patients with alcohol or drug dependence. Poland has a large number of outpatient clinics and an extensive network of sheltered workshops. Most inpatient psychiatric beds are located in mental hospitals; few general hospitals have psychiatric units. Deinstitutionalization has been less extensive in Poland than in many other countries; only about 10 percent of the chronic patients treated in mental hospitals were deinstitutionalized between 1970 and 1981. During that period the proportion of patients hospitalized for a year or more decreased, the number of chronic patients treated in nursing homes increased, and the pattern of hospitalization shifted toward multiple readmissions.

Glycosuria in childhood

AbstractThe major relevance of glycosuria in childhood is in the diagnosis of diabetes mellitus. Children presenting either in the primary health or hospital setting with symptoms suggestive of diabetes, should routinely have their urine tested for glucose. If glycosuria is discovered, the diagnosis of diabetes mellitus can be rapidly confirmed with a blood glucose estimation. The next step must be admission to hospital or paediatric consultant domicillary visit on the same day. In this way a totally preventable cause of paediatric mortality could be avoided.

Sexual Health Education and Counseling

In the past decade, there has been a concentrated effort to develop much needed advances in human sexuality, but many sexually misinformed or troubled members remain in our society. As more information is disseminated and people become sophisticated, there will be many people requesting help with sexual problems in primary and secondary health settings. Nurses need to equip themselves in this important aspect of health care. First, one's own values, attitudes, and knowledge must be carefully examined. Desensitizing, and incorporatin experiences have been used effectively to help get in touch with feelings and attitudes about the sensitive area of sexuality. Second, the nurse must be aware of the wide range of feeling and attitudes on specific sexual issues that have proved troublesome to our society. Third, the nurse must take advantage of educational opportunities to gain knowledge of psychosexual growth and development during the entire life span. Fourth, if the nurse desires to become involved in sexual conseling further education with concentration on the various innoviative techniques and approaches will be necessary to help clients with specific problems and concerns. Finally, sexual health programs need to be affiliated with a reputable health agency with prefessional supervision. All programs and new approaches must be evaluated to determine their effect on sexual health care.