Primary Health Research Articles

Patient's conception and attitude regarding triage system and waiting time at emergency department at Riyadh, Saudi Arabia

Background: An increase in the number of visitors to the emergency department (ED) leads to overcrowding, long wait, and patient dissatisfaction. It is important to implement the decision-making process to avoid congestion and nonurgent cases. This study aims to assess patients\' knowledge and attitude about the triage system and waiting times in ED. Methods: This was a cross-sectional study conducted at the ED at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia. Data were collected using an online questionnaire form for all participants who met the inclusion criteria. Results: In this study, 389 participants with mean age of 33.77 (SD =12.96) years were included, of them 54.2% were males. Moreover, only 15.2% of patients reported having primary care doctor or health providers among whom 41.9% reported that they tried to call their primary care doctor before coming to the ED. Moreover, 66.2% of participants reported having no knowledge about triage. Furthermore, 57% of participants wanted to know how long other patients have been waiting. Moreover, results showed that the most important information required by the patients was the periodic updates from ED staff about the delays (51.4%) followed by information about the health care system and how to find a primary care provider. Conclusion: Most of the population were unaware of the triage and its definition; however, most of the participants had good knowledge considering why some patients were seen before others. Finally, the waiting expectation of tests results was worse in this study, which reflected low satisfaction level.

Perspectives of young people who access support for mental health in primary care: a systematic review of their experiences and needs.

BackgroundThere is an increasing demand for mental health support in primary care, especially for young people. To improve mental health support for young people in general practice, the needs of young people must be considered.AimTo explore the experiences of young people (aged 12–25 years) on receiving mental health care in primary care and identify the needs of young people who present with mental health concerns.Design and settingA systematic review and narrative synthesis.MethodThis was a systematic review and narrative synthesis. Six databases were searched for literature relating to young people’s experiences of receiving mental health care in primary care. Additional handsearching and manual internet searching were conducted. Narrative synthesis was employed.ResultsFive papers and a further two reports from manual internet searching were found, resulting in the inclusion of 1823 young people from four different countries (UK, US, Ireland, and Canada) for synthesis. The synthesis generated four themes: the centrality of a trusting relationship; showing empathy and taking concerns seriously; being given time to talk; and barriers to accessing mental health support in primary care.ConclusionYoung people need a trusting relationship to discuss sensitive issues. To enable high-quality and effective mental health consultations with young people and the development of trust, GPs require unhurried consultations and the ability to maintain continuity of care.

Barriers to managing elder abuse in primary care services: experiences of healthcare providers in Mexico City

ABSTRACT The purpose of this study was to analyze the barriers to managing elder abuse from the perspective of primary care health workers in Mexico City. We performed an ethnographic qualitative-descriptive study. Thirty semi-structured interviews were conducted with healthcare providers associated with three health centers located in areas with medium and high levels of poverty. A phenomenological approach was used to identify themes, subthemes and codes. Three main types of barriers were found: 1) institutional framework; 2) professional competency limitations and the dominance of a biomedical vision; and 3) the invisibilization of elder abuse. These barriers, described by healthcare workers, highlight the complexity involved in integrating the treatment of elder abuse into primary care health services. It is necessary to develop public educational and preventive public policies for elder abuse that are coordinated both with support services to treat such cases as well as with programs to strengthen healthcare providers professional competency.

Opioid Use Among Rural Medicare Beneficiaries

This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.

Empirically Evaluated Suicide Prevention Program Approaches for Older Adults: A Systematic Review

Suicide is a serious public health concern, particularly for individuals in later life. Studies suggest that greater attention to suicide prevention programs for older adults is needed as well as continued research related to interventions with older adults at risk of attempting suicide. A systematic review of the literature on suicide prevention treatment and effectiveness is fundamental to assessing existing services and developing new programs and practice standards. This systematic review of the literature extends an earlier and well-cited systematic review (1966-2009) by examining articles published between 2009 and 2021 with a focus on what types of empirically evaluated suicide prevention programs effectively prevent and reduce suicidality in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to gather the appropriate extant research and improve reporting accuracy. A three-stage review guided the selection of the articles. At stage one, titles were screened, which excluded 284 articles based on the inclusion criteria. Second, after a full review of each abstract, a final 14 articles remained for full-text review. Lastly, three independent researchers reviewed each of the full-text articles, and six articles were excluded. The final sample includes eight articles (N=8). The articles were categorized into three types of programs: 1) primary and home health care, 2) community-based outreach, and 3) counseling. Following a description of the articles, the authors assessed each study using the GRADE rating system. Findings underscore the critical need for evidence-based suicide prevention programs for older adults. Implications for future research are offered.

Association between Food Intake and Overweight in Children Assisted by Primary Care

Background: The child feed in the first two years of life is of fundamental importance for a healthy growth and development. Aims: To verify the association between food consumption indicators and overweight in children under the age of two, followed up by primary care health professionals. Methods: A cross-sectional study was conducted on 232 children assisted by primary care. A structured questionnaire was used with questions on sociodemographic data of mothers or guardians and food intake and anthropometric data of children. The analysis of the association between excess weight and food intake indicators was performed using the Pearson’s chi-square test (χ2) and Fisher’s exact test (f ˂ 5). Results: Regarding food intake in children under 6 months of age, 35.1% of the children were exclusively breastfed. Among children at the age of 6 to 23 months: 66.3% were on continued breastfeeding; 16.7% consumed adequate foods at the age of 6 to 8 months; 90.4% consumed foods that belonged to the six food groups; 76.3% consumed food at the minimum frequency and with adequate consistency; 88.9% consumed iron-rich and vitamin A-rich foods, and 59.3% consumed ultra-processed foods. Regarding nutritional status, 24.5% of the children were overweight. Conclusion: There was no statistically significant association between overweight and food consumption indicators among the surveyed children. However, exclusive breastfeeding was below the recommended level, a low percentage of the introduction of complementary foods at the appropriate age and high consumption of ultra-processed foods reveal the need to improve the assistance provided by primary care to this group.

Periviable Breech Delivery Decision Analysis

Background/Objective: The optimal mode of delivery (MOD) for malpresentation in periviable deliveries (22-24 weeks), remains a source of debate. Neonatal and maternal complications can arise from both vaginal (VD) and cesarean delivery (CD), and the threat of maternal morbidity extends to subsequent pregnancies. It has been difficult to compare these risks while counseling patients about MOD options, so we sought to create a decision tree that maps probable outcomes associated with breech deliveries at 23- and 24-weeks’ gestation, as well as complications posed for subsequent pregnancies. 
 
 Methods: An extensive literature review was conducted to identify risk estimates of periviable maternal and neonatal outcomes, along with elective repeat CD (ERCD) and trial of labor after cesarean (TOLAC) for subsequent pregnancies. Probabilities were inputted into TreeAge software, starting with primary maternal health states that may result from CD and VD – “death”, “hysterectomy”, or “no hysterectomy”, followed by the probability of neonatal health states– “death”, “severe morbidity”, or “no severe morbidity”. The likelihood of placenta previa or normal placenta was considered for subsequent pregnancies. We factored in the possibility of ERCD or TOLAC and the associated maternal and neonatal risks for each. 
 
 Results: Final design of the tree is complete and risk estimates have been inputted. Primary analysis and sensitivity analyses are planned for August 2021. Ultimately, we will also be able to use measured utility values to calculate quality adjusted life years (QALYs) for each health state. 
 
 Conclusion and Clinical Impact: Whether CD or VD is optimal for breech presentation in periviable delivery is influenced by a complex array of factors, including future reproductive plans and maternal values related to potential neonatal and maternal morbidity and mortality. Quantifying risks associated with each MOD will aid providers in their efforts to help families make informed decisions and reduce morbidity across the reproductive lifespan.

Perturbação do Espetro do Autismo: A Ligação Entre Cuidados de Saúde Primários e Secundários

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Primary care coverage and individual health: evidence from a likelihood\xa0model using biomarkers in Brazil

BackgroundAlthough the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects.MethodsThe empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey.ResultsHousehold ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage.ConclusionsThe presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.

Health indices for the evaluation and monitoring of health in children and adolescents in prevention and health promotion: a scoping review

BackgroundHealth indicators are used in different settings to monitor health outcomes. Child and adolescent health is arguably one of the most important areas for the application of indices and indicators in prevention and health promotion. Although single health indicators may be better suited to display the complexity of the health status and its determinants, a selected set of indicators will still offer a complex picture. Therefore, it is argued that a group of indicators combined into an index may offer a pragmatic tool that is easier to use in order to inform stakeholders.MethodsA scoping review was conducted to identify and describe health indices that monitor and evaluate health of children and adolescents and to appraise the quality and value of the identified indices that may guide the further applications of these indices in particular settings. The three bibliographic databases MEDLINE, EMBASE and PsycINFO were searched and a double screening of titles and abstracts as well as double screening of full texts was performed. Indices contained in these studies were analysed in terms of focus and composition and evaluated in terms of quality criteria.ResultsThe scoping review identified 36 eligible studies with 18 health indices in six thematic categories. Of the identified indices, seven indices focus on anthropometrical variables, three indices focus on special aspects of newborns and five indices focus on oral health. One index assesses “healthy lifestyle” and one “functional ability” whereas one index a combination of different aspects. Most indices are calculated by using primary health data.ConclusionsAlone or in combination with single sets of indicators, indices in six major thematic domains may be used as pragmatic tools for monitoring children’s and adolescents´ health and the evaluation of interventions in health promotion and prevention settings.

Rehabilitation care planning on a digital communication platform for patients with a work disability: protocol for the RehaPro-SERVE feasibility study

BackgroundLong-term disability to work is a risk factor for a permanent reduction in income. Rehabilitation care can support people to return to work. In Germany, rehabilitation care to return to work is mostly provided in specialised clinics. The aim of the Rehapro-SERVE study is to reduce work disability days by facilitating rehabilitation care planning using a digital communication platform. To investigate the feasibility, we will test the implementation of the digital platform and evaluate the study procedures. The Rehapro-SERVE study is funded by the German Federal Ministry of Labour and Social Affairs (BMAS) (grant number: 661R0053K1).MethodThe feasibility study includes a two-armed unblinded block randomised controlled study (RCT) without follow-up assessments as well as an interview study. Participants for the RCT (n = 16) are primary care patients with a minimum of 4 weeks of absence from work due to musculoskeletal, oncological or psychological conditions and at high risk of early retirement. Eligibility criteria are age 40 to 60 years; minimum of 4 weeks continuous sick leave before recruitment due to musculoskeletal, mental health or oncological conditions; and being at high risk of early retirement. Patients will be recruited from 8 primary care practices in urban and rural areas in Hesse, Germany. Following baseline assessments, patients will be randomised to either digitalised care planning (treatment) or a control group. The digitalised care planning platform will include the patients’ primary care physicians, jobcentres and public health physicians to decide on a tailored return-to-work programme. The collaboration will be supported by a case administrator and, if considered beneficial, a social worker for the patient. An interview study will evaluate the acceptability of the study procedures and the intervention.DiscussionThe use of a digital communication platform enables stakeholders to exchange information and discuss rehabilitation care planning in a timely fashion. The results of the feasibility study will lead to the adaptation of study procedures for the main study. The results will support the design and conduct of similar studies including digital applications in primary care or across different healthcare settings.Trial registrationDRKS- German Clinical Trials Register, DRKS00024207. Registered on 22 March 2021

The limited screening accuracy of the Patient Health Questionnaire-2 in detecting depression among perinatal women in Italy.

The PHQ-2 was recently recommended by the International Consortium for Health Outcomes Measurement as a form of initial perinatal screening, followed by the EPDS only for women with positive PHQ-2 score. However, the accuracy of the PHQ-2 in perinatal clinical practice has been barely researched, to date. In the present study, we aim to assess the accuracy of the PHQ-2 against the EPDS in a large sample of perinatal women. A total of 1155 consecutive women attending eleven primary or secondary health care centres throughout Italy completed the EPDS and the PHQ-2 during pregnancy (27-40-weeks) or postpartum (1-13-weeks). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, post-test probabilities and area under the curve (AUC) of the PHQ-2, using a cut-off of ≥ 3, were calculated. During pregnancy, PHQ-2 revealed low sensitivity (39.5%) and PPV (39.4%) but high specificity and NPV (97.5%). In postpartum, it revealed very low sensitivity (32.7%) and moderately high NPV (80.9%), but high specificity (99.3%) and PPV (94.4%). Given the low sensitivity despite the high specificity, the PHQ-2 demonstrated poor accuracy (AUC from 0.66 to 0.68). Initial screening by means of PHQ-2 failed to identify an acceptable number of perinatal women at-risk of depression in Italian clinical practice. The PHQ-2 performance suggested that it has insufficient sensitivity and discriminatory power, and may be inadequate as a screening tool for maternal depression.

Social capital and self-rated health among Chinese rural empty nesters: A multiple mediation model through sleep quality and psychological distress

Background: many studies explore the relationship between social capital and self-rated health. However, few studies clarified the mechanisms underlying the relationship between social capital and self-rated health among Chinese rural empty nesters. This study aimed to explore the multiple mediating roles of sleep quality and psychological distress between this relationship.Methods: A total of 2,254 rural empty-nest older adults were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. Logistic regressions were performed to assess the relationships between social capital and self-rated health. The multiple mediating roles of sleep quality and psychological distress was analyzed using Mplus 8.3.Results: we found that social capital has a significant directly affect self-rated health (β=0.127, 68.65% CI=0.082−0.171), and through three significantly mediation pathways: (1) the path through sleep quality (β=0.013, 95% CI=0.005−0.021), which accounted for 7.03% of the total effect; (2) the path through psychological distress (β=0.037, 95% CI=0.024−0.049), which accounted for 20.00% of the total effect; (3) the path through sleep quality and psychological distress (β=0.008, 95% CI=0.004−0.013), which accounted for 4.32% of the total effect. The total mediating effect was 31.35%.Conclusions: sleep quality and psychological distress mediate the relationship between social capital and self-rated health. Attention should be paid to mental health and sleep quality of empty nester through primary health, strengthen the attention to social resources, provide intervention and treatment for the empty nesters with sleep problem and psychological distress.

Hypertension and cardiovascular\xa0risk factor management in a\xa0multi-ethnic cohort of\xa0adults with CKD: a cross sectional study in general practice

BackgroundHypertension, especially if poorly controlled, is a key determinant of chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD).AimTo assess hypertension and risk factor management, and determinants of systolic blood pressure control in individuals with CKD and hypertension.Design and settingCross-sectional survey using primary care electronic health records from 47/49 general practice clinics in South London.MethodsKnown effective interventions, management of hypertension and cardiovascular disease (CVD) risk in patients with CKD Stages 3–5 were investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure control status as outcome. Individuals with diabetes were excluded.ResultsAdults with CKD Stages 3–5 and hypertension represented 4131/286,162 (1.4%) of the total population; 1984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed hypertension, 23.0% had systolic blood pressure > 140 mmHg compared with 39.8% hypertensives, p < 0.001. Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years. African ethnicity and obesity were associated with poorer systolic blood pressure control.ConclusionWe found both underdiagnosed CKD and underdiagnosed hypertension in patients with CKD. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases.Graphic abstract

Awareness And Knowledge Of Glaucoma Among Workers In A Primary Public Health Centre In Rote Ndao

Glaucoma was one of the biggest causes of blindness in the world. Early detection of glaucoma is important to reduce the morbidity of visual impairments and blindness. Primary Public Health Centre is expected to be able to educate people about visual impairment and blindness due to glaucoma. This study aims to evaluate the level of awareness and knowledge about glaucoma in the staff of UPTD Puskesmas Delha as a way to increase the public awareness campaigns of glaucoma. Methods An observational study took place in the primary public health centre, UPTD Puskesmas Delha in West Rote District, Rote Ndao Regency, East Nusa Tenggara Province. The population was all staff, divided into two groups that were health workers and non-health workers. The subjects filled a questionnaire about the awareness and knowledge of glaucoma that was consisting of 12 questions. Data collected were analyzed by SPSS software version 21 using the Independent T-Test method with a significance level of 5%. Result A total of 51 staff participated in this study consisting of 7 males (13.7%) and 44 females (86.3%), age distribution between 22-54 years old. A total of 44 health workers (86.3%) and 7 non-health workers (13.7%), 84.3% aware of glaucoma, but only 62.7% has good knowledge. The result of Independent-T test P-value=0.084 (p &gt;0.05). Conclusion there is no significant difference in awareness and knowledge of glaucoma between health workers and non-health workers. Continuing education is needed to improve the awareness and knowledge of glaucoma.

Knowledge, attitudes and practices of health care providers trained in responding to violence against women: a pre- and post-intervention study

BackgroundViolence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India.MethodsThe study used a pre-post intervention design with assessment of HCPs’ (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up.ResultsTotal median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude.ConclusionsThis package of interventions, including training of HCPs, improved HCPs’ knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women.

Role of small private drug shops in malaria and tuberculosis programs in Myanmar: a cross-sectional study

BackgroundThe role of community drug shops in providing primary care has been recognized as important in Myanmar as in other countries. The contribution by private community drug shops to National Tuberculosis case notifications and National Malaria testing and positive cases is significant. Population Services International Myanmar (PSI/Myanmar) has been successfully training and engaging community drug shops to screen presumptive Tuberculosis to make referrals to public health clinics and perform malaria rapid diagnostic tests (mRDT) to malaria fever cases and provide management accordingly.ObjectivesThe study aims to identify barriers to service provision of the trained providers at the drug shops that are currently engaged in PSI/Myanmar Tuberculosis and malaria programs. Exploring their needs enabled us to identify and address barriers, to provide evidence for better linkage with the primary care system.MethodA mixed method study was conducted with the service providers at the drug shops. A quantitative follow up survey was done with 177 trained Tuberculosis service providers and 65 trained malaria service providers. A total of 32 qualitative in-depth interviews were completed. Seventeen Tuberculosis trained providers and 15 malaria trained providers participated in individual interviews. Content analysis approach was used to generate themes for the data analysis.ResultsFrom the survey, the majority of drug shops reported that they performed appropriate first steps, particularly referring symptomatic Tuberculosis cases and offering mRDT testing to fever cases. Nevertheless, in-depth interviews with them revealed they did not adhere to the national guidelines for every client. There was a need to emphasize the importance of following the national guidelines for referring patients with prolonged cough and fever cases management. For those who were trained in Tuberculosis case referral, support from program staff was needed to make smooth referrals. Those who were trained in malaria often considered differential diagnosis of fever other than malaria and did not test with malaria rapid diagnostic test due to declining numbers of malaria cases.ConclusionThe study findings highlighted that the drug shops trained in Tuberculosis referral seemed to have the potential to fully engage into the primary care health system if provided with suitable support and supervision. On the other hand, those trained in malaria case management might be less motivated to engage in the era of declining malaria endemicity.

The degree of equity and coupling coordination of staff in primary medical and health care institutions in China 2013\u20132019

BackgroundPrimary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013–2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI.MethodsThe data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022.ResultsBetween 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens’ living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of − 13.53, − 5.77%, and − 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively.ConclusionsIn China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas.

An Exploration of the Possibilities of Current Mental Health Services to Tackle Transgenerational Effects of Parental Mental Illnesses on Offspring Adjustment in Lithuania.

The topic of mental health and mental disorders is very sensitive and delicate in families and the society. Stigma is one of the main reasons for little help-seeking for mental disorders. Transgenerational effects of mental disorders is the utmost sensitive theme that brings difficulties for service organization and research. By emphasizing the importance of the effects of parental mental illnesses on the health of offspring and their adjustment, together with sharing the international experience between professionals, both the administration of services and society could provide opportunities for further positive change in this little-studied but utmost actual field. There is still a lack of appropriate long term systematic programs and ways to overcome complex organizational challenges. Sharing international experience and research could help find ways that best fit the situations in each country. After a descriptive analysis of the current system of mental health services in Lithuania, opportunities were sought to meet the needs of children and adolescents whose parents have mental disorders by ensuring their healthy psychosocial development. Child and adolescent psychiatry services are a more favorable and less stigmatized area in Lithuania than adult psychiatry, so assistance and specialized programs for children of parents with mental health problems could be organized using the country's relatively well-developed network of child and adolescent psychiatric and pediatric services. For such a small country with limited resources, there could be a possibility to use and strengthen the existing network of services together with finding opportunities for mixed models of financing and cooperation with non-governmental initiatives and organizations. A unique network of primary mental health outpatient centers that provide services for adults and children/adolescents could serve as a reasonable basis for the systematic implementation of specialized programs and initiatives in this field. This network is still not adequately used in the organization of mental health prevention, early intervention, and complex treatment services for the children of parents with mental illness.

The organisation of resilient health and social care following the COVID-19 pandemic – A critical review

Abstract As second presentation, a recent Opinion by the Expert Panel on effective ways of investing in Health (EXPH) will be shared and used as point of reference to assess what the key components are of a future Partnership. This Opinion on the organisation of health and social care following the COVID-19 pandemic (1) identifies the building blocks of resilient health and social care systems, (2) explores the elements and conditions for capacity building to strengthen health system resilience, (3) addresses healthcare provision for vulnerable patient groups and how to sustain such provision in a system under stress, and (4) sets out an approach to develop and implement “resilience tests” of Member State's health systems. The recommendations target a number of key areas, including: enhancing workforce training and resilience, identifying and reducing disinformation, fostering interprofessional and inter-sectoral collaboration with community health workers and informal care givers for example, strengthening primary and mental health care, and a number of other priorities. An overarching recommendation is to enhance investment from the European Commission in the development and implementation of (a) comprehensive resilience testing of health systems that use qualitative and quantitative data collection methodologies to generate meaningful, actionable results for health system transformation, and (b) corresponding learning communities within and across Member States to share lessons learned through this process. Based on this work, what are the priorities for a Partnership, and how can it add value to existing initatives?