Primary Health Care In Relation Research Articles

Men's health in primary care: challenges faced by nurses regarding the determinants of the health-disease process

To identify the challenges faced by nurses working in primary health care in relation to the care provided to the male population. This is an integrative literature review, with a quantitative approach, carried out using the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database - BDENF - and Scientific Electronic Library Online (SCIELO) and with the help of the Health Sciences descriptors (DeSC): "men's health", "primary health care" and "nursing". Fourteen studies were selected to make up the review. The challenges faced by nursing in relation to the health of the male population are mainly related to the socialization that gender involves, the deficit in the organization of services due to the feminization of systems, the incompatibility of schedules, the lack of training and qualification of health professionals who work in PHC. It was possible to identify that health services are deficient in meeting the demands presented by the male population. This study will provide a better insight into the structuring and preparation of health services to care for men of all ages.

Challenges of primary health care leadership during the COVID-19 pandemic in Sweden: a qualitative study of managers’ experiences

PurposeAt the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work.Design/methodology/approachThe authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis.FindingsData analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization’s capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus.Originality/valueLooking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.

Πρόσβαση σε Υπηρεσίες Πρωτοβάθμιας Φροντίδας Υγείας και Βαθμός Ικανοποίησης: Δεδομένα της Ελληνικής Πραγματικότητας

Public health services in Greece have been under persistent pressure, due to the constant fiscal crisis. Health policies related to Primary Health Care (PHC) in the country, despite long-term restructuring efforts, need to be reviewed and redefined. The aim of this study is to analyse the accessibility and satisfaction rates in Greece, as part of the health policies for the PHC of the country. We performed research for the analysis of data with respect to the accessibility to PHC and the investigated data included satisfaction, accessibility, and waiting times. Data were obtained from the European Statistical Authority (EuroStat). A literature search was performed also in the PubMed database, using as appropriate indexing words «quality indicators», «health care», «primary health care», «Greece», and «fiscal crisis». We found that, before the onset of the economic crisis (2004-2008) in Greece, the proportion of citizens unable to access the PHC struc- tures ranged from 4% to 5.5% (2008). During the fiscal crisis period, this figure has almost doubled to 9% (2014). Similarly, the satisfaction of patients from PHC services showed a particularly downward trend. The pre-crisis rate ranged from 94.7% to 92.6% (2008), declining steadily over the crisis and dropping to just 88.8% (2013). The year 2016 appears to be a turning point, to the patterns found up to that time, where the accessibility improved. The Greek fiscal crisis has created many challenges in PHC in relation to the accessibility and satisfaction of citizens with the services provided. In conclusion, the goal of further improvement of the provided primary care services can be achieved by the Greek state through strategic planning, which will take into account the nowadays and particular socio-economic conditions.

“PCATool versão profissionais cuidando da saúde do idoso”: adaptação, análise de conteúdo e desempenho do instrumento

Abstract The objective of this study was to adapt the instrument “Primary Care Assessment Tool (PCATool)-professional version” to measure the performance of the care provided by Primary Health Care (PHC) to the health of the elderly, from the perspective of professionals. The original instrument was critically analyzed by specialists with experience in Gerontology and PHC in relation to the health specificities of the elderly, with 64 syntactic-semantic adaptations and 28 inclusions of new parameters. The adapted instrument was applied to 105 health professionals from PHC in Campinas-SP and, compared to the original instrument, the adaptation proved to be able to distinguish the new parameters with statistically significant differences, and in the sample of the analyzed professionals the performance obtained was better avaliated in relation to “Accessibility” and “Comprehensiveness” attributes, and worse avaliated in the attributes “Longitudinality”, “Coordination”, “Essential and General Scores”. In the adapted instrument, it was verified adequate results in terms of content validity and reliability, good discriminative capacity in relation to the specificities of the elderly population, and potential to become a national instrument for evaluating PHC in care to the elderly.

"PCATool version to professionals in the primary care of the elderly": adaptation, content analysis and first results.

The objective of this study was to adapt the instrument "Primary Care Assessment Tool (PCATool)-professional version" to measure the performance of the care provided by Primary Health Care (PHC) to the health of the elderly, from the perspective of professionals. The original instrument was critically analyzed by specialists with experience in Gerontology and PHC in relation to the health specificities of the elderly, with 64 syntactic-semantic adaptations and 28 inclusions of new parameters. The adapted instrument was applied to 105 health professionals from PHC in Campinas-SP and, compared to the original instrument, the adaptation proved to be able to distinguish the new parameters with statistically significant differences, and in the sample of the analyzed professionals the performance obtained was better avaliated in relation to "Accessibility" and "Comprehensiveness" attributes, and worse avaliated in the attributes "Longitudinality", "Coordination", "Essential and General Scores". In the adapted instrument, it was verified adequate results in terms of content validity and reliability, good discriminative capacity in relation to the specificities of the elderly population, and potential to become a national instrument for evaluating PHC in care to the elderly.

A atuação da equipe de enfermagem frente à prevenção de lesão por pressão na atenção primária: revisão sistemática da literatura

Analisar a produção científica sobre a atuação da equipe de enfermagem inserida na Atenção Primária a Saúde frente à prevenção de LPP. Revisão sistemática realizada a partir da questão norteadora “O que se tem publicado sobre as ações da equipe de enfermagem na prevenção de lesão por pressão no contexto da Atenção Primária à Saúde?”. As bases de dados consultadas foram LILACS, MEDLINE e SciELO. Foram elegíveis três artigos, delimitados entre os anos 2008 a 2018. Dos 03 artigos selecionados, um foi publicado em 2013 e os demais em 2016 e 2018. Em relação à origem dos estudos, dois foram realizados no Brasil e um na Espanha, sendo um de abordagem qualitativa e descritiva e dois de delineamento transversal. Todos foram classificados em nível de evidência científica IV. Os conteúdos abordados nos estudos foram: a atuação da enfermagem na prevenção de lesão por pressão, os desafios e os métodos utilizados na promoção de lesão por pressão. O conteúdo evidenciado nesse estudo permitiu concluir sobre a importância de discutir sobre a prevenção de LPP de modo a contribuir na melhoria da qualidade da assistência à saúde, assim como a necessidade de novos estudos, haja relevância do tema e escassa produção científica na área.

Spending on primary healthcare in two government administrations in Chile since the dictatorship

Since the Declaration of Alma-Ata in 1978, primary healthcare (PHC) is considered an essential component of health systems. In the Chilean case, management of primary care was municipalized during the dictatorship and maintained by the subsequent governments, with some reforms. The aim of this article was to estimate and analyze spending in PHC in Chile, during the governments of Sebastián Piñera and Michelle Bachelet. Collection of financial data was oriented by the model of National Health Accounts (CNS), and later the amounts were deflated according to the Consumer Price Index. The principal source of information was the National System of Municipal Information (SINIM). The results show that during the period there was a permanent increase in spending in PHC; however, the average percent change was slightly higher in the first government compared to the second. The percentage of spending in PHC in relation to public spending in health was 21.4% for the eight years, with few variations. Indicators show that inequalities between administrative and health regions are increasing steadily. Therefore, although transfers to fund primary care services are increasing, they may be poorly distributed. This and other problems like the commodification of services and dismantlement of the network compromise the consolidation of PHC, especially in a health system based on contributive insurance like the Chilean system.

Correction: The Integration of Interlinkages Between Nature and Human Health in Primary Health Care: Protocol for a Scoping Review.

[This corrects the article DOI: 10.2196/12510.].

The Integration of Interlinkages Between Nature and Human Health in Primary Health Care: Protocol for a Scoping Review.

BackgroundInternational overview reports and the majority of scientific publications on interlinkages between nature and human health (NHI) do not seem to focus on the role of the health care sector. Primary health care (PHC) is often the first point of contact people have with the health care system and provides comprehensive, accessible, and community-based care that meets the health needs of individuals throughout their life. PHC is a vital backbone for linking knowledge and practice within the organization of health care. This scoping review aims to focus on the potential role of PHC in relation to NHI.ObjectiveThe objective of this protocol is to present the method used to scope international overview reports and scientific publications on what is mentioned on the integration of NHI in PHC.MethodsThe international overview reports have been screened for keywords relating to PHC. We developed a specific search strategy to scope scientific literature on NHI in relation to PHC. The scientific literature search ran in Web of Science (WOS) and PubMed from inception to May 2017. The scientific publications are screened by 2 independent reviewers, which will result in a list of relevant publications that meet eligibility and inclusion criteria.ResultsOn the basis of a first screen on the title of the first 200 results in both search engines, we decided to restrict to WOS. First insights in the international overview reports and the quantitative overview of the results in WOS give a first impression of a missing link between NHI and PHC. The findings are expected to identify knowledge gaps in the translation of evidence on NHI in PHC practices and the role of PHC regarding the application of that evidence in health care practice.ConclusionsThis is, to our knowledge, the first study that seeks to relate existing knowledge on NHI to PHC. The presentation of our method through this protocol allows researchers to build upon and improve our work in future research on the practical implementation of NIH. The findings of the scoping review are expected to guide future scientific research, international policy directives, and PHC workers to fill the gaps in the integration of NHI in PHC.International Registered Report Identifier (IRRID)DERR1-10.2196/12510

Application of medical aphorisms at the general practice-family medicine teaching on the pregradual stage of high medical education

The article presents the results of the analysis of literary sources on the history of medicine and formed the actual content of the aphorisms of the great doctors and philosophers in the field of medicine for their using in the teaching of discipline «general practice–family medicine» at the pregradual stage of higher medical education. The aim is to create and strengthen the motivation of future specialists in the primary health care in relation to healthy lifestyles, prevention and rehabilitation of the most common diseases in the human population. It is recommended to use this material as an additional pedagogical method of optimizing the supply of materials for preparing students for classes.

O Processo de trabalho dos enfermeiros da atenção primária e a Política Nacional de Plantas Medicinais/Fitoterápicos

RESUMO O estudo objetivou conhecer o processo de trabalho dos enfermeiros da atenção primária em relação à Política Nacional de Plantas Medicinais e Fitoterápicos. O referencial foi baseado em Guareschi e Kleinman. A abordagem foi qualitativa, descritiva. Fizeram parte dos estudos enfermeiros de 21 municípios da região Sul do estado do Rio Grande do Sul. Os dados foram coletados por questionário autoadministrado, no período de junho a agosto de 2013. A análise seguiu a proposta operativa de Minayo, emergindo dois temas: processo de trabalho dos enfermeiros e a Política Nacional de Plantas Medicinais e Fitoterápicos; viabilização desta na atenção primária. Observou-se o desconhecimento da política, apesar de ter sido constatado a indicação de plantas medicinais no processo de trabalho. A política é viável quando o enfermeiro organiza grupos, coloca em prática o diálogo interdisciplinar, e contempla a questão dos aspectos culturais do usuário.

Quality of chronic kidney disease management in primary care: a retrospective study

Background: Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. Aim: To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Design and setting: Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). Method: CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Results: Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Conclusion: Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model.Key pointsQuality of care for chronic kidney disease patients in primary care can be improved.In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients.Quality of care was higher in patients with diabetes.Chronic kidney disease management may be improved by developing strategies similar to diabetes care.

Mental health care: how can Family Health teams integrate it into Primary Healthcare?

Mental health is one of the responsibilities of Brazil's Family Health system. This review of literature sought to understand what position Mental Health occupies in the practice of the Family Health Strategy. A search was made of the scientific literature in the database of the Virtual Health Library (Biblioteca Virtual de Saúde), for the keywords: 'Mental Health'; 'Family Health'; 'Primary Healthcare'. The criteria for inclusion were: Brazilian studies from 2009 through 2012 that contributed to understanding of the following question: "How to insert Mental health care into the routine of the Family Health Strategy?" A total of 11 articles were found, which identified difficulties and strategies of the professionals in Primary Healthcare in relation to mental health. Referral, and medicalization, were common practices. Matrix Support is the strategy of training and skill acquisition for teams that enables new approaches in mental health in the context of Primary healthcare. It is necessary for Management of the Health System to take an active role in the construction of healthcare networks in mental health.

Evolução do quantitativo de nutricionistas na Atenção Básica do Brasil: a contribuição dos Núcleos de Apoio à Saúde da Família e da Estratégia Saúde da Família de 2007 a 2013

Objetivo Identificar a evolução do quantitativo de nutricionistas atuantes na Atenção Básica nos municípios brasileiros, com ênfase nas Equipes de Saúde da Família e nos Núcleos de Apoio à Saúde da Família. Métodos Estudo descritivo utilizando dados secundários do número de nutricionistas, tempo no serviço, tipo de equipe, estabelecimentos onde são cadastrados e perfil dos municípios brasileiros, solicitados pela equipe da pesquisa e fornecidos pelo Ministério da Saúde, com base no Cadastro Nacional de Estabelecimentos de Saúde no período de 2007 a 2013. Foi utilizada a estatística descritiva. Resultados O número de nutricionistas aumentou ao longo dos anos porque mais municípios brasileiros contrataram estes profissionais. O incremento foi mais acentuado (cerca de 700% entre 2008 e 2013) para os Núcleos de Apoio à Saúde da Família, nos quais o profissional é o terceiro mais presente, após psicólogos e fisioterapeutas. Pequena parcela dos nutricionistas (6-15%) permaneceu no cargo por mais de cinco anos; o percentual variou de acordo com o ano e com o tipo de equipe. Os municípios de pequeno porte, pertencentes à região Nordeste e com Índice de Desenvolvimento Humano Municipal médio, foram os que mais contrataram profissionais nutricionistas. Por outro lado, houve um menor aumento, de 75%, no número de nutricionistas contratados para as Unidades Básicas/Centros de Saúde (excluindo os profissionais dos Núcleos e da Estratégia Saúde da Família). Conclusão Foi constatado o aumento do número de nutricionistas na Atenção Básica, bem como o aumento no número de municípios que contrataram este profissional, principalmente para os Núcleos de Apoio à Saúde da Família. A manutenção dessa taxa de aumento poderá influenciar na inversão da proporção de nutricionistas da Atenção Básica, em relação aos outros níveis de atenção à saúde, como a média e alta complexidade.

Hospitalizations of children due to primary health care sensitive conditions in Pernambuco State, Northeast Brazil.

Admissions due to primary health care sensitive conditions from 1999 to 2009 among children < 5 years old were analyzed for municipalities in Pernambuco State, Brazil. Using data from the Brazilian Unified National Health System's Hospital Information System, a negative binomial regression was applied to estimate rate ratio (RR) and 95%CI for the effect on primary health care sensitive condition rates (admissions/10,000 inhabitants) of the Family Health Program (FHP) coverage (%), some demographic variables and living conditions. Hospitalizations due to primary health care sensitive conditions represented 44.1% of 861,628 admissions and the rate declined from 557.6 to 318.9 (-42.8%), a reduction three times greater than the rate due to all other causes. Increased FHP coverage was protective against primary health care sensitive conditions (RR = 0.94; 95%CI: 0.89-0.99). A decline in hospitalizations due to primary health care sensitive conditions indicated improvements in health status and may be associated with the consolidation of primary health care. Studies on access and quality of primary health care in relation to child morbidity and hospitalizations are needed.

Diagnostic accuracy of respiratory diseases in primary health units.

Respiratory diseases are responsible for about a fifth of all deaths worldwide and its prevalence reaches 15% of the world population. Primary health care (PHC) is the gateway to the health system, and is expected to resolve up to 85% of health problems in general. Moreover, little is known about the diagnostic ability of general practitioners (GPs) in relation to respiratory diseases in PHC. This review aims to evaluate the diagnostic ability of GPs working in PHC in relation to more prevalent respiratory diseases, such as acute respiratory infections (ARI), tuberculosis, asthma and chronic obstructive pulmonary disease (COPD). 3,913 articles were selected, totaling 30 after application of the inclusion and exclusion criteria. They demonstrated the lack of consistent evidence on the accuracy of diagnoses of respiratory diseases by general practitioners. In relation to asthma and COPD, studies have shown diagnostic errors leading to overdiagnosis or underdiagnosis depending on the methodology used. The lack of precision for the diagnosis of asthma varied from 54% underdiagnosis to 34% overdiagnosis, whereas for COPD this ranged from 81% for underdiagnosis to 86.1% for overdiagnosis. For ARI, it was found that the inclusion of a complementary test for diagnosis led to an improvement in diagnostic accuracy. Studies show a low level of knowledge about tuberculosis on the part of general practitioners. According to this review, PHC represented by the GP needs to improve its ability for the diagnosis and management of this group of patients constituting one of its main demands.

Access to diagnosis and treatment of Chagas disease/infection in endemic and non-endemic countries in the XXI century

In this article, Médicos Sin Fronteras (MSF) Spain faces the challenge of selecting, piecing together, and conveying in the clearest possible way, the main lessons learnt over the course of the last seven years in the world of medical care for Chagas disease. More than two thousand children under the age of 14 have been treated; the majority of whom come from rural Latin American areas with difficult access. It is based on these lessons learnt, through mistakes and successes, that MSF advocates that medical care for patients with Chagas disease be a reality, in a manner which is inclusive (not exclusive), integrated (with medical, psychological, social, and educational components), and in which the patient is actively followed. This must be a multi-disease approach with permanent quality controls in place based on primary health care (PHC). Rapid diagnostic tests and new medications should be available, as well as therapeutic plans and patient management (including side effects) with standardised flows for medical care for patients within PHC in relation to secondary and tertiary level, inclusive of epidemiological surveillance systems.

Report on the activities carried out by ‘Sonrisas’ to promote oral health: the experience of a Canadian dental hygienist in the Dominican Republic

Smiles Foundation is a non-profitable organization established in Canada as a sister foundation to the Dominican Fundacion para la Prevencion y la Salud Bucal de los Ninos "Sonrisas" the Dominican Republic, which provides free dental treatment and oral health education to underprivileged children. Its founder Elina Katsman, a Canadian dental hygienist embarked on this project in 1986, and started giving lectures in the small community of Samana along with two local nurses that she trained in the principles of oral hygiene and related primary health care. Today, the foundation runs eight dental clinics and five mobile units that serve remote areas and has benefited 1,723,119 people in total. The aim of this article was to report on the growth that Smiles Foundation has experienced to promote oral health among children and adults in the Dominican Republic including its activities and the results it has achieved up until 2005.

Musculoskeletal chronic pain in general practice: Studies of health care utilisation in comparison with pain prevalence

Objective - To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. Design - A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. Setting - General population in a well-defined Swedish PHC district. Subjects - A random sample of 15% of the population aged 25-74, n=1101. Annual visitors to district physicians at the health centre. Main outcome measures - Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. Results - Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. Conclusion - Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

Primary health care in relation to leprosy in Sri Lanka.

Primary health care in relation to leprosy in Sri Lanka.