Primary Health Care Organizations Research Articles

The results of analysis of assessment of quality of medical care in the Kyrgyz Republic.

The article presents results of analysis of quality of medical care of population in the Kyrgyz Republic. The calculated index of quality of primary health care organizations and structure of defects at primary level of health care by region are considered. The analysis of examination of quality of medical services at in-patient level demonstrated annual increase of unjustified hospitalizations and detected defects in examination and treatment of patients.

Competing in the "war for talent" in nursing homes: A quantitative investigation.

This study explores the characteristics of primary care organizations that are likely to attract and retain highly skilled professionals, meeting their expectations and increasing Person-Organization fit. Both "hard" dimensions (ownership) and organizational/managerial traits under the span of control of management are investigated. The objective is to raise awareness on how to mitigate unpopular features of primary healthcare organizations so to effectively compete in the war for talent. This study has been carried out based on data extrapolated from a broader study conducted by the Italian National Agency for Regional Health Services and commissioned by the Italian Ministry of Health. Data deriving from Italian nursing homes was extrapolated from the broader public dataset and multiple regressions were carried out to detect associations between managerial variables and staff seniority. Several significant associations were detected, suggesting that both physicians and nurses are affected by some investigated variables when deciding where to work and for how long. While some of these are common to the two categories of professionals (e.g., the presence of a nursing director), others are not (e.g., the presence of internal training programs). The implications of this study are related to the need of increasing awareness of managers of nursing homes on those features that are likely to increase their attractiveness and long-lasting appeal to professionals. This is a paramount topic in times in which the war for talent is strong. A lack of attention on this field may lead to the inability to attract and retain staff in primary care settings and, in turn, to implement strategic trends of change healthcare systems are facing in Italy and worldwide.

Case management in primary healthcare for people with complex needs to improve integrated care: a large-scale implementation study protocol

IntroductionCase management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM...

The Influence of the COVID‑19 Pandemic on the Detection, Diagnosis and Treatment in the Republic of North Ossetia — Alania

Introduction. Prioritization of measures to contain the COVID-19 pandemic has led to a decrease in the coverage and intensity of TB control activities.The aim of study to assess the indicators of detection, diagnosis and treatment of tuberculosis during the COVID-19 pandemic in the Republic of North Ossetia-Alania and compare them with those at the all-Russian level.Materials and methods. A preliminary collection of statistical information in Russian and several foreign sources closest to the topic was carried out on the PubMed, ResearchGate, ScienceDirect, CyberLeninka and eLibrary platforms. An analysis of the epidemiology of tuberculosis in North Ossetia for 2020–2021 was performed. according to annual reporting forms and reports from epidemiological monitoring systems for tuberculosis.Results. The detection rate of tuberculosis has decreased during the pandemic. The indicator in North Ossetia was higher than the national level. Clinical and diagnostic indicators for tuberculosis in the republic in 2020 were lower compared to those for 2021 for the study of sputum, decay phase, and bacterial excretion. The proportion of successful tuberculosis chemotherapy in the republic was higher than in a number of regions of the Russia.Discussion. There was a decrease in registered and, obviously, accumulation of latent cases of tuberculosis during the COVID 19 2020 pandemic due to a drop in preventive coverage of the population in the Russia. A worsening of the clinical structure of tuberculosis in 2021 in Republic of North Ossetia and an increase in the proportion of patients with destruction of lung tissue and the fibrous-cavernous type of disease in the Russia are revealed, possibly due to untimely detection of tuberculosis.Conclusion. Low activity of primary health care organizations regarding tuberculosis was revealed. Restrictions to prevent the spread of the SARS-CoV-2 pathogen contributed to a decrease in the coverage and intensity of anti-tuberculosis measures. The COVID-19 pandemic clearly affected the rates of primary diagnosis of tuberculosis in 2020, and in 2021 a significant increase was noted.

Evaluation of the Implementation of Integrated Primary Care for Patients with Type 2 Diabetes and Hypertension in Belgium, Cambodia, and Slovenia.

Integrated care of chronic patients improves quality of their management, but there is scarce evidence of its implementation in different healthcare settings. With this article, we wanted to determine the level of integrated care implementation in the management of T2D (diabetes) and HT (hypertension) in three different settings: Belgium, Slovenia, and Cambodia. This was an observational study with integrated approach. It was conducted in primary health care organisations in three countries. In each primary health care organisation, we aimed to include primary care workers that worked with Type 2 Diabetes (T2D) and hypertension (HT) patients. Data was collected with the Integrated Care Package (ICP) grid (consisting of six elements: identification, treatment, health education, self-management, caregiver collaboration, and care organisation). ICP is almost completely implemented without major differences within Slovenia. There is a considerable variability across practice types in Belgium. Implementation is constrained by health system resources in Cambodia. Some elements, especially identification, are better implemented then others, across health systems. Countries can enhance integrated care for chronic diseases by implementing central policies, standardized protocols, and local adaptation, addressing resource constraints, promoting systematic screening and health education, and providing training for healthcare workers, tailored to community needs, to improve patient outcomes and healthcare delivery.

Prevalence of Autism risk among children undergoing regular Psychophysical Development Screening in Kazakhstan

BackgroundInformation about the situation with autism in Kazakhstan is extremely limited due to the lack of research on autism in both Kazakhstan and Central Asia. The prevalence of autism spectrum disorder risk among young children during routine screening was assessed using the M-CHAT-R/F tool. MethodsThis study took place in the offices of pediatric neurologists and family doctors in three primary healthcare organizations in the Karaganda, Kazakhstan. The researchers offered participation in the study and M-CHAT-R checklist completion during visits by parents and children to pediatric neurologists and family doctors for the purpose of screening for psychophysical development. Linear regression analysis was used to determine risk factors for the development of autism spectrum disorder. ResultsThe results of an analysis of 526 study participants showed the prevalence of high-risk autism spectrum disorders to be 27.4 %. Factors associated with a high risk of autism spectrum disorder in this study were child age, gender, parental age, and a diagnosis of developmental disorder. ConclusionsThe use of specific tools to screen for developmental disorders by primary care organizations is recommended. Primary care providers have regular contact with children before they reach school age and can provide family-centered, comprehensive, and coordinated care, including more comprehensive medical assessments.

Evaluation of the Effectiveness of Otorhinolaryngology Examination and Hearing Evaluation Training for Family Physicians

Objective: In our study, we aimed to investigate the level of knowledge of family physicians working in primary health care organizations about ENT diseases, to examine how they manage frequently admitted ENT patients, to identify the problems they experience during examination and to examine the effect of the training given. Method: Participants were first administered a 30-question pre-test created by the researcher based on the literature. Then, a collective training lasting 2 days and 1.5 hours per day was given by an ENT specialist from the researchers and a post-test was applied. Afterwards, the topics in which the researchers made the most mistakes or remained uninterpreted were recorded and a training program including these topics was created and training was given. Results: Of the 21 family physicians over 30 years of age, 2 (14.29%) were male and 18 (85.71%) were female. When the time of graduation from medical school of the family physicians in the study was analyzed, the number of family physicians with 5-10 years of medical school graduation was 4 (19.05%), 10 (47.62%) with 10-20 years of medical school graduation, and 7 (33.33%) with more than 20 years of medical school graduation. All of the family physicians who participated in the study think that ENT education is important for primary care medicine. Conclusion: ENT diseases are common in primary care. In order for family physicians to manage their patients more comfortably, we believe that rotations in the field of ENT diseases in the postgraduate period would be appropriate.

THE THEORY OF CONSUMER BEHAVIOUR AND DEMAND IN A NEW PARADIGM OF DIGITAL HEALTHCARE

The article assesses the changing trends in the behaviour of consumers of medical services and building a new behavioural integrated model of medical services in the context of digital transformation of healthcare. The methodological basis of the study is the analysis of relevant domestic and foreign scientific literature on the issues under consideration, as well as the results of published expert interviews with healthcare specialists. The authors describe the concept of digital healthcare as a fundamental ecosystem in terms of the formation of new channels of interaction with the patient while providing medical services. They then characterise the role of new investors in the field of digital medicine - the largest technological leaders in terms of market capitalisation. The paper examines the basic principles of consumer behaviour in the medical services market underlying the demand in the traditional doctorcentered model of medical care, formulates the key approaches to changing the behaviour of the consumer s under the influence of healthcare digital transformation. The authors argue that through digitalisation healthcare goes far beyond the medical industry and acquires an intersectoral integrated character. They build a behavioural patient-centered model of a consumer of medical services in the new paradigm of digital healthcare. The new role of the patient as a partner in managing the healthcare system is substantiated. The results of the work contribute to the economic theory of consumer behaviour in the provision of medical services, as well as to the theory of health economics. The practical significance of the work lies in the possibility to implement the proposed target model for the provision of medical care in primary and secondary health care organisations as part of digitalisation programs.

Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage?

The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings. The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality. Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers. Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.

Service Quality and Related Factors in Primary Health Care Services: A Cross-Sectional Study.

Primary health care services aim to prevent diseases and improve health efficiently and effectively. This study measures perceived service quality in a primary healthcare organization and examines the effect of personality traits on service quality. The cross-sectional study population comprised individuals over the age of 18 who applied to the Bingöl Central Community Health Centre. A total of 460 participants were included in the study between November 2018 and March 2019. The participants completed a face-to-face questionnaire that included socio-demographic characteristics, the SERVQUAL Scale, and an abbreviated form of the revised Eysenck Personality Questionnaire. This study is based on doctoral research in public health. The study found median values for personality trait sub-dimensions as follows: neuroticism: 2, psychoticism: 2.65, extraversion: 4, and lying: 5. The SERVQUAL Score was -0.02. The study revealed that the quality of primary health care services did not meet the participants' expectations. The study findings also indicated that age, educational attainment, and extraverted and psychotic personality traits were significantly associated with the satisfaction of service quality expectations (p < 0.05). It is recommended to provide primary health care services in facilities with good physical characteristics, with sufficient and competent health personnel, and in a timely and accurate manner to improve service quality.

MEANINGFUL MULTIDISCIPLINARY REHABILITATION FOR HEART AND LUNG CONDITIONS: A COLLABORATION BETWEEN ORGANISATIONS AND SECTORS TOWARDS SELF-MANAGEMENT

It is well documented that mainstream services are not always well attended by Aboriginal and Torres Strait Islander people due to a range of issues including transport and culturally safe practice. Establishing these services within the community-controlled sector is one way to increase access and culturally responsive care. This initiative involved a new model of service delivery, whereby a partnership between Hospital Health Services and community-controlled Aboriginal and Torres Strait Islander primary healthcare organisations enabled the establishment of new Cardiac and Pulmonary Rehabilitation Programs within the Institute for Urban Indigenous Health (IUIH) Network for First Nations people. This Network is comprised of the five Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ATSICCHO’s) who operate as a regional collective with IUIH providing leading strategic direction and coordination. Through a multidisciplinary team, specialised cardiac and pulmonary rehabilitation is provided to First Nations people as a culturally capable alternative to hospital cardiac and pulmonary rehabilitation, particularly for those not currently accessing treatment. The specialised rehabilitation programs are supported by the IUIH System of Care that supports clients to access a wide array of holistic health services and programs designed to meet community needs and strengthen pathways for clients to self-manage their health needs in a self-led manner. The Rehabilitation Programs are a multidisciplinary exercise and education program delivered by a range of health professionals including Accredited Exercise Physiologist’s, Physiotherapists, Nurses and Aboriginal and Torres Strait Islander Allied Health Assistants. Clients also have access to a range of other Allied Health Professionals, including Dieticians Occupational Therapists, Pharmacists, Social Health, Podiatrists, Optometrists, Speech Therapists and Audiologists. Referrals are received from ATSICCHOS, Queensland Health and Primary Health General Practitioners and Specialists. The client journeys through a multidisciplinary assessment to then determine their goals and health needs. This presentation will provide insights into the First Nations-led partnership, challenges and solutions to working across the whole health sector and outcomes for clients.

Primary care nurses’ knowledge of palliative care, attitude towards caring for dying patients, and their relationship with evidence-based practice

Background &amp; Aim: Palliative care is an approach designed for critically ill patients, improving their quality of life and alleviating suffering through early detection, proper assessment, and treatment of pain and other problems, whether physical, psychosocial, or spiritual. The purpose of this study was to assess nurses' knowledge of palliative care and attitudes toward caring for dying patients and their relationship with evidence-based practice. Methods &amp; Materials: A cross-sectional study design was employed to collect data from 565 nurses working in primary healthcare organizations from January 2022 to March 2023. An online questionnaire included four parts: demographic and professional characteristics, PCQN, FATCOD, and EBPQ questionnaires. An independent T-test, One-Way ANOVA, and Kendall tau rank correlation coefficient, hierarchical multiple regression were performed. Results: Nurses’ palliative care knowledge level was low (mean score: 9.06±2.93). The majority of nurses (93%) have a neutral or negative attitude toward caring for dying patients (94.50±12.41). The obtained score (4.39 ±1.05) on the EBPQ scale indicates an average level of competence in evidence-based practice. Work experience (β=0.534; &lt;0.001) and competencies in evidence-based practice (β=0.136; p=0.001) are statistically significant factors that affect knowledge of palliative care. The aspect of Knowledge/skills in EBP is the most significant (β=0.122; p=0.005). Conclusion: An insufficient level of nurses' knowledge about palliative care and a neutral or negative attitude towards caring for dying patients were revealed. The results also indicate that much attention and resources should be directed toward improving the level of knowledge of nurses in the field of evidence-based practice.

Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool

BackgroundFamily violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta’s PHC settings by exploring readiness factors.MethodsAn integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators.ResultsPhase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta.ConclusionThe current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.

Experience of strategic sessions to improve the quality of lean technology implementation in medical organizations in Krasnodar Krai: a one-stage observational study

Background. Lean production is mainly focused on increasing value in processes and improving the quality of services provided. These principles are implemented in medical organizations within the framework of the national project “Healthcare” and the federal project “Development of the Primary Healthcare System”. Introduction of lean technologies at all levels of the organization can serve as a highly effective method of positive changes. In 2023, Kuban State Medical University, together with the Ministry of Health of Krasnodar Krai and the Regional Center for Primary Healthcare, held a strategic session aimed at identifying problematic processes in medical organizations of the region and jointly searching for ways to solve them. The session involved 73 primary healthcare organizations. Its results formed the basis for a study of the project activity of medical organizations. Objective. To analyze the current state of project activities of medical organizations in Krasnodar Krai to achieve a “new model” through the introduction of lean technologies.Methods. A one-stage observational study was carried out in two steps. The first step involved participant observation. Its results determined a set of tools to be compiled. The second step of the study included a questionnaire survey and analysis of information. The data obtained from the questionnaire survey and observation were coded, the distribution and frequency were identified using frequency analysis and calculation of mean values. The qualitative analysis of open-ended questions was additionally applied.Results. The analysis showed that the prevailing number of projects are aimed at forming and developing the availability of medical care for the population (50.6 %), including projects focused on inclusiveness and provision of medical care to low-mobility patients at home. It was also revealed that 42 projects in four areas are planned for implementation in 47 organizations using lean technology tools in 2024. The study showed that 91.49 % of projects failed to calculate financial efficiency and evaluate project results in monetary terms. Meanwhile, 8.51 % of those who carried out the efficiency calculations lacked an analysis methodology and revealed the superficiality of the calculations. Of all the participants, 53.19 % reported the need for help in organizing and implementing project activities, and 36.17 % of the participants had enough resources to cope on their own. The three most problematic processes requiring joint work with colleagues included “Reducing the wait times for healthcare in regional medical organizations,” “Registration of discounted prescriptions” and “Preventive medical examination and dispensary.”Conclusion. The experience of a strategic session at Kuban State Medical University proved to be effective in improving the quality of implementation of lean technologies in medical organizations of Krasnodar Krai. The study was instrumental in assessing the current state of the project activities of medical organizations to achieve a “new model” through the introduction of lean technologies, as well as in identifying the most common areas of project activities and the main problems. The performed analysis revealed a positive trend in improving the quality of work of medical organizations in Krasnodar Krai and disseminating the lean technologies in primary healthcare.

Data-Driven Decision Support Tool Co-Development with a Primary Health Care Practice Based Learning Network

Background The Alliance for Healthier Communities is a learning health system that supports Community Health Centres (CHCs) across Ontario, Canada to provide team-based primary health care to people who otherwise experience barriers to care. This case study describes the ongoing process and lessons learned from the first Alliance for Healthier Communities’ Practice Based Learning Network (PBLN) data-driven decision support tool co-development project. Methods We employ an iterative approach to problem identification and methods development for the decision support tool, moving between discussion sessions and case studies with CHC electronic health record (EHR) data. We summarize our work to date in terms of six stages: population-level descriptive-exploratory study, PBLN team engagement, decision support tool problem selection, sandbox case study 1: individual-level risk predictions, sandbox case study 2: population-level planning predictions, project recap and next steps decision. Results The population-level study provided an initial point of engagement to consider how clients are (not) represented in EHR data and to inform problem selection and methodological decisions thereafter. We identified three initial meaningful types of decision support, with target application areas: risk prediction/screening, triaging specialized program referrals, and identifying care access needs. Based on feasibility and expected impact, we started with the goal to support earlier identification of mental health decline after diabetes diagnosis. As discussions deepened around clinical use cases associated with example prediction task set ups, the target problem evolved towards supporting the upstream task of organizational planning and advocacy for adequate mental health care service capacity to meet incoming needs. Conclusions This case study contributes towards a tool to support diabetes and mental health care, as well as lays groundwork for future CHC EHR-based decision support tool initiatives. We share lessons learned and reflections from our process that other primary health care organizations may use to inform their own co-development initiatives.

The association between Chinese visceral adiposity index and cardiometabolic multimorbidity among Chinese middle-aged and older adults: a national cohort study.

This study aimed to explore the association between the Chinese visceral adiposity index (CVAI) and cardiometabolic multimorbidity in middle-aged and older Chinese adults. The data used in this study were obtained from a national cohort, the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018 wave). The CVAI was measured using previously validated biomarker estimation formulas, which included sex, age, body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol. The presence of two or more of these cardiometabolic diseases (diabetes, heart disease, and stroke) is considered as cardiometabolic multimorbidity. We used Cox proportional hazard regression models to examine the association between CVAI and cardiometabolic multimorbidity, adjusting for a set of covariates. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to show the strength of the associations. We also conducted a subgroup analysis between age and sex, as well as two sensitivity analyses. Receiver operator characteristic curves (ROC) were used to test the predictive capabilities and cutoff value of the CVAI for cardiometabolic multimorbidity. A total of 9028 participants were included in the final analysis, with a mean age of 59.3 years (standard deviation: 9.3) and women accounting for 53.7% of the sample population. In the fully-adjusted model, compared with participants in the Q1 of CVAI, the Q3 (HR = 2.203, 95% CI = 1.039 - 3.774) and Q4 of CVAI (HR = 3.547, 95% CI = 2.100 - 5.992) were associated with an increased risk of cardiometabolic multimorbidity. There was no evidence of an interaction between the CVAI quartiles and sex or age in association with cardiometabolic multimorbidity (P >0.05). The results of both sensitivity analyses suggested that the association between CVAI and cardiometabolic multimorbidity was robust. In addition, the area under ROC and ideal cutoff value for CVAI prediction of cardiometabolic multimorbidity were 0.685 (95% CI = 0.649-0.722) and 121.388. The CVAI is a valid biomarker with good predictive capability for cardiometabolic multimorbidity and can be used by primary healthcare organizations in the future for early warning, prevention, and intervention with regard to cardiometabolic multimorbidity.

Bridging the voice of healthcare to digital transformation in practice – a holistic approach

BackgroundDigital transformation is key for healthcare to meet future needs and expectations and compete equally with new actors on the market. Medical digital diagnosis tools and clinical decision support systems (CDSS) are improving and offer new opportunities. To introduce new technology in healthcare can however be a challenging mission, too often ending in failure, with excessive costs or the actual transformation work not being carried out at all. It is unclear how to drive the establishment to reach desired results in this environment, and how industrial experiences can be used to support healthcare.ObjectiveThe objective of this study was to develop a holistic approach for introducing new information technology (IT), such as a CDSS, into a primary healthcare organization supported by industry best practices for digital transformation.MethodsThis qualitative study used a combined inductive and deductive method where the perceptions and beliefs of selected primary healthcare stakeholders were used as directions for developing an approach that could utilize existing industry best practices for digital transformation.ResultsA holistic healthcare-ified approach including 20 requirements was developed, that meet the needs of healthcare. The voice of healthcare was used as prism to healthcare-ify the industry practices and adapt it to match specific healthcare conditions. An example was provided showing how the research could be put into practice.ConclusionsThis study proposed a holistic approach, based on industry best practices, but adapted to healthcare using the voice of healthcare as a bridge, that may be used to introduce CDSS and other IT into a primary healthcare organization and step up the needed digitalization.

The personnel maintenance of primary health care physicians in condition of challenges from menaces to population health

In condition of challenges from menaces to health due to COVID-19 the role of primary health care physicians increases that requires development of management decisions at the regional level. The purpose of the study. On the basis of analysis of medical demographic indicators and data concerning provision of primary health care personnel in the Russian Federation, proposals were made related to reforming of primary health care system in conditions of implementation of general medical practice with purpose to counteract menaces to population health. The analytical and statistical methods were applied. The official statistics data from the Minzdrav of the Russian Federation and Rosstat, results of original researches with content analysis and interpretation were used. The COVID-19 pandemic negatively impacted population health. The indicator of newly detected morbidity in the Russian Federation in 2020 decreased as compared to 2019 from 78024.3 to 75989.7‰oo (by 2.6%). This is the result of decreasing of dispensary and preventive activities among population. In next COVID-19 year (2021), as compared to 2020, indicator of primary morbidity increased to 85531.6‰oo that 12.6% higher than in 2020. The increase occurred in all classes of diseases that caused necessity of rehabilitation of these patients. The COVID-19 morbidity increased up to 2.4 times i.e. from 3391.1 in 2020 to 8085.7‰oo in 2021. The provision of physicians in the Russian Federation was 37.7‰o in 2021. Across the Federal Okrugs differences in indicators made up to 1.3 times and in subjects of the Russian Federation - up to 2.7 times. In conditions of COVID-19 significance of menaces to population health worsened. The situation requires both enhancement of primary health care and implementation of physicians of new formation - general practitioners responsible for patient health. The general practice (GP) widely developed in Russia in the 1990s during last ten years loses its significance in most subjects of the Russian Federation. In 2021, provision of general practitioners in the Russian Federation made up to 0.67‰o. In the Federal Okrugs, difference between indicators made up to 5.6 times. In the subjects of the Russian Federation the difference is enormous - 141.5 times. The article presents and scientifically substantiates prospective functional organizational models of general practice. The established situation with COVID-19 infection requires development of management decisions and measures at the regional level concerning improvement of organization of primary health care and implementation of general practice in conditions of counteracting risks of menaces to population health and health preservation.

Exploring stakeholders’ perceived problems associated with the care and support of children and youth with mental ill health in Sweden: a qualitative study

BackgroundCare and support for children and youth with mental ill health have become more specialized and are provided by an increasing number of stakeholders. As a result, services are often fragmented, inefficient and unco-ordinated, with negative consequences for the service user and their family. Enhanced collaboration could lead to improved care and support but requires a shared understanding and a joint problem formulation between involved stakeholders to commence. The aim of this study was to explore different stakeholders’ perceived problems associated with delivering care and support to children and youth with mental ill health and to discuss how the perceived problems relate to collaboration.MethodsA qualitative descriptive study was conducted, using short statements of perceived problems written by stakeholders involved in the care and support of children and youth with mental ill health during an inter-organizational workshop. The 26 stakeholders represented school and student health, primary health care, specialist care, social services, and different service user organizations. Data were collected during February 2020. Inductive content analysis with a summative approach was used when analysing the data.ResultsThe perceived problems were summarized in a model consisting of four main categories: Resources and governance; Collaboration and co-ordination; Knowledge and competence; and Stigma and confidence, containing 24 subcategories. These categories and subcategories were distributed over three levels: Societal level, Organizational level and Individual level. The perceived problems were shared on the category level but to some extent varied between stakeholder groups on the subcategory level. The perceived problems were either directly or indirectly related to collaboration.ConclusionsThe perceived problems often acted as barriers to achieving successful collaboration. The problems were distributed on all three levels in the developed model, indicating a complex problem. Even though the perceived problems were shared by stakeholders on an overall level, the findings indicate that the stakeholders did not have a completely shared understanding of the perceived problems, as they tended to focus on aspects most relevant to their own organization or perceptions. The challenge is to find which perceived problems are appropriate for inter-organization problem-solving and which can be solved within individual organizations.

Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study.

During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.