Primary Health Care Patients Research Articles

Nationwide study on multimorbidity prevalence: 7.64 million primary healthcare users in Portugal with multiple chronic conditions.

The goal of this study was to explore the prevalence of multimorbidity, its geographic variation, and changes from 2022 to 2024 in Portugal. Information regarding the chronic health conditions active in the primary healthcare patients' health problems lists on the electronic health records are derived from the digital platform Identity Card of Primary Healthcare (Bilhete de Identidade dos Cuidados de Saúde Primários, BI CSP) data for the period of 2022 and 2024. BI CSP nationwide data from May 2024 of the 10,366,861 registered users in Portuguese primary healthcare were used to determine the prevalence of multimorbidity (presence of 2 or more chronic health conditions) and analize differences to 2022. By May 2024, 73.7% of the population (7.64 million out of 10.37 million registered users in primary healthcare) were living with multimorbidity, indicating a 4.7% increase from 2022. The most common chronic conditions in 2024 included lipid disorders, hypertension, obesity, and tobacco abuse. Regionally, multimorbidity exceeded 65% in all zones, with the North (78.9%) and Alentejo (78.3%) regions having the highest rates. The prevalence increased across all regions, with the North region showing the smallest increase from 2022 to 2024. The prevalence of multimorbidity in Portugal is increasingly high across all the regions considered. Additional studies will be helpful in determining the extent to which the now-reported high prevalence of multimorbidity will impact the healthcare system in Portugal.

Empowering Health: Innovative Strategies to Successfully Increase Physical Activity Promotion in Brazilian Primary Health Care Settings.

Implementation of physical activity (PA) initiatives within the scope of Primary Health Care (PHC) is still a challenge for the field of public health. It is necessary to consolidate operational processes to promote PA in the daily lives of patients in PHC. The use of implementation science has significant potential for advancing PA initiatives. The present study is a methodological study, which includes a macroproject titled "Saúde a Partir de Atividades Físicas Exitosas-SAFE Research." The project is organized by 5 steps, and a descriptive manuscript about an intervention as well, to increase, or promote PA in a community settings. Eight strategies have been developed, related to the attributes of a successful PA promotion initiative in PHC (autonomy, participation, planning, replication, and sustainability), and the dimensions of RE-AIM (reach, effectiveness, adoption, implementation, and maintenance). Each strategy presents a set of processes that can be systematically operationalized to make the PA initiative more successful. The strategies were based on practical experiences in the PHC context in Brazil, which can potentially be replicated in low- and middle-income countries. These strategies make it possible to cover other initiatives in the field of health promotion so that they can be implemented in an organized, systematized way and with robust processes in community interventions.

Assessing e-Health Literacy and Digital Competence among Peruvian Primary Health Care Patients

Assessing e-Health Literacy and Digital Competence among Peruvian Primary Health Care Patients

Self-Efficacy in Hypertension Management Using e-Health Technology: A Randomized Controlled Trial in Primary Care.

Self-efficacy is tightly intertwined with person-centered care and correlates with engaging in self-care behaviors, an important part of hypertension treatment. Evidence indicates that e-Health-based self-management interventions could increase self-efficacy. The objectives of this study were to investigate whether an intervention with a person-centered approach supported by e-Health technology can impact self-efficacy. Furthermore, to examine the impact of self-efficacy on hypertension management, and assess if self-efficacy can indicate which patients might see the greatest improvement on blood pressure from an e-Health-based self-management intervention for hypertension. This multicenter randomized controlled trial included 949 primary healthcare patients with hypertension. After exclusions, data was analyzed for 862 patients. The intervention group used an e-Health-based self-management system for 8 weeks. Self-efficacy was measured with the general self-efficacy (GSE) scale at inclusion, 8-week follow-up and 1-year follow-up. A significant increase in the mean GSE score in the intervention group was identified (p 0.042). No significant association between self-efficacy and blood pressure control was found. GSE scores did not significantly differ between the patients that had the best effect on blood pressure and those that had none. This study showed a significant increase in self-efficacy after the intervention. Self-management-based e-Health interventions might have a role in clinical practice to increase self-efficacy and improve general health. We found no association between self-efficacy and achieving a blood pressure below 140/90. Furthermore, no support was found to claim that self-efficacy would be an indicator of which patients might have the greatest effect from a self-management-based e-Health intervention for hypertension.

Current status of intestinal parasitosis and microsporidiosis in industrialized countries: Results from a prospective study in France and Luxembourg.

Human intestinal parasitosis and microsporidiosis are a global health concern, mostly in endemic areas but should not be neglected elsewhere. Recent nationwide epidemiological data are scarce, especially from primary health care and developed countries. Diagnosis by molecular tools are increasing and several commercial gastrointestinal panel assays including protozoans and/or helminths are now available. These news tools improve the knowledge into real human parasite epidemiology. This study provides an epidemiological update on intestinal parasites found in primary health care in France and Luxembourg. Two thousand fifty-six stools from primary health care patients were analyzed for the presence of intestinal parasites (IPs) during two different seasons of 2022, the winter and the summer, corresponding to more than 1500 patients from all over France and Luxembourg. Parasite detection was performed combining standard microscopy (merthiolate-iodine-formaldehyde and Bailenger concentration procedures) with two molecular panel assays (AMPLIQUICK Fecal Pretreatment, AMPLIQUICK Protozoans and AMPLIQUICK Helminths, BIOSYNEX, France). The prevalence of IPs in primary care patients reached 33.2%. Blastocystis sp. and Dientamoeba fragilis were the most frequently detected parasites in 20.5% and 13.1% of patients, respectively. Coinfection with two or more parasites was detected in 9.9% of patients. For some parasites, patterns according to gender, age, geography or season have been observed. The high prevalence of pathogenic IPs (about 7%) underlines the importance of investigating gastrointestinal disorders through parasite examination, even in developed countries. The detection of parasites, pathogenic or not, remains a marker of the faecal-oral route of transmission and results should be interpreted accordingly. Parasites molecular characterization give new insights and should encourage further research as industrialized countries are not exempt of parasitic circulation and a better survey is necessary.

Deployment of Tablet‐based Cognitive Assessment Tool (TabCAT) for detecting cognitive impairment in elderly Primary Health Care Population in Southeast Nigeria

AbstractBackgroundCognitive assessment should be actively incorporated into the clinical evaluation of patients in Primary Health Care (PHC) settings. This is because of the imminent demand with the changing demographics especially in low‐ and middle‐income countries (LMICs) concerning dementia and Alzheimer’s disease.MethodA cross‐sectional mixed‐method descriptive study was conducted to evaluate the useability and performance of a tablet‐based cognitive assessment tool (TabCAT) for use in geriatric primary healthcare settings in southeast Nigeria.ResultIn our study involving 207 participants, with an average age of 64.69 years, educational levels varied, with 51.8% having primary education, 41.2% secondary, and 6.6% tertiary. The research found that education had a significant positive impact on associative memory, processing speed, executive function, language skills, and visuospatial skills (p<0.001). Rural residents exhibited higher scores in associative memory, processing speed, executive function, language, and visuospatial skills (p<0.000). However, gender and location did not show significant contributions to cognitive performance across the examined domains.ConclusionThere is an urgent need to deploy and routinely conduct cognitive assessments in primary healthcare clinics for elderly patients for early detection of cognitive changes to improve healthy living.

Singular Therapeutic Plan: Strategies For The Well-Being Of The Elderly In Primary Care

Background: Elderly health faces challenges due to increased life expectancy and the prevalence of chronic diseases. In this scenario, the Singular Therapeutic Project (PTS) emerges as an innovative strategy, initially developed in mental health, but now applied in geriatrics. The PTS promotes a personalized care plan, created in collaboration with the elderly person, their family and an interdisciplinary team, focusing on the needs This approach not only improves adherence to treatment, but also promotes autonomy and protagonism, essential for quality of life in old age. Aim: This experience report aims to describe the practical learning experience of medical students in the implementation of a STP for an elderly patient in primary health care, highlighting the impact on medical care and education. Experience Report: During the second semester of 2024, medical students had the opportunity to experience the practice of the Singular Therapeutic Project (PTS) in a real context, through home visits in the territory of Primary Health Care at the Basic Health Unit (UBS) Riozinho in the municipality of Bragança-PA. During the home visit to the patient's home, several instruments were applied for a more complete evaluation of both the elderly woman and her caregiver, her husband, 83 years old. Among these tools, the Adult Stress Symptom Inventory (LIPP) and the Zarit Caregiver Burden Interview (ZBI) scale were used to assess caregiver stress and burden. Conclusion: The participation of medical students in the construction of the Singular Therapeutic Plan (PTS) in primary health care is an essential training experience that significantly enriches the training of future professionals.

Avoiding anti-inflammatories: a randomised controlled trial testing the effect of an eHealth information package on primary healthcare patient medication knowledge and behaviour in Aotearoa New Zealand

BackgroundPatient medication knowledge and health literacy affect patient safety. Taking angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs), with diuretics and non-steroidal anti-inflammatory medications (NSAIDs) is nephrotoxic. Patients...

Multidisciplinary models of primary health care for patients with chronic non-communicable diseases

Introduction. Chronic non-communicable diseases (CNCD) requires a variety of strategies from different perspectives and at different levels, including individual and country-specific. Comprehensive patient-oriented and proactive approaches play an important role in the provision of multidisciplinary teams of medical care to patients with established CNCD. The purpose of this study is to present the Moscow experience in managing multidisciplinary teams for the treatment of CND patients, using the example of arterial hypertension in the framework of a pilot project in the outpatient clinics of the Troitsk and Novomoskovsky administrative districts (TiNAO; were attached to the territory of Moscow in 2012). Materials and methods. The study was conducted in two stages: at the first, a literature review was carried out, at the second, the stages of launching a pilot project on the management of multidisciplinary teams for the treatment patients with CNCD, using the example of arterial hypertension in the outpatient clinic of TinAO, were developed and discussed. Results. The research analyzes approaches to the use of multidisciplinary teams in the world. Based on the analyzed current regulatory documents, adjustments were made to the foreign model for its possible adaptation to Moscow polyclinics, focusing on proactive dispensary dynamic monitoring. Research limitations. The results of the conducted research are based on operational data from Moscow and can be applied only to the formation of management decisions in Moscow. Conclusion. According to the results of the pilot project testing, an increase in the level of coverage of the attached population with medical care, accessibility of narrow specialists and provision of equal opportunities for obtaining medical care for Muscovites was noted.

Did Primary Healthcare Patients in Riyadh Experience Their First Migraine Episodes After a Stressful Event, and What Triggers and Relievers Do They Commonly Report?

This study aimed to investigate whether the first onset of migraine episodes among primary healthcare patients in Riyadh, Saudi Arabia, is preceded by a highly stressful event, as well as to identify common potential triggers and relievers reported by these patients. Migraine is a prevalent and debilitating neurological disorder. The pathophysiology of migraine involves complex interactions between genetic, neurological, and environmental factors, including the trigeminovascular system and neuropeptides such as calcitonin gene-related peptide (CGRP). A cross-sectional study was conducted in 2024 involving 271 patients. Data were collected using a Google Forms questionnaire, and analysis was performed using IBM Corp. Released 2023. IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp, employing both descriptive and inferential statistics. A total of 271 participants were included, with a predominance of females (82.3%). The majority (68.3%) reported experiencing a stressful event before their first migraine attack, particularly among the 18-25 age group. The most frequently reported triggers included sleep disturbances (70, 25.8%), emotional stress (53, 19.5%), and hormonal changes in women during the menstrual cycle (28, 10.3%). Relief strategiesinclude falling asleep (101, 37.2%) and food intake (85, 31.3%). A significant association was found between age and the type of migraine experienced, as well as the frequency of attacks. The findings indicate a notable relationship between stressful events and the onset of migraines, emphasizing the need for targeted management strategies in primary healthcare settings. Understanding the common triggers and effective relief methods can help improve the quality of care for migraine patients in Saudi Arabia.

Use of herbal medicinal products among patients in primary health care in a Brazilian southeastern city: evidence from the Prover project.

To determine the prevalence and factors associated with herbal medicinal product use among primary healthcare patients in southeastern Brazil. A cross-sectional study combined with documentary research was conducted between August and November 2017, involving interviews with 1,221 adults following dispensing from primary healthcare units. The characterization of herbal medicinal product usage included assessing the prevalence, redundancy, and interaction indicators, as well as identifying sources of recommendation and acquisition. Descriptive statistics were used for variable analysis and logistic regression was used to estimate the factors associated with herbal medicinal product usage, calculating odds ratios at a significance level of 5%. The prevalence of herbal medicinal product usage was 3.8%, with 60% of them prescribed by physicians. Private pharmacies (53%) were the main sources, and Valeriana officinalis (42%) was the most cited plant species and the sole herbal medicinal product on the municipal list. The indicators of redundancy and interactions between concurrently prescribed pharmaceutical and herbal medicinal products were 42.9% and 28.6%, respectively. Herbal medicinal products usage correlated with the female sex (OR= 2.50; 95%CI= 1.11-5.59), non-white race (OR= 0.52; 95%CI= 0.28-0.94), monthly income above 1 minimum wage (OR= 3.48; 95%CI= 1.51-8.01), and self-reported of anxiety, mood disorder or depression (OR= 2.97; 95%CI= 1.55-5.66). Despite the low use of herbal medicinal products, users face a high potential for interactions and therapeutic redundancy. Special attention should be paid to patients taking herbal medicinal products and allopathic medicines concurrently. Women with anxiety, mood disorders, or depression were more likely to use herbal medicinal products, whereas non-white people were 48% less likely to use them, suggesting potential socioeconomic disparities in access.

Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners’ knowledge, perception and experience in Belgium and Malta

BackgroundAt least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs’ knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs’ care for Long Covid patients at a cross-country level.MethodsA cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed.ResultsA total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37–61). Concerning GPs’ knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs’ country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation. ConclusionsGPs frequently provide (multidisciplinary) care to Long Covid patients and GPs’ care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid.

Working with Joanne Elphinston Movement Systems® - physiotherapists’ experiences in primary health care. A focus group study

Background JEMS® (Joanne Elphinston Movement Systems) described as a systematic, holistic approach to analyze and create sound foundations for movement, is increasing in popularity among physiotherapists. The aim of this study was to investigate and capture the experiences and narratives of physiotherapists (PTs) using JEMS® for rehabilitation with patients in primary healthcare. Materials and methods In this qualitative description study, we invited 13 PTs to focus group discussions (FGD). Four groups were conducted, three FGD at different locations in Region Västra Götaland, Sweden, and one FGD using Skype. The groups met on one occasion. The FGD method has a qualitative semi-structured research design based on a social constructivist tradition of research. Data were analyzed using the Kreuger method, considering the content of the discussion in a collective understanding of the subject and the interaction taking place among participants. Results Three themes were identified: how the PTs describe their practical and emotional experiences, and how JEMS® has changed their clinical work. Most clearly emerged subjects considering the interaction and communication with the patient, about finding a structure in clinical practice and about the development the informants experience in their role as a physiotherapist and as an individual. Conclusions The FGD was chosen to capture the variety and width of experiences of the PTs using JEMS®. The opportunity for learning and reflecting in the FGDs was appreciated by the PTs. The interaction between the patient and the PT was described as fundamental in establishing foundations for movement. Opportunities to meet and treat patients regardless of functional limitations elaborated and were in that way applicable in primary healthcare where patients seek a physiotherapist for a variety of reasons.

Evaluating the accuracy and adequacy of ChatGPT in responding to queries of diabetes patients in primary healthcare

Evaluating the accuracy and adequacy of ChatGPT in responding to queries of diabetes patients in primary healthcare

Correlation between self-efficacy and health status of Type 2 Diabetes Mellitus patients in primary health care

The health status of Type 2 Diabetes Mellitus (T2DM) patients is observed to decrease simultaneously along with the length of time. Despite the various treatment management offered in primary care, a decrease in health status is also observed among patients in Indonesia as shown by the low self-care ability. Therefore, this research aimed to analyze the relationship between self-efficacy and the health status of patients in primary care in Indonesia to provide evidence for the development of care management interventions for T2DM patients.The research used a descriptive analytical method with a cross-sectional design, including 327 T2DM patients in primary health care selected through cluster random sampling. Data collection used the Indonesian version of the Diabetes Management Self-Efficacy Scale (DMSES) and Short Form 12 (SF-12) questionnaires which had been tested for validity and reliability. The data obtained were analyzed using the Pearson Product Moment test with a significance value of 0.01.The results obtained an r-value of 0.485 with a p-value of 0.00, showing a significant relationship between self-efficacy and health status in T2DM patients (0.00<0.01; CI 99%).In conclusion, this study highlights a significant correlation between self-efficacy and the health status of individuals diagnosed with T2DM. The findings emphasize the pivotal role of self-efficacy in shaping the health outcomes of patients with T2DM.

Assessment of primary health care accessibility and patients’ perception in Madurai district: a geo-medical study

Assessment of primary health care accessibility and patients’ perception in Madurai district: a geo-medical study

Continuity of care and mortality in patients with type 2 diabetes.

How continuity of general practitioner care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear. The aim of this study was to examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D. Cohort study in patients aged 60 years or older with T2D within the public PHC of the city of Vantaa, Finland. Inclusion period was between 2002-2011 and follow-up period between 2011-2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardized mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson comorbidity index (CCI). In total 11,020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95%CI: 2.24-2.71), 3.55 (3.05-4.14), 1.15 (1.06-1.25), 0.97 (0.89-1.06), 0.92 (0.84-1.01) and 1.21 (1.11-1.31), respectively. With continuous MMCI, mortality formed a u-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI adjusted HR for death between men and women was 1.45 (1.35-1.58). Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality turned to rise with high GP-CoC.

Feasibility and Determinants of Performance for a Tablet-Based Cognitive Assessment Tool in Rural and Urban Southeast Nigeria.

Cognitive assessment is a key component of clinical evaluations for patients with dementia and Alzheimer's disease in primary health care (PHC) settings. The need for well-validated, culturally appropriate, and easy-to-use assessments is especially urgent in low- and middle-income countries (LMICs) that are experiencing rapid growth in their older adult populations. To examine the feasibility and demographic determinants of performance for a tablet-based cognitive assessment tool (TabCAT) battery, which includes subtests for four cognitive domains, among older PHC patients in southeastNigeria. A cross-sectional mixed-method descriptive study evaluating the useability and performance of TabCAT. We enrolled 207 participants (mean age of 64.7±13.5 years; 52% with only primary, 41% secondary, and 7% tertiary education). Most (91%) who initiated the assessment were able to complete it, requiring 10-15 minutes to complete. More years of education was associated with better test scores across all tests (p < 0.001). Living in a rural location was also associated with better performance (p < 0.05). Male compared to female sex did not associate with performance on any of the tests (all ps > 0.05). Tablet-based cognitive assessment was feasible in rural and urban settings of Nigeria. Better performance on cognitive subtests linked to more education and residing in a rural area; however, sex did not predict performance. Digital cognitive assessment tools hold potential for widespread use in healthcare and educational contexts, particularly in regions with varying levels of urbanization and educational access.

Health-related quality of life in psychiatric outpatients: a cross-sectional study of associations with symptoms, diagnoses, and employment status

BackgroundThis cross-sectional study aimed to explore health-related quality of life (HRQoL) in a large heterogeneous patient sample seeking outpatient treatment at a specialist mental health clinic.MethodA sample of 1947 patients with common mental disorders, including depressive-, anxiety-, personality-, hyperkinetic- and trauma-related disorders, completed the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) to assess HRQoL. We investigated clinical and sociodemographic factors associated with the EQ-5D index and the EQ Visual Analogue Scale (VAS) using regression analyses.ResultsThe sample reported lower HRQoL compared with the general population and primary mental health care patients. Sick leave, disability pension, work assessment allowance, and more symptoms of anxiety and depression were associated with lower EQ-5D index and EQ VAS scores. Furthermore, being male, use of pain medication and having disorders related to trauma were associated with reduced EQ-5D index scores, while hyperkinetic disorders were associated with higher EQ-5D index scores.ConclusionHRQoL of psychiatric outpatients is clearly impaired. This study indicated a significant association between employment status, symptom severity, and HRQoL in treatment-seeking outpatients. The findings highlight the importance of assessing HRQoL as part of routine clinical assessment.

Analysis of Risk Factors for the Quality of Health Services in Primary Health Facilities: An Observational Study in North Bengkulu Regency, Indonesia

Primary health care (PHC) is crucial for overall health system performance, particularly in developing nations. However, variations in the quality of PHC services in Indonesia, particularly in North Bengkulu Regency, raise concerns. This study aimed to identify and analyze risk factors associated with suboptimal quality of health services in these facilities. This observational, cross-sectional study was conducted in 20 primary health centers (PHCs) in North Bengkulu Regency. A multi-stage random sampling technique was used to select 400 patients and 80 healthcare providers. Data were collected using validated questionnaires assessing various dimensions of service quality (tangibles, reliability, responsiveness, assurance, and empathy), patient satisfaction, and potential risk factors (socio-demographic, facility-related, and provider-related). Descriptive statistics, bivariate analysis, and multivariate logistic regression were used for data analysis. The study found a significant association between perceived service quality and patient satisfaction. Socio-demographic factors (lower education and income), facility-related factors (inadequate staffing and lack of essential medicines), and provider-related factors (insufficient communication and perceived lack of empathy) were identified as risk factors for lower service quality. The quality of health services in North Bengkulu PHCs is influenced by a complex interplay of patient, facility, and provider factors. Interventions targeting these risk factors, such as community education, capacity building for providers, and improvements in resource allocation, may improve PHC service quality and patient satisfaction in this region.