Primary Health Care Settings Research Articles

Pharmacotherapy for overweight and obesity: past and current clinical practice, available medications and possible applications

Overweight and obesity are a global pandemic that continues to escalate year by year. Also in Poland, there is a steady increase in the prevalence of overweight and obesity cases among both adults and children. The most effective methods for treating these conditions include improved dietary habits and increased physical activity. Pharmacotherapy is another treatment option. Psychological care is also proven to be effective. It is important to note that in Polish primary health care settings, practitioners are unable to prescribe free dietary consultations for patients. Due to limited visit time, it can be challenging to monitor whether patients have implemented the required lifestyle changes. Primary medical care is often the first point of entry for overweight and obese patients seeking treatment. Consequently, pharmacotherapy has become a crucial aspect of overweight and obesity treatment. In recent decades, many appetite-suppressing medications have been withdrawn from the market because of serious side effects. On the other hand, new medications have been approved for sale in recent years or even months. All indications are that the trend will continue. This article includes a description of both historically used and currently approved overweight and obesity medications, both in the European Union and in the USA. For each medication, the mechanism of action, efficacy, and potential adverse effects are described.

Implementation of Preventive Care in the setting of primary care: opportunities, hurdles and policy needs for integration of Preventive Care in the daily practice of primary care practitioners.

In Flanders, as in the entire industrialized world, the population is eldering and chronic conditions and comorbidities are increasing importantly. Today, non-communicable diseases (NCD’s) have an important negative impact on the quality of life and represent the most important cause of premature and/ or preventable death. Moreover, they also put an enormous burden on the health care system, in terms of need for health professionals, procedures and medicines, short and long term care institutions as well as on the affordability of the health care system. The knowledge that the majority of these NCD’s can be avoided by prevention, through a healthy lifestyle and early detection, calls for more emphasis on and means for preventive health care.
 Traditionally and still today, the primary and secondary care practice in Flanders is focused on curation and preventive health care is mainly practiced by others, such as school health services and Maternal and child health services. The fundamental principles of curative and preventive care are very different. Curative care is based on an individual approach and is driven by individual demands. However preventive health care is mainly based on population health management and driven by, often not expressed, population needs.
 When it comes to implementation of preventive care, the WHO advocates a Health in all Policies approach, in which preventive care is implemented in all life settings surrounding the citizen, in order to achieve an integrated preventive care policy that is supported by all policy domains and is part of daily life. One of these settings is health care.
 In this workshop we want to exchange experiences on implementation of preventive health care into primary healthcare and to explore the opportunities, hurdles and policy needs to come to a successful adoption of preventive health care in the setting of primary healthcare. To introduce the debate, the session will start with two short presentations of 10-15 minutes in which experiences in two different health care systems, i.e. a national health care system and a predominant private health care system, are shared with the participants.

VALIDATION OF THE EASYCARE STANDARD 2010 INSTRUMENT TO IDENTIFY OLD PEOPLE’S FUNCTIONING AND WELLBEING IN AKTOBE, KAZAKHSTAN

Objective: The purpose of this study was to assess the reliability of the EASYCare Standard 2010 questionnaire among older adults in a primary healthcare setting in Aktobe, Kazakhstan. Methods: A group of 100 participants aged 65 and older, without cognitive impairments, were recruited from a local healthcare clinic. The Russian translation of the EASYCare questionnaire was administered to the participants. Two assessments were conducted with a time interval of 10-14 days. Concurrent validity was assessed by comparing the results of the EASYCare with the Barthel Index and Lawton scale, which measure physical and mental function, respectively. The three main indices of the EASYCare questionnaire, Independence score (IS), Risk of breakdown in care (RBC), and Risk of falls (RF), were evaluated. Results: The Kappa Cohen coefficient for all domains was high, ranging from 0.89 to 0.99. There were no significant differences in IS, RBC, and RF between the two assessments (10.4 ± 14.6 vs. 10.1 ± 14.2, 3.9 ± 2.5 vs. 3.9 ± 2.5, and 1.6 ± 1.5 vs. 1.6 ± 1.4, respectively). Discussion: This study confirms that the Russian version of the EASYCare provides reliable results and can be used as a comprehensive tool for assessing the health and well-being of older adults. Additionally, most participants were found to be relatively independent. However, there were slight differences in the Barthel Index scores between males and females (88.9 ± 14.6 vs. 95.6 ± 7.4, p<0.01), indicating that older men are more independent in performing basic activities of daily living compared to women of the same age. A similar pattern was observed for the Lawton scale (5.1 ± 2.0 vs. 6.4 ± 1.3, p<0.0001). These findings suggest that in Kazakhstan, men maintain their activity and independence for a longer period compared to women.

Improving foot ulcer risk assessment and identifying associated factors: Results of an initiative enhancing diabetes care in primary settings

BackgroundDiabetes-related lower extremity complications contribute significantly to the overall disability burden of type 2 diabetes (T2D). The screening of Diabetic Foot Ulcer (DFU) risk is essential for the early identification of its components, thereby preventing the progression to advanced complications. Unfortunately, identifying elements associated with foot ulcer development is often poorly executed, especially in primary care settings, particularly in low-middle-income countries. We assess the prevalence of DFU risk and its components while exploring sociodemographic, clinical, and behavioral characteristics linked to DFU risk in patients with T2D. MethodsThis cross-sectional study examined the characteristics of the feet of subjects involved in an initiative to enhance the quality of diabetes care in primary healthcare settings. The assessment included the presence of foot deformities, peripheral neuropathy through Loss of Protective Sensation (LOPS) evaluation, peripheral arterial disease (PAD), and a history of foot ulcer or lower extremity amputations. Participants were classified according to the IWGDF Risk Classification and subsequently divided into two groups for analysis: those at high risk for DFU (Groups 1, 2, or 3) and those at low risk for DFU (Group 0). Logistic regression was employed to identify the factors associated with DFU risk and its components. ResultsAmong the 1361 patients evaluated, 63.8 % were found to be at an increased risk for DFU. The reported prevalence of foot deformities, LOPS, PAD, and a history of foot ulcer was 91.9 %, 44.3 %, 36.5 %, and 4.5 %, respectively. In the adjusted analysis, factors significantly associated with DFU risk included male gender (OR =2.01; 95 % IC 1.54–2.61), secondary education or less (OR =1.65, 95 % IC 1.27–2.14), diabetes duration exceeding 10 years (OR = 1.75, 95 % IC 1.34–2.30), chronic kidney disease (OR =1.44, 95 % IC 1.11 – 1.88), diabetic retinopathy (OR =1.93, 95 % IC 1.42–2.62), onychomycosis (OR =1.46, 95 % IC 1.14–1.88) properly cut toenails (OR =0.60, 95 % IC 0.45–0.79), and sedentary behavior (OR =1.56, 95 % IC 1.14–2.14). ConclusionsRisk assessment of DFU within a comprehensive care program for adults with T2D receiving conventional primary care showed that a substantial proportion of these patients are at an increased risk and, thus, qualify as candidates for interventions aimed at mitigating foot-related risks. We recommend that diabetes healthcare schemes incorporate preventive organizational interventions to facilitate the timely identification of DFU risk, particularly in primary care scenarios, thereby alleviating the burden of diabetes-related lower limb complications.

Effect of COVID-19 on chronic care management in primary health settings

The COVID-19 outbreak has brought changes to the management of conditions in primary healthcare settings, leading to a reassessment of current practices and the adoption of innovative approaches. This article examines the symptoms and treatment methods that have emerged in response to the challenges posed by the pandemic. We explore how disruptions in care for people with illnesses and the complex relationship between chronic diseases and COVID-19 severity have influenced healthcare delivery. Additionally, we discuss the increased reliance on telehealth services, which have been crucial in ensuring patient care but have also revealed disparities in access and digital literacy. The need for a patient-centered approach is emphasized through a reevaluation of care delivery models- heightened attention to psychosocial factors. We also delve into the challenges related to resource allocation adjustments to treatment plans and the psychological impact on patients dealing with diseases. Finally, we highlight opportunities for the management of chronic conditions in the future through better integration of telehealth services and an enhanced focus on patient empowerment and preventive care. As healthcare systems adapt to this evolving landscape, there are lessons from this pandemic that can inform more patient-centric and adaptable strategies for managing chronic conditions.

Effect of self reiki and slow deep breathing on blood pressure of patients with hypertension

Hypertension presents a significant challenge in Indonesia, commonly encountered in primary healthcare settings. This study aimed to assess the impact of self-administered reiki and slow, deep breathing techniques on individuals with hypertension. The research comprised 78 participants, split into two groups: 39 in the control group and 39 in the intervention group. The intervention group practiced self-reiki combined with slow, deep breathing for 21 days, while the control group solely practiced slow, deep breathing for the same duration. Statistical analysis employed the Wilcoxon and Mann‒Whitney tests. The Wilcoxon test yielded a P-value of 0.000 for both Systole and Diastole between the Intervention and Control Groups post-treatment, while the Mann‒Whitney test showed a P-value of 0.002 for Systole and P = 0.000 for Diastole between the Intervention and Control Groups after Treatment. Consequently, it can be deduced that a significant disparity in systolic and diastolic blood pressure exists pre- and post-self-reiki and slow, deep breathing exercises in both the intervention and control groups. These practices demonstrate a significant potential to reduce blood pressure among patients dealing with hypertension.

The effect of education based on a health belief model and motivational interviews on cardiovascular disease risk factors and healthy lifestyle behaviour changes in patients with essential hypertension: A randomized controlled trial

ObjectiveTo determine the effects of "Health Belief Model (HBM)-based education" and "education and motivational interviews (MIs)" by comparing the two methods on cardiovascular disease (CVD) risk factors and healthy lifestyle behaviour changes of patients diagnosed with essential hypertension. MethodsThe study was a single-centre, single-blind, parallel-group, 6-month follow-up, randomized controlled trial. It was conducted on 80 individuals (40 in the study group, 40 in the control group). Both groups received HBM-based education and an educational booklet on healthy lifestyle behaviour changes at the beginning of the study. Additionally, the study group underwent a total of 6 MIs. ResultsThe decrease in the study group's 10-year Framingham CVD risk scores (mean difference 5,33) compared to the baseline values was higher than that observed in the control group (mean difference 3,95). Over the six-month follow-up period, the study group's knowledge of CVD risk factors increased, and healthy lifestyle behaviour improved. ConclusionHBM-based education and an educational booklet, either alone or in combination with MI, supported patients with essential hypertension in lowering their CVD risk through lifestyle modifications. Practice implicationsHealthcare professionals within primary healthcare settings can use HBM-based health education and short-term MIs to reduce CVD risk and improve health outcomes.

Exploring Factors Shaping Primary Health Care Readiness to Respond to Family Violence: Findings from a Rapid Evidence Assessment

Abstract Purpose Family violence (FV) is defined as any situation where an individual employs abusive behaviour to control and/or harm a former or current spouse, non-marital partner, or a member of their family. The health consequences of FV are vast, including a wide range of physical and mental health conditions for individuals experiencing violence or survivors, perpetrators, and their children. Primary health care (PHC) is recognized as a setting uniquely positioned to identify the risk and protective factors for FV, being an entry point into the health care system and a first, or only, point of contact for families with professionals who can facilitate access to specialist care and support. Methods A rapid evidence assessment of empirical studies on FV interventions in PHC was conducted to examine outcomes of effective FV interventions that promote identification, assessment, and care delivery within diverse PHC settings, factors shaping PHC provider and system readiness, and key intervention components that are important for sustaining PHC responses to FV. After completing data extraction, quality appraisal, and a hand search, a total of 49 articles were included in data synthesis and analysis. Results Several FV interventions that include multiple components such as, screening and identification of FV, training of PHC providers, advocacy, and referrals to supports, have been rigorously tested and evaluated in diverse PHC settings in rural and urban areas including primary care/family medicine practice clinics and community PHC centers. These interventions have demonstrated to be effective in identifying and responding to violence primarily experienced by women. There is a dearth of FV interventions or programs from empirical studies focused on men, children, and perpetrators. Additionally, provider and system readiness measurement tools and models have been implemented and evaluated in PHC specifically to assess physician or the health care team’s readiness to manage FV in terms of knowledge and awareness of FV. The findings highlight that there is no clear or standardized definition of provider or system “readiness” in the literature related to FV responses in PHC. Further, the findings revealed four key intervention components to facilitate PHC provider and organization readiness to address FV: (1) multidisciplinary teamwork and collaboration, (2) improving provider knowledge on the social and cultural determinants impacting FV, and (3) embedding system-level supports within PHC. Conclusions FV is a serious public health concern and PHC providers have a vital role in early detection of FV and the poor health outcomes associated with violence A focus on comprehensive or multi-component FV interventions are more likely to change provider behavior, and would allow for safe, confident, and professional identification and assessment of FV within PHC.

Genetic Variants at the 9p21.3 Locus Are Associated with Risk for Non-Compressible Artery Disease: Results from the ARTPER Study.

Peripheral artery disease (PAD) and non-compressible artery disease (NCAD) constitute predictors of subclinical atherosclerosis easily assessed through the ankle brachial index (ABI). Although both diseases show substantial genetic influences, few genetic association studies have focused on the ABI and PAD, and none have focused on NCAD. To overcome these limitations, we assessed the role of several candidate genes on the ABI, both in its continuous distribution and in the clinical manifestations associated to its extreme values: PAD and NCAD. We examined 13 candidate genomic regions in 1606 participants from the ARTPER study, a prospective population-based cohort, with the ABI assessed through ultrasonography. Association analyses were conducted independently for individuals with PAD (ABI < 0.9) or with NCAD (ABI > 1.4) vs. healthy participants. After including potential covariates and correction for multiple testing, minor alleles in the genetic markers rs10757278 and rs1333049, both in the 9p21.3 region, were significantly associated with a decreased risk of NCAD. Associations with the ABI showed limited support to these results. No significant associations were detected for PAD. The locus 9p21.3 constitutes the first genetic locus associated with NCAD, an assessment of subclinical atherosclerosis feasible for implementation in primary healthcare settings that has been systematically neglected from genetic studies.

A health economic analysis of an integrated diabetes care program in China: based on real-world evidence.

An integrated care program was set up in China to improve the collaboration between primary healthcare centers and hospitals on diabetes management. This study aims to evaluate the economic value of this program with real-world data and to examine whether it can be promoted in primary healthcare settings in China. This integrated diabetes care program was implemented in Yuhuan City, China, to coordinate primary care and specialty care, treatment and prevention services, as well as the responsibilities of doctors and nurses. Cost-effectiveness analysis was used to compare the short-term economic value of this program (intervention group) versus usual diabetes management (control group). The cost data were collected from a societal perspective, while the effectiveness indicators pointed to the improvement of control rates of fasting blood glucose (FBG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels after the 1 year intervention. In addition, cost-utility analysis was applied to evaluate the long-term value of the two groups. Patients' long-term diabetes management costs and quality-adjusted life years (QALYs) were simulated by the United Kingdom Prospective Diabetes Study Outcomes Model 2. The results showed that for 1% FBG, SPB, and DBP control rate improvement, the costs for the intervention group were 290.53, 124.39, and 249.15 Chinese Yuan (CNY), respectively, while the corresponding costs for the control group were 655.19, 610.43, and 1460.25 CNY. Thus, the intervention group's cost-effectiveness ratios were lower than those of the control group. In addition, compared to the control group, the intervention group's incremental costs per QALY improvement were 102.67 thousand CNY, which means that the intervention was cost-effective according to the World Health Organization's standards. In conclusion, this study suggested that this integrated diabetes care program created short-term and long-term economic values through patient self-management support, primary care strengthening, and care coordination. As this program followed the principles of integrated care reform, it can be promoted in China. Also, its elements can provide valuable experience for other researchers to build customized integrated care models.

Understanding context of violence against healthcare through citizen science and evaluating the effectiveness of a co-designed code of conduct and of a tailored de-escalation of violence training in Eastern Democratic Republic of Congo and Iraq: a study protocol for a stepped wedge randomized controlled trial

BackgroundViolence against health care workers (HCWs) is a multifaceted issue entwined with broader social, cultural, and economic contexts. While it is a global phenomenon, in crisis settings, HCWs are exposed to exceptionally high rates of violence. We hypothesize that the implementation of a training on de-escalation of violence and of a code of conduct informed through participatory citizen science research would reduce the incidence and severity of episodes of violence in primary healthcare settings of rural Democratic Republic of Congo (DRC) and large hospitals in Baghdad, Iraq.MethodsIn an initial formative research phase, the study will use a transdisciplinary citizen science approach to inform the re-adaptation of a violence de-escalation training for HCWs and the content of a code of conduct for both HCWs and clients. Qualitative and citizen science methods will explore motivations, causes, and contributing factors that lead to violence against HCWs. Preliminary findings will inform participatory meetings aimed at co-developing local rules of conduct through in-depth discussion and input from various stakeholders, followed by a validation and legitimization process. The effectiveness of the two interventions will be evaluated through a stepped-wedge randomized-cluster trial (SW-RCT) design with 11 arms, measuring the frequency and severity of violence, as well as secondary outcomes such as post-traumatic stress disorder (PTSD), job burnout, empathy, or HCWs’ quality of life at various points in time, alongside a cost-effectiveness study comparing the two strategies.DiscussionViolence against HCWs is a global issue, and it can be particularly severe in humanitarian contexts. However, there is limited evidence on effective and affordable approaches to address this problem. Understanding the context of community distrust and motivation for violence against HCWs will be critical for developing effective, tailored, and culturally appropriate responses, including a training on violence de-escalation and a community behavioral change approach to increase public trust in HCWs. This study aims therefore to compare the effectiveness and cost-effectiveness of different interventions to reduce violence against HCWs in two post-crisis settings, providing valuable evidence for future efforts to address this issue.Trial registrationClinicalTrial.gov Identifier NCT05419687. Prospectively registered on June 15, 2022.

The Principles of Exercise Prescription for Brain Health in Aging

ABSTRACT Alzheimer’s disease and related dementias are among the world’s greatest health challenges. As the population ages, global dementia rates are rising, and with no imminent cure, there is an urgent need for interventions that reduce the risk of dementia in healthy older adults. Exercise is a promising intervention; however, exercise prescriptions for optimizing brain health are lacking. This may undermine the perceived clinical utility of exercise and pose a barrier that prevents practitioners from prescribing exercise for brain health in primary care settings. This graphical review briefly summarizes the prominent neural changes in healthy aging versus Alzheimer’s disease that exercise counteracts and provides evidence-informed principles for prescribing exercise to improve cognition as a reference point for formulating personalizable prescriptions.

Understanding the issues and challenges in the implementation of nursing services in primary health care: A qualitative study in Garut, West Java, Indonesia

Background: Primary healthcare centers provide a wide range of healthcare services, with nurses playing pivotal roles in maintaining the quality of care. To enhance nurse performance, it is essential to gain insights into their experiences regarding the implementation of nursing services in these institutions. Objective: This study aimed to explore the issues and challenges related to nursing services in primary health care centers through the perspectives of Indonesian nurses. Methods: Qualitative research using a phenomenological approach was conducted. Twelve nurses from primary health care centers were purposively selected as study participants. Data were collected through face-to-face, semi-structured interviews between January 2022 and March 2022. Thematic analysis was employed for data analysis. Results: The analysis yielded five main themes: 1) Working with additional roles and duties, 2) Uncertainty regarding nurses’ roles and functions, 3) Nurses' concerns about the nursing profession, 4) Barriers to implementing nursing services, and 5) Nurses' expectations concerning nursing services. Conclusion: Nurses in primary health care centers face challenges in fully carrying out nursing services. Numerous issues and obstacles exist in the provision of nursing services at primary healthcare facilities. Therefore, it is essential to strengthen the authority and autonomy of nurses working in primary health care settings.

Insights from primary care workers supporting people at risk of suicide in local communities in Japan: A qualitative descriptive study.

To identify insights for supporting people at risk of suicide in the community based on primary healthcare workers' experiences. Qualitative descriptive design. Semi-structured interviews were conducted with fifteen primary healthcare workers employed by Japanese municipalities between August and October 2019. The data were subjected to qualitative descriptive analysis. The analysis revealed eleven subthemes, clustered under the following three themes: (1) fostering 'opportunities for discovery' for people at risk of suicide by encompassing strategies such as increasing access to services and promoting a holistic understanding of the life cycle; (2) fostering 'meaningful connections' by searching for channels to reach the heart and taking approaches from different objectives; and (3) engaging in 'risk management', by understanding and coping with real-life struggles and implementing timely crisis intervention. Not only direct care targeting suicide prevention but also holistic care that includes atypical perspectives such as 'approaches from different objectives' may provide important insights for supporting people with suicide risk. Beyond the limitations of existing suicide risk screening methods, this study highlights the importance of a holistic approach that sees people at risk of suicide in the context of their daily lives and aims to alleviate the difficulties in their lives that have brought them to the point of considering suicide. By describing support focused on the difficulties that people at risk of suicide face in their daily lives, this study identified insights for supporting people at risk of suicide in communities where screening and intervention are difficult. These findings will contribute to the relief of people at risk of suicide by stimulating suicide prevention measures in primary healthcare settings. This study complied with the COREQ guidelines. No patient or public contribution.

Challenges and strategies for conducting research in primary health care practice: an integrative review

BackgroundProviding accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice.ObjectiveTo identify challenges and strategies for conducting practice-based research in primary health care services.MethodAn integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results.ResultsOut of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks.ConclusionThe challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada

BackgroundIndividual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers.MethodsA case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation.ResultsIntegration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge.ConclusionsImplementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.

Psychotropic medicine use without current or prior medical advice, storage at home and association with perceived stress in a primary health care setting in Greece

ObjectivePsychotropic medicines use alters according to socio-economic factors and perceived stress. The study aimed to assess the prevalence of use of psychotropic medicines and supplements (PMS) without medical advice, including storage at home, and its relationship with socio-demographic characteristics and perceived stress in primary care patients. Materials and methodsA cross-sectional sample of adult attendees in an urban primary care unit in Crete, Greece, were surveyed during regularly scheduled appointments during a three-week period in October 2020. A questionnaire was distributed to investigate PMS use during the last 12 months. The validated Greek version of Perceived Stress Scale (PSS-14) was adopted to measure perceived stress. ResultsOf 263 respondents (mean age 46.3±14.5 years; 66.5% females), 101 (38.4%; 95%CI 33.1–43.7%) recalled having psychotropic medicines stored at home cabinets and 72 (27.4%; 95%CI 22.4–32.3%) reported using PMS without medical advice in the last 12 months. ConclusionsThis study revealed a high prevalence of PMS use without medical advice, including storage at home. People>59 years of age, experiencing irregular sleep and scoring high in PSS, displayed increased prevalence of storing PMS at home or using them without medical advice. The findings could potentially inform primary care providers to focus on patients most likely to be users of PMS without medical advice.

Healthcare professionals' experience regarding competencies in specialized and primary stroke units: A qualitative study

AimTo describe healthcare professionals’ experience of needed competence in patient stroke care within specialist and primary healthcare. BackgroundHealthcare professionals who provide stroke care need multifaceted, multi-professional skills; ongoing training is important for competent stroke care. DesignA descriptive qualitative study. MethodsSix focus group interviews with semi-structured interviews were conducted in October and November 2020. Healthcare professionals (n = 25) working in stroke care units in both specialist and primary healthcare settings were interviewed. The interviews were recorded, transcribed and analyzed inductively by content analysis. The study was conducted, and results were reported according to the Consolidated Criteria for Reporting Qualitative Research. ResultsFive main categories were identified: clinical competence; multiprofessional networking competence; competence in interaction skills; emotional and psychoeducational support competence; and self-management and development competence. ConclusionCompetence in stroke care includes both in-depth and wide-ranging professional competences that require ongoing development. Utilizing various education models and collaborative learning approaches can help meet the requirements for developing competence in stroke care. Patient or public contributionNo patient or public contribution

Facilitators and barriers to communication in rehabilitation services across healthcare levels: a qualitative case study in a Norwegian context

BackgroundPeople with problems in functioning following severe injury or illness often need multiple and combined interventions in their rehabilitation processes. In these processes, communication and collaboration between the involved healthcare professionals are essential. Despite efforts in research and policy, communication across hospital and primary healthcare services and within the primary healthcare settings remains challenging. In one region of Norway, a new intermunicipal rehabilitation team has been established to supplement the traditional services and context-bound research is needed to gain insight into the complexity of the new communication structures that are developing. The aim of this study was to explore facilitators and barriers to communication to inform further improvement of the services.MethodsA qualitative case study design was used to explore the exchange of patient information in the rehabilitation processes of four patients. Data collection included participant observations in communication situations and an exploration of the electronic patient records of these four patients. Reflexive thematic analysis was used to analyse the empirical data.ResultsThe complex rehabilitation processes explored involved a large number of actors across healthcare organisational levels. Lacking a common culture for rehabilitation, poor access to written information and unclear responsibility for sharing information across organisational boundaries seemed to represent barriers to interprofessional communication. Joint meetings, the use of common rehabilitation tools and language and establishing informal communication channels served to facilitate communication.ConclusionThe intermunicipal team collaborating across different organisational levels added complexity to communication structures, but also facilitated interprofessional communication by promoting formal and informal ways of exchanging information. However, the intricate organisational divisions of healthcare provision in the Norwegian context represent boundaries which can be difficult to overcome. Therefore, cross-organisational coordination services should be developed.

Does training on the WHO package of essential noncommunicable (PEN) disease interventions enhance consultation quality? A real-world assessment of adherence to PEN protocol in primary health centres in the Republic of Moldova

ABSTRACT Background Noncommunicable diseases (NCDs) pose a significant global health challenge. Primary health centres are pivotal in addressing this challenge by providing essential care to NCD patients. The WHO Package of Essential Noncommunicable (PEN) disease interventions has been designed to enhance the quality of NCD consultations and ensure adherence to the protocol. This study investigates the effects of PEN training in Moldova. Objectives The primary objective of this study is to assess the effects of training on WHO PEN on the quality of NCD consultations and adherence to the PEN protocol in a real -world setting in primary health centres in Moldova. Methods An observational, cross-sectional study was conducted, comparing primary health centres where health personnel received PEN training, provided by the Healthy Life project, to those where such training was not provided. In total, 24 family doctors and 24 medical assistants were observed for 233 workdays and covering 2,166 NCD consultations. Results Intervention primary health centres (PHCs) showed longer NCD consultation durations, with family doctors and medical assistants spending an added 1 minute 43 seconds and 3 minutes 10 seconds, respectively. These PHCs also reported a higher proportion of primary NCD consultations, indicating better screening for new NCD patients. Medical assistants in the intervention group took on a more pronounced role in NCD care. However, the findings also highlight the necessity to refine aspects of the PEN training, especially concerning follow-up consultations, risk assessments, and task delegation. Conclusions The findings suggest that the PEN training contributed to improvement of both the quality of NCD consultations and adherence to the PEN protocol. Yet, there is a need for enhancing the identified aspects of the PEN training. The findings highlight the potential of PEN training in primary healthcare settings for improved NCD management.