Primary Health Care Team Research Articles

The implementation of a mobile application to support community-based health workers

Abstract Issue Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information. Description of the Problem During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry. Results Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application. Lessons A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced. Key messages A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.

The correlation between the quality of primary healthcare attributes and different health outcomes

Abstract Background Measuring the structure and processes of healthcare services form the basis of improvement efforts and make it possible to hold organizations accountable for the services they provide. Besides having a positive impact in different health outcomes, primary health care (PHC) could also affect experiences in secondary and tertiary care through its coordinating role, therefore efforts to assess the quality of the delivery of its services are important. Hence, the study objectives were to evaluate the PHC attributes of PHC teams and the correlation of these attributes with different health outcomes. Methods This was a cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate 28 PHC teams working on the public healthcare sector at the city of São Paulo, Brazil. The Spearman's correlation coefficient was used to evaluate the association between each PCATool dimension and referral rates, hypertension, diabetes, prenatal care and gestational outcomes. The study was approved by the local ethics committee. Results A statistically significant positive correlation was identified between controlled hypertension and care coordination (rho=0.396; 95% CI:0.012-0.678; p = 0.036), and between 6 or more prenatal care visits and comprehensive care (rho=0.441; 95% CI:0.063-0.708; p = 0.018). A statistically significant negative correlation was identified between low birth weight and care coordination (rho=-0.502; 95% CI:-0.748- -0.136; p = 0.006) and between referral rates and comprehensive care (rho=-0.499; 95%CI:-0.753- -0.114); p = 0.009). Conclusions This study reinforces the importance of the PHC attributes for different relevant health outcomes and of their continuous evaluation for services improvement. Key messages The quality of PHC attributes has a direct impact on different relevant health outcomes. Ways to improve the PHC performance must be considered based on its attributes.

Health Literacy Policy in Israel – Culturally Appropriate Health Systems

Abstract Background The diverse culture in Israel created the need for developing and implementing a national policy for culturally and linguistically appropriate health services. The need stems from trends in immigration to Israel, various levels of religiosity, and the ethnic diversity of the veteran population. Health literacy plays a prominent role in this policy. Methods A national policy directive was developed and disseminated by the Israel Ministry of Health calling for culturally appropriate health information to the public, communication while receiving healthcare including ongoing staff training, health promotion intervention, and research for needs assessment. Results The national policy has been implemented for the past five years in primary care, hospitals and non-governmental health organizations. Cultural health liaisons have been integrated into primary healthcare teams in over 30 community clinics caring for Ethiopian immigrants, telephone translation services are available for Amaharic/Tigrinia, Russian and Arabic speaking communities, quality healthcare standards defined on topics such as of diabetes, and training of staff on cultural sensitivity continuously conducted. Culturally appropriate printed and digital sources of health information are available for diverse ethnic and religious communities. Appropriate health promotion intervention is routinely implemented on healthy lifestyle, early detection, and self-care, focusing mainly on NCDs and system navigation, supported by applied research and evaluation. Conclusions The policy implementation was the result of significant investment by stakeholders at all levels and requires support for sustainability regarding health literacy, health behaviour and health outcomes. Resource allocation is necessary for assessment and outcome measurement, and for applying more participatory methods for policy development, training, implementation and evaluation.

Intersectoral actions for mental health care in areas of high vulnerability in São Paulo/ Brazil

Abstract Background The objective of this research was to analyze the results achieved after intersectoral actions carried out by primary health care teams working in areas of high socio-environmental vulnerability in the city of São Paulo / Brazil. The establishment of intersectoral partnerships to tackle social inequalities and inequalities can be a reality in vulnerable health territories and a way to give sustainability to expanded health care (De Andrade et al, 2015). Methods Primary data were obtained from August to October 2018 in four focus groups formed by a total of 24 health professionals, selected after quantitative analysis. The data were transcribed in full and the qualitative analysis was according to Van Den Hoonaard (2018): a) open coding of the transcriptions; b) identification of recurrent themes and respective subthemes and c) connection of themes and concepts interpreted in the light of social processes. The research was approved by the Research Ethics Committee of the Centro Universitário Saúde ABC. Results The themes found were: a) Search for partnerships for mental health assistance: in a personalized way, the teams entered into partnerships with the sectors of education, social assistance, leisure and justice for assistance; b) Effectiveness of treatment by intersectoral basis: the teams helped to insert people into public policy actions, they realized the reduction in the need to use psychotropics and specialized services in mental health. Conclusions Intersectoral collaboration was established and maintained to resume mental health care for people with psychological distress who were waiting in line for specialized treatment. Key messages Primary health care teams when looking for partners to assist patients in mental health have an expanded look at the citizen who should be embraced by public policies. There is a need to add community-based care for people with mental suffering to care based on intersectoral actions in health territories.

Primary health care attributes of family health teams with and without family physician

Abstract Background The four essential attributes of primary health care (PHC): access, longitudinality, comprehensiveness and coordination, guide the professional practices of service management and also the professionals of the family health strategy teams. Family medicine residence (FMR) is the speciality that trains medical practitioners capable of acting properly in PHC. It develops a person-centred approach, oriented towards the individual, his family and community, which dialogues with the PHC precepts of comprehensive patient care from a social point of view. Thus, the objective of this study was to verify whether there are differences in the PHC attributes perceived by patients treated by teams with FMR doctors and by the others. Methods This was an observed cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate preliminarily 28 PHC teams working at the city of São Paulo, Brazil. The teams were compared based on 337 patient answers using domains medians and Mann-Whitney tests. The study was approved by the ethics committee. Results Eight teams (28.6%) had doctors trained in FMR. The attributes of longitudinality and access were very similar between the two groups. The teams with FMR doctors showed better evaluations in the components: information systems, median 7.78, versus 6.67 (p = 0.391); services available, median 6.52, versus 6.06 (p = 0.086); and services received, median 4.85, versus 3.85 (p = 0.180) of the coordination and comprehensiveness attributes. Conclusions We didn't find statistically significant results indicating better PHC attributes of teams with FMR doctors, based on user perception. A continuous study is recommended to follow the evolution of this speciality in the PHC context. Key messages FMR is a fundamental key to PHC and must be evaluated continuously. It is necessary to strengthen their insertion in the Brazilian health system and discuss the ways to do so.

Discriminating Metabolic Health Status in a Cohort of Nursing Students: Protocol for a Cross-Sectional Study.

BackgroundObesity is currently a worldwide health crisis. Nurses are integral members of the primary health care team and have an important role in managing obesity and administering physical activity (PA) for patients. However, research shows that nurses tend to be overweight or obese, have poor metabolic health, and do not meet PA recommendations. This is problematic because PA is linked to both physiological and psychological well-being and may also influence how nurses counsel their patients. Nursing students are the next generation of nurses; however, there is limited research examining PA (among other lifestyle factors) and metabolic health in nursing students.ObjectiveThe goal of this research is to examine multiple lifestyle factors (including PA, nutrition, sleep, and stress) and determine whether these factors are associated with metabolic health in full-time undergraduate nursing students.MethodsAn estimated 320 nursing students (18 years of age and older) will be assessed for their metabolic health. Metabolic status will be determined by measuring body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage [skinfold measures (FitSystems Inc)], resting blood pressure [automated oscillatory (Omron Healthcare Inc)], and fasting blood glucose (glucometer). Lifestyle factors will also be measured, including PA and sleep [the International Physical Activity Questionnaire (IPAQ) and 7-day accelerometry (wGT3X-BT, Actigraph LLC)], nutrition [3-day diet log (Nutritionist Pro, Axxya Systems)], and stress [the Depression Anxiety Stress Scale, heart rate variability assessments, and salivary cortisol (ELISA, Eagle Biosciences)]. The association between metabolic status and PA, sleep quantity and quality, nutrition, and stress will be examined by linear regression analyses. Differences by year of study in metabolic health status, PA, sleep, nutrition, and stress will be examined by 1-way analyses of variance (ANOVAs). To determine the ability of PA, sleep, nutrition, and stress to discriminate prevalent overweight and obesity or poor metabolic status, logistic regression and receiver operating characteristic (ROC) curves will be constructed. Statistical analyses will be performed in Stata (version 16.1, StataCorp LLC).ResultsBased on pilot data, we believe senior nursing students will have worse metabolic health (ie, higher BMI and WHR, increased body fat percentage, higher blood pressure, and increased fasting blood glucose) compared to first-year students. We hypothesize that poor PA participation, poor sleep quantity and quality, increased food intake, poor nutrition, and increased stress will be associated with worse metabolic health in full-time nursing students. The study received funding in February 2020. Due to the coronavirus disease 2019 (COVID-19) pandemic, work on this study has been delayed. We are currently completing our application for institutional research ethics approval. Data collection is projected to begin in January 2021, with data collection and analyses expected to be completed by May 2022.ConclusionsThis study will be the first published research to examine the relationship between lifestyle choices and metabolic status in nursing students attending a Canadian institution. More importantly, the results of this study will support the development of an informed intervention that will target the identified lifestyle factors, improving the physiological and mental health and well-being of nursing students.International Registered Report Identifier (IRRID)PRR1-10.2196/21342

Recomendações para a Atenção Domiciliar em período de pandemia por COVID-19

A pandemia da COVID-19 trouxe como uma de suas consequências a necessidade de reorganização dos sistemas de saúde. A Atenção Domiciliar (AD) se apresenta como opção para: interromper a transmissão; identificação precoce e cuidado de pacientes infectados; possibilidade de alta precoce e continuidade do cuidado fora do hospital; além da orientação aos familiares. Este artigo apresenta as possibilidades de cuidados no domicílio pelas equipes de Atenção Primária à Saúde (APS) e de AD e os cuidados necessários que estas equipes devem ter ao realizar seu trabalho. É necessário manter pessoas seguras em casa, evitar a exposição ao risco, manter o papel de vigilância e cuidado das que dependem da AD, e as equipes devem reorganizar o processo de trabalho para um cuidado domiciliar efetivo. Na APS o cuidado remoto parece ser uma alternativa viável pelos agentes de saúde para o monitoramento, orientação e seguimento dos pacientes, deixando a visita domiciliar com a equipe para aqueles casos indicados. AD na suspeita ou confirmação da COVID-19 é possível, desde que a equipe esteja treinada, disponha de todos os Equipamentos de Proteção Individuais (EPI) necessários e o ambiente domiciliar compatível. Deve-se garantir continuidade do cuidado para pessoas com doenças crônicas durante a pandemia necessitam, sendo possível equacionar ferramentas da telemedicina e cuidado presencial caso a caso. Para os pacientes que foram hospitalizados e evoluíram satisfatoriamente é possível avaliar a continuidade do cuidado no domicílio sob acompanhamento da APS e AD. Devem ser instituídas medidas de precauções para a equipe e pacientes, garantindo que todos os profissionais sejam capacitados para uso de EPI, além de orientações para prevenção da transmissão de agentes infecciosos no domicílio. AD é essencial para acesso a pessoas com condições agudas, descompensação de doenças crônicas, tendo o desafio da organização do serviço utilizando a telessaúde e cuidados domiciliares de forma racional.

The Role of Social Workers in Interprofessional Primary Healthcare Teams.

Background:In Ontario, Canada, social workers are employed in a number of primary healthcare (PHC) settings such as Community Health Centres (CHCs) and Family Health Teams (FHTs). However, many aspects of social work practice within PHC settings are unknown.Objectives:The objectives of our study are to determine the amount of social work services provided in CHCs and FHTs, identify the types of services that social workers provide in CHCs and FHTs and ascertain the methods social workers use to deliver services in CHCs and FHTs.Method:An analysis of a cross-sectional data set obtained from a survey conducted in June 2016 in Ontario was performed.Results:The majority of practices (84.2%) had a social worker, although several practices also hosted other types of mental health workers. In virtually all practices with social workers, they (and individuals designated as mental healthcare providers) were also involved in practice level efforts to support mental healthcare delivery. In several practices, the care they delivered extended beyond that related directly to mental healthcare, ranging from preventive care and health promotion (64.5%) to palliative care (16.8%). In several practices, these workers also offered group appointments related to healthy behaviour (43.6%) and self-management (~33%).Interestingly, the role of social workers in practices where they were the sole designated mental healthcare worker was not meaningfully different from practices where other mental health professionals work.Conclusions:In PHC, social workers deliver or support the delivery of mental healthcare, but their role extends beyond that domain to encompass a broader set of services that contribute to the individual's health and wellbeing.

Health TAPESTRY Ontario: protocol for a randomized controlled trial to test reproducibility and implementation

BackgroundHealth TAPESTRY (Health Teams Advancing Patient Experience: STRengthening qualitY) aims to help people stay healthier for longer where they live by providing person-focused care through the integration of four key program components: (1) trained volunteers who visit clients in their homes, (2) an interprofessional primary health care team, (3) use of technology to collect and share information, and (4) improved connections to community health and social services. The initial randomized controlled trial of Health TAPESTRY found promising results in terms of health care use and patient outcomes, indicating a shift from reactive to preventive care. The trial was based on one clinical academic center, thus limiting generalizability. The study objectives are (1) to test reproducibility of the established effectiveness of Health TAPESTRY on physical activity and hospitalizations, (2) to test the feasibility of, and understand the contributing factors to, the implementation of Health TAPESTRY in six diverse communities across Ontario, Canada, and (3) to determine the value for money of implementing Health TAPESTRY.MethodsThis planned study is a pragmatic parallel randomized controlled trial with a delayed intervention for control participants at 6 months. This trial will simultaneously assess effectiveness and implementation in a real-world setting (type II hybrid) in six diverse communities across Ontario. Participants 70 years of age and older will be randomized into the Health TAPESTRY intervention or the control group (usual care). Intervention clients will receive an individualized plan of care from an interprofessional care team. The plan will be based on a client’s goals and current health risks identified through volunteer visits. The study’s outcomes are mapped onto the RE-AIM framework, with levels of physical activity and number of hospitalizations as the co-primary outcomes. The main analysis will be a comparison at 6 months.DiscussionIt is important to evaluate the effectiveness and implementation of Health TAPESTRY in multiple communities prior to scaling or widespread adoption.Trial registrationClinicalTrials.gov NCT03397836. Registered on 12 January 2018

Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare.

Pandemic situations present enormous risks to essential rural primary healthcare (PHC) teams and the communities they serve. Yet, the pandemic policy development for rural contexts remains poorly defined. This article draws on reflections of the rural PHC response during the COVID-19 pandemic around three elements: risk, resilience, and response. Rural communities have nuanced risks related to their mobility and interaction patterns coupled with heightened population needs, socio-economic disadvantage, and access and health service infrastructure challenges. This requires specific risk assessment and communication which addresses the local context. Pandemic resilience relies on qualified and stable PHC teams using flexible responses and resources to enable streams of pandemic-related healthcare alongside ongoing primary healthcare. This depends on problem solving within limited resources and using networks and collaborations to enable healthcare for populations spread over large geographic catchments. PHC teams must secure systems for patient retrieval and managing equipment and resources including providing for situations where supply chains may fail and staff need rest. Response consists of rural PHC teams adopting new preventative clinics, screening and ambulatory models to protect health workers from exposure whilst maximizing population screening and continuity of healthcare for vulnerable groups. Innovative models that emerge during pandemics, including telehealth clinics, may bear specific evaluation for informing ongoing rural health system capabilities and patient access. It is imperative that mainstream pandemic policies recognize the nuance of rural settings and address resourcing and support strategies to each level of rural risk, resilience, and response for a strong health system ready for surge events.

Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review.

This scoping review aimed to examine the state of the evidence for interprofessional, team-based primary health care for adults with intellectual and developmental disabilities. Adults with intellectual and developmental disabilities are a complex, vulnerable population known to experience health inequities. Interprofessional primary health care teams are recommended to improve access to comprehensive and coordinated health care for these individuals. Limited information is available regarding what services interprofessional primary health care teams provide and how services are evaluated specific to the care of this population. This scoping review considered all studies that referenced individuals with intellectual and/or developmental disabilities who were 18 years or older. It considered all studies that referred to health care provision within a primary health care context. All studies that discussed the provision of interprofessional primary health care services were included. "Interprofessional primary health care team" was the term used to describe services provided by health providers (e.g. physicians, nurse practitioners, nurses, dietitians, social workers, mental health workers, occupational therapists, physical therapists) working in a team-based model of care. This scoping review was conducted in accordance with JBI methodology for scoping reviews. Quantitative, qualitative, and mixed methods study designs were considered for inclusion. In addition, systematic reviews, program descriptions, clinical reviews, and opinion papers were considered. Studies published in English and French were included. The period considered was from 2000 to the date of the searches (July and August 2018 for bibliographic databases and January 2019 for the final searches of unpublished studies and selected papers from key authors). The search identified 2761 records. Despite the global search strategy, only 20 records were included in the final review, mainly consisting of work based in the United States and Canada. Results were heterogeneous and descriptive in nature, consisting of cross-sectional designs, program descriptions, and clinical reviews. The findings represent only a few distinct interprofessional primary health care team models of care and multiple contributions from a small pool of researchers. Roles for physicians, nurse practitioners, nurses, social workers, and mental health providers were identified. Ten studies identified either patient-reported outcomes or health-utilization outcomes. Overall, there was no consistent reporting of outcomes across studies, and outcomes specifically related to many interprofessional services were not captured. Although interprofessional, team-based approaches are supported at a policy and practice level, the concept of interprofessional primary health care for this population remains understudied and is challenged by differences in primary health care provision across the world, complexity in how the field is defined, as well as a lack of consistent reporting of the organizational attributes and processes that support interprofessional primary health care provision. To fully realize the potential of interprofessional primary health care teams, health services research is needed to describe organizational attributes and processes, and evaluate interventions for this population. Engaging in this work will ultimately provide a more fulsome evidence base to support high-quality, interprofessional primary health care provision for adults with intellectual and developmental disabilities.

Association between Frailty and Public Health Care Services Utilization among Older Adults: A Cross-Sectional Study

Frailty leads to exceedingly high budgets for the public health system with maintenance and rehabilitation of health services. To evaluate the association between frailty and Health Care Services utilization among older people enrolled at Primary Health Care (PHC). cross-sectional study. Territory of units of PHC, in older people’s home. The sample was composed of older people enrolled in 14 PHC teams, divided into 12 Primary care units. Health care services utilization was assessed by self-report medical consultations at the primary and secondary levels, participation in groups, home visits and hospitalization. Frailty was identified by the Frailty Phenotype. The association between frailty and health care services utilization was verified by crude and adjusted logistic regression models, at significance level of 0.05. The total sample was 496 older people with a mean age of 71 years (± 6.93), 62.2% females. In the univariate analyses, frailty was associated with all investigated health care services (p < 0.05). In the crude models, frail older people had higher odds of hospitalization compared to non-frail counterparts (OR = 2.91, 95% CI 1.43–5.88). Considering the adjusted models, clinical and sociodemographic variables showed an association with health care services utilization but not with frailty. Frailty was not directly associated with health care service utilization. However, it has multidimensional level and can be influenced by other factors.

Coronavirus disease-2019 epidemic response in Uganda: The need to strengthen and engage primary healthcare.

In Uganda, the numbers of new coronavirus disease cases have continued to increase slowly since the first case was confirmed. Given that the disease is likely to be holoendemic, the role of primary care (PC) with its features of comprehensiveness, accessibility, coordination and continuity, functioning at the heart of a primary healthcare (PHC) approach, will be important. The elements of PC are applicable in the epidemic preparation, case finding and management, follow-up and post-epidemic phases of responding to this pandemic. This also presents opportunities and lessons for strengthening PHC as well as for reflections on missed opportunities. The effective use of available resources in response to the epidemic should mainly focus on community mobilisation and PHC teams for the prevention, screening, testing and treatment of mild and moderate cases.

The annual dementia review: exploring current practice in primary care.

Dementia is a global public health challenge, the significant consequences of which are recognised in global and national health policies. Despite approaches to improve the implementation of evidence-based dementia care in primary care and the inclusion of indicators for dementia in the Quality and Outcomes Framework (QOF), there is consistent evidence that people with dementia and their family carers lack access to care which meets their needs. This study aims to explore current practice regarding the annual dementia review in primary care by investigating: 1) what 'should' be happening in annual dementia reviews; 2) how dementia reviews are delivered in a sample of general practices; 3) the barriers and facilitators to the implementation of evidence-based care in dementia reviews; and 4) the experience of these reviews from the perspectives of people with dementia and their informal carer(s). Qualitative methods will be used. In the first stage, semi-structured interviews with national and regional experts in dementia policy and healthcare will be used to explore what 'should' be happening in an annual dementia review. In the second stage, interviews with primary healthcare team members will explore how annual dementia reviews are delivered in a sample of practices in North East England. Interviews with people with dementia and their carers will then be used to explore how reviews are experienced by service users. Thematic analysis will be used to analyse data. Key themes from the first stage will be presented and their implications in primary care discussed. The research plan for the second stage will be presented.

Atenção Primária e Coordenação do Cuidado: dispositivo para ampliação do acesso e a melhoria da qualidade

The objective of this article is to investigate the viewpoint of health professionals regarding the coordination of care in Primary Health Care (PHC) and the challenges for performing it. Qualitative research with professionals from two PHC teams working in territories with vulnerabilities and inequalities in Rio de Janeiro. Use of the Content Analysis method, thematic modality with semi-structured interviews and participant observation. To coordinate care is to be involved with the activities that foster the provision of individualized and comprehensive care, aiming at the care continuity. The challenges of coordinating care by the PHC are overcoming the network fragmentation, the low supply of openings for specialists, the fragile communication between the services, the non-integrated electronic medical record, the low professional qualification and the unawareness of the PHC role by other services. The strengthening of the PHC as the gateway, coordinator and organizer of the network requires efforts by managers, professionals and society, so this way of organizing the systems can bring benefits regarding equity, accessibility, clinical and sanitary effectiveness, economic efficiency and allow care integration.

Would primary care paediatricians improve UK child health outcomes? No.

Why did you become a GP or family physician? Whatever we call ourselves, one of the attractions is being a generalist physician who cares for families over time, rather than individuals or specific body systems in isolated encounters. Many GPs will have been particularly attracted by the opportunity to see children and their carers in the context of their community. The challenge of providing continuity is such that every household may not be known to us, but electronic records allow us to cross-check information about people registered at the same home address; and personal knowledge is shared between primary healthcare team members. Around 11% of our consultations are for people under 15 years1 and the idea of community-based paediatricians, rather than GPs, providing primary care to children is not new.2,3 A mix of different types of providers is found in Europe, with paediatric primary care provided by GPs in only 41% of European countries;4 and in the US, where a third of children are cared for by family physicians rather than paediatricians.5 Yet, there are recurring calls for all …

Pharmacist intervention in colorectal cancer screening initiative

ObjectivesTo assess the novel approach of using the community pharmacist as the primary health care team member to facilitate colorectal cancer (CRC) risk counseling and screening in socioeconomically disadvantaged populations. SettingA collaborative effort between the UConn Health Colon Cancer Prevention Program and UConn School of Pharmacy in conjunction with large independent chain pharmacies (medium to medium-high volume) located in metropolitan areas of Connecticut, including Hartford, Bridgeport, New Haven, and Stamford. Pharmacies located in hospitals, across the street from a large physician practice, or within the community. Practice descriptionThe study involved 2 phases. The first phase involved education and training for community pharmacists regarding counseling approaches for patients on the topic of CRC. The second phase of the study involved patient recruitment and counseling with subsequent fecal immunohistochemical testing (FIT). Practice innovationA community pharmacist provided face-to-face counseling on CRC risk factor reduction and provided CRC screening to patients who were without insurance or underinsured. No CRC screening or education program existed beforehand. EvaluationA target sample size of 60 participants was needed with a type 1 error rate of 5% and a power of 80%. Exploration of variables using multivariate logistic regression model included any variable with a univariate P < 0.2. Multivariate P values < 0.05 were considered independent predictors. ResultsAfter approaching 312 consumers, 16 of them consented to the study. The majority of participants (88%) were African American or Latino, and 69% were currently unemployed. Eight participants agreed to complete FIT, and 88% of participants completed FIT correctly. Only 1 positive FIT result was observed, but a subsequent colonoscopy was negative. Of the 12 questions that assessed baseline CRC knowledge in the initial survey, 16 participants answered an average of 2.6 (range, 0–6, SD, 1.6) questions incorrectly. Only 4 participants completed the follow-up survey of CRC knowledge and program satisfaction; thus, exploration of variables was not conducted. Patients indicated high satisfaction with the program of education and FIT dispensing. ConclusionThis study faced difficulty in recruiting pharmacists to participate, with the main reason being lack of compensation and disruption to workflow. Patient participation in the trial was also low because of a lack of time or interest in participation. Of the patients who did participate, the level of satisfaction in having the pharmacist speak to them about CRC screening was high. This service is an excellent example of how the pharmacist can provide a more accessible, convenient, and responsive approach to patients’ needs while improving health equity. Future studies that employ a revenue model to build the infrastructure and capacity necessary to offer this service efficiently and consistently are needed.

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study.

The overuse of antimicrobials in primary care can be linked to an increased risk of antimicrobial-resistant bacteria for individual patients. Although there are promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs) in hospitals and long-term care settings, there is limited knowledge in primary care settings and how to implement ASPs in these settings is unclear. In this context, a qualitative study was undertaken to explore the perceptions of primary care prescribers of the usefulness, feasibility, and experiences associated with the implementation of a pilot community-focused ASP intervention in three primary care clinics. Qualitative interviews were conducted with primary care clinicians, including local ASP champions, prescribers, and other primary health care team members, while they participated in an ASP initiative within one of three primary care clinics. An iterative conventional content analyses approach was used to analyze the transcribed interviews. Themes emerged around the key enablers and barriers associated with ASP implementation. Study findings point to key insights relevant to the scalability of community ASP activities with primary care providers.

Structure for the work and composition of Family Health Support Unit teams: national survey - Program for Improving Primary Health Care Access and Quality (PMAQ), 2013.

to describe the structure of Family Health Support Unit (FHSU) teams with regard to physical space, training received, continuing education and professionals that support Primary Health Care (PHC) teams in Brazil, in 2013. this is a descriptive study using data from the external evaluation stage of the Program for Improving Primary Health Care Access and Quality (PMAQ). the 1,773 FHSU teams mainly used shared clinics at primary health care centers (85.7%); 63.4% of professionals were offered specific training when they started work at their FHSU, while 67.4% were offered continuing education; the teams received support mainly from physiotherapists (87.4%) and Physical Education professionals (87,0%). the structure available for FHSU teams is in accordance with the guidelines; some FHSU professionals have not received any specific training for the job.

Increasing access to primary health care through distributed leadership

ABSTRACT Background: Primary health care is a vital component of an effective health-care system. However, there are challenges in access to primary health care. The leadership approach adopted in primary health-care delivery has been called a key determinant of access to care. Objectives: In this study, the researcher examines the adoption of distributed leadership in primary health-care delivery and how it affects access to primary health care. The researcher seeks to establish the features of distributed leadership in primary health care, adoption of said leadership, and the impact of leadership approach on barriers to access. Methods: The study is based on a quantitative analysis of 12 studies from various countries globally that were retrieved from seven electronic databases. Results: It is noted that the main features of distributed leadership in primary health care include leadership coalitions among members of primary health care teams, a collective approach to decision-making, and shared accountability. The adoption of distributed leadership is seen to significantly reduce communication barriers (P = 0.01) and knowledge barriers (P = 0.028) while enhancing continuity of care in primary health-care delivery (P = 0.03). The researcher also reports a statistically significant difference in health-care access, depending on the different features of distributed leadership (χ 2(2) = 6.003, P = 0.014). Conclusions: The evidence presented could equip primary health-care leaders and policy makers with insights and knowledge regarding the enhancement of primary health-care access through the adoption of a distributed leadership approach.