Quality Of Primary Health Care Research Articles

The impact of COVID-19 on primary health care delivery in Australia.

To validate the 'safe and effective staffing tool' and explore the impact of COVID-19 on the quality of Australian primary health care (PHC). A national survey was conducted from October to December 2020. The online survey was distributed via social media and professional organisations to PHC nurses. Three-hundred fifty-nine PHC nurses participated. A two-factor solution was found with factors named; 'Perception of quality of care provided' and 'Personal satisfaction with care delivered'. Cronbach's alpha demonstrated good internal consistency for the total scale (α=.915) and each subscale (α=.879/α=.864). Nearly three-quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor 'perceptions of quality of care provided' and the total 'quality and satisfaction with care'. A lack of time, inadequate supervision and support, and performing non-nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID-19had impacted negatively on the detection and management of non-COVID related health conditions. The 'safe and effective staffing tool' is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID-19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID-19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high-quality care to optimise health outcomes and maintain nurse satisfaction. This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses.

Perception and Use of Primary Healthcare Services Among People With Cardiometabolic Diseases in Two Resource-Limited Areas in Nepal: A Mixed Methods Study.

Nepal is a country in south Asia with a high burden of cardiometabolic diseases (CMDs). Strengthening primary healthcare (PHC) is a key strategy to mitigate this increasing burden and achieve universal health coverage. While previous studies in Nepal have assessed PHC use among the elderly, none have specifically explored PHC use among people with CMDs. Therefore, this mixed-methods study aimed to assess the use and perception of PHC services in Nepal among people living with CMDs for primary and secondary prevention of cardiovascular disease. We used a quantitative survey followed-up by semi-structured qualitative interviews. The sampling frame comprised five PHC facilities in Sindhuli district (rural; eastern Nepal) and five in Kailali district (urban; western Nepal), with participants selected from each facility via convenience sampling. 114 people (mean age: 54.5 ± 14.7, sex ratio 1.04) with CMDs participated in the survey. Survey data showed general dissatisfaction with PHC services. Medicine cost was rated “too expensive” by 52 and 63% of rural and urban participants, respectively. Interview data showed that perceived poor bedside manner was tied to negative perceptions of PHC quality, and vice versa. Lack of resources and excessive barriers to care was mentioned by every interviewee. In conclusion, PHC use was high but overall satisfaction relatively low. Our results suggest that bedside manner is a practical target for future research. Additionally, we identified several barriers to care, and, based on existing literature, we suggest electronic-health interventions may have potential to mitigate these challenges.

COVID-19 in Brazilian cities: Impact of social determinants, coverage and quality of primary health care.

Brazil, as many other countries, have been heavily affected by COVID-19. This study aimed to analyze the impact of Primary health care and the family health strategy (FHS) coverage, the scores of the National Program for Improving Primary Care Access and Quality (PMAQ), and socioeconomic and social indicators in the number of COVID-19 cases in Brazilian largest cities. This is an ecological study, carried out through the analysis of secondary data on the population of all Brazilian main cities, based on the analysis of a 26-week epidemiological epidemic week series by COVID-19. Statistical analysis was performed using Generalized Linear Models with an Autoregressive work correlation matrix. It was shown that greater PHC coverage and greater FHS coverage together with an above average PMAQ score are associated with slower dissemination and lower burden of COVID-19. It is evident that cities with less social inequality and restrictions of social protection combined with social development have a milder pandemic scenario. It is necessary to act quickly on these conditions for COVID-19 dissemination by timely actions with high capillarity. Expanding access to PHC and social support strategies for the vulnerable are essential.

Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study

BackgroundLanguage is a barrier to many patients from refugee backgrounds accessing and receiving quality primary health care. This paper examines the way general practices address these barriers and how this changed following a practice facilitation intervention.MethodsThe OPTIMISE study was a stepped wedge cluster randomised trial set within 31 general practices in three urban regions in Australia with high refugee settlement. It involved a practice facilitation intervention addressing interpreter engagement as one of four core intervention areas. This paper analysed quantitative and qualitative data from the practices and 55 general practitioners from these, collected at baseline and after 6 months during which only those assigned to the early group received the intervention.ResultsMany practices (71 %) had at least one GP who spoke a language spoken by recent humanitarian entrants. At baseline, 48 % of practices reported using the government funded Translating and Interpreting Service (TIS). The role of reception staff in assessing and recording the language and interpreter needs of patients was well defined. However, they lacked effective systems to share the information with clinicians. After the intervention, the number of practices using the TIS increased. However, family members and friends continued to be used to interpret with GPs reporting patients preferred this approach. The extra time required to arrange and use interpreting services remained a major barrier.ConclusionsIn this study a whole of practice facilitation intervention resulted in improvements in procedures for and engagement of interpreters. However, there were barriers such as the extra time required, and family members continued to be used. Based on these findings, further effort is needed to reduce the administrative burden and GP’s opportunity cost needed to engage interpreters, to provide training for all staff on when and how to work with interpreters and discuss and respond to patient concerns about interpreting services.

A mixed-methods study exploring adherence to the referral of severely sick children in primary health care in Southern Ethiopia

BackgroundWe have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primary healthcare register reviews and explore health care providers’ and parents’ perceptions regarding factors that hinder or enhance referral.MethodsA mixed-methods study was conducted in 11 districts and a town administration of the Hadiya zone in Ethiopia’s Southern region from May to June 2019. Data collection included interviews and focus group discussions with healthcare providers, key informant interviews with parents of sick children who had been referred, and reviewing registers of sick children treated during the last 12 months at health posts and health centres. We analysed the association between healthcare providers’ and sick children’s characteristics and providers’ compliance with referral guidelines for sick children 0–59 months old. Content analysis was undertaken to explore the perceived factors that influenced referral and adherence to referral from providers’ and parents’ perspectives.ResultsHealthcare providers did not refer nearly half of the severely ill children that should have been referred, according to guidelines. Providers who had received in-service training on child healthcare were more likely to adhere to referral guidelines. The severity of the child’s illness and mobile phone communication and transport availability were perceived to be positively associated with adherence to referral guidelines. Lack of knowledge of treatment guidelines and skills, and high health worker workload, were among the factors perceived to be linked to lower adherence to guidelines. The healthcare providers considered parents of referred sick children as having low compliance with the referral advice. In contrast, parents had the opinion that compliance with a referral for sick children was high. Perceived awareness of severity of the child’s illness, ability to afford referral costs, and availability of transport or ambulance services were perceived to motivate parents to take their children to the referral facility. Traditional illness perceptions, lack of confidence in the referral site’s medical care, and a long distance were perceived to hurdle caregivers’ referral compliance.ConclusionsWe found that the healthcare providers’ adherence to referral guidelines was not optimal. Care providers and parents had divergent opinions on parents’ compliance with referral advice. Factors related to the health system, family economy, and available ambulance services influence whether care providers and parents pursued severely ill children’s referral. Adequate referral of sick children is an aspect of primary healthcare quality that is essential to avoid unnecessary under-five deaths.

Chronic disease patients' satisfaction with primary health-care services provided by the second health cluster in Riyadh, Saudi Arabia

Background: Having a high quality primary health-care (PHC) system leads to a more efficient health-care system, which lower rates of hospitalization and leads to better health outcomes. One of the main criteria for assessing the quality of PHC services is the assessment of patient satisfaction, so the study aims to assess the chronic disease patients' satisfaction with PHC services provided by centers. Methods: A descriptive cross-sectional study conducted on patients with chronic diseases who follow-up in PHC centers within the Second Health Cluster in Riyadh using a questionnaire to assess their satisfaction level. A total 210 patients with different chronic diseases from the seven PHC centers (30 patients from each PHC center) who agreed to participate were included in the study. Results: In the study, 126 (60%) participants were females and 96 (45.7%) participants were in the age group more than 50 years. The survey showed that patients were satisfied with services offered by physicians, nurses, laboratory, and pharmacy with weighted means (3.81, 3.54, 3.59, and 3.88, respectively), while they were not satisfied with waiting time and services offered by receptionists with weighted means (3.22 and 3.27, respectively). The patient satisfaction showed a significant association with gender and level of education (P = 0.003 and 0.005, respectively). Conclusions: The survey showed that patients with chronic diseases were satisfied with services provided by PHC centers of the Second Health Cluster in Riyadh except receptionists' services, appointments, and waiting time. This survey will guide the policymakers for improving the services provided at the PHC centers.

On epidemiology of congenital ichthyosis in Moscow

Ichthyosis is an extensive group of hereditary skin diseases characterized by keratinization disorders of the type of hyperkeratosis, which leads to the formation of scales on the skin resembling fish scales. Of all hereditary diseases of keratinization, ichthyosis is the most common disease. In many countries, there are various support groups for patients with ichthyosis, in particular, the All-Russian Charity Foundation for Helping Children with Ichthyosis, the Children- Butterflies Foundation, the Public Organization Support for People with Ichthyosis (Russia), the Foundation for Ichthyosis and Related Skin Types (USA), etc.Objective. To assess the dynamics of the incidence of congenital ichthyosis in the city of Moscow among the population of all age groups for 2015–2020, according to the data of the Moscow Scientific and Practical Centre for Dermatovenerology and Cosmetology (Russia).Materials and methods. Using federal statistical observation form No. 12 ‘Information on the number of diseases registered in patients living in the service area of a medical organization’, approved by the order of Rosstat No. 679 dated November 22, 2019, we analyzed the incidence of congenital ichthyosis in Moscow for 2015–2020.Results. Analysis of data on the incidence of congenital ichthyosis in the context of age groups of the population of the city of Moscow for 2015–2020 showed a trend towards an increase in the incidence of congenital ichthyosis. The increase in the incidence of ichthyosis was detected in almost all age groups of the city's population and was most pronounced in 2018 and 2019 in comparison with the previous time interval.Conclusions. The revealed increase in the incidence of congenital ichthyosis in Moscow may be due to both the true number of cases and the improvement in the quality and availability of primary specialized health care. An important trend is towards wider implementation in medical practice methods, which make it possible to identify a specific genetic defect, to carry out prenatal diagnostics during pregnancy, an intravital histological (pathological-anatomical) study of a skin biopsy, if necessary, differential diagnosis and verification of the diagnosis, as well as genetic counseling of parents, including to assess the birth of children with ichthyosis during pregnancy.

The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis

BackgroundEvidence is limited on health benefits from quality improvement of primary healthcare (PHC) in low- and middle-income countries (LMICs). This study investigated whether increasing PHC quality in Brazil with highly-skilled health professionals and integrated community health workers (CHWs) was associated with reductions in hospitalizations and mortality beyond benefits derived from increasing access. MethodsAnnual municipal-level data for 5,411 municipalities between 2000 and 2014 were analysed using fixed effects panel regressions. PHC quality was measured as: i) the proportion of consultations provided by highly-skilled health professionals (doctors and nurses); and ii) the proportion of visits provided by CHWs from multidisciplinary PHC teams. Models assessed associations between PHC quality and hospitalization and mortality from diabetes, cardiovascular disease (CVD), tuberculosis, leprosy, perinatal and maternal causes, and adjusted for PHC access, utilisation, presence of secondary care services, and socioeconomic factors. FindingsA one percentage point increase in the proportion of consultations provided by highly-skilled health professionals was associated with 0•019 fewer deaths from diabetes per 100,000 population (95%CI: -0•034, -0•003; p-value: 0.0167) and 0•029 fewer hospitalizations per 100,000 from leprosy (95%CI: -0•055, -0•002; p-value: 0.0321). A one percentage point increase in the proportion of care provided by CHWs from multidisciplinary PHC teams was associated with 0•025 fewer deaths from CVD per 100,000 (95%CI: -0•050, -0•001; p-value: 0.0442) and 0•148 fewer maternal hospital admissions per 100,000 (95%CI: -0•286, -0•010; p-value: 0.0356). No significant associations were found for the other twenty pairs of exposures and outcomes analysed. InterpretationInvesting in higher-quality PHC models with highly-skilled health professionals and integrated CHWs can deliver reductions in mortality and hospitalizations in LMICs. FundingNone.

Implementation research on measuring quality in primary care: balancing national needs with learning from the Eastern Mediterranean Region.

Universal Health Coverage (UHC) is a core element of ensuring healthy lives, marking the third Sustainable Development Goal. It requires providing quality primary health-care (PHC) services. Assessment of quality of care considering a wide variety of contexts is a challenge. This study lists practical indicators to enhance the quality of PHC. Demonstrating quality indicators for PHC that are feasible, comprehensive and adaptable to wide array of health systems and resource settings. We applied the research framework: Exploration, Preparation, Implementation and Sustainment. Exploration included a scoping review to identify quality indicators. Preparation included an eDelphi to refine the primary indicators' list. A panel of 27 experts reviewed the list that was later pilot tested in PHC facilities. The outcomes were presented to two further expert consultations, to refine indicators and plan for broader testing. Implementation included testing the indicators through a five-step process in 40 facilities. A regional consultation in May 2016 discussed the testing outcomes. Initial efforts identified 83 quality indicators at the PHC level that were then refined to a 34-indicator list covering the six domains of quality. A toolkit was also developed to test the feasibility of each indicator measurement, data availability, challenges and gaps. Pilot testing provided insight into modifying and adding some indicators. Wide variability was encountered within and in between facilities, and timely initiation of antenatal care, for example, ranged 31-90% in Oman and 11-98% in Tunisia. Indicators were highly feasible, and 29 out of 34 were measured in 75% of facilities or more. While challenges included gaps in capacity for data collection, the tool showed high adaptability to the local context and was adopted by countries in the Eastern Mediterranean Region (EMR) including Libya, Oman, Iran, Pakistan, Sudan and Palestine. Stakeholders agreed on the high relevance and applicability of the proposed indicators that have been used to inform improvement. A cross-regional set of 34 quality indicators of PHC in the EMR was developed and adopted by a diverse group of countries. The toolkit showed high feasibility in pilot testing reflecting the practicality needed to encourage local uptake and sustainability. The core quality indicators are highly adaptable to different local and regional contexts regardless of current PHC strength or available resources. Continuous evaluation and sharing lessons of implementation and use are needed to ascertain the indicators' effectiveness in driving improvements in PHC and to refine and strengthen the evidence supporting the set of indicators for wider adoption.

Exploring the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa.

BackgroundThe challenges in leadership roles hinder the rendering of quality primary healthcare service in the mines. Mining, the heart of the South African economy, requires good health to its personnel to carry out operations. However, nurse managers, the leaders in a mining primary healthcare setting experience difficulties in their leadership roles.ObjectivesThe aim of this study was to explore and describe the challenges in leadership roles experienced by nurse managers in a mining primary healthcare setting in South Africa.MethodThe study was conducted in a mining primary healthcare setting in West Rand, Gauteng province, South Africa. A qualitative, exploratory, descriptive design that is contextual in nature, using a phenomenological approach, was adopted. Data from nurse managers in the mine were collected and data saturation was reached by the seventh participant. The study followed Giorgi’s four stages of the phenomenological descriptive data analysis. An expert independent coder in qualitative research coded the data, and consensus on the findings was reached with the researcher.ResultsThree subthemes emerged from the study: mining management and unions interfere with nurse managers’ leadership roles, incongruent mining primary healthcare policies and communication gap between nurse managers and mining management.ConclusionThe triangulation of nurse managers, mining management and unions requires a collective fusion to directly tackle the challenges in leadership roles in mining primary healthcare.

The gendered implications of energy gaps in health care: A comparative analysis of Haiti, Senegal, and the Democratic Republic of Congo

Delivering quality primary health care requires reliable energy access. In rural health facilities, electricity is often unreliable or absent. Low energy access has a gendered impact, affecting the ability of mothers to experience safe childbirth, for which basic lighting and sterilization are essential. Moreover, low energy access acts as a barrier to attract and retain female medical staff, who constitute women-predominated nursing and midwifery cadres that are critical for providing care to women. Using quantitative facility-level data, we explore the intersection of energy, health care, and gender in Haiti, Senegal, and the Democratic Republic of the Congo.

Does a mobile clinical decision-support system (CDSS) help improve the quality of primary health care?

Does a mobile clinical decision-support system (CDSS) help improve the quality of primary health care?

Quality of Primary Health Care models for brazilian children

Aim. To evaluate the quality of Primary Health Care (PHC) models for Brazilian children. Methods. A cross-sectional study was performed with 516 parents or guardian of children in the public preschools from a city in São Paulo State, Brazil. The participants completed the questionnaires on the perception of the quality of the PHC (Primary Care Assessment Tool-PCATool), and the socioeconomic conditions in their families. The data were analyzed by statistical tests (95% confidence level). Results. Private services, Family Health Strategies (FHS), and Conventional Health Care (CHC) were the modalities of PHC used by children. Among the three modalities, in all groups were observed statistically significant differences (p<0.001), the best quality of care was provided by FHS (8.22±1.69). The CHC (5.69±1.34) and the private service (6.65±0.99) need improvement in accessibility, continuity of care, integrality, family, and community orientation. The socioeconomic class of the families was associated with modalities of PHC (p<0.001). Conclusions. The quality of primary care for children in the public health system still requires much improvement, primarily in conventional model. However, the Family Health Strategies was the model that presented the best quality of primary health care for children.

Adapted fairness benchmarks for the evaluation of Iran health system reform.

This study has been designed to localize fairness benchmarks for the evaluation of health system reform with an ethical approach. A descriptive-analytic study was applied in which a questionnaire with selected indicators and based on main fairness benchmarks was validated. Besides, the final indicators were chosen for surveys of 255 health equity experts from 31 provinces of Iran to localize fairness benchmarks using the exploratory factor analysis through the SPSS software. Seven fairness benchmarks were adopted: (1) Efficacy, Efficiency, and Quality of Health Care; (2) Impact of Information Infrastructure on Health Reform; (3) Responsiveness; (4) Equitable Access, and Universal Health Coverage; (5) Equitable Financing; (6) Social Determinant of Health; and (7) Financial Barriers to Equitable Access. The priorities of fairness benchmarking through localization included focusing on the quantity and quality of primary health care, allocating resources based on the need; for equitable efficiency, and paying attention to community-based information infrastructure, and social determinants for fair reform. Moreover, respecting patient rights as a part of democratic accountability was more close to equity. Elimination of financial and nonfinancial barriers for health access and coverage based on vulnerability, through fair financing, was also confirmed.

Epidemiology and Economic Burden of Continuing Challenge of Infectious Diseases in India: Analysis of Socio-Demographic Differentials

Unlike other low and middle-income countries, infectious diseases are still predominant and non-communicable diseases are emerging without replacing the burden of infectious diseases in India. Therefore, the study aimed to analyze the socio-economic and demographic differentials in the magnitude of economic burden and coping strategies associated with health expenditure on infectious diseases in India. National Sample Survey Organization (NSSO) data on ‘Key Indicators of Social Consumption in India: Health, (2017-18)’ has been employed in this study. Results revealed that out of the total ailed population, 33 percent reported ailed with infectious diseases in India. In both inpatient and outpatient care, individuals residing in a rural area, females, educated up to secondary level, very poor, more than average households’ size and eastern region of the country spends a bigger portion of its total consumption expenditure (TCE) on health. Further, to cope up with the burden of OOP health expenditure, people residing in rural areas, SCs followed by OBCs, illiterates, poor and very poor, and southern region are more dependent on distress financing such as borrowing and others which includes the sale of assets and contribution from friends and relatives in the study. The study deliberates the need for comprehensive policy initiatives including an action plan against ailments, awareness against unhygienic conditions, immunizations, subsidized medical facilities, expansion of quality primary health care facilities in the country.

Experiences of Indigenous peoples in Canada with primary health care services: a qualitative systematic review protocol.

The objectives of this review are to aggregate and synthesize experiences of Indigenous peoples in Canada when receiving primary health care services; differentiate experiences from services provided in urban versus rural or remote settings; and identify recommendations to enhance quality of primary health care provision. Primary health care plays a crucial role in overall population health and health equity. In Canada, Indigenous peoples continue to face disproportionate health disparities. Survey and qualitative studies on the experiences of Indigenous populations with primary health care services reveal alarming findings of inadequate health care access, racial discrimination, negligence, and cultural insensitivities. However, these studies do not entirely assess the primary care and essential public health functions component. This protocol will be the first qualitative systematic review to thoroughly synthesize Indigenous peoples' overall primary health care experiences across all Canada, in both rural and urban settings. The population of interest is self-identified Indigenous peoples, who have first- and/or second-hand experience receiving primary health care services in Canada, regardless of their age, gender, or medical condition. Our focus is on patients' experiences in contexts where primary health care services are delivered in Canada. Only qualitative studies in English or French will be considered. MEDLINE, CINAHL, PubMed, PsycINFO, Embase, and Web of Science will be used as information sources in addition to Google Scholar, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, and other relevant organization websites. Two independent reviewers will perform the screening, critical appraisal, and data extraction of selected articles. Results will then be synthesized using the meta-aggregation approach. PROSPERO CRD42020192353.

Validity of algorithms for identifying five chronic conditions in MedicineInsight, an Australian national general practice database

BackgroundMedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. It is one of the largest and most widely used primary health care EHR databases in Australia. This study examined the validity of algorithms that use information from various fields in the MedicineInsight data to indicate whether patients have specific health conditions. This study examined the validity of MedicineInsight algorithms for five common chronic conditions: anxiety, asthma, depression, osteoporosis and type 2 diabetes.MethodsPatients’ disease status according to MedicineInsight algorithms was benchmarked against the recording of diagnoses in the original EHRs. Fifty general practices contributing data to MedicineInsight met the eligibility criteria regarding patient load and location. Five were randomly selected and four agreed to participate. Within each practice, 250 patients aged ≥ 40 years were randomly selected from the MedicineInsight database. Trained staff reviewed the original EHR for as many of the selected patients as possible within the time available for data collection in each practice.ResultsA total of 475 patients were included in the analysis. All the evaluated MedicineInsight algorithms had excellent specificity, positive predictive value, and negative predictive value (above 0.9) when benchmarked against the recording of diagnoses in the original EHR. The asthma and osteoporosis algorithms also had excellent sensitivity, while the algorithms for anxiety, depression and type 2 diabetes yielded sensitivities of 0.85, 0.89 and 0.89 respectively.ConclusionsThe MedicineInsight algorithms for asthma and osteoporosis have excellent accuracy and the algorithms for anxiety, depression and type 2 diabetes have good accuracy. This study provides support for the use of these algorithms when using MedicineInsight data for primary health care quality improvement activities, research and health system policymaking and planning.

Quality and Cost in Community Health Centers.

Quantifying health care quality has long presented a challenge to identifying the relationship between provider level quality and cost. However, growing focus on quality improvement has led to greater interest in organizational performance, prompting payers to collect various indicators of quality that can be combined at the provider level. To explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality. Using the Uniform Data System collected by the Bureau of Primary Care, we constructed composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015-2018. We explored different weighting schemes and different combinations of individual quality indicators constructed at the intermediate domain levels of chronic condition control, screening, and medication management. We used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors. We examined the sensitivity of results to different weighting schemes and to combining individual quality indicators at the overall level compared with the intermediate domain level. Both overall and domain level composites performed well in the estimations. Average cost of a medical visit was negatively associated with quality, although the magnitude of the effect varied across weighting schemes. Efforts toward improvement of primary health care quality delivered in CHCs need not involve greater cost.

Assessment of the quality of Primary Health Care in Fortaleza, Brazil, from the perspective of adult service users in 2019.

Primary Health Care (PHC) is the "front door" and keystone of Brazil's public health system, meaning that the evaluation of the quality of primary care services is of utmost importance. Using the Primary Care Assessment Tool (PCAT), this study evaluated the performance of public PHC services in Fortaleza from the view of adult service users. We conducted a cross-sectional study of 233 adult service users from 19 primary care centers (PCCs) between June and December 2019, collecting data on the sociodemographic and epidemiological characteristics of users and structural features of PCCs. The association between user and PCC characteristics and primary care attribute scores was measured by multilevel logistic regression. Most participants were women, aged between 30 and 59 years, brown, house owners, had completed high school, did not own health insurance, and belonged to families with at least 4 members. The lowest and highest-scoring attributes were "first contact accessibility" and "first contact utilization" (2.8 and 8.1, respectively). The overall essential and general scores were 6.0 and 5.7, respectively. Having complete health teams, more community health workers, and a family and community medicine residency program had a positive effect on the general score (p<0.05). Overall, the public services analyzed in Fortaleza received a low performance rating from the adult service users.

Laboratory for innovation in Primary Health Care: implementation and results.

This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.