Reorganization Of Primary Care Research Articles

The COVID-19 health emergency: the influence of the Human Development Index on the reorganization of primary care.

This study aimed to analyze and compare the organization and care offered by Primary Health Care (PHC) to people with suspected and/or diagnosed COVID-19 in Brazilian municipalities, considering the Human Development Index (HDI). This is an analytical cross-sectional study carried out with managers of PHC services in Brazilian municipalities. The data were collected using a self-administered questionnaire via Google Forms between April and September 2022 and were analyzed using prevalence ratios, using a Poisson regression model with a random effect and a 5% significance level. The results indicated that municipalities with a low HDI were the most adherent to measures to reorganize PHC services during the health emergency phase of the pandemic when compared to municipalities with a medium, high, or very high HDI. This may be related to the better organization and structure of this level of care in the municipalities analyzed, pointing to the need for management that considers the population's living conditions when dealing with public health emergencies.

Identification of conditions which lead to unjustified requests for emergency treatment of hypertensive patients.

Aim To determine most common factors making patients with high blood pressure seek professionally unacceptable treatment of hypertension at the Emergency Department. Methods The survey was conducted at the Emergency Department of the Primary Health Care in Gradačac on randomly selected 207 patients who requested medical help because of high blood pressure. For all patients arterial blood pressure and body mass index (BMI) were measured. A survey about knowledge and attitudes regarding habits that affect high blood pressure as well as the socio-economic conditions was made. Results Prevalence of 10.3% was found with regard to visits to emergency care by patients due to high blood pressure. Most patients, 127(61.4 %), were overweight and 36(17.4%) were obese. Patients who rarely controlled their blood pressure were more frequent visitors of emergency medical services. Stressful situation occurs as a factor in a variety of forms. The survey showed that 76 (36.7%) patients sought medical help even though they had no blood pressure values that required emergency care. Conclusion Poorly organized health care system with no continuous and comprehensive preventive promotional programs caused by inappropriate use of resources in health care. The reorganization of primary care with full implementation of family medicine and greater integration of family medicine with other levels of the health care system should provide a better control and treatment of other diseases such as hypertension.

Delivering PACT-Principled Care: Are Specialty Care Patients Being Left Behind?

With the reorganization of primary care into Patient Aligned Care Teams (PACT) teams, the Veteran Affairs Health System (VA) aims to ensure all patients receive care based on patient-centered medical home (PCMH) principles. However, some patients receive the preponderance of care from specialty rather than primary care clinics because of the special nature of their clinical conditions. We examined seven VA (HIV) clinics as a model to test the extent to which such patients receive PCMH-principled care. To examine the extent to which HIV specialty care in VA conforms to PCMH principles. Qualitative study. Forty-one HIV providers from seven HIV clinics and 20 patients from four of these clinics. We conducted semi-structured interviews with HIV clinic providers and patients about care practices and adherence to PCMH principles. Using an iterative approach, data was analyzed using both a content analysis and an a priori, PCMH-principled coding strategy. Patients with HIV receive varying levels of PCMH-principled care across a range of VA HIV clinic structures. The more PCMH-principled HIV clinics largely functioned as PCMHs; patients received integrated, coordinated, comprehensive primary care within a dedicated HIV clinic. In contrast, some clinics were unable to meet the criteria of being a patient's medical home, and instead functioned primarily as a place to receive HIV-related services with limited care coordination. Patients from the less PCMH-principled clinics reported less satisfaction with their care. Even in a large, integrated healthcare system, there is wide variation in patients' receipt of PCMH-principled care in specialty care settings. In order to meet the goal of having all patients receiving PCMH-principled care, there needs to be careful consideration of where primary and specialty care services are delivered and coordinated. The best mechanisms for ensuring that patients with complex medical conditions receive PCMH-principled care may need to be tailored to different specialty care contexts.

The House Of Health: the need for a new welfare

Under a conception of community welfare, the "Health home" (Casa della salute) allows the re-organization of primary care and the implementation of the "initiative medicine" based on the integration and participation of professionals, associations and citizens. Starting from an analysis of the regional laws, the article presents the results of a comparative research on the Health homes of different Italian areas. The organizational analysis is based on structural indicators, functional indicators and process indicators.

Opinião dos graduandos em odontologia diante da estratégia de saúde da família

Saúde da família, Currículo, Saúde bucal

La Casa della Salute: esigenza di un nuovo welfare

Under a conception of community welfare, the home (Casa della Salute) allows the re-organization of primary care and the implementation of the initiative medicine based on the integration and participation of professionals, associations and citizens. Starting from an analysis of the regional laws, the article presents the results of a comparative research on the Health homes of different Italian areas. The organizational analysis is based on structural indicators, functional indicators and process indicators.

Práticas dos trabalhadores de saúde na comunidade nos modelos de atenção básica do Sul e Nordeste do Brasil

In order to verify the prevalence of health workers' participation in health practices in the community, a cross-sectional study was conducted with 3,743 primary care health workers in 41 municipalities with more than 100 thousand inhabitants each in South and Northeast Brazil. Overall prevalence of participation in the community was 62.7%, and was significantly higher in the Northeast and in the Family Health Program (FHP). The most common practice was health education on special holidays, in talks, and in groups. There was a positive association between participation and: female gender, training in the management of chronic diseases, use of protocols, satisfaction with community meetings, and academic health services. Differences in the prevalence of participation by region and health care model reaffirmed the inherent expectations in the historical context of reorganization of primary care. The results indicate that it is necessary to expand participation by health workers in the community, considering that primary care is the level of care that provides the best possibilities for promoting health practices with equity.

The implementation evaluation of primary care groups of practice: a focus on organizational identity

BackgroundSince 2002 the Health Ministry of Québec (Canada) has been implementing a primary care organizational innovation called 'family medicine groups'. This is occurring in a political context in which the reorganization of primary care is considered necessary to improve health care system performance. More specifically, the purpose of this reform has been to overcome systemic deficiencies in terms of accessibility and continuity of care. This paper examines the first years of implementation of the family medicine group program, with a focus on the emergence of the organizational identity of one of the pilot groups located in the urban area of Montreal.MethodsAn in-depth longitudinal case study was conducted over two and a half years. Face to face individual interviews with key informants from the family medicine group under study were conducted over the research period considered. Data was gathered throuhg observations and documentary analysis. The data was analyzed using temporal bracketing and Fairclough's three-dimensional critical discourse analytical techniques.ResultsThree different phases were identified over the period under study. During the first phase, which corresponded to the official start-up of the family medicine group program, new resources and staff were only available at the end of the period, and no changes occurred in medical practices. Power struggles between physicians and nurses characterized the second phase, resulting in a very difficult integration of advanced nurse practitioners into the group. Indeed, the last phase was portrayed by initial collaborative practices associated with a sensegiving process prompted by a new family medicine group director.ConclusionsThe creation of a primary care team is a very challenging process that goes beyond the normative policy definitions of who is on the team or what the team has to do. To fulfil expectations of quality improvement through team-based care, health care professionals who are required to work together need shared time/space contexts to communicate; to overcome interprofessional and interpersonal conflicts; and to make sense of and define who they collectively are and what they do as a clinical team.

Is the number up for district nursing?

Recent conversations have highlighted the growing discrepancy between the government's plans for community nursing in England and the reality in some PCTs. Although the reorganization of primary care has been seen as an opportunity for district nurses to redefine their role, it increasingly seems that unless district nurses take drastic action now, PCT managers will simply reorganize their role out of existence.

NHS changes promise an uncertain future

Just as everyone was getting to grips with one reorganization of primary care, so another one comes along out of the blue to upset the apple cart again. The NHS Chief Executive, Nigel Crisp, has announced a major restructuring of primary care to begin in just a few months’ time.

Community health centres in Canada.

In an increasing trend, clients are being moved from tertiary and secondary care to primary care. This "down-loading", accompanied by the increasingly complex needs of clients, has forced providers and policy makers to acknowledge the importance of primary care. In exploring options for the reorganization of primary care, the characteristics of community health centres are often promoted as the model with the best potential. This article outlines a descriptive overview of community health centres (CHCs) across Canada.