Primary Health Care Resources Research Articles

1743. Health Care Resource Utilisation (HCRU) Due to Respiratory Syncytial Virus (RSV) Before the Age of Two in England

Abstract Background RSV is responsible for 33 million lower respiratory tract infections (LRTI) worldwide. The highest burden occurs in infants < 1 year of age during RSV season, which is from October to February in England. Due to lack of routine laboratory testing, its true disease burden is unknown. This study aimed to estimate the respiratory related primary and secondary care healthcare resource utilisation (HCRU) of RSV admissions before the age two in England. Methods This retrospective cohort study used Clinical Practice Research Datalink (CPRD)-Hospital Episode Statistics (HES) linked data to establish a birth cohort of all infants born between 01/03/2015 and 28/02/2017 (n=449,591). Case cohorts included infants under two with a hospital admission of: 1) confirmed RSV (n=4,813), 2) bronchiolitis (n=22,913), 3) any RTI (n=56,871). Each case cohort was compared with all birth cohort infants without the corresponding admission (comparative cohorts). Respiratory related HCRU (primary care, outpatient, accident and emergency [A&E], and inpatient admissions) were estimated in the month prior to and up to 24 months following the first admission in each cohort. Results The RSV-coded cohort had the highest HCRU overall, mean (SD) of 5.1 (4.8) admissions vs. 1.5 (2.4) in its comparative cohort (71% difference). This difference was largely due to A&E and inpatient admissions. Comparable results were found for bronchiolitis-coded and RTI-coded cohorts. The highest rates of inpatient admissions were observed for the RSV-coded case cohort, and these occurred during the calendar months of November and December. Inpatient admissions were largely among infants up to 12 months of age and included infants that were born both before and during the season (Figure 1). Conclusion Infants with an RSV admission had higher HCRU than infants without. Most hospitalisations occurred in November and December when services are at their most stretched. During the first year of life, the HCRU rates observed for infants born before and in the season were equally very high, emphasizing the need for preventative strategies to all infants entering their first RSV season. Funding: This research was funded by collaborative agreement with Sanofi / AstraZeneca and is part of the RODEO research program for RSV disease. Disclosures Maria João Fonseca, n/a, Sanofi: Advisor/Consultant Mathieu Bangert, PhD, Sanofi: Staff member Rolf Kramer, n/a, Sanofi: Stocks/Bonds Richard Hudson, n/a, Sanofi: I am an employee of Sanofi|Sanofi: Stocks/Bonds

Sociodemographic characteristics and COVID-19 testing rates: spatiotemporal patterns and impact of test accessibility in Sweden.

Diagnostic testing is essential for disease surveillance and test-trace-isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates. We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8-1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood. We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5-69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5-14 years) ranging from 0.56 (95% CI 0.47-0.67) to 0.87 (95% CI 0.80-0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10-18% decrease in inhabitants 15-29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70-105, supporting an intervention effect. Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.

The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform.

Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity. We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations. From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density. In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.

Bridging gaps across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases: Results from a stepped-wedge cluster randomized controlled trial

Objective To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. Design A pragmatic stepped-wedge cluster randomized trial. Setting Eight rehabilitation centers in secondary healthcare, Norway. Participants A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). Interventions A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients’ needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. Main measures Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients’ goal attainment measured by the Patient Specific Functional Scale (0–10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. Results No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: −0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. Conclusion The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group.

Non-Urgent Pediatric Presentations to the Emergency Department, Khamis Mushayt Maternity and Children Hospital, Saudi Arabia

Aim of Study: To explore parents’ perspectives regarding why parents (caregivers) prefer to escort their less urgent, or non-urgent sick children to the emergency departments (EDs) instead of using other more appropriate healthcare services. Methods: This study followed a quantitative cross-sectional design at Khamis Mushayt Maternity and Children’s Hospital (KMMCH). A study questionnaire was designed by the researchers to interview parents of 400 children who inappropriately attended the ED to identify the reasons for their inappropriate attendance at the ED. Data collection was performed during the period of January 2023 to explore the proportions of different attendances that were deemed inappropriate according to the hospital’s followed triage system. The interviews were conducted with parents/caregivers of non-urgent and less urgent children during their waiting times. Results: The age of 18.3% of parents was <30 years, while 28.5% were 30-39 years old. More than half of the parents’ visits were non-urgent, while 43.25% were less-urgent, 55.3% of patients visited the ED before due to similar complaints, while 46% visited a primary health care center before their ED visits. The main reasons for visiting the ED instead of the primary healthcare centers (PHCCs) were to save time (49.3%) and to get an earlier appointment (48%). Patients’ triage levels differed significantly according to parents’ age groups (p<0.001), nationality (p=0.022), educational level (p=0.022), ED visits for similar complaints (p<0.001), and previously visiting the PHCC for the current health problem (p=0.002). Triage levels also differed significantly according to some reasons for choosing to go to the ED instead of the PHCC, especially to get an earlier appointment (p=0.044), preferring the healthcare services provided by the ED (p=0.005), having a nearby ED (p=0.001), or being at the hospital at that time (p=0.002). Conclusions: There is a clear relationship between inappropriate ED visits and certain associated factors, indicating that prevention would be best targeted to certain categories, such as Saudi, younger, and educated parents. The main reasons for inappropriate ED visits are to save time and to avoid getting a late appointment. Recommendations: This study emphasized the importance of implementing proper health education and redirection of patients with inappropriate ED visits. Conducting a detailed analysis of the shortages in the utilization of primary healthcare resources is a pressing necessity. Further nationwide research on patients’ perspective for non-urgent ED presentations is largely needed. Key Words: Emergency Department, Triage, Children, Non-urgent level, Less urgent level.

Indigenous Plant-Derived Medical Applications for Primary Health Care

Traditional medicine is an important primary health care resource for many people and has been acknowledged as a necessary component of reaching universal health. The purpose of this research is to offer an overview of indigenous plant-derived medicinal applications administered to treat current human ailments. The data were collected via a mixed-methods research in four Bapedi communities in South Africa's Limpopo Province. The research documented six different techniques for administering indigenous plant-derived medications, including decoction, infusion, steam bath, incense, poultice, and powder. These uses are determined by the kind of plant material employed and the type of illness being treated. For instance, a leaf poultice is applied directly to wounds to promote healing, while decoctions and infusions of the root, bark, and bulb are used as purgatives and enemas to treat gastrointestinal diseases and as emetics to alleviate cough. Steam baths and incense inhalation increase sweat, which is beneficial in the treatment of fever and cough. The standard dose for decoctions and infusions is a teacup, but there are no accounts of particular dosages for poultices, steam, ash, burned root, or leaf sap. This research advises hastening the process of authenticating traditional medicine in order to assure optimal practices, such as accurate dosage uses for medications.

Informal Providers-Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review.

South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.

Integrating Gestational Diabetes Screening and Care and Type 2 Diabetes Mellitus Prevention After GDM Into Community Based Primary Health Care in South Africa-Mixed Method Study.

Background:Despite high gestational diabetes mellitus (GDM) prevalence in South Africa (9.1% in 2018), its screening and management are not well integrated into routine primary health care and poorly linked to post-GDM prevention of type 2 diabetes mellitus (T2DM) in South Africa’s fragmented health system. This study explored women’s, health care providers’ and experts’ experiences and perspectives on current and potential integration of GDM screening and prevention of T2DM post-GDM within routine, community-based primary health care (PHC) services in South Africa.Methods:This study drew on the Behaviour Change Wheel (BCW) framework and used a mixed method, sequential exploratory design for data collection, analysis and interpretation. Individual semi-structured interviews were conducted with key informants (n = 5) from both national and provincial levels and health care providers (n = 18) in the public health system of the Western Cape Province. Additionally, focus group discussions (FGDs) with Community Health Workers (CHWs n = 15) working with clinics in the Western Cape province. A further four FGDs and brief individual exit interviews were conducted with women with GDM (n = 35) followed-up at a tertiary hospital: Groote Schuur Hospital (GSH). Data collection with women diagnosed and treated for GDM happened between March and August 2018.Thematic analysis was the primary analytical method with some content analysis as appropriate. Statistical analysis of quantitative data from the 35 exit interview questionnaires was conducted, and correlation with qualitative variables assessed using Cramér’s V coefficient.Results:Shortage of trained staff, ill-equipped clinics, socio-economic barriers and lack of knowledge were the major reported barriers to successful integration of GDM screening and postnatal T2DM prevention. Only 43% of women reported receiving advice about all four recommendations to improve GDM and decrease T2DM risk (improve diet, reduce sugar intake, physical exercise and regularly take medication). All participants supported integrating services within routine, community-based PHC to universally screen for GDM and to prevent or delay development of T2DM after GDM.Conclusion:GDM screening and post-GDM prevention of T2DM are poorly integrated into PHC services in South Africa. Integration is desired by stakeholders (patients and providers) and may be feasible if PHC resource, training constraints and women’s socio-economic barriers are addressed.

Capacity issues in primary health care implementation: examples from Ghana

PurposeResources as well as the capacity to employ them judiciously may well be the key to the attainment of the SDGs and other related health goals through primary health care (PHC). Within this PHC framework, however, the source of resources for PHC as well as the systems for managing these associated resources remain unclear, complex and lack substantive integration systems of implementing ministries, departments and agencies (both local and international) in Ghana. These issues are addressed by this study.Design/methodology/approachThe framework approach to thematic analysis was used to analyse qualitative data collected from key PHC managers in Ghana selected purposively from the national, regional and district levels. Data were collected through in-depth interviews specially designed in line with the study objectives. The study was also governed by the Noguchi Memorial Institute for Medical Research which provided ethical clearance for the study.FindingsAs per Alma Ata's recommendation, PHC in its purest form is a resource dense activity with far-reaching implications on individuals and communities. Without adequate resources, PHC implementation remained merely on paper. Findings show that the key capacities required for PHC implementation were finance, human resource, technology and logistics. While significant cases of shortages and inadequacies were evident, management and maintenance of these capacities appeared to be another significant determinant of PHC implementation. Additionally, the poor allocation, distribution and sustainability of these capacities had a negative effect on PHC outcomes with more resources being concentrated in capital towns than in rural areas.Research limitations/implicationsThis study has significant implications on the way PHC is seen, implemented and assessed not in Ghana but in other developing countries. In addition to examining the nature and extent of capacities required for PHC implementation, it gives significant pathways on how limited resources, when properly managed, may catalyse the attainment of the PHC goals. Subsequently, PHC implementation will profit from stakeholder attention and further research into practical ways of ensuring efficiency in the allocation, distribution and management of resources especially considering the limited resources available and the budding constraints associated with the dependency on external stakeholders for PHC implementation.Originality/valueThis study is part of a series on PHC implementation in Ghana. Quite apart from putting core implementation issues into perspective, it presents first-hand information on Ghana's PHC implementation journey and is thus relevant for researchers, students, practitioners and the wider public.

Efficiency Evaluation and Spatial Autocorrelation Analysis of Primary Health Care Resources Distribution: The Panel Three-Stage DEA Model

Objective: To analyse the distribution of Primary Health Care (PHC) in efficiency among provinces from 2010 to 2019 in China, to examine the factors influencing performance, and to describe the spatial agglomeration characteristics of allocation efficiency, so as to optimize and balance the utilization thereof. Method: Using a panel Three-stage DEA comparative analysis model to describe factors that may lead to high efficiency, combined with a descriptive study for spatial agglomerating features of provinces using Spatial autocorrelation analysis. Results: The overall performance of PHC distribution efficiency is unreasonable, with an average comprehensive technical efficiency of 0.688 from 2010 to 2019. The external and management noise had a significant impact on the efficiency of PHC resource allocation. The increase in per capital GDP could enhance the efficiency, but the dependence ratio of the elderly population and the rate of urbanization were inversely. The effectiveness of PHC allocation had spatial agglomeration features. Moran’s I index was the lowest in 2016 (0.293) and the highest in 2019 (0.421) at the significance level of 1%. The Getis_Ord GI* index demonstrates that the general level of spatial agglomeration had improved, with the number of cluster provinces increasing from 11 to 15. Conclusion: The PHC distribution efficiency should be improved, the establishment of balanced eastern, central and western regions should be encouraged, and a new PHC ecosystem should be established. Further, new patterns should be created in the geographic area of primary health care, and citizens’ access to medical services should be increased.

Burden of heart failure in primary healthcare

ObjectivesTo determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization. DesignRetrospective observational cohort study. SettingStudy was carried out in primary care setting. Participants and interventionsPatients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. Main measuresInformation came from electronic medical records. ResultsA total of 64441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes. ConclusionHeart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.

Research on Disparities in Primary Health Care in Rural versus Urban Areas: Select Perspectives

Much of the differences in health care outcomes can be attributed to the differential rates of primary health care utilization and resource allocation across population subgroups [...].

Human Resources in Primary Health-Care Institutions before and after the New Health-Care Reform in China from 2003 to 2019: An Interrupted Time Series Analysis.

At the end of March 2009, the Chinese government put forward the new health-care reform with its long-term goal to achieve universal access to basic medical and health services. Primary health-care institutions and adequate health human resources are the basic and specific guarantee to achieve the above goals. We aimed to explore the differences in the trends of human resources before and after the new health-care reform from 2003 to 2019, based on Chinese Health Statistics Yearbook, an using interrupted time series analysis. The number of primary health workers serving for every 1000 people in China gradually rose from 1.98 in 2003 to 3.07 in 2020, with an immediate sharp rise from 2008 to 2009. Subsequently, the number of primary health workers increased at a significant speed, but it still failed to meet people’s basic medical needs (3.5/1000). There was an increase of 51,301 primary health staff in 2010, and 6007 more primary health workers per year were added after the reform compared to the basic increasing number before 2009, but both were not statistically significant (p > 0.05). The annual increased number of health workers in township health centers was 2.63 times greater than that before the reform, with a total annual increase of 34,192 people (p < 0.05). The growth trend changed the most in western China (p < 0.001), while the human resources of primary health-care institutions in the eastern region were relatively richer than those in the central and western regions. Numerous registered nurses and pharmacists have been devoted to the construction of the primary health-care service since 2010, while the increase in the number of doctors per year was not statistically significant (p = 0.066). In total, the primary health-care human resource in China is constantly expanding, but the primary health-care needs are still not fully met, especially for doctors, and the problem of unbalanced allocation urgently needs to be solved. Reasonably formulating regional policies to strengthen the construction of primary health personnel and expand the accessibility of primary health services is the top priority in the development of primary medical and health undertakings.

Assessment of primary healthcare accessibility and inequality in north-eastern Kazakhstan.

Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.

Hajj health examination for pilgrims with asthma in Malaysia: An ethnographic study.

BackgroundAsthma was one of the top causes of hospitalization and unscheduled medical attendances due to acute exacerbations and its complications. In Malaysia, all pilgrims must undergo a mandatory health examination and certified fit to perform pilgrimage. We studied the current organisational and clinical routines of Hajj health examination in Malaysia with a focus on the delivery of care for pilgrims with asthma.MethodsWe conducted non-participant observation to obtain ethnographic understanding of Hajj health examination activities for 2019. Observations were guided by a checklist and recorded as notes that were analysed thematically. The study was conducted at 11 public (from each region in Malaysia, namely, North, South, East, West of Peninsular Malaysia, and Sabah and Sarawak of East Malaysia) and two private primary care clinics.ResultsWe observed considerable variation in the implementation and practice of Hajj health examinations among the 11 public clinics but no marked variation among the private clinics. The short time span of between three to four months was inadequate for disease control measures and had put pressure on health care providers. They mostly viewed the Hajj health examination as merely a certification of fitness to perform the pilgrimage, though respiratory health assessment was often inadequate. The opportunity to optimise the health of pilgrims with asthma by providing the appropriate medications, asthma action plan and asthma education including the preventive measures was disregarded. The preliminary health screening, which aimed to optimise pilgrims’ health before the actual Hajj health examination was not appreciated by either pilgrims or health care providers.ConclusionsThere is great potential to reform the current system of Hajj health certification in order to optimise its potential benefits for pilgrims with asthma. A systematic approach to restructuring the delivery of Hajj health examination could address the time constraints, clinical competency of primary health care providers and resources limitations.

Analysis of factors affecting medical personnel seeking employment at primary health care institutions: developing human resources for primary health care

BackgroundThe serious shortage of human resources for primary health care (PHC) is a common issue in health reforms worldwide. China has proposed that it is an effective way to encourage and guide qualified medical personnel to work in primary health care institutions (PHCIs). However, few studies have been conducted on the willingness and influencing factors of medical personnel to seek employment at PHCIs.MethodsBased on implicit theory and lexical approach, pre-investigation was conducted to collect the items that influence the medical personnel to seek employment at PHCIs from the perspective of guided objects. Through a three-phase investigation of 1160 doctors in 29 public hospitals in 9 cities, the items were categorized, and a structural equation model was established and verified to explore the interrelationship of influencing factors.ResultsA total of 6 factors were rotated, including Sense of Gain (SG), Internal Organization Development (IOD), Remuneration and Development (RD), Condition of the City Where the PHCI Is Located (CCPL), Job Responsibilities (JR) and Family Support (FS). The results of the model showed that IOD, RD, JR and FS had a significantly positive effect on the SG. In addition, the FS, RD and JR significantly mediated the relationship between the internal and external environment of PHCIs and SG. The values of the fit index indicated an acceptable-fitting model.ConclusionFamily, remuneration, individual development, and job responsibility are closely related to the willingness of medical personnel to seek employment at PHCIs, and the internal and external environment of PHCIs is also an important factor. Therefore, the development of PHC providers can be promoted by paying attention to the family members of medical personnel, establishing a reasonable remuneration system, providing suitable development opportunities, arranging work rationally and improving the internal construction of PHCIs.

Insights of South African medical interns on their intentions towards careers in primary healthcare and child health.

Health provision in South Africa requires a focus on primary health care within the public health system. Medical practitioners continue to migrate from the public health service. Given the need for human resources in primary health care, this study was conducted to explore the perceptions and experiences of newly-qualified medical practitioners (interns) about pursuing a career in primary health care in the public health sector. This exploratory, qualitative study specifically explored the factors related to interns' perceptions about careers in primary health and child health care in the public health service in five hospitals in KwaZulu-Natal (KZN). Data was collected through focus group discussions with a purposive sample of intern participants, who were chosen for having had the necessary experience to decide on long-term careers. The data were coded, categorised and themed using a combination of manual and computer-assisted methods. (NVivo 11 software). Themes both external and specific to the intern-supervisor relationship were identified that influences intern career intentions. A high disease burden in resource-constrained institutions that are perceived to be poorly managed and sub-optimal intern-supervisor relationships lead to inadequate participation within 'communities of practice' during internship. Interns viewed careers related to primary health care negatively, preferring to specialise in other fields. Multiple challenges are identified when participating in caring for adults and children in KZN's public health service. This coupled with a perceived inadequate supervisor support favour interns to see medical specialisation as a more feasible career option rather than primary health care. Experiences during internship possibly influence future career intentions that are discordant with SA's national health priorities. Improving the intern working environment may be a way forward to stimulate interns' interests in careers congruent with SA's health needs, specifically careers in primary health care.

Assessing Spatial Accessibility to Primary Health Care Services in Beijing, China.

Primary health care has been emphasized as a pillar of China’s current round of health reforms throughout the previous decade. The purpose of this study is to analyze the accessibility of primary health care services in Beijing and to identify locations with a relative scarcity of health personnel. Seven ecological conservation districts, which are relatively underdeveloped, were selected in the study. The Gini coefficient and Lorenz curve, as well as the shortest trip time and modified two-step floating catchment area (M2SFCA) approach, are used to quantify inequalities in primary health care resources and spatial accessibility. The Gini coefficient of primary medical services was calculated as high as 0.705, showing a significant disparity in primary care services. A total of 81.22% of communities reached the nearest primary care institution within 15 min. The average accessibility of primary healthcare services, as measured by the number of health professionals per 1000 population, was 2.34 in the 1715 communities of seven ecological conservation districts. Three hundred and ninety-one communities (22.80%) were identified with relatively low accessibility. More primary health professionals should be allocated to Miyun, Mentougou, and Changping Districts. Overall, the primary healthcare resources were distributed unevenly in most districts. According to our study, expanding primary healthcare institutions, increasing the number of competent health professionals, and enhancing road networks will all be effective ways to increase spatial accessibility and reduce primary healthcare service disparity in Beijing.

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Assessment and Diagnosis of Mental Illness in EDs Among Individuals Without a Home: Findings from the National Hospital Ambulatory Care Survey.

IntroductionHomeless individuals lack resources for primary healthcare and as a result use the emergency department (ED) as a social safety net. Our primary objective in this study was to identify the differences between features of visits to United States (US) EDs made by patients without a home and patients who live in a private residence presenting with mental health symptoms or no mental health symptoms at triage.MethodsData for this study come from the 2009–2017 National Health and Ambulatory Medical Care Survey, a nationally representative cross-sectional survey of ED visits in the US. We examined differences in waiting time, length of visit, and triage score among homeless patients, and privately housed and nursing home residents. We used logistic regression to determine the odds of receiving a mental health diagnosis. Residence, age, gender, race, urgency, and whether the person was seen in the ED in the previous 72 hours were controlled.ResultsHomeless individuals made up less than 1% of all ED visits during this period. Of these visits, 47.2% resulted in a mental health diagnosis compared to those who live in a private residence. Adjusting for age, race, gender, triage score, and whether the person had been seen in the prior 72 hours, homeless individuals were still six times more likely to receive a mental health diagnosis despite reporting no mental health symptoms compared to individuals who lived in a private residence. Homeless individuals reporting mental health symptoms were two times more likely to receive a mental health diagnosis compared to privately housed and nursing home residents.ConclusionsHomeless individuals are more likely to receive a mental health diagnosis in the ED whether or not they present with mental health symptoms at triage. This study suggests that homelessness as a status impacts how these individuals receive care in the ED. Community coordination is needed to expand treatment options for individuals experiencing emergent mental health symptoms.