Responsibility For Primary Health Care Research Articles

Tendência do uso e fontes de obtenção de antidiabéticos orais para tratamento de diabetes no Brasil de 2012 a 2018: análise do inquérito Vigitel

To estimate the prevalence of use of oral medications for the treatment of diabetes, as well as the distribution of sources for obtaining according to sociodemographic variables, in the Brazilian states' capitals and in the Federal District, and their evolution from 2012 to 2018. Cross-sectional and population-based study with individuals aged ≥ 20 years who reported a medical diagnosis of diabetes, interviewed through Vigitel from 2012 to 2018. We estimated the prevalence of use and the distribution of sources for obtaining according to sociodemographic variables (95%CI). We checked differences among proportions using the Pearson's χ2 test (Rao-Scott), with a significance level of 5%. There was an increase in the prevalence of use of oral medications for the treatment of diabetes from 77.4 to 85.2% between 2012 and 2018, and a decrease in obtaining in the Health Unit Pharmacies of the Unified Health System (SUS), while there was an increase in obtaining in Popular Pharmacies. In Brazil, SUS remained the main source for obtaining oral antidiabetic drugs, financing more than 70% of them in the country, considering the Health Unit Pharmacies and Popular Pharmacies, thereby showing the importance of public Pharmaceutical Policies in guaranteeing the access to medications by the Brazilian population, as well as in reducing inequities in the country. Nevertheless, the migration of obtaining by users from SUS Health Units to Popular Pharmacies suggests the weakening the responsibility of Primary Health Care in the provision oral antidiabetic drugs, thereby undermining the bond and the longitudinal care.

Social Responsibility of Primary Health Care and Millennium´s Development Goals

Social Responsibility of Primary Health Care and Millennium´s Development Goals

Bridging miles to achieve milestones: Corporate social responsibility for primary health care.

Sustainable Developmental Goals aim to provide "Good health for all". The task though immense ,requires equitable and efficient distribution of health resources to the community, reached predominantly by the Primary Health Centres. Strengthening these centres is essential to attain the goal. Adequate health financing is one of the important determinants for utilizing the optimal potential of these centres . Pooling funds from alternate financing strategies as Corporate Social Responsibility (CSR) funds may give impetus and facilitate healthcare affordability to the underserved population. This convergence of vision of corporate funding for "basic health services" may bridge the gap arising out of inadequate funding and facilitate "Good Health for all" in India.

Os atuais desafios da Atenção Domiciliar na Atenção Primária à Saúde: uma análise na perspectiva do Sistema Único de Saúde

A Política Nacional de Atenção Domiciliar (PNAD) definiu três níveis de atenção domiciliar (AD), reconhecendo o primeiro nível (AD1) como responsabilidade das equipes de Atenção Primária à Saúde (APS). Ao longo da história, a legislação passou por alterações importantes e essa política representa a valorização dos serviços de APS como âmbito privilegiado do cuidado, sendo responsável pela maior parte dos cuidados em AD no Brasil. O cuidado no domicílio deve ser feito sob critérios de elegibilidade específicos, e um planejamento adequado. A visita domiciliar (VD) é um momento ímpar para o conhecimento do contexto da pessoa sob AD e deve se pautar pela observação ativa, pela abordagem da família e reconhecimento dos determinantes sociais presentes. Assim, é necessário que o profissional de saúde visitador tenha um rol de competências profissionais bem definidas, que em geral não são contempladas na graduação dos cursos de saúde, e de maneira insuficiente pelos cursos de pós-graduação. A PNAD representou um avanço ao reconhecer a APS como responsável pela AD1 numa lógica de cuidados contínuos crescentes, mas as lacunas no entendimento entre equipes de AD e APS, de formação profissional, e de sobrecarga de tarefas persistem. Este estudo apresenta uma análise crítica da implantação da PNAD até o momento, baseada na legislação vigente confrontada a prática das equipes de APS trabalhando no Sistema Único de Saúde.

How decentralisation influences the retention of primary health care workers in rural Nigeria

BackgroundIn Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC – usually the only form of formal health service available in rural communities – is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees.ObjectiveThis study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities.DesignThe study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation.ResultsThe results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular – in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co-manage PHC services in order to ensure that PHC facilities are functional.ConclusionsIn Nigeria and other low- and middle-income countries with decentralised health systems, intervention to increase the retention of health workers in rural communities should seek to reform and strengthen governance mechanisms, using both top-down and bottom-up strategies to improve the remuneration and support for health workers in rural communities.

General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

BackgroundPrimary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care.MethodData were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden.ResultsFive descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter.ConclusionsFindings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this area.

Palestinian primary health care in light of the National Strategic Health Plan 1999–2003

In 1994, the Palestinian Health Authority took over responsibility for primary health care (PHC) in Gaza Strip and West Bank. This paper reports on the Palestinian National Strategic Health Plan (PNSHP 1999--2003). The extent to which the PHC objectives were achieved is discussed, together with areas that still require improvement. This descriptive study used content analysis with a retrospective review of data gathered from the PNSHP and other related reports and publications. The crude death rate and total fertility rate had improved, but the infant mortality rate had increased by the end of the study period. Heart diseases were the primary cause of death in Palestine. Acceptable vaccination coverage had mainly been achieved, particularly for tetanus, diphtheria, measles and polio. There were still concerns regarding water supply and other sanitary conditions, a notable increase in the incidence of vector-borne diseases, especially cutaneous Leishmaniasis in West Bank, and mental health had worsened by the end of the study period. Certain health promotion and environmental health actions should be undertaken urgently by the Palestinian health care services to cope with environmental and sanitary conditions, and to further improve health status regarding communicable and non-communicable diseases in Palestinians. Health research and surveys are insufficient and should be undertaken regularly. The main barrier to the success of the PNSHP was the lack of follow-up due to political and socio-economic instability. There is an urgent need for international intervention and support.

Rehabilitation of Patients with Chronic Pain in Primary Health Care

Chronic pain is a frequent condition in society. Besides the patients' suffering, chronic pain leads to high costs in the form of compensation for absence due to illness and production loss, but also for health care utilisation. The responsibility of primary health care for treatment and rehabilitation of patients chronic pain have increased in the last decade. Rehabilitation programmes for these patients using multidisciplinary, behavioural-orientated treatment has mostly taken place in pain centres or pain clinics. The clear effects of those are well documented in several studies. There is a lack of data in similar programmes conducted in primary health care. The principal aim of this work was to study the gains of a biopsychosocial programme in primary health care for chronic pain patients. The intervention programme was based on ego-strengthening psychotherapy and the salutogenetic model. An occupational therapist and a physiotherapist led the intervention. The gains were to be regarded from the perspective of the patient, the treatment and society. Three sub-studies were included in the study. The first sub-study, using a descriptive, qualitative design, investigated how ten patients with fibromyalgia conceived their health after taking part in the programme. The patients were interviewed and data were analysed by the phenomenographic method. The patients gave words for received confirmation, distance to things, gained insight and gained control. Those factors had a positive impact on the patient's meaningfulness, comprehensibility and manageability, which led to improved health. The second sub-study, including 70 chronic pain patients, used a non-randomised longitudinal, evaluative design in order to measure the gains of the programme in terms of ego-resources as well as, personality, physical and cognitive factors (=PPC factors). The sub-study was was performed by Visual Analogue Scale (VAS) and a PPC questionnaire as well as statistically analysed. The programme led to the patients describing significant (p= <0.01 - <0.001) changes compared with before the intervention, in the form of reduced perception of complaints, increased general well-being and ability to manage pain. The third sub-study evaluated follow-up effects of the programme on the patients visits to the doctor, frequency of sick-listing and the level of disability. Ninety-four chronic pain patients were divided into an intervention group with 70 patients, and a non-intervention group with 24 patients. A longitudinal, prospective, cross-over design was used in a non-randomised study conducted over a three-year period. The programme was effective in decreasing doctor visits but not concerning return to work. Instead there was a change from sick-listing to disability pension or temporary disability pension for the intervention group (p=0.009) as well as for the non-intervention group (p=0.046). The study shows that biopsychosocial rehabilitation programme for chronic pain patients in primary health care resulted in gains from the perspective of the patient, the treatment as well as society. The programme gave the patients better health as well as methods for the patients to mange the pain and the pain situation herself/himself. It also informed the health care professionals how to establish an effective treatment, even in small health care units and finally it seems to stop the chronic pain patient's journeys around the health care system by decreasing the need of doctor visits.

Las hospitalizaciones por ambulatory care sensitive conditions: selección del listado de códigos de diagnóstico válidos para España

BackgroundHospitalisations due to Ambulatory Care Sensitive Conditions (ACSC) are considered an indicator to measure the use of hospital services because of health conditions that could have been prevented and controlled by primary health care. The objective of this study is to select the list of diagnostic codes to assess the performance of primary health care in Spain. MethodsThe five criteria proposed by Weissman and Solberg, to select an appropriate indicator, were applied to a first list of 87 ACSC diagnostic codes identified through bibliographic search. Information on two main criteria –whether care for a health condition was a primary health care role and whether hospitalisation was needed once the health problem occurred– was obtained by means of the Delphi technique. A group of 44 experts gathered together for the study. For the remaining criteria, information came from the results of the «Pilot study on hospitalisations due to ACSC in Catalonia, Spain». Meeting the five criteria was the criterion selected to evaluate the solving ability of primary health care. Resultsa) from the Delphi group: 42 (95.4%) participants completed the three rounds. The question on whether the care of the selected health conditions was responsibility of primary health care reached a high level of consensus (between 86.1 and 100%). The consensus on the need for hospitalisation was lower, from 75.7 to 88.6%, moreover, 5 diagnostic codes did not reach the established consensus, and b) from the ACSC selection process: five diagnostic codes did not meet the criteria and were excluded. Out of the remaining 82, all them were considered as health problems to be cared for at primary level and in 37 cases hospitalisation was considered always as necessary. Thirty-five diagnostic codes, that met the five criteria, represented the set of ACSC diagnostic codes in our setting. ConclusionsA set of 35 diagnostic codes of ACSC, adapted to our setting, is proposed to evaluate primary health care performance. The selected codes reduce significantly the limitations that stem from hospital admission criteria due to patient clinical characteristics, variations in hospital medical practice, and hospital admission policies.

Management of terminal cancer patients: attitudes and training needs of primary health care doctors and nurses.

The objective of the study was to ascertain the attitudes and training needs of primary health care (PHC) professionals regarding the management of terminal cancer patients. A cross-sectional study involving 30 PHC teams (15 urban and 15 rural) in the health district of Majorca (Spain) was carried out. Out of the 224 doctors and 186 nurses initially included, 157 and 156, respectively, completed a questionnaire designed to elicit the participant's opinions on the role of PHC in palliative care, their needs in terms of training and their management of clinical and psychological symptoms. Forty percent of professionals considered that terminal care should be the responsibility of PHC, whereas 59.5% thought it preferable for such care to be given either in Palliative Care Units or by oncologists. All kinds of relationships between PHC professionals and specialists were highly valued. Seventy-five percent of general practitioners referred to pain control, and 83% of doctors and nurses provided emotional support. Most health professionals felt training in emotional aspects would be the most desirable. One group of professionals considered palliative care to be an asset in PHC, whereas another group thought that patient care should be provided by specialists. The majority of doctors and nurses pinpointed the need for improving co-ordination with specialists. A need for tuition in palliative care was clearly stated. In conclusion, the planning of palliative care should take into account the attitudes and opinions of PHC doctors and nurses.

Evaluation of a Biopsychosocial Rehabilitation Programme in Primary Healthcare for Chronic Pain Patients

The responsibility of primary healthcare for treatment and rehabilitation of chronic pain patients has increased in the last decade. Experiences of multidisciplinary, behavioural treatments in pain clinics have demonstrated positive effects. The aim of the study was to evaluate a biopsychosocial rehabilitation programme in primary healthcare for chronic pain patients. The study included 70 chronic pain patients, who participated in an intervention based on ego-strengthening psychotherapy, led by an occupational therapist and a physiotherapist. The study was performed by Visual Analogue Scale (VAS) and a questionnaire as well as statistically analysed. The results showed increased general well-being (p<0.01) and ability of pain management (p<0.001) together with decreased level of perceived complaints (p<0.001). The intervention was also associated with positive changes in personality, physical and cognitive factors. The results suggest that the biopsychosocial rehabilitation programme is useful in primary healthcare. Further studies should be carried out into the effects of such a rehabilitation programme in controlled randomized designs.

Health Services and Decentralized Government: The Case of Primary Health Services in Norway

Decentralized forms of government are becoming more common in Western European countries. The effects of decentralization of public health services are explored in this article. In 1984 the Norwegian Municipal Health Act allocated the responsibility for primary health care to the municipalities. Based on data from a sample of 70 municipalities, the author shows that the number of primary health service personnel has expanded considerably during 1984-88, but the distribution of services has not become more equitable. Though the formal role of local politicians in the decision-making process has increased, the health sector officers and the Municipal Executives have in practice controlled the evolution of the municipal health services. The author concludes that decentralization does not necessarily lead to more democracy, and that an equitable distribution of public health services becomes more difficult to attain.