Role Of Primary Care Research Articles

Evaluation of the first pharmacy-led weight management programme in Greece

Abstract Introduction Obesity is one of the main cardiovascular disease (CVD) risk factors.(1) In primary care, pharmacists are in a unique position to offer weight management (WM) interventions. Greece is the European country with the highest number of pharmacies (84.06 pharmacies per 100,000 citizens).(2) The UK was chosen as a reference country, because of the structured public health services offered, the local knowledge and because it was considered to be the closest country to Greece geographically, unlike Australia and Canada, where there is also evidence confirming the potential role of pharmacists in WM. Aim To design and evaluate a 10-week WM programme offered by trained pharmacists in Patras. Methods This WM programme was a step ahead of other interventions worldwide as apart from the usual measuring parameters (weight, body mass index, waist circumference, blood pressure (BP)) it also offered an AUDIT-C and Mediterranean diet score tests. Results In total,117 individuals participated. Of those, 97.4% (n=114), achieved the programme’s aim, losing at least 5% of their initial weight. The mean % of total weight loss (10th week) was 8.97% (SD2.65), and the t-test showed statistically significant results (P<0.001; 95% CI [8.48, 9.45]). The programme also helped participants to reduce their waist-to-height ratio, an early indicator of the CVD risk in both male (P=0.004) and female (P<0.001) participants. Additionally, it improved participants’ BP, AUDIT-C score and physical activity levels significantly (P<0.001). Conclusion The research is the first systematic effort in Greece to initiate and explore the potential role of pharmacists in public health. The successful results of this WM programme constitute a first step towards the structured incorporation of pharmacists in public’s health promotion. It proposed a model for effectively delivering public health services in Greece. This study adds to the evidence in relation to pharmacists’ CVD role in public health with outcomes that superseded other pharmacy-led WM programmes. It also provides the first evidence that Greek pharmacists have the potential to play an important role within primary healthcare and that after training they are able to provide public health services for both the public’s benefit and their clinical role enhancement. This primary evidence should support the Panhellenic Pharmaceutical Association, to “fight” for their rights for an active role in primary care. In terms of limitations, it must be noted that the participants’ collected data were recorded by pharmacists, and the analysis therefore depended on the accuracy of the recorded data, in particular on the measurements or calculations obtained. Although the sample size was achieved, it can be argued that it is small for the generalisation of findings across Greece. Therefore, the WM programme should be offered in other Greek cities to identify if similar results can be replicated, so as to consolidate the contribution of pharmacists in promoting public health. Additionally, the study was limited as it did not include a control group. Despite the limitations, our findings provide a model for a pharmacy-led public health programme revolving around WM that can be used as a model for services in the future.

Supporting bereavement and complicated grief in primary care: a realist review.

BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.Design & settingA review of evidence on the management of CG and bereavement in UK primary care settings.MethodA realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

The ageing population

As we all age, the demographic of the world changes. Looking after older people well can bring a huge amount of pleasure and satisfaction, not just to the individual, but also to their family, friends and indeed healthcare professionals. How we care for our elderly now is likely to set a precedent for our own care in the future. This article highlights some of the features of ageing and discusses the role of primary care in the management of the older population, within the context of the general practice curriculum.

Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics.

BackgroundCOVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies.ObjectiveTo synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19.MethodsWe conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts.ResultsOf 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions.ConclusionsEvidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon.

The critical role of health promotion for effective universal health coverage

The Political Declaration from the United Nations High-Level Meeting on Universal Health Coverage: Moving Together to Build a Healthier World (2019) provided important reaffirmation of health as a precondition for sustainable development and equity, as well as of the role for primary care as a cornerstone of universal health coverage. Health promotion, prevention and sustainable healthcare go hand in glove. Health promotion can enable more effective use of health resources by reducing demand for expensive health services and reducing hospital admissions. Promoting mental and physical health, and addressing health literacy and the social determinants of health, enables governments and departments of health to (i) empower citizens and communities to take control of their health, and (ii) better support innovative and financially sustainable healthcare. Without the bedrock underpinning of effective health promotion, treasuries and health systems will struggle to meet the rising costs and burden of ill health.

A scoping review of research on Canadian team-based primary care pharmacists

An ageing population with an increasing prevalence of chronic disease and complex medication regimens has placed a strain on healthcare systems in Canada. A limited number of team-based primary care pharmacists are integrated into primary care clinics across the country, working alongside other members of the health care team to identify and resolve drug therapy problems and improve outcomes. While many studies have been completed in the area, the extent of research on integrated team-based primary care pharmacists in Canada is unknown. The objectives of this work were to describe the literature that exists surrounding pharmacists in a primary health care team setting in Canada. A scoping review of research focusing on pharmacists in team-based primary health care settings in Canada was performed. Thematic analysis was then performed to categorize the identified studies. The search identified 874 articles, of which 93 met inclusion criteria relevant to the objective. From these 93 studies, 4 themes and 23 subthemes were identified, with some studies having more than one theme or subtheme. Themes identified were the following: primary care pharmacist scope of practice (n = 79 studies), collaboration/communication within the primary care setting (n = 26), chronic disease management (n = 24) and 'other' (n = 15). This research quantified and categorized 93 studies on pharmacists in interprofessional primary care teams in Canada. As this is an expanding role for pharmacists in Canada, understanding the current state of the literature is an important consideration when developing future team-based primary care roles.

Role of primary care in the management of prostate cancer

GPs play an important role in identifying and referring men with suspected prostate cancer for further investigation, and are also increasingly responsible for the management of men with stable disease in the community. This article gives an overview of the recommended approaches to diagnosis and management of prostate cancer with a focus on the role of primary care.

The Reform of Primary Health Care / PHC in Algeria : A First Step Towards a More Equitable and Efficient Health System

Primary care in the national health care service in Algeria plays an important role: the execution of the National Immunization Schedule for infants, the care of mother and child, the monitoring of chronically ill patients, etc. However, offering modern primary health care to cover the real health needs of the population requires responsible and courageous self-criticism, either by health officials or by health economists.This is a descriptive and analytical study that highlights the reality of primary health care in the Algerian health system, which aims to make a constructive critique in relation to the pillars and principles of modern and effective primary health care. We have arrived that the sine qua none conditions must be realized in order to boost the role of primary health care in Algeria, among them: organizational non-accessibility, medium or poor quality care, non-availability of resources early detection of some pathologies… are recurring problems which push the care-seeker to desert primary health care structures, as well as non-compliance with the organization of care.

Exploring general practitioners\u2019 perceptions about the primary care gatekeeper role in Indonesia

BackgroundIn the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors.MethodsWe conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs’ knowledge and attitude with performance as gatekeepers.ResultsGPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score.ConclusionGPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

Role of Primary Care and Challenges for Public-Private Cooperation during the Coronavirus Disease 2019 Pandemic: An Expert Delphi Study in South Korea.

PurposeThe aim of this study was to explore the role of primary care facilities and their support measures in response to coronavirus disease 2019 (COVID-19) and to identify challenges to achieving public–private cooperation in South Korea.Materials and MethodsTwenty-four leading experts were selected and recruited to participate in this iterative web-based Delphi study. An open-ended questionnaire was administered to collect the expert panel's views in the first round. In the second round, the panel was asked to rate on a 5-point Likert scale their agreement with individual items gleaned from qualitative content analysis of views expressed in the first round. The participants were offered the opportunity to reevaluate and correct their initial responses in subsequent rounds. Responses in the second and following rounds were analyzed using quantitative descriptive statistics.ResultsThe first and second rounds were completed by 54.2% (n=13/24) and 58.3% (n=14/24) of the selected panel, respectively, while 10 out of these 14 participants completed the third round. The panel cited in-person essential medical services, telehealth for fever/respiratory symptoms, surveillance for influenzae-like illness, and minimization of spread to staff as important and appropriate roles of primary care, which are urgent and feasible during a pandemic. Regarding conditions/support for these roles, the panel indicated that institutional support and funding for separate areas, workforce, and telehealth, along with public-private collaborative governance, are urgent, but not feasible.ConclusionThis study provides guidance on strategies for continuing the required roles of primary care and highlights a need to strengthen public-private partnerships during pandemic events in Korea.

Improving the Development of Public Health Emergency Preparedness and Response System via Reinforcing Primary Care in Pandemic and Non-pandemic Periods

Background: Since the outbreak of COVID-19, the ability to manage public health emergencies in mega-cities has been put on the policy agenda, and the role of primary care in public health system is critical. Objective: To explore the status, problems and challenges of practical exploration of Shanghai's primary care in responding to COVID-19, providing policy recommendations and decision-making basis for improving the public health emergency system. Methods: From June to September 2020, a qualitative study was conducted using group interviews with administrators and healthcare professionals selected from 10 representative community health centers(CHCs) in suburban, fringe and urban areas in Shanghai's 5 districts for exploring major tasks shouldered by the CHCs, organizational structure of the CHCs, actual tasks performed by the CHCs, internal collaboration, major problems in service delivery during the pandemic, and recommendations, and with directors, as well as professionals responsible for information, healthcare management and quality control, public emergency management and infectious disease containment selected from health commissions and centers for disease control and prevention in the districts, for exploring the functions and roles of CHCs during the pandemic and their weaknesses in anti-pandemic actions, anti-pandemic supports from health commissions and centers for disease control and prevention for CHCs, and ideas about actions of primary care in pandemic and non-pandemic periods. The interviews with individuals from three kinds of affiliations were guided using different types of semi-structured outlines developed by our research team. Results: The interviews revealed that during the pandemic, the CHCs gave emergency responses to COVID-19, participated in regional collaboration for COVID-19 containment, delivered in-hospital COVID-19 screening and triage services while providing routine medical services, and continued to offer family doctor services. Four issues were found to be addressed: insufficient healthcare resources and workers, insufficient services targeting psychological influence of COVID-19, unsatisfied internal coordination and multi-departmental management, and lack of appropriate mechanisms incentivizing healthcare workers and invigorating primary care. Conclusion: In view of the challenges in fighting COVID-19 faced by primary care, it is recommended to take actions on the basis of appropriately balancing the delivery of routine primary care services and public health services, and tasks during pandemic and non-pandemic periods, and appropriately coordinating with higher level departments, as well as developing incentive programs according to the local conditions as a supplement for the government programs. Copyright © 2021 by the Chinese General Practice.

Communicational relations between healthcare professionals and their influence on coordination of care

The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.

A Tale of 3 Asian Cities: How is Primary Care Responding to COVID-19 in Hong Kong, Singapore, and Beijing.

Hong Kong, Singapore, and Beijing have some of the highest numbers of international arrivals and densest living spaces globally, yet these cities have reported low numbers of deaths amid the coronavirus disease 2019 (COVID-19) outbreak. Primary care has played different roles in each of the health systems in combatting the pandemic. Both Hong Kong and Singapore have a 2-tiered health system with the majority of primary care provided in the private sector. The primary care system in Beijing consists of community health facilities, township health centers, and village clinics. The role of primary care in Hong Kong includes using the public primary care clinics as part of an enhanced surveillance program together with accident and emergency departments, as well as triaging patients with suspected infection to hospitals. Singapore's response to COVID-19 has included close cooperation between redeveloped polyclinics and private and public health preparedness clinics to provide screening with swab tests for suspected cases in the primary care setting. Beijing's unique response has consisted of using online platforms for general practitioners to facilitate monitoring among community residents, as well as public health education and a mobilized pharmacy refill program to reduce risk of transmission. Established challenges, however, include shortages of personal protective equipment and the heavy workload for health care staff. Regardless, all 3 cities have demonstrated enhanced preparedness since experiencing the severe acute respiratory syndrome epidemic, and the responses of their primary care systems therefore may offer learning points for other countries during the COVID-19 pandemic.

The Reform of Primary Health Care / PHC in Algeria : A First Step Towards a More Equitable and Efficient Health System

Primary care in the national health care service in Algeria plays an important role: the execution of the National Immunization Schedule for infants, the care of mother and child, the monitoring of chronically ill patients, etc. However, offering modern primary health care to cover the real health needs of the population requires responsible and courageous self-criticism, either by health officials or by health economists.This is a descriptive and analytical study that highlights the reality of primary health care in the Algerian health system, which aims to make a constructive critique in relation to the pillars and principles of modern and effective primary health care. We have arrived that the sine qua none conditions must be realized in order to boost the role of primary health care in Algeria, among them: organizational non-accessibility, medium or poor quality care, non-availability of resources early detection of some pathologies… are recurring problems which push the care-seeker to desert primary health care structures, as well as non-compliance with the organization of care.

Maintaining essential health services during the pandemic in Bangladesh: the role of primary health care supported by routine health information system

In the initial phase of the coronavirus disease 2019 crisis, Bangladesh’s health systems faced competing demands to respond to the pandemic and concurrently maintain the continuity of essential health service delivery, particularly at the primary care level. Bangladesh’s established network of primary care health facilities, the country’s backbone for delivering essential health services, routinely feed data into the national health information system, the District Health Information Software 2 platform, which provides near real-time data on the utilization of essential health services, visualized through user-friendly integrated dashboards. Trend analyses of these data showed that by April and May 2020 there had been sharp reductions in the utilization of key essential health services across all levels of care.Early and continuous monitoring and analysis of these data informed public health policy-makers and health facility managers on rapid response strategies to restore the availability and use of essential health services. Through corrective policy measures and targeted interventions, Bangladesh’s primary health care network provided a critical platform for Bangladesh to build back most of its essential health services by October 2020. Bangladesh’s experience highlights the critical role of primary-level health facilities as a touchpoint for monitoring population access to services and as a staging point for implementation of strategies and interventions that rebuild and strengthen health service delivery towards achieving universal health coverage and more resilient health systems.

Prevention and control of cardiovascular diseases in India needs a strengthened and well-functioning primary health care system: A narrative review

This article reviews the ongoing initiatives to prevent and control cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) in India and analyses the role of primary health care (PHC) system. The authors note that in last 2 decades, there has been increasing policy recognition of the challenges posed by CVDs and NCDs in India. The review of ongoing government health program in India indicate that while the interventions to tackle CVDs and NCD have also been launched and scaled up, a majority of these initiatives continue to be delivered through district or sub-district levels. Though, there has been plans, the scale up through PHC system is at early stage only. There is sufficient scientific evidence that the effective prevention and control of CVDs need accessible health services and a series of public health interventions through strengthened PHC system. There are learnings from COVID-19 pandemic response in India (in areas such as private sector engagement, effective enforcement of health regulation, community engagement and the use of tele-consultations), which can be useful. The authors conclude that a strengthened and well-functioning PHC system can ensure increased access to CVD and NCD services. As India plans to scale up ongoing health programs and launch a few new initiatives, the learnings from the past, documented in this paper, could be useful. These steps would help India to accelerate progress towards universal health coverage.

COVID-19 second wave: appropriateness of admissions to the Emergency Department of a main metropolitan hospital in Milan.

Background:In Europe, Italy and Lombardy, in autumn 2020, there was a steep increase in reported cases due to the second epidemic wave of SARS-Cov-2 infection. We aimed to evaluate the appropriateness of COVID-19 patients’ admissions to the Emergency Department (ED) of the San Raffaele Hospital.Methods:We compared data between the inter-wave period (IWP, from 1st to 30th September) and the second wave period (WP, from 1st October to 15th November) focusing on the ED presentation, discharge priority colour code and outcomes.Results:Out of 977 admissions with a SARS-Cov-2 positive swab, 6% were in the IWP and 94% in the WP. Red, yellow and white code increased (these latter from 1.8% to 5.4%) as well as self-presented in yellow and white code. Discharges home increased from 1.8% to 5.4%, while hospitalizations decreased from 63% to 51%.Discussion:We found a rise in white codes (among self-presented patients), indicating inappropriateness of admissions. The increase in discharges suggests that several patients did not require hospitalization.Conclusions:The pandemic brought out the fundamental role of primary care to manage patients with low-intensity needs. The important increase in ED admissions of COVID-19 patients caused a reduction of NO-COVID-19 patients, with possible inadequate treatment. (www.actabiomedica.it)

Population-based analysis of sociodemographic predictors, health-related quality of life and health service use associated with obstructive sleep apnoea and insomnia in Australia.

Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n=2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6-6.7) and 6.8% (95% CI 5.7-7.9) of subjects self-reported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions; however, lower mental HRQoL among those frequently visiting a doctor was observed only among individuals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated.

O papel da atenção primária à saúde no controle de infecções sexualmente transmissíveis em adolescentes

Objetivo: Analisar o papel da atenção primária à saúde no controle de infecções sexualmente transmissíveis (IST) em adolescentes. Revisão Bibliográfica: Os adolescentes apresentam uma série de comportamentos de risco e vulnerabilidades que os tornam mais susceptíveis a contrair IST. A atenção primária de saúde é um meio imprescindível para divulgação de atividades de prevenção, realizadas diretamente nos centros de saúde ou em parcerias com as escolas. O atendimento do adolescente necessita muitas vezes de busca ativa, devendo ser realizado de modo qualificado e sempre buscando a criação de vínculo e confiança. É importante também que os profissionais de saúde tenham preparo para abordar e atender de forma diferenciada às especificidades de adolescentes homens e mulheres. Considerações Finais: A prevenção é sem dúvidas a melhor forma de controle das IST em adolescentes, portanto, faz-se necessária a criação de políticas públicas voltadas a esse grupo, qualificação dos profissionais de saúde para lidarem com as demandas específicas dessa faixa etária e também, distribuição ampla da principal forma de prevenção, o preservativo.

'We're definitely that link': the role of school-based primary health care registered nurses in a rural community.

Children and adolescents in rural Australia experience poorer health and educational outcomes than those in urban areas. This paper presents findings from a qualitative study exploring the role of primary health care registered nurses (RNs) working in the School-Based Primary Health Care Service in Broken Hill, far west New South Wales. The Service integrates health district-employed RNs with school learning and support teams to increase service access and improve health and education outcomes for students. The findings show that RNs used care navigation to reduce barriers to care by addressing healthcare candidacy with students and families. The RNs also linked schools, families and health and social care services, and facilitated intersectoral collaboration to improve the support provided to students experiencing health and developmental issues. Integrating health district-employed RNs with existing student support services is a promising approach to improving the health and education of disadvantaged students. This study provides individual- and system-level explanations of the role of the school-based primary health care RN and can inform the development of similar services elsewhere.