Role Of Primary Health Care Research Articles

Nosological profile of dermatological diseases in primary health care and dermatology secondary care in Florianópolis (2016–2017)

BackgroundDermatology encompasses the management of many disorders of the skin and cutaneous appendages, making the analysis of epidemiological profiles relevant for health planning. ObjectiveThe study aims to describe the nosological profile of dermatological diseases in Florianopolis, analyzing the interrelation among the primary health care and dermatology services, from January 2016 to December 2017. MethodDescriptive study from records of medical visits from the primary health care and dermatology services, as well as records of reports issued by the teledermatology service. ResultsIn primary health care, from 55,265 medical visits – 28,546 in 2016 and 26,719 in 2017, there was a higher prevalence of “Atopic dermatitis” (6.38%), “other disorders of skin and subcutaneous tissue” (5.10%), and “Scabies” (4.55%). In dermatology secondary care, from 19,964 visits – 10,068 in 2016 and 9626 in 2017, the most prevalent diagnoses were “Other malignant neoplasms of the skin” (14.75%) and “Skin changes due to chronic exposure to nonionizing radiation” (10.20%). Study limitationsSome dermatological consultations in primary health care may have been under-registered due to the attribution of non-specific or overly broad diagnoses. ConclusionThis study presents different nosological profiles of skin diseases in primary health care and dermatology secondary care, reinforcing the importance of primary health care's role in the management of less complex conditions, referring more complex cases that require more specialized experience to dermatology services..

Atenção Primária e Coordenação do Cuidado: dispositivo para ampliação do acesso e a melhoria da qualidade

The objective of this article is to investigate the viewpoint of health professionals regarding the coordination of care in Primary Health Care (PHC) and the challenges for performing it. Qualitative research with professionals from two PHC teams working in territories with vulnerabilities and inequalities in Rio de Janeiro. Use of the Content Analysis method, thematic modality with semi-structured interviews and participant observation. To coordinate care is to be involved with the activities that foster the provision of individualized and comprehensive care, aiming at the care continuity. The challenges of coordinating care by the PHC are overcoming the network fragmentation, the low supply of openings for specialists, the fragile communication between the services, the non-integrated electronic medical record, the low professional qualification and the unawareness of the PHC role by other services. The strengthening of the PHC as the gateway, coordinator and organizer of the network requires efforts by managers, professionals and society, so this way of organizing the systems can bring benefits regarding equity, accessibility, clinical and sanitary effectiveness, economic efficiency and allow care integration.

Role of Primary Health Care in the Face of the Coronavirus Pandemic

Claribel Plain Pazos1*, Carmen Rosa Carmona Pentón1, Anisbel Pérez de Alejo Plain2, Malena Nodarse Quintero3 and Nereyda A Caraballo Moya4 Author Affiliations 1Specialist of II Degree in Comprehensive General Medicine, Assistant Professor, Faculty of Medical Sciences of Sagua la Grande, Villa Clara, Cuba 22nd Year Student of Medicine, Faculty of Medical Sciences of Sagua la Grande, Villa Clara, Cuba 3Bachelor of Education, Instructor teacher, Cuba 4Specialist of I Degree in Comprehensive General Medicine, Assistant Professor, Faculty of Medical Sciences of Sagua la Grande, Villa Clara, Cuba Received: April 13, 2020 | Published: April 24, 2020 Corresponding author: Claribel Plain Pazos, Specialist of II Degree in Comprehensive General Medicine, Faculty of Medical Sciences of Sagua la Grande, Villa Clara, Cuba DOI: 10.26717/BJSTR.2020.27.004474

Menispermaceae family of plants and its action against infectious diseases: A review

India is a country where traditional medicines play a huge role in primary health care. Ayurveda, Siddha, Unani are some of the well-known traditional practices used for centuries and these traditional systems are highly dependent on medicinal plants. India is a rich source of these medicinal plants. The Western Ghats is known for its rich diversity, richness, and presence of endemic species. Menispermaceae family consists of more than 400 species; all are reported to have high medicinal values. Different classes of alkaloids present may be the major reason for these biological potentials, which are of great interest for various research groups. Benzylisoquinoline alkaloids, protoberberine alkaloids, aporphine alkaloids, etc are some examples for the alkaloids present in the Menispermaceae family. This review deals with the phytochemistry and pharmacological study of the Menispermaceae family and the action of these plants against various infectious diseases, described in Ayurveda.

Nature's Contributions to Human Health: A Missing Link to Primary Health Care? A Scoping Review of International Overview Reports and Scientific Evidence.

Nature's contributions to human health (NCH) have gained increased attention internationally in scientific and policy arenas. However, little attention is given to the role of the health care sector in this discussion. Primary health care (PHC) is a vital backbone for linking knowledge and practice within the organization of health care. The objective of this scoping review is to evaluate how international overview reports and scientific literature on NCH address to PHC. More specifically, we extracted data on arguments, practice supporting tools and guidelines, challenges and constraints, and management approaches to integrate NCH and PHC. The scientific literature search was run in Web of Science. Two independent reviewers screened the scientific publications. Through the scientific literature search, we identified 1,995 articles of which 79 were eligible for analysis. We complemented the search with a selection of six international overview reports. Both the international overview reports and the scientific publications paid limited attention to the role of PHC regarding NCH. To cope with the current challenges and constraints to integrate NCH and PHC, more evidence on NCH, further development of PHC practice supporting tools, bottom–up integrated approaches, and closer interdisciplinary collaborations are required.

A Study on Utilization of Primary Health Care Services among the People Residing in a Semi-Urban Area

Background: Primary healthcare is a vital strategy which remains the backbone of health service delivery. As on March 31st 2017, there were a total of 25, 650 primary health centres(PHC) functioning in the country. Though the number of PHC’s had increased, the utilization is declining over the years as people seek private health sectors due to various reasons. Objective: To assess the awareness and utilization of primary health care services provided by Thirumazhisai PHC. Methodology: A Community based cross-sectional study was conducted among people residing in Thirumazhisai. The Sample size of 233 was calculated. The study population was selected by simple random sampling technique. A pre-designed, pre-tested semi- structured questionnaire was used to collect data. Data entered in MS excel and analyzed using proportion. Results: Among 233 people, 183 (78.8%) people knew about PHC services. Regarding utilization of services, 165(70.8%) were availing services provided by PHC. The reasons given for non utilization of services were long waiting time (51.4%), dissatisfaction of Doctor-Patient relationship(17.7%), non-availability of essential medicines (14.7%), PHC not clean (8.8%), and PHC does not have all required services (7.4%).Conclusion: In resource-constrained developing countries like India, all efforts should be undertaken to bring about the maximum efficiency of health care delivery. Role of primary healthcare is essential in the progress towards achieving universal health coverage (UHC).

Recommendations to strengthen primary health care in BrazilRecomendaciones para el fortalecimiento de la atención primaria de salud en Brasil

RESUMOObjetivo.Elaborar recomendações estratégicas para fortalecer a atenção primária à saúde (APS) no Sistema Único de Saúde (SUS) no Brasil a partir da consulta a especialistas.Método.Este estudo qualitativo, desenvolvido de março a agosto de 2018, foi composto pela aplicação de questionário aberto e construção de consenso entre 20 participantes representativos das cinco macrorregiões brasileiras, selecionados a partir do critério de reconhecida experiência profissional na APS. Os participantes responderam 20 perguntas abertas em questionário on-line elaborado pelos pesquisadores. Os achados foram sistematizados na forma de recomendações, submetidas a avaliação de prioridade pelo grupo de especialistas utilizando a metodologia Delphi em rodada única. As recomendações finais foram discutidas em oficina presencial.Resultados.Dos 20 especialistas, 18 responderam ao questionário aberto, gerando 84 temas, sistematizados em 44 propostas. Após avaliação, foram elaboradas 20 recomendações, que enfatizaram a expansão da Estratégia Saúde da Família; a ampliação do acesso à APS; a formação de profissionais para atuação multidisciplinar na APS; a alocação de tecnologias para garantir resolutividade na APS; o aprimoramento da regulação/coordenação de serviços para fortalecer a APS como elemento estruturante do SUS; estrutura e financiamento; recursos humanos, provimento de profissionais, apoio e estímulo às equipes; produção e divulgação de conhecimento; transparência nas ações da APS; e o papel mediador da APS no sistema de saúde.Conclusões.Os achados reforçam a ESF como melhor modelo para garantir uma APS forte no SUS, aliada a políticas que priorizem os atributos essenciais da APS, sobretudo pela inovação em tecnologias assistenciais, de gestão e de comunicação.

The role of primary health care in the conservative management of pelvic floor disorders

The role of primary health care in the conservative management of pelvic floor disorders

Management in the private clinics: impact of the health care reforming

This article aims to study the preconditions for establishing and functioning a private pediatric service in Ukraine. The authors analyzed the regulatory framework governing the private health care field. In the study framework, the authors characterized the controlling mechanism, determined the private pediatrician role in primary health care, identified the features of doing business under reforming Ukrainian medicine. The authors noted that the pediatrics service (particularly the private one) providing primary health care to children is essential for maternity and childhood care service. Thus, it is relevant to improve the work of the private pediatric service under medical reform in Ukraine. The study findings showed a decrease in the efficiency of the pediatric service in recent years due to the depletion of human, material and technical resources, problems in pediatricians training, etc. The mentioned above caused a decrease in occupational prestige and changed the pediatrician status. Despite that, the authors noted that the launching of the private doctors’ offices contributed to the qualified medical care quality. Therefore, medical staff and, especially, pediatricians are considered to be important and valuable resources in providing primary children health care under outpatient treatment. The authors concluded that the proactive private pediatrician status, behaviour and real actions are significant in ensuring quality medical services. In turn, that contributes to the health care system functioning under new development conditions of Ukraine. Given reforming Ukrainian medicine, the authors highlighted the necessity to reorganize it for creating a new model providing access to the necessary health care services to all Ukrainians. Besides, this model has to ensure high-quality medical services and affordability while maintaining socially acceptable public guarantees. Therefore, the mentioned above would contribute to the sustainable development of the medical field.

A Study on Utilization of Primary Health Care Services among the People Residing in a Semi-Urban Area

Background: Primary healthcare is a vital strategy which remains the backbone of health service delivery. As on March 31 st 2017, there were a total of 25, 650 primary health centres(PHC) functioning in the country. Though the number of PHC’s had increased, the utilization is declining over the years as people seek private health sectors due to various reasons. Objective: To assess the awareness and utilization of primary health care services provided by Thirumazhisai PHC. Methodology: A Community based cross-sectional study was conducted among people residing in Thirumazhisai. The Sample size of 233 was calculated. The study population was selected by simple random sampling technique. A pre-designed, pre-tested semi- structured questionnaire was used to collect data. Data entered in MS excel and analyzed using proportion. Results: Among 233 people, 183 (78.8%) people knew about PHC services. Regarding utilization of services, 165(70.8%) were availing services provided by PHC. The reasons given for non utilization of services were long waiting time (51.4%), dissatisfaction of Doctor-Patient relationship(17.7%), non-availability of essential medicines (14.7%), PHC not clean (8.8%), and PHC does not have all required services (7.4%). Conclusion: In resource-constrained developing countries like India, all efforts should be undertaken to bring about the maximum efficiency of health care delivery. Role of primary healthcare is essential in the progress towards achieving universal health coverage (UHC).

Assessing the correlation between sublingual varices and hypertension among the adults of Satara district, Maharashtra: An observational study

Aim: In most of the times, sublingual varices (SLV) are noticed during aging process, cardiovascular disease, and smoking. The aim of this study was to find the relation of SLV and the presence of hypertension. Materials and Methods: A total of 215 dental patients were enrolled for the study, of which 14 were dropped, and the status of tongue and blood pressure of a total of 201 study subjects was recorded. The patients with an average blood pressure (at home) of ≥85 mm Hg (diastolic) and ≥135 mm Hg (systolic) were reported to the hospital, where three hypertension measurements were recorded with an interval of 1 week. Student t test and Pearson chi-square test were used for the analysis. Results: An association was found between hypertension and SLV (odds ratio = 2.16, P < 0.001). The systolic blood pressure was found to be 121.2 mm Hg and 138.1 mm Hg in subjects with grade 0 and grade 1 SLV, respectively (P < 0.001). The mean diastolic blood pressure was found to be 81.2 mm Hg and 85.2 mm Hg in patients with grade 0 and grade 1 SLV, respectively (P < 0.05). Conclusion: An association was observed between SLV and hypertension. Examination of lateral borders of tongue can be performed easily, and causes no harm to the patients, and can be considered as an important diagnosis method for the dentists to take an active role in preventive and primary health care.

Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation

BackgroundWith rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention.MethodsA qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators.ResultsAcross all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members.ConclusionsThe study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.

Exploration of Community Health Workers\u2019 views about in their role and support in Primary Health Care in Northern Cape, South Africa

Community health workers (CHWs) play a significant role in Primary health Care due to their proximity to households, communities and the health care system. Many studies focus on CHWs and the work they do. However, few have examined their experiences and identity and how that might influence how they view and perform their roles. The objectives of the study were to: Describe the role of CHWs in community-based health care in Northern Cape, Identify the perceived barriers and enablers to CHWs role performance, Explore CHWs views regarding the support from the communities and the formal healthcare system in Northern Cape. An exploratory qualitative design using focus groups was adopted. Forty-six (46) CHWs were purposively selected using the critical case sampling approach. Data were collected through three focus group interviews in three regions. Analysis followed the Graneheim & Lundman thematic analysis. Three themes emerged from data: perceived contribution to Primary Health Care, recognition of CHWs role, measures to improve working conditions. Findings showed that CHWs were engaged in various health and social care roles, they believed that they made a significant contribution to PHC, and that the health system persistently relied on their services. The enabler for finding meaning in their work was the positive community response and the good relations they had with the team leaders. The major barrier was the structure of the CHWs programme and the perceived lack of support by the government. The complex issues CHWs address in the community call for a review of their roles and workload as well as the support they receive from the formal healthcare system.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability.

AimDeveloping a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability.DesignEmpirical research ‐ qualitative.MethodClassic grounded theory with face‐to‐face interviews, 2017–2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients.ResultsTo initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses’ facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person‐centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work.ConclusionsPublic health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi‐professional cooperation. The implication is testing the emerged theory at primary health care centres.ImpactObesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

Obesity prevention and the role of hospital and community-based health services: a scoping review

BackgroundControl of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research.MethodsDatabases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention.ResultsThe evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals’ views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice.ConclusionsThis review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.

\u2018Thinking outside the box\u2019: advanced geriatric nursing in primary health care in Scandinavia

BackgroundOlder people are frequent users of primary health care (PHC) services. PHC services have been critiqued, mainly regarding limited accessibility and continuity of care. In many countries, investment in nurse practitioners (NPs) has been one strategy to improve PHC services. In the North of Europe, the NP role is still in its infancy. The aim of this study was to explore the feasibility of introducing geriatric nurse practitioners (GNPs) in PHC in Scandinavia, from multiprofessional and older persons’ perspectives.MethodsThe study had a qualitative design, including 25 semi-structured interviews with nurses, nurse leaders, physicians, politicians and older persons from several communities in Scandinavia. The material was analysed by means of qualitative content analysis.ResultsThe results highlight current challenges in health services for the older population, i.e. comorbid older patients with complex care needs aging in place, lack of competent staff, and organisational challenges. The results present an envisioned GNP scope of practice in health services for the older population, including bringing advanced competence closer to the patient, an autonomous role including task-shifting, and a linking role. The results also present factors influencing implementation of the GNP role, i.e. GNP competence level, unclear role and scope of practice, and openness to reorganisation.ConclusionsThe results indicate that it is feasible to implement the GNP role in primary health care in Scandinavia. Notwithstanding, there are factors influencing implementation of the GNP role that should be considered.

'We just don't talk about it': Aboriginal and Torres Strait Islander peoples' perceptions of cancer in regional Queensland.

Disparities in cancer outcomes between Indigenous and non-Indigenous people are well reported. Some Australian Indigenous communities' beliefs about cancer may influence health behaviours, support for those with cancer and ,ultimately, treatment outcomes. This project was instigated by request of a cultural adviser from a regional Queensland community and aims to make community perceptions of cancer visible, facilitate development of resources representing these perceptions and briefly evaluate the project from the community's perspective. The project was guided by qualitative, participatory and visual research methodology. Community participation was engaged by identifying community champions who helped recruit interested community members and continued project momentum. The project was defined and driven by community, and a consensus decision making approach was used to select resources or activities to represent community perceptions of cancer and raise cancer awareness. Qualitative data were collected from yarning groups at two community forums and subsequent group sessions to explore and define community perceptions of cancer. Informed consent was obtained prior to audio-taped yarning groups. Data were also included from publicly available interviews broadcast on radio and television. All data about community perceptions of cancer and of the project were thematically analysed. Photovoice using cameras was the visual method chosen to capture images and stories representing community cancer beliefs. Three main themes were derived from thematic analysis of data collected about community perceptions of cancer, identified by participants as important to improving cancer outcomes: (1) silence in the community, (2) support is important for survivorship and (3) awareness of cancer and the importance of sharing positive stories. A consensus decision-making approach resulted in the community choosing two resources to stimulate community discussion about cancer, raise awareness and reduce stigma. These were creating a community quilt, with each quilt square representing community perceptions of cancer, and producing a community calendar, with messages promoting healthy behaviours and cancer screening. The overall project was viewed as valuable for facilitating and improving the conversation about cancer with family, friends, the broader community and health professionals. Group sessions were considered important for providing a shared, safe space for support, for asking health related questions and as an instigator to share cancer related knowledge and stories with others. Silence around cancer may influence awareness and discussion about cancer, screening participation and help-seeking behaviour in this community. In this project, engaging with the community created a safe space for conversation around a previously taboo topic, which could lead to improved screening and help seeking behaviour. The role of primary health care in reducing health disparities by partnering with community to conduct awareness and prevention activities and by providing culturally appropriate care for Indigenous people is emphasised.

The Role of Primary Health Care in the Prevention of Noncommunicable Diseases

Noncommunicable diseases (NCDs) currently cause more deaths than all other causes combined. Cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are the four major NCDs that are responsible for 82% of NCD deaths. Approximately 42% of all NCD deaths globally occurred before the age of 70 years; 48% of NCD deaths in the low- and middle-income countries and 28% in high-income countries were in individuals aged under 70 years.(1) Because of its chronic nature and the complications that arisen, NCDs bring devastating social, economic and public health impact. The management of its various long-term complications accompanied by the typical existence of multimorbidity will give rise to an increased complexity of care in the future. Aging, improved medical therapies, demographic transition, life-style changes, globalization and urbanization are factors that are contributing to the increased prevalence, severity and complexity of NCDs.........

Correction: The Integration of Interlinkages Between Nature and Human Health in Primary Health Care: Protocol for a Scoping Review.

[This corrects the article DOI: 10.2196/12510.].

Is prescribing by PAs and NPs comparable to physician prescribing?

PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.1.