Strengthening Of Primary Health Care Research Articles

Effect of primary health care reforms in Turkey on health service utilization and user satisfaction

Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P < 0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations.

Non-communicable diseases in an older, aging population: a developing country perspective (Jamaica).

Changes in the non-communicable disease (NCD) profile of older adults living in a rapidly-aging, developing country are described. Data from a 2012 nationally representative survey of 2,943 older adults were used to determine the burden of NCDs important to elder health. Additionally, the percentage change in NCD prevalence over a 23-year period (1989-2012) was determined. In 2012, approximately 75.3% of the sample reported at least one NCD; 47.5% reported comorbidities. High blood pressure (61%), arthritis (35%) and diabetes (26%) were the most reported conditions, peaking in the 70-79 age group. Females reported higher rates of disease than males. Significant increases in prevalence occurred for all conditions except arthritis; the most significant were in diabetes (157%) and cancer (118%). Rapid increases in NCDs are of great public health importance. Strengthening of primary health care and improvements in human resources must occur if the well-being of older adults is to be improved.

Healthcare in Singapore: the present and future

Singapore’s rapidly evolving economy and social progress has helped accelerate the milestones of healthcare development in the country.(1) In 1970, a committee on specialisation was commissioned by the Singapore government to look into the development of specialised medical services and postgraduate specialty training. Since then, there has been a steady focus on the development of our healthcare sector and the advancement of medical specialties. This has catapulted Singapore’s health system to a level on par with other advanced nations.(2) Today, healthcare systems around the world spend trillions of dollars annually to tackle the growing challenges in healthcare.(2-6) These challenges include epidemiological transitions of death rates (from maternal, perinatal and infectious diseases to cardiovascular diseases and cancers) and an ageing population with improved life expectancies.(2,7) Current lifestyle trends, which are by and large the result of technological advancements, have led to individuals having an increased number of risk factors, leading to the increased prevalence of multiple chronic diseases.(2,6) These chronic diseases are also increasingly being diagnosed in the younger adult population in the recent years.(2,4-6,8) Such trends will result in greater financial costs for the nation and the individual, and our current healthcare system may not remain sustainable if we continue to invest in and develop what had served us well in the past five decades.(1) It is intuitive that the answer does not lie in ‘more of the same’. An increase in healthcare spending does not always translate to better outcomes due to the complexity of the healthcare situation. The fundamental question that should be asked is what will likely deliver better value or outcome per unit cost in the coming years. The new funding model for healthcare should be one that moves away from the episodic, fee-for-service model to one that is outcome- or value-based for a population. The targeted outcome or value should be patient-centred, with each member of the healthcare system providing for all the needs of a patient as a whole.(9) Members of the healthcare system should no longer be called healthcare ‘stakeholders’. This term is passe, and was used when we built and developed our healthcare system in parts.(1) As we move toward a more patient-centric healthcare system, healthcare institutions and services would be more correctly termed ‘providers’ because they serve as providers for the healthcare needs of a patient. The term ‘stakeholders’ should be reserved for the public, patients, payers (the government, employers or other third-party payers), policy-makers and the healthcare system (the regional health system and their partners). There are three main areas that we can focus on in order to deliver better value – healthcare integration, strengthening of primary healthcare, and collaboration for health in the community. These are further elaborated in the following text.

Strengthening of primary health care: Key to deliver inclusive health care

Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in 'Right to Life.' It is imperative to define 'essential health care,' which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of 'family physician' in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

Primary health care in municipalities at high risk for malaria

This study aims to characterize aspects of Primary Health Care in the Amazon Region of Brazil, considered as the main endemic area for malaria in the country. The Ministry of Health recommends the expansion of Primary Health Care in endemic areas for malaria. A survey focusing on patients infected with malaria was conducted in 6 municipalities, in January and February 2007, to investigate specific aspects of Primary Health Care. Data was analyzed quantitatively and field records helped to give support to context and policy issues in the visited sites. Quality of access to health services and medicines, continuity of health care, system coordination and community orientation are still incipient in the visited areas. The study showed that there is little integration between Primary Health Care and malaria control in the region, which calls for development of joint strategies and for the strengthening of Primary Health Care per se, as a benefit to the population of this endemic area.

Enhancing measurement of primary health care indicators using an equity lens: An ethnographic study

IntroductionOne important goal of strengthening and renewal in primary healthcare (PHC) is achieving health equity, particularly for vulnerable populations. There has been a flurry of international activity toward the establishment of indicators relevant to measuring and monitoring PHC. Yet, little attention has been paid to whether current indicators: 1) are sensitive enough to detect inequities in processes or outcomes of care, particularly in relation to the health needs of vulnerable groups or 2) adequately capture the complexity of delivering PHC services across diverse groups. The purpose of this paper is to contribute to the discourse regarding what ought to be considered a PHC indicator and to provide some concrete examples illustrating the need for modification and development of new indicators given the goal of PHC achieving health equity.MethodsWithin the context of a larger study of PHC delivery at two Health Centers serving people facing multiple disadvantages, a mixed methods ethnographic design was used. Three sets of data collected included: (a) participant observation data focused on the processes of PHC delivery, (b) interviews with Health Center staff, and (c) interviews with patients.ResultsThematic analysis suggests there is a disjuncture between clinical work addressing the complex needs of patients facing multiple vulnerabilities such as extreme levels of poverty, multiple chronic conditions, and lack of housing and extant indicators and how they are measured. Items could better measure and monitor performance at the management level including, what is delivered (e.g., focus on social determinants of health) and how services are delivered to socially disadvantaged populations (e.g., effective use of space, expectation for all staff to have welcoming and mutually respectful interactions). New indicators must be developed to capture inputs (e.g., stability of funding sources) and outputs (e.g., whole person care) in ways that better align with care provided to marginalized populations.ConclusionsThe current emphasis on achieving greater equity through PHC, the continued calls for the renewal and strengthening of PHC, and the use of monitoring and performance indicators highlight the relevance of ensuring that there are more accurate methods to capture the complex work of PHC organizations.

Primary health care in a changing world

This article considers the changing nature of primary health care in a changing international context. Four family physicians from four continents and all involved in the change process, reflect on the developments in primary health care as they perceive them. Jan De Maeseneer was involved in the incremental strengthening of primary health care in Belgium and has an international perspective as Chairman of the European Forum for Primary Care. Shabir Moosa is the acting chief specialist of District Health Services in Gauteng (South Africa) and coordinates a project on strengthening family medicine training in Africa. Yongyuth Pongsupap is the primary care component manager of Health Care Reform Project and expert in health policy at the National Health Security Office in Nonthaburi (Thailand). He has been working as a GP in a new established health centre since he was assigned as a pilot family doctor in 1991. Arthur Kaufman is involved in programmes for better access to health care for vulnerable groups and in primary care innovations in the state of New Mexico (US). Today, we face unprecedented demographic and epidemiologic transitions. The world population is aging rapidly. In 2005, 19% of all deaths were among children and 53% were among people aged 60 years and older. By 2030 the respective proportions will have changed to 9% and 62%.1 Non-communicable disease mortality will increase from 61% to 68% worldwide, and a similar trend will occur in Africa despite the HIV/AIDS pandemic and poor socioeconomic circumstances. As the population ages, the number of people with multimorbidity (two or more chronic conditions) will increase.2 There are wide differences in healthy life expectancy across the world: for Africa, healthy life expectancy is 40 years for males and 42 years for females, for Europe it is 62 and 68 years respectively.3 Encouragingly, …

Enabling Quality Improvement within Primary Healthcare through the CCHSA Accreditation Program

Progress is being made on the journey to strengthen primary healthcare within Canada. As an essential component of the healthcare continuum, primary healthcare must be more effectively linked and its role optimized for better patient/client outcomes to be realized. The Canadian Council on Health Services Accreditation (CCHSA) is an enabler to change and is committed to contributing to the strengthening of primary healthcare. During the first 20 years, the focus of CCHSA's accreditation process was on facility-based acute and long-term care. Since that time, accreditation standards have been established across a wide range of healthcare sectors and specialty areas. CCHSA's accreditation program will increasingly contribute to strengthening the essential and integral role of primary healthcare in the healthcare system.

Developing an information system to support the pursuit of decentralization. The perspective of Cearà State in Brazil.

Discusses the national health information system in Brazil which, until very recently, consisted of two main structures of health services with a dichotomy between curative and preventive health care acting in a vertical manner. The autonomy of health authorities and specialized structures created numerous independent health information systems with different methods of data collection. Although the issues of decentralization and a unified health system had been agreed on in 1963, they had not been implemented until the new health policy reform was lunched in 1988. The reform was based on the strengthening of primary health care at national level and accelerating decentralization of health systems. However, in spite of strong political will the new health managers at local level are lacking essential information, data and instruments that only a decentralized health management information system can provide. Based on a study conducted in the Cearà State of the north east of Brazil, explores how the present health information system can support the process of decentralization.

Lower referral rates for integrated health centres in The Netherlands

The strengthening of primary health care is an important issue in health policy in The Netherlands. The stimulation of co-operation and cohesion within primary health care and, in particular, the stimulation of ingetrated health centres is supposed to be an Important mean to reduce the expansive growth of expenditures in the so-called second line (mainly medical specialists and hospitals). This article first describes recent trends in co-operation within primary health care and referral rates. For a better understanding of the Issue in the context of the Dutch health care system we will also describe some of the ratlonals of the government policy to strengthen primary health care. In the second part results are presented of a study carried out to test If differences in referral rates among GPs in different practice settings can be explained by structural factors.