Total Primary Healthcare Research Articles

Improving access to primary health care through financial innovation in rural China: a quasi-experimental synthetic difference-in-differences approach

BackgroundInadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund.MethodsWe employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform’s impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure.ResultsThe reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59–23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China.ConclusionsThis research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.

Association between the development stage of the oral health care network and primary health care coverage in a state of southeastern Brazil

Aim: The present study analyzed the association between the development stage of the oral health care network in a Brazilian state and oral health coverage of Primary Health Care (PHC). Methods: A cross-sectional descriptive and analytical study was conducted with 205 municipal oral health coordinators of a state in the southeast of Brazil. Data collection was carried out through a validated questionnaire. Descriptive and cluster analysis were performed. Variables oral health coverage (total PHC and in the Family Health Strategy – FHS), allocation factor (AF) of financial resources, and expanded health area of municipalities were compared with the clusters (p < 0.05). Results: Cluster 1 was classified as containing incipient health care networks (n = 109), and cluster 2 was classified as containing advanced health care networks (n = 96). Descriptive analysis showed that oral health coverage in total PHC was 100% and in FHS was 78.1%. The majority of municipalities were classified in quartiles AF 1 and 2. The expanded health areas with the highest number of municipalities were South and Southeast. Clusters were associated with total PHC coverage (p = 0.038) and FHS (p = 0.009), and no association between clusters with AF (p = 0.754) and expanded health area of municipalities (p = 0.519). Conclusion: The municipalities’ PHC coverage was related to the effectiveness of oral health network implantation.

Trends in the utilization of youth primary healthcare services and psychological distress

BackgroundPsychological distress among young people is increasing in Northern Europe. According to established healthcare utilization theory, this will create a greater need for youth primary healthcare and subsequently lead to more help-seeking behavior by distressed young people. The aim of this study was to investigate the association between the use of youth primary healthcare services and psychological distress in times of increasing mental health problems and increased service need.MethodsThis study consisted of five waves of repeated annual cross-sectional data collected from young people (aged 13–19) living in Norway between 2014 and 2018 (n = 368,579). Population-weighted and design-adjusted generalized linear regression with a log-link was used to examine the use of youth primary healthcare services over time.ResultsWe found that a large proportion of young people use primary healthcare services and that young people with high levels of psychological distress use primary healthcare services twice as much as their peers with low levels of psychological distress. In addition, between 2014 and 2018 both psychological distress and primary healthcare service utilization increased: psychological distress increased by 5% and total primary healthcare service use increased by 500 consultations per 1000 young people. Overall, psychological distress had a conditional association with youth primary healthcare service use and could account for between 16 and 66% of the change in the use of services between 2014 and 2018, depending on the service type. However, the absolute increase seen in the use of primary healthcare services was mainly driven by young people with low levels of psychological distress as opposed to young people with high psychological distress. This suggest a converging trend.ConclusionsOur findings suggest that there might be serious barriers between need and help-seeking behavior for young people with high levels of psychological distress and that the pattern of utilization among young people with lower distress may indicate overuse, possibly as an inadvertent consequence of a newly introduced school absence policy. While further research is needed to confirm these findings, our work may inform healthcare providers and policy makers about primary healthcare utilization trends among young people.

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013).

BackgroundMajor health sector reform and the need for baseline measures of performance to determine impact.AimBaseline audit of primary healthcare (PHC) performance.SettingCape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.MethodThe South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.ResultsData from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.ConclusionGaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.

Environmental attributable fractions in remote Australia: the potential of a new approach for local public health action

Objectives:To determine local values for environmental attributable fractions and explore their applicability and potential for public health advocacy. Methods:Using World Health Organization (WHO) values for environmental attributable fractions, responses from a practitioner survey (73% response rate) were considered by a smaller skills‐based panel to determine consensus values for Kimberley environmental attributable fractions (KEAFs). Applied to de‐identified data from 17 remote primary healthcare facilities over two years, numbers and proportions of reasons for attendance directly attributable to the environment were calculated for all ages and children aged 0–4 years, including those for Aboriginal patients. Results:Of 150,357 reasons for attendance for patients of all ages, 31,775 (21.1%) were directly attributable to the environment. The proportion of these directly due to the environment was significantly higher for Aboriginal patients than others (23.1% v 14.6%; p<0.001). Of 29,706 reasons for attendance by Aboriginal children aged 0–4 years, 7,599 (25.6%) were directly attributable to the environment, significantly higher than for non‐Aboriginal children aged 0–4 years (25.6% v 18.6%; p<0.001). Conclusions:By addressing environmental factors, 20% of total primary healthcare demand could be prevented and, importantly, some 25% of presentations by Aboriginal children. Implications:KEAFs have potential to monitor impact of local environmental investments.

An assessment of the reasons for oral poliovirus vaccine refusals in northern Nigeria.

Accumulation of susceptible children whose caregivers refuse to accept oral poliovirus vaccine (OPV) contributes to the spread of poliovirus in Nigeria. During and immediately following the OPV campaign in October 2012, polio eradication partners conducted a study among households in which the vaccine was refused, using semistructured questionnaires. The selected study districts had a history of persistent OPV refusals in previous campaigns. Polio risk perception was low among study participants. The majority (59%) of participants believed that vaccination was either not necessary or would not be helpful, and 30% thought it might be harmful. Religious beliefs were an important driver in the way people understood disease. Fifty-two percent of 48 respondents reported that illnesses were due to God's will and/or destiny and that only God could protect them against illnesses. Only a minority (14%) of respondents indicated that polio was a significant problem in their community. Caregivers refuse OPV largely because of poor polio risk perception and religious beliefs. Communication strategies should, therefore, aim to increase awareness of polio as a real health threat and educate communities about the safety of the vaccine. In addition, polio eradication partners should collaborate with other agencies and ministries to improve total primary healthcare packages to address identified unmet health and social needs.

Diarrheal diseases research: priority areas.

Diarrheal disease is perhaps one of the most important causes of sickness and death among infants and children in developing countries like India. Appreciable amount of research is being conducted in various to Centres/Institutions all over the country to find solutions to unresolved issues in control of diarrheal diseases. There is considerable expertise in basic diarrheal disease research, as well as in operational research in the country, unfortunately this is not been focussed according to a plan of priority. To draw up such a priority action plan, the Indian Council of Medical Research, convened a meeting of Research Advisory group on diarrheal diseases. The group included epidemiologists, programme managers, clinicimls, microbiologists, molecular biologists and public health specialists. Tile group emphasized that diarrheal disease control and research on diarrheal diseases need to be integrated and co-ordinated with total primary health care approach. The research activity should be able to produce quick applicable results and should focus on application of available knowledge. Applied research which should generate new knowledge with immediate operational capability should be combined with specifically di-