Urban Primary Health Care Centre Research Articles

Antibiotic use on acute respiratory tract infection nonpneumonia and nonspecific diarrhea in Primary Health Care Centre in Banjarbaru City, South Kalimantan, Indonesia.

Acute respiratory tract infection (ARTI) nonpneumonia and nonspecific diarrhea are the most common cases in primary health care centre (PHCC) in Indonesia with the enormous use of antibiotics. The aims of this study were to analyze the antibiotic use and factors affected to the quality of antibiotic use in PHCC in Banjarbaru City, South Kalimantan, Indonesia. The study was conducted in four PHCCs, two in urban and two in rural areas. All of the patients visited these PHCCs since March to April 2018 were recruited as samples after signing informed consent. Data were analyzed using SPSS version 18. There were no significant difference in antibiotic use between urban and rural PHCC, both on ARTI nonpneumonia and nonspecific diarrhea. The most prescribed antibiotics were amoxycillin and cephadroxil. Based on DDD/1,000 patients-day calculation, the quantity of antibiotics in urban PHCC was 3,544.4 and in rural PHCC was 3,478.6. Physicians with more than seven years of service, both in rural and urban PHCCs, were prescribe the antibiotics higher than who had been working for shorter period. There were no significant difference between physicians who had trained on rational drug use and had not trained yet in urban PHCC (p=0.874), while in rural PHCC there were a significant difference among them. The quantitative analysis showed that the antibiotics use in DDD in urban PHCC was 3,544.416 and in rural PHCC was 3,478.693. Factors affected to the quality of antibiotic use were physician's years of service and rational drug use training's.

Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India

AimTo explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians.MethodsA qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis.ResultsBarriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records.ConclusionComprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

Early Infant Diagnosis of HIV in Primary Health Care Centers

Background: Early diagnosis of HIV to identify infected children for early therapy is aimed at preventing high mortalities associated with child HIV infection. Early infant diagnosis (EID) intervention occurs across the three tiers of the Nigerian health care delivery system, including the primary health care centers (PHC). This study evaluates the implementation of early infant diagnosis of HIV in PHCs in a southern state of Nigeria. Methods: This was a cross-sectional descriptive study that took place between September and November 2019. Primary data were obtained from an interviewer-administered questionnaire on 120 health workers in six Local Government Areas (LGA) that were selected through a multi-stage, random sampling method. Secondary data were from the records of program implementation at the state headquarters of Ministry of Health and the PHCs. Results: A total of 116 (96.6%) health workers were interviewed; 17.2% were males, and 82.8% were females. More than two-thirds of respondents were aged between 41 and 60 years and 84.5% of them had worked in the PHC system for 11 years and above. Rural or urban location of the PHC, educational level of the health workers, and years of service in the PHC system did not have any significant effect on implementation of EID program in the health facilities. Implementation of EID program was ineffective in both rural and urban PHCs of Akwa Ibom state with the p-value of 0.337. In multiple regression analysis, access to EID program and provision of adequate supplies significantly affected implementation of the program with p = 0.001 and p = 0.000 respectively. Conclusion and Implication for Translation: The study indicates general ineffectiveness in the implementation of EID in a Southern State of Nigeria. There is need to improve access to EID services and provide needed supplies if the state, and by extension Nigeria, hopes to meet the target of joining the global community in ending HIV by 2030. Copyright © 2021 Markson. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Immunisation-related Knowledge, Attitudes and Promotive Practices among Mothers in an Urban Primary Health Care Centre in South-East Nigeria: a Call for Improved Clinic-based Education

Background: Nigeria is among the five countries accounting for half of the world’s unimmunised children. Maternal knowledge and attitude play key roles in uptake and timeliness of routine childhood vaccination. This study assessed immunisation-related knowledge, attitudes and promotive practices among mothers in Abakaliki Ebonyi State Nigeria. Methods: This was a cross-sectional study among 117 mothers with children aged 0-23 months attending a Primary Health Care Centre in Abakaliki, Ebonyi State. Data were collected using an interviewer-administered questionnaire and analysed using SPSS version 20 with a p value of ≤ 0.05 considered statistically significant.Results: Over half (55.6%) of the respondents were aged 26-35years while 47% had secondary school education. Majority (91.5%) had previously vaccinated their children, but only 31.7% knew the dosing of polio vaccine. Less than half (42%) of the mothers had adequate knowledge about routes of vaccine administration. About half (49.7%) had adequate knowledge about the children’s next vaccination appointments. Most (94%) considered immunisation important in preventing childhood diseases with up to 95% of them willing to bring their children for immunisation. Only 57.3% were satisfied with the adequacy of immunisation-related information received from the clinic. Majority (81.2%) were timely in accessing immunisation for their babies. Educational status (P=0.035) and child’s age (P=0.008) were associated with knowledge and practice of immunisation respectively. Conclusion: Mothers in this study had good immunisation-related practices and positive attitude towards immunisation. Although majority had good knowledge, some knowledge gaps were identified. We recommend improved maternal education and content of clinic-based education on immunisation.

Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease

BackgroundThe use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are.MethodsWe conducted a preference-eliciting survey incorporating a best–worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design.ResultsAccording to the mean (SD) BWS scores, which can be (+ 4) in maximum and (− 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (− 3. 03 (1.03)), nausea/headache (− 2.69 (0.94)), and treatment discontinuation due to side effects (− 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals.ConclusionThe rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.

Newborn Resuscitation Resources in Selected Rural and Urban Primary Healthcare Centres in Enugu State, Nigeria: A Comparative Analysis

Newborn Resuscitation Resources in Selected Rural and Urban Primary Healthcare Centres in Enugu State, Nigeria: A Comparative Analysis

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco.

Background:Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients.Objective:The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco.Methods:This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke.Findings:A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI95%: 1.08–3.44) primary education (OR 3.43; CI95%: 1.63–7.21), rural residential (OR 1.67; CI95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4).Conclusions:The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.

Characteristics of recovery from near misses in primary health care nursing: A Prospective descriptive study.

To describe the frequency and types of near misses and the recovery strategies employed by nurses in primary health care. Insufficient data are available on the role of nurses in near miss events and related factors in primary health care. A prospective descriptive study was carried out at one Urban Primary Health Care Centre, within the Málaga-Guadalhorce Health District (Malaga, Spain), from January to December 2018. Four of the ten nurses volunteered to take part. The nurses recovered 185 near misses, prevailing administrative or communication-related errors, followed by medication-related errors. No near misses were reported on the centre's anonymous error information platform. A significant number of near misses occurred which could have been avoided with better communication among health care personnel. A striking finding is the failure to inform the health centre, which suggests that improvements in safety culture are needed. It is the responsibility and the duty of nursing management to be aware of the characteristics and frequency of near misses in primary health care, to implement strategies for improvement and to foster a culture in which the necessary information on actual or potential errors is supplied.

Portraits of HIV: a pilot photovoice study of adolescent experiences with HIV treatment in South Africa

Background Adolescents are one of the fastest growing groups of people living with HIV (PLWH) in South Africa. They are also more likely than PLWH in other age groups to report poor adherence to antiretroviral therapy (ART). This trend is likely due to a confluence of factors including life stage and transition from child to adult care. Solutions are urgently needed to support adolescent adherence, since ART can improve the lives of PLWH and limit HIV transmission. We explored adolescents’ facilitators and barriers to ART adherence via photovoice, to pilot the method with South African youth and gain information to inform future interventions. Methods The pilot study included three Photovoice groups, with 10 adolescents, who were enrolled in ART at two urban public primary health care centres in the Western Cape province of South Africa. Groups were organized by age and sex (group 1: 10-14 years, girls; group 2: 15-19 years, girls; group 3: 15-19 years, boys). Participants were given cell phones with cameras, and instructed to take pictures representing their experiences with HIV and treatment. Results Youth’s pictures and discussions focused on four key themes related to treatment and ART adherence. These themes included motivations for taking medicine, forming an identity with HIV, managing disclosure and treatment, and relationships between living conditions and HIV treatment. Treatment motivation was informed by familial support. Themes shed light on participants’ challenges and resilience in the face of HIV. Conclusion Adolescents found expressing their views through photos ‘exciting’ and were encouraged to share personal meanings in discussion with peers and researchers. Older adolescents needed less direction and encouragement than younger adolescents, to fully participate in photo-taking and discussions. Findings pave the way for future, larger Photovoice studies. Themes reiterate the importance of personal motivation including aspects of positive identity with HIV in helping youth adhere to medicine, as well as the need to address relational (e.g. family, disclosure) and structural (e.g. living conditions) factors in adherence interventions for this age group. Despite challenges, youth also have strengths (e.g. desire to commit to treatment) that interventionists can capitalize on to support adolescent treatment outcomes.

SUGGESTED OPINION BY THE CLIENTS FOR IMPROVING STANDARD OF SERVICE ON URBAN PRIMARY HEALTH CARE SERVICES DELIVERY PROJECT WORKING IN SELECTED MUNICIPALITY, BANGLADESH

Good health of the common people is a basic requirement for national development. As Bangladesh is one of the fastest growing economics in South Asia, the health status of its Population is vital for the sustainable of their socio-economic development. Government and NGOs have been providing primary health care through a variety of outlets ranging from satellite clinics through primary health care centers, many new and innovative programs are in operation now. This study aimed to examine suggested opinion by the clients for improving standard of service on Urban Primary Health Care Services Delivery Project working in selected Municipality. This was a cross-sectional study carried out at three urban primary health care centers in Kushtia Municipality, Bangladesh. A sample of 576 patients was selected for this study by random sampling. The data were collected through questionnaires were processed using SPSS statistical software. Suggested opinion regarding improving standard were ensuring availability of doctor/nurse in due time (7.1%), behavior of the clinic staffs would be more friendly (13.0%), increasing lab test facilities (16.0%), improvement overall management (14.8%) and ensuring free treatment for the poor patient (11.6%). Though the overall health care services of the health centers were good, the clients gave some of their opinion to develop the standard of NGO clinic services.

“Get back on the horse and start over again”: Long-Term Effects of a Diabetes Self-Management Education (DSME) Program in an Underserved Population

Purpose: The purpose of this retrospective, mixed methods study is to examine the relationship between participation in an interdisciplinary diabetes self-management education (DSME) program at an urban primary health care center and patients’ perceived knowledge and skills, as well as clinical markers, on four cohorts of patients over a two-year period. Methods: Participants, mainly African-American females, responded to survey questions including self-care behaviors, perceived knowledge, and self-efficacy. The researchers also reviewed the participants’ clinical records for glycosylated hemoglobin (HbA 1c) and body mass index (BMI) data and compared these to similar patients in the health center who had not participated in the DSME program. Additional analysis involved a cross comparison of earlier cohorts (2014-15) to later cohorts (2016-17). Results: Quantitative analysis showed strong statistical evidence that those in the DSME program had more control over their BMI as compared to the control group. The results also suggested that those in the program after 2016 had more control over their HbA1c than those in the program before 2016, although this evidence was more limited. Qualitative themes that emerged highlighted the participants’ valuing most what they learned about nutrition, exercise, and disease management. Conclusions: Population specific DSME programs can help produce both quality of life and clinical improvements that persist over time in underserved populations. This study was limited by a small sample size.

A study of collaborative telepsychiatric consultations for a rehabilitation centre managed by a primary healthcare centre.

Background & objectives:Telepsychiatric methods can be used for the purpose of providing clinical care comparable to in-person treatment in various settings including rehabilitation. Previous evidence has shown that clinical outcomes for both are comparable. In view of challenges posed in the implementation of traditional psychiatric care in India, telepsychiatry offers an avenue to provide feasible, affordable and clinically useful psychiatric services. This study was conducted to examine the utility, feasibility and clinical effectiveness of providing collaborative telepsychiatric services with a primary care doctor for inpatients in a rehabilitation centre through a telepsychiatrist of estabilished psychiatry department in a tertiary care centre in south India in a collaborative care model with a primary care doctor.Methods:Patients at the rehabilitation centre attached to an urban primary healthcare centre received collaborative care using telepsychiatry for a period from January 2013 to December 2016. A retrospective review of their charts was performed and sociodemographic, clinical and treatment details were collected and analyzed.Results:The sample population (n=132) consisted of 75 per cent males, with a mean age of 43.8 ± 12.1 yr. Each patient received an average of 7.8 ± 4.9 live video-consultations. Initially, an antipsychotic was prescribed for 84.1 per cent (n=111) of patients. Fifty four patients (40.9%) had a partial response and 26 (19.7%) patients showed a good response.Interpretation & conclusions:The study sample represented the population of homeless persons with mental illness who are often brought to the rehabilitation centre. This study results demonstrated the successful implementation of inpatients collaborative telepsychiatry care model for assessment, follow up, investigation and treatment of patients through teleconsultation.

Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania.

Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.

Male Partners' Knowledge, Attitudes, and Perception of Women's Breast Cancer in Abha, Southwestern Saudi Arabia.

Background: Breast cancer (BC) is ranked as the most frequently diagnosed cancer site among women in Saudi Arabia. Several studies in Saudi Arabia have reported low awareness of BC and significant obstacles to early presentation among Saudi women. A key sociocultural obstacle against breast screening and early detection of BC in several conservative cultures is that men manage women’s choices and activities. The aim of this research is to find out the key background knowledge, attitudes, and related practice among male partners in the city of Abha in relation to women’s BC prevention and means for early detection. Methods: A cross-sectional study targeting husbands aged 20 years or older chosen from the outpatient clinics in the Urban Primary Health Care Centers in Abha City. Through questionnaires, interview data were collected regarding knowledge about BC and wife practices and attitudes towards BC. Results: The study included 832 husbands. The study showed that only 20.2% (95% confidence interval (CI): 19.9–24.1) of husbands had heard about mammography and only 22.1% had heard about breast self-examination among women as a screening test for BC. The most commonly mentioned variations that might occur in relation to BC were size changes (45.6%). The leading source of BC knowledge was from television (48.9%), and the least-mentioned source of information was healthcare workers (22.4%). Husbands mentioned that only 9.3% of wives had been examined before by mammography. In a multivariate logistic regression of male factors associated with wives’ practices and attitudes towards BC, only good knowledge among husbands was a significant factor. Conclusions: The study documented the low level of BC knowledge among male partners. There is an urgent need to pay more consideration to disseminating awareness among men, as they are associates, and they must be armed with proper awareness. There is an urgent demand for establishing a national program and educational campaigns towards BC. Stressing the advantages and access to free mammography is necessary.

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.

Análisis de pacientes con diabetes tipo 2 en un centro de salud urbano. Estudio DESENROQUE

ObjectivesTo determine the health status of patients with type 2 diabetes (T2D) in an urban Primary Healthcare centre, and to assess the follow-up carried out by health professionals.To analyse the pharmacological treatment in patients with T2D, as well as to assess the individualisation according to their comorbidities. Material and methodsDescriptive and cross-sectional analysis conducted on patients with DM2. Out of a total of 920 patients, a randomised and simple sample of 460 individuals was obtained, from which the parameters related to associated comorbidities and the integral treatment of T2D were collected. ResultsThe study included 460 patients (42.4% women) with a mean age of 67.1 years (SD=13.07). The mean value of their last HbA1c was 6.75% (SD=1.24). The large majority (83.7%) fulfilled the proposed individualised HbA1c objectives according to their age and comorbidities.Approximately two-thirds (65.43%) of patients had a suboptimal follow-up by health professionals.As regards the suitability of the treatment, 19.8% had non-recommended pharmacological combinations or drugs applied outside the indications of the data sheet. A comprehensive T2D treatment that could be improved was observed in 74.3%. ConclusionsAlthough 83.7% of patients had good control of HbA1c, the treatment is centred on blood glucose and improvable in a high percentage of patients (74.3%).Given that the therapy must be adjusted to the needs of each patient, and since the BMI (body mass index) is a determining factor for the selection of treatment, it is striking that it is not recorded in the clinical histories of 44.13% of the patients.

Service providing scenario of urban primary health care services delivery project working in selected municipality

Background: The urbanization and urban growth is going through very rapid in Bangladesh. This growth is being fuelled by rising incomes due to rapid expansion of commerce and industry. The rapid and incessant growth of urbanization on Kushtia district is creating continuous pressure on urban health care services. Urban poor people are also a vital factor for promoting urban primary health care services delivery project (UPHCSDP) to provide health care facilities.Methods: A cross sectional survey was carried out among 576 patients in 3 selected urban primary health care centres in Kushtia Municipality with a major concentration of people residing in urban areas. Data were collected using questionnaires regarding type of care or treatment patients demanded and type of care they received from the clinic.Results: Study results showed that total of 46.5% of the subjects demanded maternal and obstetric health services and 8.6% demanded child health diagnosis and care. It was found that a total of 22.0% of the subjects received physical diagnosis from the centres. About 7.1% clients received advice or suggestions and 8.0% received normal delivery service from the centres.Conclusions: The result shows that these clinics provide a lot of health care services to the clients especially on maternal and child health care delivery system. These services are provided to the patient with less or free of cost. Study exhibited that the overall health care services of health care centres are good. The clients come to these centres for the good quality of treatment.

Medication Adherence and its Predictors in Type 2 Diabetic Patients Referring to Urban Primary Health Care Centers in Kerman City, Southeastern Iran

Background: Medication adherence (MA) is one of the crucial aspects in the management of chronic diseases such as diabetes. Objectives: This study aimed to evaluate MA and its predictors in type 2 diabetic patients referring to urban primary health care centers. Methods: This cross-sectional study was carried out among type 2 diabetic patients referring to urban primary health care centers in 2017. The data were collected by the Persian version of the eight-item Morisky MA scale. Demographic and disease-related data were also collected. The data were analyzed using SPSS version 22. Results: Of 589 patients under study, more than 70% used oral hypoglycemic agents as the medication regimen and 29.2% received insulin as monotherapy or in combination with oral antidiabetic agents. Over half of the diabetic patients (51.1%) had other comorbid chronic diseases; moreover, 51.3% of them had at least one of diabetes-related complications. The mean MA score was 6.27 ± 1.81. One-third (33.3%, n = 196) of the patients had a moderate level of MA while 35.4% (n = 208) and 31.3% (n = 184) showed low and high MA levels, respectively. Binary logistic regression analysis showed that education level, type of medication, age, and treatment duration were the predicting factors of MA. Conclusions: MA was at a suboptimal level among diabetic patients referring to the urban primary health care centers. Poor medication adherence can have negative outcomes for diabetic patients. Thus, primary health care providers should consider self-care behaviors of patients and monitor their medication adherence, as well as other aspects of diabetes management.

Effectiveness of a new one-hour blood pressure monitoring method to diagnose hypertension: a diagnostic accuracy clinical trial protocol

Introduction24-hour ambulatory blood pressure monitoring (ABPM) is the gold standard diagnostic method for hypertension, but has some shortcomings in clinical practice while clinical settings often lack sufficient devices to accommodate...

Antibiotic Expenditure by Public Healthcare Institutions in Shandong Province in China, 2012-2016.

Background: Overuse of antibiotics may not only increase the burden of antimicrobial resistance, but also accelerate the growth of healthcare expenditures. China has issued a series of policies to improve antibiotic use and reduce the cost of medicine in healthcare institutions. This study aimed to evaluate the trends of antibiotic expenditure in public healthcare institutions in Shandong from 2012 to 2016 and to assess antibiotic expenditure by drug class and the level of healthcare institutions.Methods: We collected data from the centralized bidding procurement (CBP) system in Shandong province between 2012 and 2016. Governmental health facilities including secondary and tertiary hospitals, and urban and rural primary healthcare centers (PHCs) procured antibiotics via this system. Antibiotics were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Antibiotic expenditure was assessed using total annual expenditure (US dollars) and expenditure per person per year (US dollars).Results: The overall antibiotic expenditure was $717 million in 2016, a 56% increase compared to 2012. Parenteral antibiotics accounted for 84% of the total antibiotic expenditure in 2016. Most of the antibiotics were procured by secondary and tertiary hospitals (33 and 44%, respectively). The expenditures continuously increased in secondary hospitals, tertiary hospitals, and urban PHCs from 2012 to 2016, while antibiotic procurement decreased in urban PHCs since 2015. The third-generation cephalosporins (J01DD) were among the top five ATC classes of antibiotics in all healthcare institutions. Fluoroquinolones (J01MA) were commonly procured by tertiary hospitals, rural and urban PHCs. The expenditure on carbapenems (J01DH) raised sharply in tertiary hospitals.Conclusions: The overall antibiotic expenditure kept increasing in the public healthcare institutions in Shandong. The trends of increasing expenditure began to decline in 2016, which may be associated with antibiotic stewardship initiatives. The expenditure for expensive and critical important classes of antibiotics increased, therefore it is of importance to develop policies on improving the rational use of antibiotics.